Efficacy Of Pharmacotherapy Research Articles

HGMMX: Host Gut Microbiota Metabolism Xenobiotics Database.

The metagenome of bacteria colonizing the human intestine is a set of genes that is almost 150 times greater than the set of host genes. Some of these genes encode enzymes whose functioning significantly expands the number of potential pathways for xenobiotic metabolism. The resulting metabolites can exhibit activity different from that of the parent compound. This can decrease the efficacy of pharmacotherapy as well as induce undesirable and potentially life-threatening side effects. Thus, analysis of the biotransformation of small drug-like compounds mediated by the gut microbiota is an important step in the development of new pharmaceutical agents and repurposing of the approved drugs. In vitro research, the interaction of drug-like compounds with the gut microbiota is a multistep and time-consuming process. Systematic testing of large sets of chemical structures is associated with a number of challenges, including the lack of standardized techniques and significant financial costs to identify the structure of the final metabolites. Estimation of the compounds' ability to be biotransformed by the gut microbiota and prediction of the structures of their metabolites are possible in silico. However, the development of computational approaches is limited by the lack of information about chemical structures metabolized by microbiota enzymes. The aim of this study is to create a database containing information on the metabolism of drug-like compounds by the gut microbiota. We created the data set containing information about 368 structures metabolized and 310 structures not metabolized by the human gut microbiota. The HGMMX database is freely available at https://www.way2drug.com/hgmmx. The information presented will be useful in the development of computational approaches for analyzing the impact of the human microbiota on metabolism of drug-like molecules.

Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports.

Chronic insomnia affects 5% to 10% of the US population, increasing the demand for treatment options and the corresponding research to prove their validity.1 This review compares recommendations from 3 clinical guidelines and summarizes hypnotic medications, including their newly reported side effects not mentioned in the guidelines. In addition, we aim to provide an overview of what pharmacotherapies are available for prescribers and patients. A literature search was conducted for articles published prior to January 10, 2022, and case reports and clinical studies were retrieved from PubMed and Google Scholar. Definitive conclusions cannot be drawn regarding the safety and efficacy of medications reviewed; however, trends are apparent. All 3 guidelines included in this review remarked most treatment recommendations as weak except for cognitive behavioral therapy for insomnia, which is effective but not readily available. Furthermore, based on the 15 case reports and 13 clinical studies presented in this review, many of the medications used for treatment of insomnia present safety concerns. Benzodiazepines and benzodiazepine receptor agonists are commonly used hypnotic agents with the "Z-drugs" having robust data establishing their efficacy for the short-term treatment of chronic insomnia. However, significant adverse effects related to the central nervous system (CNS), including developing tolerance, addiction, CNS depression, and amnesia, remain barriers to their long-term use. In comparison, newer agents present more favorable side-effect profiles although with less established efficacy. Additionally, off-label agents, including antidepressants, antihistamines, and natural supplements, are discussed due to their prominent use.

Current Approaches to Assessing the Safety and Efficacy of Lamotrigine in Children and Adolescents with Epileptic Syndromes Associated with Focal Seizures

Scientific relevance. Epileptic syndromes associated with focal seizures often develop in children and adolescents and may be accompanied by cognitive impairment, mental disorders, and endocrine disorders, which require additional medication apart from anti-epileptic medicinal products. Currently, the selection of safe and effective therapies for epileptic syndromes, especially in paediatric populations, is a pressing challenge for epileptology.Aim. This study aimed at a comprehensive assessment of the safety and efficacy of lamotrigine in therapeutic doses for children and adolescents with epileptic syndromes associated with focal seizures.Materials and methods. A total of 53 patients aged 3 to 18 years with various epileptic syndromes associated with focal seizures were under observation in 2020–2023. During this period, 37 patients (69.8%) received monotherapy with lamotrigine, and 16 patients (30.2%) received combination therapy including lamotrigine and two or more other medicinal products. When evaluating the safety and efficacy of pharmacotherapy in adolescent patients, the authors selectively used the Software for Post-marketing Studies of Anti-epileptic Medicinal Products developed at the Scientific Centre for Expert Evaluation of Medicinal Products.Results. With lamotrigine, the highest rate of complete clinical remission was observed in patients with focal epilepsy with onset in childhood and adolescence (90.9% of cases). For structural focal epilepsy, 16.7% of patients achieved complete freedom from seizures, and 50% demonstrated a pronounced response to treatment. However, patients with epilepsy due to local structural changes in the neocortex (33.3% of cases) had a prognosis of severe epilepsy. For epileptic encephalopathies with onset in childhood, 66.7% of patients achieved a ≥50% reduction in the frequency of seizures. Seizure reduction improved the quality of life of patients and their parents, especially of those with a long history of unsuccessful treatment attempts. There were no adverse reactions associated with lamotrigine except those listed in the summary of product characteristics. The Software for Post-marketing Studies of Anti-epileptic Medicinal Products provided a means for scoring and plotting the changes in the condition of adolescents without severe cognitive and memory impairment undergoing lamotrigine treatment.Conclusions. According to the study results, lamotrigine is highly effective and has a favourable safety profile in patients with early-onset epileptic syndromes associated with focal seizures. Moreover, lamotrigine is applicable to the treatment of attention, memory, expressive speech disorders, and aggressive behaviour. Therefore, lamotrigine may be recommended for treating children and adolescents with comorbid epileptic syndromes and cognitive and emotional disorders. Specialised software improves the quality of real-world evidence regarding the safety and efficacy of anti-epileptic medication.

The influence of atorvastatin, amlodipine and ethoxidol on ubiquinol and ubiquinone endogenous plasma concentrations in patients with chronic heart failure.

Coenzyme Q10 is a key component of the mitochondrial respiratory chain and a fat-soluble endogenous antioxidant performing many vital functions in the human body. Many researchers studied the plasma concentrations of ubiquinol, ubiquinone, total CoQ10 and the redox state (ubiquinol/ubiquinone ratio) of CoQ10 in healthy volunteers. However, these parameters in the plasma of patients with chronic heart failure (CHF) remain almost uninvestigated. The aim of this case-control study was to investigate the effect of atorvastatin, amlodipine and ethoxidol on endogenous plasma concentrations of ubiquinol, ubiquinone, total CoQ10 and its redox state in patients with CHF. The study included 62 patients with CHF divided into four groups depending on the prescribed therapy. For the quantitative determination of ubiquinol, ubiquinone, and total CoQ10 in the plasma of patients, HPLC-MS/MS was used. It was established that the endogenous plasma concentration of total CoQ10 in patients with CHF is significantly lower than in healthy volunteers, and the ratio of reduced and oxidized forms of CoQ10 is shifted towards ubiquinone. It was a statistically significant effect of drugs with different physicochemical structures and pharmacological action on the plasma concentrations of ubiquinol, ubiquinone and total CoQ10: atorvastatin administration led to a decrease in the concentration of ubiquinol (-33.3Δ%), and total CoQ10 (-15Δ%), administration of amlodipine contributed to an increase in the levels of ubiquinol (+27.7Δ%) and total CoQ10 (+18.2Δ%), and the administration of ethoxidol caused an increase in the concentration of ubiquinol (+25Δ%), ubiquinone (+17.7Δ%) and total CoQ10 (+20.2Δ%). Amlodipine is able to neutralize the negative effect of atorvastin on the redox balance of CoQ10 in patients with CHF. An additional prescription of the antioxidant ethoxidol to standard therapy for patients with CHF was substantiated. Determination of the redox state of CoQ10 in plasma can be used to diagnose and assess the degree of oxidative stress in patients with cardiovascular diseases, as well as to assess the efficacy and safety of ongoing pharmacotherapy.

Childhood and Adolescents Sleep Bruxism Treatment: A Systematic Review.

Introduction Sleep Bruxism (SB) is a common condition in childhood that can cause multiple consequences such as abnormal tooth wear, tensional headaches, masticatory muscle pain, or fatigue. The literature reports some interventions, however the treatment for SB in children is not well-established. Objectives A systematic review was performed to investigate the effectiveness of the treatments described for SB in children and adolescents: pharmacological and psychological treatments; behavioral guidelines; and dental approaches. Materials and methods Randomized clinical trials comparing different SB treatments with a control group were searched in the electronic databases PubMed, Scopus, Web of Science, Cochrane Library, and VHL until August 04, 2021. Two independent reviewers selected the studies, extracted the data, and assessed the risk of bias. After a two-phase selection process, 07 articles were selected. The methodology of the selected studies was analyzed using the Cochrane Risk of Bias Tool. The criteria used to qualify the studies were based on randomization, allocation, blinding of participants and evaluators, and analysis of results. Results The signs and symptoms of SB were reduced with pharmacotherapy (hydroxyzine/diazepam) and medicinal extracts ( M. Officinalis ), but with occlusal splints and physiotherapy, this improvement was not statistically significant when compared to control groups. Conclusion Some evidence of the efficacy of pharmacotherapy (hydroxyzine/diazepam) and medicinal extracts ( M. Officinalis ) was found. However, this systematic review is not enough to establish a protocol for the treatment of SB. Besides, the individualized management of SB in this population should be considered, emphasizing the management of risk factors.

National Institute on Drug Abuse (NIDA) research priorities to support the development of incentive-based treatments for substance use disorders

The purpose of this commentary is to highlight current research priorities of National Institute on Drug Abuse (NIDA) Division of Therapeutics and Medical Consequences (DTMC) regarding the development and testing of incentive-based interventions for the treatment of substance use disorders (SUDs). This manuscript summarizes the NIH Stage Model for behavioral intervention development, briefly reviews existing research on incentive-based treatments for SUDs that falls within the scope of DTMC at NIDA and highlights the development of digital therapeutics-based incentive interventions as an exemplar and high priority area. We briefly review how digital therapeutics approaches may address some common limitations to dissemination of incentive-based interventions and highlight opportunities for integrating incentive-based approaches into pharmacotherapy efficacy trials. Finally, we mention several related funding opportunities for researchers interested in developing incentive-based approaches for SUD treatment. The overall goal of this commentary is to inform the research community of current NIDA priority areas for intervention development and funding.

Efficacy and safety of pharmacotherapy for refractory or unexplained chronic cough: a systematic review and network meta-analysis

Refractory chronic cough (RCC) has a significant impact on patient's health-related quality of life and represents a challenge in clinical management. However, the optimal treatment for RCC remains controversial. This study aimed to investigate and compare the efficacy and safety of the current pharmacological therapeutic options for RCC. A systematic review was performed by searching PubMed, Web of Science, Embase, and Ovid databases from January 1, 2008 to March 1, 2023. All randomised control trials (RCTs) reporting outcomes of efficacy or/and safety were included in the Bayesian network meta-analysis. Here, we compared the effects on Leicester Cough Questionnaire (LCQ), Visual Analogue Scale (VAS), and objective cough frequency of patients with RCC. Besides, we also compared the incidence of adverse events (AEs) for analysis of safety. PROSPERO registration: CRD42022345940. 19 eligible RCTs included 3326 patients and 7 medication categories: P2X3 antagonist, GABA modulator, Transient Receptor Potential (TRP) modulator, NK-1 agonist, opioid analgesic, macrolide, and sodium cromoglicate. Compared with placebo, mean difference (MD) of LCQ and 24 h cough frequency for P2X3 antagonist relief were 1.637 (95% CI: 0.887-2.387) and-11.042 (P=0.035). Compared with placebo, effect sizes (MD for LCQ and cough severity VAS) for GABA modulator were 1.347 (P=0.003) and-7.843 (P=0.003). In the network meta-analysis, gefapixant is the most effective treatment for patients with RCC (The Surface Under the Cumulative Ranking Curves (SUCRA) is 0.711 in LCQ, 0.983 in 24 h cough frequency, and 0.786 in cough severity VAS). Lesogaberan had better efficacy than placebo (SUCRA: 0.632 vs. 0.472) in 24 h cough frequency. Eliapixant and lesogaberan had better efficacy than placebo in cough severity VAS. However, TRP modulator had worse efficacy than placebo. In the meta-analysis of AEs, the present study found P2X3 antagonist had a significant correlation to AEs (RR: 1.129, 95% CI: 1.012-1.259), especially taste-related AEs (RR: 6.216, P<0.05). In this network meta-analysis, P2X3 antagonist showing advantages in terms of efficacy is currently the most promising medication for treatment of RCC. GABA modulator also showed potential efficacy for RCC but with AEs of the central system. Nevertheless, the role of TRP modulator needed to be revisited. Further research is needed to determine the potential beneficiary population for optimizing the pharmacological management of chronic cough. National Natural Science Foundation of China (81870079), Guangdong Science and Technology Project (2021A050520012), Incubation Program of National Science Foundation for Distinguished Young Scholars (GMU2020-207).

Efficacy of endoscopic resuturing versus pharmacotherapy to treat weight recidivism after endoscopic sleeve gastroplasty

Background and aimsA subset of patients experience weight recidivism after primary endoscopic sleeve gastroplasty (P-ESG). Available options for management of weight regain include initiation of anti-obesity medications (AOM) or redo ESG (R-ESG). The comparative effectiveness of these options is not clear. MethodsThis is a retrospective analysis of a prospectively maintained database of patients undergoing ESG. From 2013 to 2021, 79 patients who were started on AOM, or underwent R-ESG for management of weight recidivisim after P-ESG were included. The primary outcome of this study was final total body weight loss (TBWL) at the end of follow up. ResultsFifty five patients were started on AOM and 24 patients underwent R-ESG. The age, gender distribution and baseline BMI did not differ significantly between groups. The proportion of non-compliant patients (defined as patients who missed their first post ESG follow up visit) was significantly higher in the AOM group compared with R-ESG group (67% versus 35%, p=0.012). The additional TBWL after R-ESG was significantly (both clinically and statistically) better than after initiation of AOM (9.5±7.2% versus 2.1±8.6%, p=0.001). Final TBWL clearly favored R-ESG over AOM for treatment of weight recidivism (19.9±10.4% versus 13.6±9.2%, p=0.028). ConclusionsR-ESG is an effective treatment to induce weight loss after experiencing weight recidivism. These results highlight an important advantage of ESG as a repeatable minimally-invasive procedure.

Treatment Efficacy of Pharmacotherapies for Frontotemporal Dementia: A Network Meta-Analysis of Randomized Controlled Trials

The neuropsychiatric symptoms of frontotemporal dementia (FTD) have a profound negative impact on disease outcomes and care burden. Available pharmacotherapies might be supported by small-scale randomized controlled trials (RCTs); however, clinical recommendations might not be conclusive. We systematically searched several databases from inception to April 30, 2022, for RCTs of drug therapy in patients with FTD and neuropsychiatric symptoms (primary outcome). Secondary outcomes included changes in caregiver stress, daily interactive activities, cognitive function, and acceptability (adverse event or dropout rates). The network meta-analysis (NMA) procedure was performed under the frequency model, showing effect sizes as standardized mean differences (SMD) or odds ratios (OR) with 95% confidence intervals (95% CIs). Seven RCTs with 243 participants were included. Compared with placebo, high-dose oxytocin (72 international units) was associated with the greatest improvement in patients' neuropsychiatric symptoms (SMD=-1.17, 95% CIs=-2.25 to -0.08, z=-2.10, p=0.035). Piracetam significantly worsened neuropsychiatric symptoms (SMD=3.48, 95% CIs=1.58 to 5.37, z=3.60, p < 0.001) and caregiver stress (SMD=2.40, 95% CIs=0.80-4.01, z=2.94, p=0.003). Trazodone had significantly higher rates of adverse events (OR=9.53, 95% CIs=1.85-49.20, z=2.69, p=0.007). No pharmacological intervention significantly benefited cognitive function. This study provides the first NMA for clinical recommendation to support the use of high-dose oxytocin and caution regarding the use of piracetam for neuropsychiatric symptoms in patients with FTD.

Genotyping of Patients with Adverse Drug Reaction or Therapy Failure: Database Analysis of a Pharmacogenetics Case Series Study.

Pharmacogenetics (PGx) is an emerging aspect of personalized medicine with the potential to increase efficacy and safety of pharmacotherapy. However, PGx testing is still not routinely integrated into clinical practice. We conducted an observational case series study where PGx information from a commercially available panel test covering 30 genes was integrated into medication reviews. The aim of the study was to identify the drugs that are most frequently object of drug-gene-interactions (DGI) in the study population. In out-patient and in-patient settings, we recruited 142 patients experiencing adverse drug reaction (ADR) and/or therapy failure (TF). Collected anonymized data from the individual patient was harmonized and transferred to a structured database. The majority of the patients had a main diagnosis of a mental or behavioral disorder (ICD-10: F, 61%), of musculoskeletal system and connective tissue diseases (ICD-10: M, 21%), and of the circulatory system (ICD-10: I, 11%). The number of prescribed medicines reached a median of 7 per person, resulting in a majority of patients with polypharmacy (≥5 prescribed medicines, 65%). In total, 559 suspected DGI were identified in 142 patients. After genetic testing, an association with at least one genetic variation was confirmed for 324 suspected DGI (58%) caused by 64 different drugs and 21 different genes in 141 patients. After 6 months, PGx-based medication adjustments were recorded for 62% of the study population, whereby differences were identified in subgroups. The data analysis from this study provides valuable insights for the main focus of further research in the context of PGx. The results indicate that most of the selected patients in our sample represent suitable target groups for PGx panel testing in clinical practice, notably those taking drugs for mental or behavioral disorder, circulatory diseases, immunological diseases, pain-related diseases, and patients experiencing polypharmacy.

Biliverdin Reductase B Is a Plasma Biomarker for Intraplaque Hemorrhage and a Predictor of Ischemic Stroke in Patients with Symptomatic Carotid Atherosclerosis

Background: Intraplaque hemorrhage (IPH) is a hallmark of atherosclerotic plaque instability. Biliverdin reductase B (BLVRB) is enriched in plasma and plaques from patients with symptomatic carotid atherosclerosis and functionally associated with IPH. Objective: We explored the biomarker potential of plasma BLVRB through (1) its correlation with IPH in carotid plaques assessed by magnetic resonance imaging (MRI), and with recurrent ischemic stroke, and (2) its use for monitoring pharmacotherapy targeting IPH in a preclinical setting. Methods: Plasma BLVRB levels were measured in patients with symptomatic carotid atherosclerosis from the PARISK study (n = 177, 5 year follow-up) with and without IPH as indicated by MRI. Plasma BLVRB levels were also measured in a mouse vein graft model of IPH at baseline and following antiangiogenic therapy targeting vascular endothelial growth factor receptor 2 (VEGFR-2). Results: Plasma BLVRB levels were significantly higher in patients with IPH (737.32 ± 693.21 vs. 520.94 ± 499.43 mean fluorescent intensity (MFI), p = 0.033), but had no association with baseline clinical and biological parameters. Plasma BLVRB levels were also significantly higher in patients who developed recurrent ischemic stroke (1099.34 ± 928.49 vs. 582.07 ± 545.34 MFI, HR = 1.600, CI [1.092–2.344]; p = 0.016). Plasma BLVRB levels were significantly reduced following prevention of IPH by anti-VEGFR-2 therapy in mouse vein grafts (1189 ± 258.73 vs. 1752 ± 366.84 MFI; p = 0.004). Conclusions: Plasma BLVRB was associated with IPH and increased risk of recurrent ischemic stroke in patients with symptomatic low- to moderate-grade carotid stenosis, indicating the capacity to monitor the efficacy of IPH-preventive pharmacotherapy in an animal model. Together, these results suggest the utility of plasma BLVRB as a biomarker for atherosclerotic plaque instability.

Targeting CMV Reactivation to Optimize Care for Critically Ill COVID-19 Patients: A Review on the Therapeutic Potential of Antiviral Treatment.

Cytomegalovirus (CMV) reactivation has been linked to adverse clinical outcomes in critically ill patients, with emerging evidence suggesting a potential connection with severe COVID-19. Mechanisms driving this association may include primary lung injury, amplification of systemic inflammation, and secondary immunosuppression. Diagnostic challenges in detecting and assessing CMV reactivation necessitate a comprehensive approach to improve accuracy and inform treatment decisions. Currently, there is limited evidence on the efficacy and safety of CMV pharmacotherapy in critically ill COVID-19 patients. Although insights from non-COVID-19 critical illness studies suggest a potential role for antiviral treatment or prophylaxis, the risks and benefits must be carefully balanced in this vulnerable patient population. Understanding the pathophysiological role of CMV in the context of COVID-19 and exploring the advantages of antiviral treatment are crucial for optimizing care in critically ill patients. This review provides a comprehensive synthesis of available evidence, emphasizing the need for additional investigation to establish the role of CMV treatment or prophylaxis in the management of severe COVID-19 and to develop a framework for future research on this topic.

Multiple sclerosis and anxiety: Is there an untapped opportunity for exercise?

Anxiety symptoms and anxiety disorders are prevalent and burdensome, yet poorly managed in multiple sclerosis (MS). Indeed, anxiety disorders occur in 22% of people with MS, and anxiety can negatively impact physical function, cognition, and quality of life. Currently, there are no treatment guidelines available for anxiety in MS, based on limited information regarding the efficacy of pharmacotherapy and psychotherapy. Exercise training may be a promising avenue for treatment of anxiety in MS, and this is based, in part, on a wealth of evidence in the general population of adults. This review provides an overview of anxiety and evidence from meta-analyses and systematic reviews for current treatments options in the general population and MS. We further make a case for exercise as a novel treatment approach that requires focal examination in persons with MS. We conducted a scoping review of available research, including systematic reviews and meta-analyses, on anxiety and its prevalence, predictors, consequences, and treatments in MS. We then noted limitations with existing evidence regarding treatment options, and then provided a backdrop based on evidence from the general population for the novel proposition of exercise as treatment of anxiety in MS. Pharmacotherapy and psychotherapy treatments of anxiety may be efficacious, but come with significant limitations, especially for persons with MS. Exercise is a promising novel avenue for treatment of anxiety in MS, and has a positive side-effect profile. Anxiety is under-investigated and poorly treated in MS. There is a paucity of evidence for the relationship between exercise training and anxiety in MS, but the evidence in the general population supports the urgent need for systematic examination of the efficacy of exercise in treating anxiety symptoms and disorders in persons with MS.

Comparison of Loratadine and Ketotifen Pharmacotherapy in Cases of Chronic Cough in Children: A Study at Petrokimia Gresik Hospital, Indonesia

Objectives: To compare the efficacy of loratadine and ketotifen pharmacotherapy in cases of chronic cough in children at Petrokimia Gresik Hospital, Indonesia.&#x0D; Materials and Methods: A retrospective case-control study on 127 chronic cough children aged less than 6 years old was done. All subjects went through a period of restrictive diet for 2-4 weeks. If the symptoms relieved, subjects were reintroduced previous daily diet gradually. All subjects were randomized to take loratadine powder (54%), once daily or ketotifen powder (46%), twice daily for 2-4 weeks, for chronic cough pharmacotherapy. Cough symptoms was evaluated during next visit. At those visits, the adverse event was also evaluated.&#x0D; Results: Of the 187 subjects enrolled, 60 dropped out. Thus, 69 children remained on loratadine, and 58 on ketotifen. Of all research subjects, only 10% experienced improvement (P= 0.582). In the non-improved group, 35% of the subjects also suffered from acute maxillary sinusitis. There were no adverse events in all groups.&#x0D; Conclusion: There were no significant difference between loratadine and ketotifen pharmacotherapy in cases of chronic cough in children at Petrokimia Gresik Hospital, Indonesia. Further investigation to look after other common uncontrolled triggers such as house dust mite sensitization, need to be done in this study, so that comprehensive therapy can be given.

Efficacy of pharmacotherapy and dialectical behavior therapy in treatment of suicide behavior among inpatient and outpatient adolescents at Federal Neuropsychiatric Hospital, Annex, Cappa-Lagos, Nigeria

Efficacy of pharmacotherapy and dialectical behavior therapy in treatment of suicide behavior among inpatient and outpatient adolescents at Federal Neuropsychiatric Hospital, Annex, Cappa-Lagos, Nigeria

Clinical efficacy of haridra in prameha purvaroop w.s.r. to prediabetes

Diabetes is a non-communicable disease which is attaining increasing importance among the adult population in both developed and developing countries. Pre-diabetes is a precursor condition for type 2 Diabetes mellitus. Although in many cases it is reversible, Pre-diabetes frequently remains undiagnosed and therefore risk of developing type 2 Diabetes Mellitus is increased. Lifestyle modification is more effective mode of preventing diabetes and reduction of 40%-70% with pre-diabetes. While there is increasing evidence to prove the efficacy of pharmacotherapy in prevention of diabetes in adults with pre-diabetes, pharmaceutical treatment options other than metformin are associated with adverse effects that limit their use for pre-diabetes. It is considered to be an at risk state, with high chances of developing diabetes. While, pre-diabetes is commonly an asymptomatic condition, there is always presence of pre-diabetes before the onset of diabetes. This aim of this study is to describe the challenges associated with diagnosis of pre-diabetes, the possible adverse medical outcomes associated with pre-diabetes and the treatment options and rationale for their use in context of pre-diabetes. This research topic is selected for prevention of type 2 Diabetes Mellitus by identification of high risk subjects and early dietary intervention in the form of Haridra. Therefore, an attempt has been made to study the clinical efficacy of Haridra In Prameha Purvaroop W.S.R. To Prediabetes.

Attention Bias Modification Treatment Versus a Selective Serotonin Reuptake Inhibitor Or Waiting List Control for Social Anxiety Disorder: A Randomized Clinical Trial.

Social anxiety disorder is common and impairing. The efficacy of pharmacotherapy is moderate, highlighting the need for alternative therapies. This study compared the efficacy of gaze-contingent music reward therapy (GC-MRT), an eye-tracking-based attention bias modification treatment, with a selective serotonin reuptake inhibitor (SSRI) treatment or a waiting list control condition in reducing social anxiety disorder symptoms. Superior clinical effects of similar magnitude were expected for the active treatments relative to the control condition. Participants were 105 treatment-seeking adults with social anxiety disorder, randomly allocated to 12 weeks of GC-MRT, SSRI, or waiting list control. Mean changes in clinician-rated and self-reported social anxiety symptoms from baseline to mid- and posttreatment assessments were compared between groups using generalized estimating equations. Changes in attentional dwell time on threat were also examined. Analysis indicated a significant differential reduction in symptoms between groups. Patients in the GC-MRT and SSRI groups had lower social anxiety scores at the mid- and posttreatment assessments compared with patients in the waiting list group. The efficacy of the active treatments did not differ. Only patients in the GC-MRT group showed reduction in dwell time on threat from baseline to posttreatment assessment. Eye-tracking-based attention bias modification is an acceptable and effective treatment option for social anxiety disorder.

Heart failure with reduced ejection fraction and atrial fibrillation: a Sub-Saharan African perspective.

Cardiovascular diseases are a well-established cause of death in high-income countries. In the last 20years, Sub-Saharan Africa (SSA) has seen one of the sharpest increases in cardiovascular disease-related mortality, superseding that of infectious diseases, including HIV/AIDS, in South Africa. This increase is evidenced by a growing burden of heart failure and atrial fibrillation (AF) risk factors. AF is a common comorbidity of heart failure with reduced ejection fraction (HFrEF), which predisposes to an increased risk of stroke, rehospitalizations, and mortality compared with patients in sinus rhythm. AF had the largest relative increase in cardiovascular disease burden between 1990 and 2010 in SSA and the second highest (106.4%) increase in disability-adjusted life-years (DALY) between 1990 and 2017. Over the last decade, significant advancements in the management of both HFrEF and AF have emerged. However, managing HFrEF/AF remains a clinical challenge for physicians, compounded by the suboptimal efficacy of guideline-mandated pharmacotherapy in this group of patients. There may be an essential role for racial differences and genetic influence on therapeutic outcomes of HFrEF/AF patients, further complicating our overall understanding of the disease and its pathophysiology. In SSA, the lack of accurate and up-to-date epidemiological data on this subgroup of patients presents a challenge in our quest to prevent and reduce adverse outcomes. This narrative review provides a contemporary overview of the epidemiology of HFrEF/AF in SSA. We highlight important differences in the demographic and aetiological profile and the management of this subpopulation, emphasizing what is currently known and, more importantly, what is still unknown about HFrEF/AF in SSA.

Development of Novel Mass Spectrum-Based Assay for Simultaneous Detection of 36 Variants in the 14 Pharmacogenetic Genes for the Japanese Population.

Pharmacogenetics (PGx) enhances personalized care, often reducing medical costs, and improving patients' QOL. Unlike single variant analysis, multiplex PGx panel tests can result in applying comprehensive PGx-guided medication to maximize drug efficacy and minimize adverse reactions. Among PGx genes, drug-metabolizing enzymes and drug transporters have significant roles in the efficacy and safety of various pharmacotherapies. In this study, a genotyping panel has been developed for the Japanese population called PGx_JPN panel comprising 36 variants in 14 genes for drug-metabolizing enzymes and drug transporters using a mass spectrometry-based genotyping method, in which all the variants could be analyzed in two wells for multiplex analysis. The verification test exhibited good concordance with the results analyzed using the other standard genotyping methods (microarray, TaqMan assay, or another mass spectrometry-based commercial kit). However, copy number variations such as CYP2D6*5 could not apply to this system. In this study, we demonstrated that the mass spectrometry-based multiplex method could be useful for in the simultaneous genotyping of more than 30 variants, which are essential among the Japanese population in two wells, except for copy number variations. Further study is needed to assess our panel to demonstrate the clinical use of pharmacogenomics for precision medicine in the Japanese population.

Predictive capabilities of the Cloninger Temperament and Character Inventory (TCI) in evaluating the effectiveness of antidepressant pharmacotherapy. Systematic review and meta-analysis

In the pharmacotherapy of depressive disorders, the problem of the predictors of a therapeutic response remains relevant, they may be important in determining treatment tactics. Objective : to determine the predictive power of the Cloninger Temperament and Character Inventory (TCI) in evaluating the results of antidepressant pharmacotherapy in patients with depression (major depressive disorder). Material and methods . PubMed and Google Scholar were searched for articles published between 1990 and November 2021. Only English-language prospective studies, that examined the relationship between pre-treatment TCI personality scores and antidepressant pharmacotherapy efficacy were selected. Results . A total of 18 studies were found (N tot =3122). The most commonly cited statistically significant predictors of therapy effectiveness were: harm avoidance (HA) in 11 studies (N tot =2413), reward dependence in 6 (N tot =1941), cooperativeness (CO) in 6 (N tot =1259). In only two studies (N tot =234), personality parameters were not associated with treatment efficacy. In 10 studies (N tot =1065) baseline values of personality characteristics were indicated, which made it possible to include them in the meta-analysis. HA (z=4.06; p&lt;0.0001; I 2 =49%) and CO (z=2.71; p=0.007; I 2 =66%) were associated – in a statistically significant way – with the likelihood of achieving a response to antidepressant pharmacotherapy. Conclusion . Personality dimensions from the TCI questionnaire are predictors of the effectiveness of antidepressant pharmacotherapy