مقاله شماره ۲۳
#Internal_Medicine
#Transplantation
عنوان:
Hepatic Encephalopathy Is Reversible in the Long Term After Liver Transplantation

نوع مطالعه:
Case - Control study

مجله:
Liver Transplantation

تاریخ انتشار:
22 August 2019

چکیده:

Cognitive dysfunction caused by hepatic encephalopathy (HE) improves within the first year after liver transplantation (LT). However, cognitive restitution seems to be incomplete in a subset of patients and after LT a new-onset cognitive decline was described. Data about the longterm development of cognitive function after liver transplantation (LT) are sparse. This prospective study analyzed whether a history of hepatic encephalopathy (HE) before LT had an impact on the longterm outcome of cognitive function after LT and if patients who underwent LT 5 years earlier showed worse cognitive function than healthy controls. The cognitive function of 34 patients was assessed before LT and at 1 year and 5 years after LT by psychometric tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the portosystemic encephalopathy syndrome test, which provides the psychometric hepatic encephalopathy score (PHES). Furthermore, patients completed surveys to assess health-related quality of life (HRQOL). An 22 additional patients were included after LT. Patients were subdivided by having a history of HE before LT. The control group consisted of 55 healthy patients adjusted for age and education. Before LT, patients performed significantly worse than controls in the psychometric tests: RBANS Total Scale (TS), mean ± standard deviation (SD), 92.6 ± 13.3 versus 99.9 ± 12.0, P = 0.01; and PHES, median (interquartile range [IQR]), 0 (-3 to 1) versus 1 (0-2), P < 0.001. At 1 year after LT, patients with a history of HE still showed cognitive impairment compared with controls: RBANS TS, mean ± SD, 89.8 ± 15.1 versus 99.9 ± 12.0, P < 0.01; and PHES, median (IQR), 0 (-2 to 1.25) versus 1 (0-2), P = 0.03. At 5 years after LT, patients with and without a history of HE showed normal cognitive function and improved HRQOL. In conclusion, HE-associated cognitive impairment seems to be reversible within 5 years after LT.

DOI: https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/lt.25626

توضیحات مهم:

✅ در این مطالعه آینده نگر ، وضعیت شناختی بیماران تحت پیوند ارزیابی شده است.

✔️ بیماران با و بدون سابقه انسفالوپاتی کبدی با کنترل های وابسته به سن با استفاده از ارزیابی های مختلف شناختی مقایسه شدند.

✔️ همانطور که انتظار می رفت ، بیماران قبل از پیوند کبد نسبت به کنترل ها در ارزیابی های شناختی بدتر بودند.

✔️ به طور جالب توجه ، با گذشت 5 سال از پیوند ، کاهش شناخت معکوس شده بود و با کنترل های مربوط به سن قابل مقایسه بود.

🔎 @Meditorha

مقاله شماره ۲۹
#Cardiology
#VascularSurgery
#Internal_medicine
#Pharmacology
#Rheumatology
عنوان:
Use of direct oral anticoagulants in antiphospholipid syndrome.

مجله:
Journal of Thromb Haemost

نوع مطالعه:
Review
تاریخ انتشار:
2018

سایتیشن:
Cohen et al.

چکیده:
The direct oral anticoagulants (DOACs) are therapeutic alternatives to warfarin and other vitamin K antagonists (VKAs), and constitute the standard of care for many indications. VKAs constitute the conventional therapy for the treatment and secondary thromboprophylaxis of thrombotic antiphospholipid syndrome (APS), but are often problematic, owing to the variable sensitivity of thromboplastins to lupus anticoagulant. Thus, the International Normalized Ratio may not accurately reflect anticoagulation intensity, or be clinically effective. Definition of the current role of DOACs in the treatment of APS is based on limited clinical trial data and information from other sources, including manufacturers' data, case series or cohort studies, and expert consensus. The Rivaroxaban in Antiphospholipid Syndrome (RAPS) randomized controlled trial (RCT), which had a laboratory surrogate primary outcome measure, suggests that rivaroxaban has the potential to be an effective and convenient alternative to warfarin in thrombotic APS patients with a single venous thromboembolism event requiring standard-intensity anticoagulation. However, further studies, in particular to provide better long-term efficacy and safety data, are needed before it can be widely recommended. APS patients are clinically heterogeneous, with the risk of recurrent thrombosis and the intensity of anticoagulation being influenced by their clinical phenotype and risk profile. DOAC trials involving homogeneous thrombotic APS populations, with the antiphospholipid antibody status well defined, will help to optimize the appropriate treatment in APS patient subgroups. Ongoing and emerging DOAC RCTs should provide further information to guide the use of DOACs in APS patients. Optimal identification of APS patients is a key step in working towards improved therapeutic strategies in these individuals.

DOI: https://doi.org/10.1111/jth.14017


🔎 @Meditorha

مقاله شماره ۳۱
#Internal_medicine
#Surgery
#Gastroenterology
عنوان:
Rituximab Is Ineffective for Treatment of Fatigue in Primary Biliary Cholangitis

مجله:
Hepatology

نوع مطالعه:
single‐center phase 2 randomized controlled trial

تاریخ انتشار:
May, 2018

سایتیشن:
Khanna et al.

چکیده:
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease. Half of patients experience debilitating fatigue, which is currently untreatable. Previous studies have shown muscle bioenergetic abnormalities in PBC, including increased muscle acidosis with exercise linked to the antimitochondrial antibody (AMA) diagnostic of the disease, and reduced anaerobic threshold. In this study we addressed the hypothesis that fatigue in PBC is driven by muscle bioenergetic abnormality related to AMA, and that AMA reduction with B-cell depletion therapy will improve fatigue. In our single-center phase 2 randomized controlled trial, 57 participants aged 18 years or older with PBC and moderate to severe fatigue were randomized to receive two doses of either rituximab (1000 mg) or saline (placebo). The primary outcome measure was fatigue severity assessed using the PBC-40 fatigue domain at 3 months. Secondary outcome measures included patient-reported outcomes and immunological and bioenergetics disease parameters. Experimental outcomes included biochemical markers of disease severity. Improvement in fatigue score at 3 months was seen in both arms, with no significant difference (adjusted mean difference -0.9 [95% confidence interval -4.6 to 3.1]). Little difference was observed in other patient-reported outcomes or physical activity. Significant anaerobic threshold improvement was seen in the rituximab group, only but this was not associated with fatigue improvement. No treatment-emergent serious adverse events were seen. Conclusions: Rituximab was safe over the 12-month study period but showed no evidence of effectiveness for the treatment of fatigue in PBC. Anaerobic threshold improvement was seen, potentially linking AMA with muscle bioenergetics dysfunction; however, this was not related to improvement in fatigue. Rituximab had some evidence of a beneficial effect on alkaline phosphatase levels in this largely ursodeoxycholic acid (UDCA)-responding, early-disease stage cohort.

DOI: https://dx.doi.org/10.1002/hep.30099

توضیحات مهم:

✅ هدف اصلی این مطالعه بهبود Fatigue ناشی از کلانژیت صفراوی اولیه (PBC) بود.

✔️ فرضیه این بود که Fatigue توسط آنتی بادی ضد میتوکندری (AMA) موجود در PBC هدایت می شود.

✔️ نتایج نشان داد که کاهش AMA از طریق کاهش سلول B باعث خستگی بیماران مبتلا به PBC می شود. اما تفاوت معنی داری در خستگی بین گروه ریتوکسیماب در مقایسه با دارونما مشاهده نشد.

🔎 @Meditorha

مقاله شماره ۳۳
#Internal_medicine
#Diabete
عنوان:
Preventing Foot Ulceration in Diabetes

مجله:
Diabetologia

نوع مطالعه:
systematic review and meta-analyses of RCT data

تاریخ انتشار:
27 November 2019

سایتیشن:
Crawford et al.

چکیده:
AIMS/HYPOTHESIS

Foot ulceration is a serious complication for people with diabetes that results in high levels of morbidity for individuals and significant costs for health and social care systems. Nineteen systematic reviews of preventative interventions have been published, but none provides a reliable numerical summary of treatment effects. The aim of this study was to systematically review the evidence from RCTs and, where possible, conduct meta-analyses to make the best possible use of the currently available data.

METHODS

We conducted a systematic review and meta-analysis of RCTs of preventative interventions for foot ulceration. OVID MEDLINE and EMBASE were searched to February 2019 and the Cochrane Central Register of Controlled Trials to October 2018. RCTs of interventions to prevent foot ulcers in people with diabetes who were free from foot ulceration at trial entry were included. Two independent reviewers read the full-text articles and extracted data. The quality of trial reporting was assessed using the Cochrane Risk of Bias tool. The primary outcome of foot ulceration was summarised using pooled relative risks in meta-analyses.

RESULTS

Twenty-two RCTs of eight interventions were eligible for analysis. One trial of digital silicone devices (RR 0.07 [95% CI 0.01, 0.55]) and meta-analyses of dermal infrared thermometry (RR 0.41 [95% CI 0.19, 0.86]), complex interventions (RR 0.59 [95% CI 0.38, 0.90], and custom-made footwear and offloading insoles (RR 0.53 [95% CI 0.33, 0.85]) showed beneficial effects for these interventions.

CONCLUSIONS/INTERPRETATION

Four interventions were identified as being effective in preventing foot ulcers in people with diabetes, but uncertainty remains about what works and who is most likely to benefit.

https://link.springer.com/article/10.1007%2Fs00125-019-05020-7

توضیحات مهم:

✅ نویسندگان این مرور ساختارمند و متاآنالیز، اثربخشی مداخلات طراحی شده برای جلوگیری از زخم پای دیابتی را در بین مبتلایان به دیابت ارزیابی کردند.

✔️ در میان 22 مطالعه RCT که 8 مداخله را ارزیابی می کند ، مداخلات نشان داده دماسنج dermal infrared، مداخلات پیچیده و کفش custom-made و offloading insole موثر بوده است.

✔️ یک آزمایش واحد از دستگاه های دیجیتالی سیلیکون نیز از مزیت متوسطی برخوردار بود.

✔✔ اگرچه 4 مداخله در پیشگیری از زخم پای دیابتی در بین مبتلایان به دیابت مؤثر شناخته شده است ، اما مطالعات آینده لازم است تا مشخص شود که کدام مداخلات مؤثرتر هستند و استفاده از این راهکارها در کدام جمعیت هدف پیشگیرانه بیشتر است.

🔎 @Meditorha

مقاله شماره ۳۴

#Internal_medicine
#Diabete
#Cardiology
عنوان:

2019 ADA and EASD Guidelines for the Management of Hyperglycemia in Type 2 Diabetes

مجله:
Diabetes Care

نوع مطالعه:
Original Research

تاریخ انتشار:
October 15, 2019

سایتیشن:
Buse et al.

چکیده:
The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min–1 [1.73 m]–2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death.

https://doi.org/10.2337/dci19-0066

توضیحات مهم:

✔ The ADA and EASD have updated their guidelines for the management of hyperglycemia in type 2 diabetes to include the use of GLP-1 receptor agonists or SGLT2 inhibitors in high-risk patients.
✔ The update also includes the consideration of GLP-1 receptor agonist use in those diabetic patients without cardiovascular disease and the use of SGLT2 inhibitors in type 2 diabetes patients with heart failure and chronic kidney disease.


🔎 @Meditorha