Gastrointestinal Effects Research Articles

Rehospitalizaciones precoces y tardías tras el cierre percutáneo de la orejuela izquierda

Introduction and objectivesPercutaneous left atrial appendage closure (LAAC) has emerged as a nonpharmacological alternative for the prevention of thromboembolic events in patients with nonvalvular atrial fibrillation. However, there are few data on readmissions after LACC. The aim of this study was to determine the rate of early (≤30 days) and late (31-365 days) readmission after LAAC, and to assess the predictors and clinical impact of rehospitalization. MethodsThis multicenter study included 1419 consecutive patients who underwent LAAC. The median follow-up was 33 [17-55] months, and follow-up was complete in all but 54 (3.8%) patients. The primary endpoint was readmissions for any cause. Logistic regression and Cox regression analysis were performed to determine the predictors of readmission and its clinical impact. ResultsA total of 257 (18.1%) patients were readmitted within the first year after LAAC (3.2% early, 14.9% late). The most common causes of readmission were bleeding (24.5%) and heart failure (20.6%). A previous gastrointestinal bleeding event was associated with a higher risk of early readmission (OR, 2.65; 95%CI, 1.23-5.71). The factors associated with a higher risk of late readmission were a lower body mass index (HR, 0.96-95%CI, 0.93-0.99), diabetes (HR, 1.38-95%CI, 1.02-1.86), chronic kidney disease (HR, 1.60; 95%CI, 1.21-2.13), and previous heart failure (HR, 1.69; 95%CI, 1.26-2.27). Both early (HR, 2.12-95%CI, 1.22-3.70) and late (HR, 1.75; 95%CI, 1.41-2.17) readmissions were associated with a higher risk of 2-year mortality. ConclusionsReadmissions within the first year after LAAC were common, mainly related to bleeding and heart failure events, and associated with patients’ comorbidity burden. Readmission after LAAC confered a higher risk of mortality during the first 2 years after the procedure.

Chocolate toxicosis in pets

Chocolate ingestion is very common in pets, particularly dogs, but has also been reported in other animals including cats and rabbits. Most cases occur around Christmas and Easter, when large amounts of chocolate are often present in the home in the form of chocolate bars, snacks, confectionery, Easter eggs and chocolate figurines. Chocolate-covered raisins, nuts and coffee beans present an additional toxicological hazard in dogs. The type of chocolate is defined in law by the percentage of cocoa solids, with dark (plain) chocolate containing more than milk chocolate. The main toxic component of chocolate is theobromine, a methylxanthine, although caffeine, another methylxanthine, is also present. These cause central nervous system stimulation with cardiac and respiratory hyperactivity. Signs include gastrointestinal effects, excitability, hyperactivity, tachycardia, tremors, hypertension and hyperthermia. Signs of toxicosis generally occur within a few hours of ingestion. The mainstays of treatment are decontamination and supportive care with rehydration, control of central nervous system stimulation and arrhythmias as required. Most pets recover fully, and death is uncommon; however, prognosis is more guarded in pets with seizures or arrhythmias.

A review of serious adverse events linked with GLP-1 agonists in type 2 diabetes mellitus and obesity treatment.

Glucagon-like peptide-1 (GLP-1) agonists play a crucial role in treating type 2 diabetes mellitus and obesity by providing glycemic control and aiding weight management. Despite their widespread use, concerns about serious adverse events have prompted extensive research. This review aims to describe the current understanding of serious adverse events associated with GLP-1 agonists. A comprehensive search of PubMed, Google Scholar and Embase databases was performed starting from 2010. Studies reporting evidence of an association between GLP-1 agonists and serious adverse events from 22 articles (5 case reports, 5 randomized controlled trials (RCTs), 9 real-world data cohort analyses, 2 meta-analyses and 1 systematic review and meta-analysis) were included and categorized by the type of adverse event. While some studies reported risks, including anaphylaxis, cardiovascular, gastrointestinal, psychiatric and thyroid-related events, others found no significant associations. The evidence remains mixed, necessitating further research to fully understand the safety profile of GLP-1 agonists and inform clinical practice.

The relationship between serum uric acid and gastrointestinal bleeding in peritoneal dialysis patients: a propensity score analysis

Purpose Gastrointestinal bleeding is an important gastrointestinal complication among peritoneal dialysis patients and correlated with a higher risk of mortality. Increased uric acid levels are a significant complication for peritoneal dialysis patients and have been associated with an increased risk of hemorrhagic stroke. The objective of the present study was to investigate the relationship between serum uric acid levels and gastrointestinal bleeding in peritoneal dialysis patients. Methods A total of 2498 peritoneal dialysis patients were recruited. Based on the optimal uric acid cutoff value, two groups of patients were divided. We constructed a propensity-score-matched population of 1762 patients by matching sex, age, and body mass index. Survival outcomes between the two groups were compared using adjusted Kaplan–Meier curves. We constructed the restricted cubic splines regression to assess the correlation between levels of uric acid and gastrointestinal bleeding. A multivariate Cox proportional hazards regression was performed to test whether higher levels of uric acid are an independent risk factor for gastrointestinal bleeding. We performed a forest plot to show interaction effects in different subgroups. Results According to restricted cubic splines regression, uric acid levels were positively correlated with the risk of gastrointestinal bleeding events. After adjusted different confounding factors, patients with high levels of uric acid were prone to experience gastrointestinal bleeding (HR 1.868, 95%CI 1.001–3.486). In subgroups, the interaction between higher levels of uric acid and utilizing proton pump inhibitors was significant (P for interaction = 0.034). Further research found that taking proton pump inhibitors could decrease the risk of gastrointestinal bleeding in peritoneal dialysis patients accompanied high levels of uric acid. Conclusion The baseline high levels of uric acid are an independent risk factor for gastrointestinal bleeding in patients undergoing peritoneal dialysis.

The Addition of a Non-Steroidal Anti-Inflammatory Drug (NSAID) in Local Infiltration Analgesia During Total Knee Arthroplasty Increases the Risk of Acute Kidney Injury in Patients Who Have Renal Impairment: A Propensity-Matched Retrospective Cohort Study

BackgroundLocal infiltration analgesia (LIA) is a crucial component of pain management during total knee arthroplasty (TKA). Various formulations of the LIA drug cocktail have been described, with non-steroidal anti-inflammatory drugs (NSAIDs) commonly included. Although NSAIDs are highly effective in improving postoperative pain, they are associated with adverse renal, gastrointestinal, and cardiovascular effects. This study aimed to investigate whether the addition of an NSAID in LIA affects the incidence of acute kidney injury (AKI) in TKA patients, especially those who have pre-existing renal impairment. The secondary aim was to determine overall AKI incidence. MethodsA retrospective cohort study was conducted on elective, primary TKA patients in a single tertiary institution between January 2020 and April 2024. Data was obtained from a prospectively collected institutional knee arthroplasty registry. Patients were administered LIA intraoperatively, with or without an NSAID (30 mg of ketorolac). The study population was divided into two subpopulations, patients who did or did not have chronic kidney disease (CKD), and analyzed separately. Propensity matching was performed on the CKD group, correcting for age, sex, BMI, ASA score, and presence of diabetes mellitus/hypertension. The outcome of interest was the incidence of AKI. A t-test or Chi-square test was used, where appropriate, to determine the statistical significance of the results. ResultsIn patients who had CKD (n = 114), the presence of ketorolac in LIA was associated with a higher AKI incidence (12.7 versus 2.0%, P = 0.041). In patients who did not have CKD (n = 870), the presence of ketorolac in LIA was not associated with a higher AKI incidence (2.0 versus 1.9%, P = 1.0). Overall AKI incidence was 2.6%. ConclusionIn patients who have CKD, orthopaedic surgeons should be highly cautious of administering ketorolac in LIA during TKA, as it is associated with a higher risk of AKI. Patients who have normal renal function can be safely given ketorolac in LIA without an elevated risk of AKI. Further studies are needed to examine AKI incidence when other NSAIDs are used in LIA.

Extraction technology determines the properties of bamboo shoots dietary fiber concentrate and its application in chicken mince gels: Systematic analysis

This study investigated how physical, chemical, and enzymatic extraction technologies affected the physicochemical properties of bamboo shoot insoluble dietary fiber (IDF). Additionally, the effects of IDF extracted by these techniques on the gel properties, water retention, microstructure, and digestibility of chicken mince gels were evaluated. Results showed that IDFs extracted by physical (P-IDF), chemical (C-IDF), and enzymatic (E-IDF) exhibited a typical cellulose polysaccharide structure and strong water and oil retention capabilities, with the highest values reaching 14.18 g/g and 6.74 g/g, respectively. Compared to P-IDF, C-IDF and E-IDF displayed a rougher porous structure and stronger adsorption capacities for glucose (409.91 mg/g and 604.95 mg/g), cholesterol (54.46 mg/g and 64.06 mg/g), sodium cholate, and nitrite. The addition of IDF improved the water retention, water stability, texture, and rheological properties of chicken mince gels, and had no negative effect on the digestion of chicken mince proteins. On the one hand, the hydrophilic groups exposed in IDF absorb water and fill the gel networks, reducing the formation of water channels in the gel and improving water stability. Furthermore, the hydrophilic groups on the glucose unit that makes up the IDF interacts with the proteins through the hydrogen bond and the transformation of protein β-structure to α-structure, promoting the formation of gel network structure and improving gel texture and rheological properties. E-IDF and C-IDF showed better overall gel performances, but E-IDF had better dry matter digestibility, protein digestibility, and gastrointestinal digestive effects. Therefore, IDF prepared by enzymatic hydrolysis is more suitable for chicken mince processing.

Diabetic Ketoacidosis Complications in Pediatrics: A Narrative Review

Introduction: Around the world type I diabetes mellitus (T1D) is becoming more prevalent among pediatrics. The most common cause of mortality in children is diabetic ketoacidosis (DKA). It affects up to one-third of people with T1D. The most common complication of pediatric diabetic ketoacidosis is cerebral edema; however, it is not the only adverse effect of DKA that necessitates continuous observation. Methods: This study was conducted as a narrative review obtaining all applicable data on complications of diabetic ketoacidosis (DKA) in the pediatrics age group. Conclusion: This review of literature discusses the effects of DKA on different body systems including neurological, coagulopathy, pulmonary, gastrointestinal, infectious, and renal effects. Aim: To educate families and healthcare professionals about the significance of strict glycemic control and early identification of DKA in order to prevent the onset of those consequences, we examine each of those multisystem impacts in children

Patient Profile-Based Management with Nintedanib in Patients with Idiopathic Pulmonary Fibrosis.

A severe and progressive interstitial lung disease (ILD) known as idiopathic pulmonary fibrosis (IPF) has an unknown etiology with poorly defined mechanisms of development. Among the currently prescribed pharmacological interventions for IPF, nintedanib demonstrates the ability to decelerate the deterioration of lung function and yield positive clinical outcomes. Multiple randomized placebo-controlled trials have confirmed the efficacy and acceptable safety profile of nintedanib. Real-world evidence studies also support the use of nintedanib in IPF, being an efficient and well-tolerated treatment option. It has the potential to stabilize the disease progression in patients with ILD. Patients with IPF frequently have comorbidities like diabetes and hypertension, which can exacerbate the course of disease, reduce quality of life, and decrease treatment adherence. For well-informed decision-making, it is important for healthcare professionals to recognize the position of nintedanib therapy in IPF with comorbidities. The gastrointestinal adverse effects, notably diarrhea, dominate the nintedanib safety profile. These can be effectively controlled by closely monitoring side effects, administering anti-diarrheal and anti-emetic drugs, reducing the nintedanib dose, and discontinuing it in case of severe symptoms with an option to reintroduce the treatment after side effects subside. Symptomatic interventions and monitoring of liver enzymes may reduce the occurrence of permanent treatment discontinuations.

Knowledge discovery of patients reviews on breast cancer drugs: Segmentation of side effects using machine learning techniques

Breast cancer stands as the most frequently diagnosed life-threatening cancer among women worldwide. Understanding patients' drug experiences is essential to improving treatment strategies and outcomes. In this research, we conduct knowledge discovery on breast cancer drugs using patients' reviews. A new machine learning approach is developed by employing clustering, text mining and regression techniques. We first use Latent Dirichlet Allocation (LDA) technique to discover the main aspects of patients' experiences from the patients' reviews on breast cancer drugs. We also use Expectation-Maximization (EM) algorithm to segment the data based on patients' overall satisfaction. We then use the Forward Entry Regression technique to find the relationship between aspects of patients' experiences and drug's effectiveness in each segment. The textual reviews analysis on breast cancer drugs found 8 main side effects: Musculoskeletal Effects, Menopausal Effects, Dermatological Effects, Metabolic Effects, Gastrointestinal Effects, Neurological and Cognitive Effects, Respiratory Effects and Cardiovascular. The results are provided and discussed. The findings of this study are expected to offer valuable insights and practical guidance for prospective patients, aiding them in making informed decisions regarding breast cancer drug consumption.

The Endocannabinoid System of the Nervous and Gastrointestinal Systems Changes after a Subnoxious Cisplatin Dose in Male Rats

Background/Objectives: Cisplatin, a common chemotherapy agent, is well known to cause severe side effects in the gastrointestinal and nervous systems due to its toxic and pro-inflammatory effects. Although pharmacological manipulation of the endocannabinoid system (ECS) can alleviate these side effects, how chemotherapy affects the ECS components in these systems remains poorly understood. Our aim was to evaluate these changes. Methods: Male Wistar rats received cisplatin (5 mg/kg, i.p.) or saline on day 0 (D0). Immediately after, serial X-rays were taken for 24 h (D0). Body weight was recorded (D0, D1, D2 and D7) and behavioural tests were performed on D4. On D7, animals were euthanized, and gastrointestinal tissue, dorsal root ganglia (DRGs) and brain areas were collected. Expression of genes related to the ECS was assessed via Rt-PCR, while LC-MS/MS was used to analyse endocannabinoid and related N-acylethanolamine levels in tissue and plasma. Results: Animals treated with cisplatin showed a reduction in body weight. Cisplatin reduced gastric emptying during D0 and decreased MAGL gene expression in the antrum at D7. Despite cisplatin not causing mechanical or heat sensitivity, we observed ECS alterations in the prefrontal cortex (PFC) and DRGs similar to those seen in other chronic pain conditions, including an increased CB1 gene expression in L4/L5 DRGs and a decreased MAGL expression in PFC. Conclusions: A single dose of cisplatin (5 mg/kg, i.p.), subnoxious, but capable of inducing acute gastrointestinal effects, caused ECS changes in both gastrointestinal and nervous systems. Modulating the ECS could alleviate or potentially prevent chemotherapy-induced toxicity.

A Novel Tetrahydroacridine Derivative with Potent Acetylcholinesterase Inhibitory Properties and Dissociative Capability against Aβ42 Fibrils Confirmed by In Vitro Studies.

Alzheimer's disease (AD) is one of the most common causes of dementia, accounting for more than 60% of all cases. It is a neurodegenerative disease in which symptoms such as a decline in memory, thinking, learning, and organizing skills develop gradually over many years and eventually become more severe. To date, there is no effective treatment for the cause of Alzheimer's disease, and the existing pharmacological options primarily help manage symptoms. Treatment is mainly based on acetylcholinesterase (AChE) inhibitors such as donepezil, rivastigmine, and galantamine, which exhibit numerous adverse cardiovascular and gastrointestinal effects due to excessive stimulation of peripheral cholinergic activity involving muscarinic receptors. Therefore, in addition to the obvious drugs that act on the cause of the disease, new drugs based on AChE inhibition that show the fewest side effects are needed. One potential drug could be a new compound under study, tetrahydroacridine derivative (CHDA), which showed significant potential to inhibit the AChE enzyme in previous in vitro studies. The present study shows that while having very potent AChE inhibitory properties, CHDA is a compound with low toxicity to nerve cell culture and living organisms. In addition, it exhibits dissociative activity against amyloid β fibrils, which is extremely important for applications in Alzheimer's disease therapy.

Pharmacokinetics and thermal anti-nociceptive effects of oral morphine in horses.

Morphine is an effective analgesic in horses, however, IV administration at therapeutic doses has been shown to produce dose-dependent neuroexcitation and unwanted gastrointestinal effects. The analgesic effects of morphine have, at least in part, been attributed to the morphine-6-glucuronide (M6G) metabolite. Oral administration to horses results in comparable M6G concentrations to that achieved following IV administration of a therapeutic dose without the adverse effects. The anti-nociceptive effects have not yet been reported. In the current study the thermal anti-nociceptive effects of single and multiple oral doses of morphine were assessed. Six horses received a single 0.2 mg/kg IV dose of morphine and multiple oral doses of 0.8 mg/kg morphine every 12 h for 4.5 days. Blood samples were collected throughout administration, morphine, and metabolite concentrations determined and pharmacokinetic analysis performed. Drug related behavior and physiologic responses were recorded. Response to noxious stimuli was evaluated by determining thermal threshold latency in response to the application of heat. The maximum concentrations of M6G were higher following oral administration compared to IV and the combined morphine and M6G concentrations exceeded that of IV administration starting at 2 h. Oral administration of 0.8 mg/kg morphine provided and maintained comparable anti-nociception effects to IV morphine with less adverse effects, following single and multiple doses. Morphine was well tolerated following oral administration with less excitation and minimal effects on gastrointestinal borborygmi scores compared to IV administration. Results of the current study warrant further investigation of the anti-nociceptive effects of oral morphine administration to horses.

Sheep (Ovis aries) Milk Exosomal miRNAs Attenuate Dextran Sulfate Sodium-Induced Colitis in Mice via TLR4 and TRAF-1 Inhibition.

Mammalian milk exosomal miRNAs play an important role in maintaining intestinal immune homeostasis and protecting epithelial barrier function, but the specific miRNAs and whether miRNA-mediated mechanisms are responsible for these benefits remain a matter of investigation. This study isolated sheep milk-derived exosomes (sheep MDEs), identifying the enriched miRNAs in sheep MDEs, oar-miR-148a, and oar-let-7b as key components targeting TLR4 and TRAF1, which was validated by a dual-luciferase reporter assay. In dextran sulfate sodium-induced colitis mice, administration of sheep MDEs alleviated colitis symptoms, reduced colonic inflammation, and systemic oxidative stress, as well as significantly increased colonic oar-miR-148a and oar-let-7b while reducing toll-like receptor 4 (TLR4) and TNF-receptor-associated factor 1 (TRAF1) level. Further characterization in TNF-α-challenged Caco-2 cells showed that overexpression of these miRNAs suppressed the TLR4/TRAF1-IκBα-p65 pathway and reduced IL-6 and IL-12 production. These findings indicate that sheep MDEs exert gastrointestinal anti-inflammatory effects through the miRNA-mediated modulation of TLR4 and TRAF1, highlighting their potential in managing colitis.

Semaglutide Versus Other Glucagon-Like Peptide-1 Agonists for Weight Loss in Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis.

Obesity places patients at higher risk for numerous problems, including prediabetes, type 2 diabetes mellitus (T2DM), hypertension, metabolic syndrome, cardiovascular disease, and nonalcoholic fatty liver disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are antidiabetic drugs that have a recognized effect on weight loss. This systematic review analyzed semaglutide against alternative GLP-1 agonists in facilitating weight loss and evaluated their associated adverse events (AEs) in diabetic patients. A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed using PubMed, Embase, and Cochrane Library for studies comparing semaglutide and other GLP-1 RAs for weight loss. A narrative synthesis and meta-analysis using SPSS program version 29 were performed to analyze the differences in weight loss between cohorts. Nine studies with 5,445 patients whose mean age was 60.01 years (55.5-70) and mean follow-up of 32.5 weeks (4-58.7) were included. The meta-analysis showed that semaglutide had a greater mean weight loss compared to liraglutide (-6.08, 95% confidence interval (Cl) = -8.40, -3.75) and dulaglutide (-2.85, 95% CI = -5.59, 0.11). Tirzepatide had a greater mean weight loss compared to semaglutide (-3.78, 95% CI = -5.52, -2.04). Common AEs included minor and moderate gastrointestinal events. In conclusion, GLP-1 RAs have shown efficacy in reducing body weight in T2DM patients. Semaglutide, liraglutide, dulaglutide, tirzepatide, and exenatide demonstrated mean weight loss reductions of 4.81 kg, 2.81 kg, 4.03 kg, 9.7 kg, and 1.9 kg, respectively, with high rates of minimal to moderate-severity AEs.Semaglutide demonstrated increased numerical weight loss compared to its comparators (dulaglutide, liraglutide, and exenatide). However, tirzepatide, a dual-agonist, produced greater weight loss compared to semaglutide. The paucity of comparative head-to-head trials prevents a definitive conclusion of the superiority of one GLP-1 RA over another.

Gastrointestinal adverse effects associated with the use of isotretinoin in the management of acne vulgaris

Introduction: Isotretinoin is widely used in the treatment of moderate to severe acne vulgaris due to its proven efficacy. However, the use of this medication is associated with several adverse effects, including gastrointestinal symptoms. The possible association with inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis remains a subject of debate. Methods: A systematic review of the literature was performed in the PubMed, Embase and Cochrane Library databases, covering studies published from 2000 to 2024. The inclusion criteria considered randomized clinical trials, cohort studies, case-control studies and systematic reviews that reported gastrointestinal adverse effects related to the use of isotretinoin. The assessment of methodological quality was performed using the GRADE system, and the data were extracted independently by two reviewers. Results: The review found that mild gastrointestinal side effects, such as abdominal pain, nausea, and dyspepsia, are relatively common during isotretinoin treatment and tend to be transient and manageable. The association with inflammatory bowel disease remains unclear, with some studies indicating an increased risk, while others found no significant correlation. Risk factors such as high dose, prolonged duration of treatment, and history of previous gastrointestinal disease were associated with an increased likelihood of adverse effects. Conclusion: Although isotretinoin remains an effective treatment for acne vulgaris, its use should be accompanied by close monitoring, especially in patients with identified risk factors. A personalized approach is essential to maximize benefits and minimize risks. Future research should focus on identifying predictive risk factors to optimize treatment safety.

443. IMPLEMENTATION OF A PROTOCOL FOR THE DIAGNOSIS AND MANAGEMENT OF LONG-TERM COMPLICATIONS FOLLOWING ESOPHAGECTOMY AND GASTRECTOMY

Abstract Background Surgery remains the mainstay of curative pathway treatment for most patients with esophageal and gastric cancer. Both esophagectomy and gastrectomy carry a significant risk of early post-operative morbidity. The gastrointestinal, nutritional, and endocrine effects of surgery can have a significant impact on patients’ quality of life and include small intestinal bacterial overgrowth, pancreatic exocrine insufficiency, bile acid malabsorption, hypoglycaemia, dumping, and others. Early diagnosis and treatment for these consequences of surgery can significantly improve quality of life. We developed a protocol for the investigation and management of patients with symptoms post-esophagogastric resection and implemented this within a nurse-led follow-up clinic. Methods A multi-disciplinary team was involved in the design of a protocol for the investigation and management of late effects following esophagectomy or gastrectomy. The protocol was implemented within a nurse-led clinic with prospective follow-up of all patients following resection. Following the introduction of the protocol, patients were divided into two groups; those with symptoms undergoing investigation prior to introduction of the protocol and all patients prospectively following introduction of the protocol in October 2022 to December 2023. The prevalence of patients undergoing investigation and the time from documentation of symptoms to diagnosis and the prevalence of each diagnosis were assessed. Results A total of 217 patients were studied, of whom 93 were part of the pre-protocol (symptomatic) group and the remaining 124 were part of the post-protocol prospective group. Within the pre-protocol group, 67 (72.0%) patients underwent investigation for late effects following surgery. The median time between the presentation of symptoms to diagnosis in the pre-protocol group was 7 months. Within the post-protocol prospective group, 33 (26.6%) patients underwent investigation for late effects following surgery. The median time between the presentation of symptoms to diagnosis in the post-protocol group was 2 months, representing a 71.4% reduction compared to the pre-protocol group. Conclusion Gastrointestinal, nutritional, and endocrine effects of esophagectomy and gastrectomy remain common. In symptomatic patients, a protocolised approach to investigation shortened the time to diagnosis and treatment by a median of 5 months. This approach can be successfully employed within a nurse-led follow-up pathway supported by a multidisciplinary team.

A Comparison of Dry Bean and Pea Consumption on Serum Cholesterol: A Randomized Controlled Trial in Adults with Mild Hypercholesterolemia

BackgroundDiets including pulses are associated with better cardiovascular profiles, including lipid, glycemia, and hemodynamics; however, evidence is lacking regarding the contributions of individual pulse varieties. ObjectivesThis randomized, controlled trial examined the effects of beans or peas individually, relative to rice, on LDL-cholesterol levels (primary outcome) and other indices of cardiovascular disease risk (secondary outcomes) at 6 wk in adults with mild hypercholesterolemia. MethodsThis randomized, controlled, single-blind, 3-arm parallel-group study was conducted in 2 Canadian cities (Edmonton, Alberta; Winnipeg, Manitoba). Participants (n = 60 per group) were randomly assigned to 6 wk of regular consumption of foods containing either 120 g (∼0.75 cups) of beans (mixture of black, great northern, navy, and pinto) or 120 g (∼0.75 cups) peas (mixture of yellow and green), or identical foods containing white, parboiled rice (control foods). LDL-cholesterol (primary outcome) and indices of lipid metabolism, glycemia, and hemodynamics (secondary outcomes) were assessed. ResultsMean LDL-cholesterol was lower in the bean group (−0.21; 95% CI: −0.39, −0.03) but not the pea group (−0.11; 95% CI: −0.29, 0.07) relative to rice after 6 wk. Non-HDL-cholesterol (−0.20; 95% CI: −0.40, −0.002) and total cholesterol (−0.28; 95% CI: −0.49, −0.06) were also lower in the bean compared with rice groups. No changes were noted in triglycerides (−0.07; 95% CI: −0.28, 0.14), glucose (0.02; 95% CI: −0.17, 0.14), insulin (4.94; 95% CI: −5.51, 11.38), or blood pressure (systolic: −1.39; 95% CI: −5.18, 2.40; diastolic: −1.89; 95% CI: −4.65, 0.88). Dietary fiber intake (grams per day or grams per 1000 kcal) was not correlated with LDL-cholesterol (grams per day: r2 = 0.209, P = 0.142; grams per 1000 kcal: r2 =0.126, P = 0.379) in the bean group. Gastrointestinal effects were transient and most often not related to the study foods. ConclusionsBeans, but not peas, lowered LDL-cholesterol, relative to rice, in adults with mild hypercholesterolemia. Fiber may not be responsible for the effect of beans, suggesting other phytochemicals may be the active component(s). Strategies incorporating 120 g of pulses in a meal are feasible for managing some cardiometabolic risk factors.This trial was registered at clinicaltrials.gov as NCT01661543.

Effectiveness and safety of semaglutide in overweight/obese adults with or without type 2 diabetes: A systematic review and meta-analysis

Background: The objective of the study was to systematically evaluate the efficacy and safety of semaglutide in overweight or obese adults with or without type 2 diabetes. Materials and Methods: The study, registered with PROSPERO (CRD42023450979), was designed as a systematic review and meta-analysis. Using a combination of subject matter and free words, a comprehensive search of Embase, PubMed, and Cochrane Library databases was performed to identify randomized controlled trials of semaglutide in overweight or obese adults with or without Type 2 diabetes mellitus from January 1, 2020, to July 14, 2023. The primary outcomes were the changes in body weight and adverse drug reaction (ADR). Random or fixed effects models were used in meta-analysis, pooling data as relative risks (RRs) or mean difference (MD) with 95% confidence intervals (CIs). Cochrane Collaboration’s Risk of Bias tool was used to assess quality. Meta-analysis was performed using RevMan 5.3. Results: A total of 2490 publications were retrieved. Fifteen publications were finally included, totaling 6984 overweight or obese adult patients. Meta-analysis showed that compared with the control group, the semaglutide group was reduced more significantly in body weight (MD = −7.49, 95% CI [−9.92, −5.07], P < 0.001), body mass index (MD = −3.35, 95% CI [−4.79, −1.92], P < 0.001), waist circumference (MD = −7.26, 95% CI [−9.94, −4.58], P < 0.001), as well as glycosylated hemoglobin (RR = −0.66, 95% CI [−1.07, −0.25], P = 0.002), fasting blood glucose values (RR = −4.81, 95% CI [−7.03, −2.60], P < 0.001), and systolic blood pressure (RR = −3.37, 95% CI [−5.32, −1.42], P < 0.001), and the proportion of patients who lost > 5%, 10%, 15%, and 20% of their overall body weight, respectively (RR = 3.19, 95% CI [1.89, 5.36], P < 0.001), (RR = 4.74, 95% CI [2.78, 8.11], P < 0.001), (RR = 6.17, 95% CI [3.88, 9.82], P < 0.001), and (RR = 9.14, 95% CI [6.05, 13.80], P < 0.001) were also superior to the control group. Regarding safety, the incidence of total ADR in the semaglutide group was close to the placebo group. Still, gastrointestinal adverse effects such as nausea, vomiting, abdominal pain, and diarrhea were higher than those in the control group. Conclusion: Semaglutide can effectively lose weight in overweight or obese adults with or without diabetes, potentially providing cardiovascular benefits; however, gastrointestinal adverse should be closely monitored.

Inadequate Evidence for Acupuncture as an Alternative or Adjunct to Antidepressants/Psychotherapy for Postpartum Depression: A Bayesian Systematic Review and Network Meta-Analysis.

Acupuncture is popular in the treatment of mental illness. This study determined its feasibility and role in managing postpartum depression (PPD) using a network meta-analysis. We systematically searched seven databases up to May 2024 for randomized controlled trials (RCTs) appraising acupuncture's efficacy and safety against waitlist-control, placebo, standard control, or as an add-on treatment. Cochrane criteria were followed. Thirteen studies encompassing 872 participants underwent analysis. Both pairwise and network meta-analysis indicated that acupuncture, psychotherapy, and antidepressants were comparable in clinical efficacy rate and in reducing Hamilton Depression Scale and Edinburgh Postnatal Depression Scalescores. Acupuncture and psychotherapy also effectively mitigated concurrent anxiety symptoms. Combining acupuncture with antidepressants augmented therapeutic efficacy and reduced reported gastrointestinal adverse effects associated with antidepressant use. Acupuncture combined with psychotherapy offered similar benefits with superior safety profile. However, the quality of evidence ranged from very low to low due to significant risks of bias and limited sample sizes. The efficacy of psychotherapy and the combination of acupuncture and psychotherapy might be underestimated, as most RCTs used supportive therapy or individual counseling as positive controls instead of recommended approaches like interpersonal psychotherapy (IPT) or cognitive behavioral therapy (CBT) per PPD guidelines. Current evidence precludes strong recommendations of administering acupuncture in PPD. Rigorous RCTs are essential to validate promising outcomes observed in comparisons between acupuncture, antidepressants, and their combined application. It remains inconclusive whether acupuncture's antidepressive effect is specific or non-specific. Given that psychotherapy is a recommended first-line treatment, investigating the potential efficacy enhancement of combining acupuncture with IPT/CBT is paramount to ascertain the preferred therapeutic approach for PPD.

Intranasal esketamine versus esketamine-dexmedetomidine combination for premedication in pediatric patients undergoing strabismus surgery: a randomized controlled trial.

Preoperative fear and anxiety are prevalent in children undergoing surgery. The combination of esketamine and dexmedetomidine has been proposed as a promising premedication for enhancing preoperative sedation and analgesia. This study compared the premedication efficacy of intranasal esketamine alone and esketamine-dexmedetomidine combination in pediatric patients undergoing strabismus surgery. One hundred and eighty preschool children aged 2-6 years scheduled for strabismus surgery were enrolled and randomly assigned to one of the three groups: intranasal premedication with esketamine 2 mg/kg (Group K), esketamine 1 mg/kg and dexmedetomidine 1 µg/kg (Group KD1), or esketamine 0.5 mg/kg and dexmedetomidine 2 µg/kg (Group KD2). The primary outcome was the level of sedation following the intervention, as measured by the modified Yale preoperative anxiety scale (mYPAS) and sedation scale (SS). Secondary outcomes included onset time of sedation, the successful rate of peripheral intravenous cannulation, parental separation anxiety scale (PSAS), mask acceptance scale (MAS), wake-up time, duration of stay in the post-anesthesia care unit (PACU), and premedication-related adverse effects. After premedication, the mYPAS score gradually decreased in the three groups, with lower values in Group K than in Group KD1 and Group KD2 patients in 1, 5, and 10 min. SS in Group KD1 and Group KD2 steadily increased until 40 min after premedication, while SS in Group K increased in the first 5 min after premedication and maintained consistent levels during the remaining time. Sedation onset was substantially faster in Group K patients (11.4±7.8 min) than Group KD1 (18.1±7.5 min, P=0.006) and Group KD2 (18.4±6.8 min, P<0.001). PSAS, separation status, the successful rate of peripheral intravenous cannulation, and MAS were comparable among groups. There was no significant difference in terms of emergence time or duration of stay in the PACU among groups. More gastrointestinal events were observed in Group K (P<0.001). Intranasal premedication with 2 mg/kg esketamine produced a more rapid onset of sedation accompanied by more gastrointestinal reactions compared with a combination of esketamine and dexmedetomidine. ClinicalTrials.gov identifier: NCT04757675.