Lymphoproliferative disorders in patients with chronic myeloproliferative neoplasms: A systematic review

Patients with a Ph‐negative myeloproliferative neoplasm (MPN) may harbor or develop lymphoproliferative disorders (LPD), however, the clinical and molecular determinants of MPN and LPD co‐occurrence are still uncertain. To systematically pool the available knowledge, we conducted a scoping review of literature published since January 2005 and analyzed single‐patient clinical data from 50 papers reporting 214 individuals harboring both MPN and LPD. Patients had been diagnosed essential thrombocythemia (44%), polycythemia vera (29%), or myelofibrosis (23%) at a median age of 67 years (26‐94): half of them incurred a LPD after a median of 72 months from MPN diagnosis, while in 20% the LPD diagnosis was antecedent or synchronous. Patients mainly incurred indolent LPD, particularly chronic lymphocytic leukemia (CLL), while aggressive lymphomas and multiple myeloma were a relevant portion of the LPDs occurring in the follow‐up of MPN. CLL was preferentially diagnosed in PV patients and was associated with a very high male‐to‐female ratio, as well as an older age at MPN diagnosis. On converse, multiple myeloma was rarely reported in PV patients and was preferentially diagnosed in female patients not harboring the JAK2 V617F mutation. Based on the 46 cases reporting follow‐up data, median survival after MPN diagnosis was 96 months. This thorough review of published evidence confirms that LPD are relevant clinical events in the history of MPN patients. Controlled studies are needed to better refine individuals at higher risk of developing LPD, to support surveillance programs and to avoid therapies possibly favoring LPD.     

Iodized salt for iodine deficiency disorders. A systematic review.

The results suggest that iodized salt is an effective means of improving iodine status, and support the current endeavors to achieve universal salt iodization. Variations in the iodine levels in the salt suggest that particular care must be taken to ensure the quality of the production and storage of iodized salt. It appears that in small children salt intake may not be high enough to guarantee adequate iodine levels through the use of iodized salt. While the studies provided no information about unwanted side effects with the use of iodized salt, most studies did not specifically consider adverse effects. so inferences about side effects remain weak. In conclusion, health policymakers and other decision makers require high-quality studies to measure the effect of iodized salt in comparison with other forms of iodine supplementation. These should be large studies lasting at least two years. Investigators should not retstrict their outcomes to goiter rates and urinary iodine excretion, but should include the other outcome measures specified above, such as mental and physical development in children, mortality, and others. Investigators should pay special attention to adverse effects and their report in primary studies, and should assess children (including very young children who may have a relatively low salt consumption) separately from adults.     

A systematic review of impulsivity in eating disorders

The purpose of this paper is to conduct a systematic review of the current literature that examines impulsivity in individuals with eating disorders (ED). Studies were obtained from Embase, Pubmed and Psycinfo, and were included if they assessed impulsivity in individuals over 18 years of age with an ED diagnosis and published in the last 10 years. The methodological quality of the studies was rated. Twelve studies were included in this review, with methodological quality varying across studies. Findings suggest that impulsivity is best assessed multi‐modally, with a combination of self‐report, behavioural and physiological measures. In general, impulsivity was found to differentiate individuals with EDs from controls, as well as across diagnostic subtypes. The current findings have important clinical implications for our understanding and treatment of both impulsivity and eating disorders. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

Interventions to enhance medication adherence in chronic medical conditions: a systematic review

BACKGROUND: Approximately 20% to 50% of patients are not adherent to medical therapy. This review was performed to summarize, categorize, and estimate the effect size (ES) of interventions to improve medication adherence in chronic medical conditions. METHODS: Randomized controlled trials published from January 1967 to September 2004 were eligible if they described 1 or more unconfounded interventions intended to enhance adherence with self-administered medications in the treatment of chronic medical conditions. Trials that reported at least 1 measure of medication adherence and 1 clinical outcome, with at least 80% follow-up during 6 months, were included. Study characteristics and results for adherence and clinical outcomes were extracted. In addition, ES was calculated for each outcome. RESULTS: Among 37 eligible trials (including 12 informational, 10 behavioral, and 15 combined informational, behavioral, and/or social investigations), 20 studies reported a significant improvement in at least 1 adherence measure. Adherence increased most consistently with behavioral interventions that reduced dosing demands (3 of 3 studies, large ES [0.89-1.20]) and those involving monitoring and feedback (3 of 4 studies, small to large ES [0.27-0.81]). Adherence also improved in 6 multisession informational trials (small to large ES [0.35-1.13]) and 8 combined interventions (small to large ES [absolute value, 0.43-1.20]). Eleven studies (4 informational, 3 behavioral, and 4 combined) demonstrated improvement in at least 1 clinical outcome, but effects were variable (very small to large ES [0.17-3.41]) and not consistently related to changes in adherence. CONCLUSION: Several types of interventions are effective in improving medication adherence in chronic medical conditions, but few significantly affected clinical outcomes.     

A systematic review of medical therapy for anal fissure

PURPOSE This is a meta-analysis of randomized, controlled trials to assess the efficacy and morbidity of medical therapies for anal fissure.METHODS Medline and the Cochrane Controlled Trials Register and the Cochrane Colorectal Cancer Review Groups Controlled Trials Register were searched using the terms anal fissure randomized from 1966 to 2002. Studies in which participants were randomized to a nonsurgical therapy for anal fissure were the focus of this review. Comparison groups included an operative procedure, an alternate medical therapy, or placebo. Chronic fissure, acute fissure, and fissure in children were included in the review, however, atypical fissure associated with inflammatory bowel disease, cancer, or anal infection were excluded. Data were abstracted from published reports and meeting abstracts, assessing method of randomization, blinding, intention to treat and dropouts, therapies, supportive measures, dosing and frequency, and crossovers. Outcome measures included nonhealing of the fissure and adverse events.RESULTS Twenty one different comparisons of medical therapies to heal anal fissure have been reported in 31 trials, including 9 agents—glyceryl trinitrate, isosorbide dinitrate, botulinum toxin, diltiazem, nifedipine, hydrocortisone, lidocaine, bran, placebo—as well as anal dilators and surgical sphincterotomy. Glyceryl trinitrate was favored in the analysis over placebo (odds ratio = 0.55, 95 percent confidence interval, 0.41–0.74). After excluding two studies from analysis because of placebo response rates >2 standard deviations below the mean for all studies, the advantage of glyceryl trinitrate over placebo was no longer statistically significant (odds ratio = 0.78; 95 percent confidence interval, 0.56–1.08). Nifedipine and diltiazem did not differ from glyceryl trinitrate in their ability to cure fissure (0.66; 0.22–2.01). Botulinum toxin compared with placebo showed no significant efficacy (0.75; 0.32–1.77), and was also no better than glyceryl trinitrate (0.48; 0.21–1.10). Surgery was more effective than medical therapy in curing fissure (0.12; 0.07–0.22).CONCLUSIONS Medical therapy for chronic anal fissure, acute fissure, and fissure in children may be applied with a chance of cure that is only marginally better than placebo, and for chronic fissure, far less effective than surgery.Reprints are not available.     

The sequential approach in eating disorders: A scoping systematic review

Objective

The sequential model has been defined as an intensive, two-stage approach that comprises administering two types of treatment consecutively to improve treatment outcomes in cases of non-optimal or absence of treatment response. A psychiatric population that would potentially benefit from the application of the sequential model is the eating disorders (EDs) population. The current scoping review aimed to explore the emerging literature on the application of sequential treatments in EDs.

Method

Using PRISMA and Population intervention comparison outcomes study guidelines, Pubmed and PsycINFO were systematically searched for studies which applied temporally sequential treatments in patients diagnosed with EDs from inception to April 2022 using a combination of keywords. Studies utilising combined or integrated approaches were excluded.

Results

A total of 12 studies were selected and reviewed. Studies included Bulimia Nervosa, Binge Eating Disorder (BED), or mixed ED samples with a majority of female patients. No studies on AN samples were identified. The majority of studies contained a Cognitive-Behavioural Therapy module of treatment, were conducted on BED patients, were in outpatient settings, and included a group format in one or more treatment conditions. Studies varied in number of comparison groups and study design. Secondary and sequentially applied treatment modules were consistent with treatment recommendations of clinical guidelines.

Conclusions

The available data on sequential treatments in EDs is scarce and exhibits methodological limitations that should be addressed in future studies. Definition of sequential treatments in EDs should be further developed to guide robust clinical research and improve empirical support of sequential treatment for complex ED cases and for non-optimal ED treatment response.     

Anemia in chronic obstructive pulmonary disease: A systematic review

IntroductionChronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease that is characterized by poor airflow and airway inflammation. It is estimated that the global prevalence of COPD is about 13.1%. Anemia is associated with increased morbidity and hospitalization duration. In this systematic review, we investigate the association between all types of anemia and COPD progression.MethodsWe systematically searched electronic databases, including Scopus, Medline/PubMed, EMBASE, Web of Sciences (WOS), and Cochrane Library, using the following mesh-standardized keywords: (((anemia1 OR anaemia1) OR “chronic anemia disease” [Mesh] OR “CAD” OR “iron deficiency anemia” OR” IDA” OR) AND (“COPD” [Mesh] OR “chronic obstructive pulmonary disease”)) until February 2022.ResultsOverall of 11,158 studies were included. Ultimately, 59 studies were included in the analysis. The most apparent findings from the analysis were that exacerbation of COPD, increased hospitalization, and increased long-term mortality were associated with anemia. Further analysis showed that iron deficiency (ID) is a common finding in COPD and is accompanied by an increase in the systolic pulmonary artery pressure.ConclusionDespite the comfortable control of anemia, the absence of treatment can be life-threatening in patients with COPD. Our systematic results showed significant homogeneity between studies on the increased mortality rate in anemic COPD, increased hospitalization, and decreased quality of life.     

Glucocorticoid sensitivity in mood disorders

In this review, we provide an overview of recent literature on glucocorticoid (GC) sensitivity in mood disorders. Assessing GC sensitivity is often performed by measuring the cortisol awakening rise (CAR), by challenging the hypothalamic-pituitary-adrenal (HPA) axis using a dexamethasone suppression test (DST) or a dexamethasone/cortisol-releasing hormone test (DEX/CRH); more recently by measuring cortisol as a retrospective calendar in scalp hair. The main findings in mood disorders are higher mean cortisol levels in hair samples and a higher CAR, showing a hyperactivity of the HPA axis. This is in line with the mild resistance for GCs previously observed in challenge tests during mood episodes. GC sensitivity is partly determined by polymorphisms in the genes encoding receptors and other proteins involved in the regulation of the HPA axis. We shortly discuss the glucocorticoid receptor, as well as the mineralocorticoid receptor, the cortisol-releasing hormone receptor-1, and the glucocorticoid receptor co-chaperone FKBP5. Data clearly indicate genetic changes, along with epigenetic changes which influence the set-point and regulation of the HPA axis. Early trauma, as well as influences in utero, appears to be important. Future research is necessary to further clarify the biological background and consequences of an individual's cortisol exposure in relation to mood.     

Frailty and chronic kidney disease: A systematic review

ObjectiveFrailty is associated with increased vulnerability to poor health. There is growing interest in understanding the association between frailty and chronic kidney disease (CKD). This systematic review explored how frailty is measured in patients with CKD and the association between frailty and adverse outcomes across different stages of renal impairment.Study designSystematic analysis of peer reviewed articles.Data sourcesPubmed, Medline, Web of Science and Cochrane were used to identify the articles.Data synthesisArticles published before the 17th of September 2016, that measured frailty in patients with CKD was eligible for the systematic review. Two independent researchers assessed the eligibility of the articles. Quality of the articles was assessed using the Epidemiological Appraisal Instrument.ResultsThe literature search yielded 540 articles, of which 32 met the study criteria and were included in the review (n = 36,076, age range: 50–83 years). Twenty-three (72%) studies used or adapted the Fried phenotype to measure frailty. The prevalence of frailty ranged from 7% in community-dwellers (CKD Stages 1–4) to 73% in a cohort of patients on haemodialysis. The incidence of frailty increased with reduced glomerular filtration rate. Frailty was associated with an increased risk of mortality and hospitalization.ConclusionFrailty is prevalent in patients with CKD and it is associated with an increased risk of adverse health outcomes. There are differences in the methods used to assess frailty and this hinders comparisons between studies.     

A systematic review of predictors of maintenance of normotension after withdrawal of antihypertensive drugs

BACKGROUND: The identification and treatment of hypertension in the general community has contributed to the reduction in strokes and coronary heart disease observed during the past 30 years. However, concerns have arisen that some patients may be receiving unnecessary antihypertensive drug therapy leading to wasted resources and the potential for adverse drug effects. Once therapy has been started, treating physicians have difficulty in selecting patients for withdrawal and have concerns regarding patient safety and their own legal liability. PROCEDURES: This study reviews and consolidates information from published studies to identify known predictors of the successful maintenance of normotension after antihypertensive drug withdrawal. The predictors were identified by determining the proportion of subjects with various baseline characteristics who remained normotensive while off medication for at least 12 months. From these data we have developed a clinical algorithm to help identify patients in whom antihypertensive drug withdrawal might be considered. This may assist primary care physicians in achieving successful withdrawal of antihypertensive therapy among selected hypertensive patients. RESULTS: The most consistent predictors identified were blood pressure (BP) (lower pretreatment, on treatment, and after withdrawal), nature of pharmacotherapy (fewer agents and lower dose), and preparedness to accept dietary intervention (weight and sodium reduction). CONCLUSIONS: On the basis of this information, a trial of withdrawal of antihypertensive medication might be recommended for patients who have mildly elevated, uncomplicated BP that is well controlled on a single agent, and who are motivated and likely to accept lifestyle changes.     

A systematic review of commonly used medical treatments for hirsutism in women

Objective To evaluate the efficacy of various drug treatments in common use for hirsutism in women. Design A systematic review of published randomized controlled trials (RCTs). We included RCTs that tested commonly prescribed pharmaceutical treatments for hirsutism and the most common outcome measure, a decrease in Ferriman–Gallwey (F–G) score for hirsutism after 6 months of treatment. We excluded trials using unconventional treatments, alternative treatment outcomes, and trials referring to women with conditions other than polycystic ovary syndrome or idiopathic hirsutism. Results We identified 79 RCTs of which 28 were eligible for analysis. A significant reduction in hirsutism was found for flutamide, spironolactone, cyproterone acetate combined with an oral contraceptive, thiazolidinediones, oral contraceptive pills (OCPs), finasteride and metformin but not for placebo. Reduction in F–G score in response to treatment was negatively associated with body mass index (BMI) (r = –0·38; P = 0·004). Conclusions Seven different drug groups result in improvement in hirsutism and creative use of these will open new options for women with hirsutism. Obesity has a negative impact on the efficacy of treatments for hirsutism, thus appropriate lifestyle advice is necessary for a successful treatment programme.     

黄芪注射液治疗慢性心力衰竭的系统评价

目的 系统评价黄芪注射液治疗慢性心力衰竭的短期疗效和安全性.方法 采用Cochrane协作网系统评价方法,制定文献纳入标准和排除标准,检索CBMdisc、CNKI、PubMed等电子数据库;评价纳入文献质量,对同质研究进行meta分析.结果 11项研究被纳入meta分析,慢性心力衰竭患者共1 044例,常规药物对照组(对照组)503例,黄芪注射液+常规药物治疗组(治疗组)541例.meta分析显示与常规药物治疗相比,加用黄芪注射液可使总效率提高,差异具有统计学意义[相对危险度(RR)=1.22,95%CI(1.15,1.29)].加用黄芪注射液组左室射血分数明显高于常规药物治疗组,差异具有统计学意义[加权均数差(WMD)=6.32,95%CI(4.69,7.95)].结论 现有临床证据表明,加用黄芪注射液治疗慢性心力衰竭可能有效,且无严重的不良反应.但由于本系统评价所纳入的文献研究用药时间较短,因未能进行较长期疗效与安全性的分析,这还需要大量此类文献的支持.     

黄芪注射液治疗慢性心力衰竭的系统评价

目的 系统评价黄芪注射液治疗慢性心力衰竭的短期疗效和安全性.方法 采用Cochrane协作网系统评价方法,制定文献纳入标准和排除标准,检索CBMdisc、CNKI、PubMed等电子数据库;评价纳入文献质量,对同质研究进行meta分析.结果 11项研究被纳入meta分析,慢性心力衰竭患者共1 044例,常规药物对照组(对照组)503例,黄芪注射液+常规药物治疗组(治疗组)541例.meta分析显示与常规药物治疗相比,加用黄芪注射液可使总效率提高,差异具有统计学意义[相对危险度(RR)=1.22,95%CI(1.15,1.29)].加用黄芪注射液组左室射血分数明显高于常规药物治疗组,差异具有统计学意义[加权均数差(WMD)=6.32,95%CI(4.69,7.95)].结论 现有临床证据表明,加用黄芪注射液治疗慢性心力衰竭可能有效,且无严重的不良反应.但由于本系统评价所纳入的文献研究用药时间较短,因未能进行较长期疗效与安全性的分析,这还需要大量此类文献的支持.