Non-pharmacological Therapeutic Options Research Articles

Methods of Prevention and Mitigation of Autoimmune Diseases - A Review of The Literature

Introduction and purpose: Autoimmune diseases are conditions where the body’s immune system is unable to distinguish between auto- and foreign antigens and mistakenly attacks its cells, tissues, and organs. In recent years it became major public health concern because of the increasing diagnosis rate. Currently, about 5% of the population in Western countries is affected by such diseases, more often in women population. The exact cause of autoimmune diseases is unknown, although most probably it results from a combination of genetic predisposition, environmental risk factors and immune dysregulation. Development of autoantigen-specific lymphocytes and autoantibodies might be decisive in starting the process of autoimmunity. Most common medication used in autoimmune diseases treatment are nonsteroidal anti-inflammatory drugs (NSADs), glucocorticoids, disease-modifying antirheumatic drugs (DMARDs). Additionally, there is biological medication available for many of them. It is known that non-pharmacological interventions, such as specific diets, supplementation or physical exercise is useful to mitigate the disease or even to prevent the body from its onset. Materials and methods: The data for the article was found using the PubMed and Google Scholar websites. The key words used for the search included: ‘diet and autoimmunity’, ‘autoimmunity and estrogens’, ‘microbiota and autoimmunity’. Articles not written in English, conference abstracts only and duplicated papers were excluded. Conclusions: There is still no cure for autoimmune diseases, although various prevention and mitigation strategies can help manage these conditions and improve quality of life for affected individuals. However, for the use of some of them, evidence-based recommendations are not available. This review highlights current non-pharmacological therapeutic options.

Effect of Prenatal Yoga On Back Pain and Sleep Quality in Pregnant Women: A Scoping Review

Throughout pregnancy, the expectant mother experiences physiological and psychological alterations. These modifications can significantly affect the mother's many pregnancy complications, including respiratory difficulties, lumbar discomfort, haemorrhoids, and sleep disruptions. Background: Lower back pain (LBP) is a musculoskeletal ailment that can negatively impact the overall well-being of pregnant women. Failure to promptly address the complaint might have detrimental effects on both the mother and the fetus. Objective: This scoping review seeks to examine the effects of prenatal yoga on the occurrence of back pain and the quality of sleep in pregnant women. Methods: This article conducted a scoping review using the PRISMA approach. Articles published in the last five years (2019-2023) were identified through various sources, including Google Scholar, PubMed, Journal SAGE, Scopus, Science Direct, and EBSCO. This search yielded ten relevant journals. Findings: Our examination revealed that engaging in prenatal yoga during pregnancy can help pregnant women reduce back pain and improve the quality of their sleep. Conclusion: prenatal yoga is a non-pharmacological therapeutic option for pregnant women to alleviate back discomfort and enhance sleep quality.

Ceramic Dressings-A New Non-Pharmacological Therapeutic Option in the Management of Chronic Wounds?

In this monocentric, intra-individually controlled, prospective study, patients with conservatively treated refractory chronic wounds were enrolled. One week before the start of the application with ceramic dressing, it was ensured during a screening phase that chronic wounds showed less than a 10% reduction in wound size. During the 4-week ceramic dressing treatment wound size measurements, wound scoring, measurement of wound exudate amount, wound swabs, and ceramic dressing sonication (low-intensity ultrasound) were carried out. The sonication fluid of the removed ceramic dressing was used for analysis of bacterial retention and compared to wound swabs. A total of 20 patients with a mean age of 64.6 years (±26.2) and 21 chronic wounds were included in this study. After a 4-week treatment, a significant reduction of median wound size from 1178 mm2 (range 104-6300) to 751.5 mm2 (range 16-4819) and better total wound scores were observed (p < 0.001). The sensitivity of bacteria detection was 90.7% in the sonication fluid from the ceramic dressings, while only 76.9% in the conventional wound swabs. The new ceramic dressing seems to have a positive impact on wound healing in chronic wounds. Bacteria-binding characteristics of the investigated ceramic dressing, in combination with its debridement, absorption, and detoxification properties, could contribute to its healing abilities. Based on those results, the investigated ceramic dressing seems to be a promising new treatment option for chronic wounds without the use of any active antimicrobial or pharmacological agents. Moreover, ceramic dressings can also be considered for microbiological diagnostic purposes.

A Multimodal Ayurveda and Mind-Body Therapeutic Intervention for Chronic Symptoms Attributed to a Postinfectious Syndrome: A Pilot Study.

Objective: Evaluate feasibility and impact of a multimodal integrative therapeutic intervention in patients presenting with chronic symptoms attributed to a postinfectious syndrome. Design: This was a prospective longitudinal single-center pilot study conducted from January 2019 to December 2020. Setting/Location: University of Maryland Lyme Program, Baltimore Maryland. Subjects: Persons presenting for Lyme evaluation for symptoms attributed to Lyme disease. Interventions: Participants attended two 1-h individual instructional sessions consisting of Ayurveda-based dietary intervention and breath-coordinated mind-body practice to be used for home practice. Outcome measures: Standard measures of impact were obtained at baseline, 1, 3, 6, and 12 months using the following validated survey instruments: Perceived Stress Scale (PSS), PROMIS Global Health v1.2 (GH), and PROMIS 29 v2.0 survey. Results: From 216 patients presenting for Lyme evaluation, 19 participants enrolled with 84% completing the study (N = 16). Baseline PROMIS GH scores consisting of general Physical Health (GPH) and general Mental Health (GMH) scores were lower in the study population than in the general U.S. population. PROMIS 29 scores were higher for fatigue, anxiety, and pain than those in the general U.S. population. Over 12-month period, improvement in both the GPH and GMH was 6.09 (confidence interval [95% CI] = 2.71-9.46; p < 0.001) and 4.65 (95% CI = 1.50-7.80; p = 0.004), respectively. PROMIS 29 scores showed the greatest improvement in fatigue at -7.91 (95% CI = -12.34 to -3.48; p < 0.001), pain interference -5.08 (95% CI = -9.20 to -0.96; p = 0.016), and ability to participate in social roles and activities 7.48 (95% CI = 3.21-11.75; p = 0.001) and least with depression -1.82 (95% CI = -4.74 to 1.10; p = 0.223). Employment status had significant effects on almost all outcome scores. Postinfectious state was associated with improvement in anxiety and PSS scores. Conclusions: A multimodal Ayurvedic and breath-coordinated mind-body therapeutic intervention is feasible and a potential nonpharmacologic therapeutic option for persons presenting with pain, stress, fatigue, physical dysfunction, and sleep disturbance attributed to a postinfectious syndrome. Further research is needed to determine efficacy in this population and in other groups with similar symptom complexes due to postinfectious syndromes.

The Benefits and Barriers of Providing Non-Pharmacological Pain Relief to Women in Labour during COVID-19: A Qualitative Study of Midwives in South Africa

Pregnancy is an exceptional event in a woman’s life. As a result of the intense pain associated with childbirth, women require encouragement and support during this crucial phase. Midwives play a crucial role in the maternal care paradigm, managing labour pain alongside ensuring the mother and baby’s safety during the labour process. This study explored midwives’ perspectives concerning the utilisation and barriers of non-pharmacological labour pain reduction methods during COVID-19 in Matjhabeng Municipality hospitals in South Africa’s Free State Province. Ten midwives participated in a semi-structured interview wherein the audio was recorded and transcribed verbatim. The data were analysed using Tesch’s approach for open-coding data analysis. Midwives’ experiences with non-pharmacological therapeutic options for relieving labour pain were varied. They used mobilisation techniques, warm bathing, deep breathing exercises, back massaging, and psychological support. Midwives affirmed that non-pharmacological labour pain interventions were poorly implemented because of staff shortages, heavy workload, and COVID-19 regulations at the time. In efforts to address the obstacles in managing labour pain and alleviate the pain of women during labour, midwives recommended the provision of education and advocacy, the employment of additional midwives and auxiliary staff, and improvement in hospital infrastructure. Due to staff shortages, heavy workloads, and COVID-19 restrictions that limit birth companions, non-pharmacological pain reduction methods are not properly implemented. Health education; employing additional midwives, professional doulas, and students; and improving health infrastructure are midwives’ concerns. Prioritising midwife training in non-pharmacological labour pain management is crucial for delivering the best possible care during childbirth.

Post-ligation cardiac syndrome after surgical versus transcatheter closure of patent ductus arteriosus in low body weight premature infants: a multicenter retrospective cohort study.

Transcatheter patent ductus arteriosus (PDA) closure is a safe and effective alternative to surgical ligation in low-body-weight infants. Post-ligation cardiac syndrome (PLCS) is defined as severe hemodynamic and respiratory collapse within 24h of PDA closure, requiring initiation or an increase of an inotropic agent by > 20% of preligation dosing and an absolute increase of at least 20% in ventilation parameters compared with the preoperative value. Whilst PLCS is routinely observed after surgery, its incidence remains poorly described following transcatheter closure. This study aimed to compare the incidence of PLCS after surgical versus transcatheter closure of PDA in low-body-weight premature infants. Propensity scores were used to compare surgical (N = 78) and transcatheter (N = 76) groups of preterm infants who underwent PDA closure at a procedural weight less than 2000g in two tertiary institutions between 2009 and 2021. The primary outcome was the incidence of PLCS. Secondary outcomes included overall mortality before discharge, risk factors for PLCS, and post-procedural complications. Procedural success was 100% in both groups. After matching, transcatheter group experienced no PLCS vs 15% in the surgical group (p = 0.012). Furthermore, overall mortality (2% vs 17%; p = 0.03) and major complications (2% vs 23%; p = 0.002) were higher in the surgical group. Surgery (100% vs 47%; p < 0.01), gestation age (25 ± 1 vs 26 ± 2weeks, p < 0.05) and inotropic support before closure (90% vs 29%; p < 0.001) were associated with PLCS occurrence. Conclusion: Transcatheter PDA closure may be equally effective but safer than surgical PDA closure in low-body-weight premature infants. What is Known: • Post-ligation cardiac syndrome is a serious and common complication of surgical closure of the ductus arteriosus in preterm infants. • Transcatheter closure of preterm ductus arteriosus is a safe and effective technique that is becoming more and more common worldwide. What is New: • Device closure is safer than surgical ligation for patent ductus arteriosus closure in preterm infants and may be the first-line non-pharmacological therapeutic option in this indication in experienced teams. • Our findings should encourage neonatologists and pediatric cardiologists to start and/or strengthen a durable interventional program for transcatheter PDA closure in premature infants.

Non-invasive Vagus Nerve Simulation in Postural Orthostatic Tachycardia Syndrome.

Postural orthostatic tachycardia syndrome (POTS) is a chronic debilitating condition of orthostatic intolerance, predominantly affecting young females. Other than postural tachycardia, symptoms of POTS include a spectrum of non-cardiac, systemic and neuropsychiatric features. Despite the availability of widespread pharmacological and non-pharmacological therapeutic options, the management of POTS remains challenging. Exaggerated parasympathetic withdrawal and sympathetic overdrive during postural stress are principal mechanisms of postural tachycardia in POTS. Non-invasive, transcutaneous, vagus nerve stimulation (tVNS) is known to restore sympathovagal balance and is emerging as a novel therapeutic strategy in cardiovascular conditions including arrhythmias and heart failure. Furthermore, tVNS also exerts immunomodulatory and anti-inflammatory effects. This review explores the effects of tVNS on the pathophysiology of POTS and its potential as an alternative non-pharmacological option in this condition.

Effects of exercise therapy using elastic bands on strength and pain in women with non-specific neck pain: A randomised controlled trial

BackgroundCervical pain has a high incidence and worldwide socio-economic effect. Its incidence is lower in men than in women. Conservative and non-pharmacological therapeutic options include strength training. Elastic bands are commonly used in physiotherapy clinics for strength work in patients. Consequently, the objective of this research was to analyse the efficacy of an exercise therapy programme using elastic bands on decreasing pain and increasing strength of the neck flexor musculature, cervical extensor, and scapular stabilizing musculature in women suffering from non-specific cervical pain. MethodsA randomised clinical trial was carried out with 35 subjects with non-specific neck pain (age = 51.7 ± 9.5 and baseline intensity of pain in Visual Analogue Scale = 52.4 ± 9.6). The experimental group (n = 18) performed the exercise programme with elastic bands, consisting of a total of 16 sessions that lasted 45 min. The control group, consisting of 27 participants, reported that they maintained their usual lifestyle throughout the study. The evaluation tools used in this research included the Visual Analogue Scale, Neck Flexor Endurance Test, Neck Extensor Muscle Endurance Test, and Scapular Muscle Endurance Test. ResultsThe experimental group obtained significant improvements in the measurements taken using the Visual Analogue Scale (p < 0.001, d = 4.2), the Neck Flexor Endurance Test (p < 0.001, d = 3.4), the Neck Extensor Endurance Test (p < 0.001, d = 6.3), in the Scapular Muscle Endurance Test (p = 0.016, d = 0.9). ConclusionsThe assessed exercise therapy program utilizing elastic bands demonstrated favorable outcomes in managing non-specific neck discomfort. This intervention resulted in pain reduction and enhanced endurance of the cervical flexor and extensor muscles, along with improved endurance of the scapular stabilizing muscles.Protocol registration in ClinicalTrials.gov: NCT05433649 (registered prospectively, date of registration: June 27, 2022).

Effects of physical exercise interventions on cognitive function in Parkinson's disease: An updated systematic review and meta-analysis of randomized controlled trials

ObjectiveTo determine whether physical exercise interventions can improve cognitive function, including overall performance and specific domains, in patients with Parkinson's disease (PD) and to provide potential evidence on how cognitive benefits can be optimized by exercise prescriptions. MethodsUsing PubMed, Web of Science, and Cochrane Library (from inception to August 2022), four independent reviewers screened the search results and extracted data from randomized controlled trials of physical exercise interventions in patients with PD with an outcome measure of cognitive function. Random-effects meta-analysis models were used to report standardized mean differences (SMDs) with 95 % confidence intervals (CIs). ResultsTwenty-one randomized controlled trials including 761 patients with PD were eligible for inclusion. Physical exercise interventions led to significant improvements in global cognitive function (SMD = 0.69; 95 % CI = 0.31 to 1.06; P < 0.001). With respect to cognitive domains, the significant effect of exercise was found on executive function (SMD = 0.94; 95 % CI = 0.05 to 1.83; P = 0.039), but not on attention/working memory, language, memory, and visuospatial function. In moderator variable analyses, the effect on global cognition was observed in combined exercise programs (SMD = 0.79; 95 % CI = 0.46 to 1.12; P < 0.001), whereas there were no significant positive effects in aerobic exercise programs, strength exercise programs, and flexibility exercise programs. In addition, exercise interventions of light-to-moderate intensity with at least 60 min in duration, and of any frequency or period, were beneficial to the global cognitive function. ConclusionThis updated systematic review and meta-analysis suggests that physical exercise interventions are effective in improving global cognitive function and, to a lesser extent, executive function in patients with PD. At least 60 min a day of combined exercise programs on as many days of the week as feasible may be recommended as the non-pharmacological therapeutic option to improve cognitive function.

Abdominal Pain in Inflammatory Bowel Disease: An Evidence-Based, Multidisciplinary Review.

Abdominal pain is one of the most common and impactful symptoms associated with inflammatory bowel disease (IBD), including both Crohn's disease and ulcerative colitis. A great deal of research has been undertaken over the past several years to improve our understanding and to optimize management of this issue. Unfortunately, there is still significant confusion about the underlying pathophysiology of abdominal pain in these conditions and the evidence underlying treatment options in this context. There is also a relative paucity of comprehensive reviews on this topic, including those that simultaneously evaluate pharmacological and nonpharmacological therapeutic options. In this review, our multidisciplinary team examines evidence for various currently available medical, surgical, and other analgesic options to manage abdominal pain in IBD.

Translational veterinary epilepsy: A win-win situation for human and veterinary neurology

Epilepsy is a challenging multifactorial disorder with a complex genetic background. Our current understanding of the pathophysiology and treatment of epilepsy has substantially increased due to animal model studies, including canine studies, but additional basic and clinical research is required. Drug-resistant epilepsy is an important problem in both dogs and humans, since seizure freedom is not achieved with the available antiseizure medications. The evaluation and exploration of pharmacological and particularly non-pharmacological therapeutic options need to remain a priority in epilepsy research. Combined efforts and sharing knowledge and expertise between human medical and veterinary neurologists are important for improving the treatment outcomes or even curing epilepsy in dogs. Such interactions could offer an exciting approach to translate the knowledge gained from people and rodents to dogs and vice versa. In this article, a panel of experts discusses the similarities and knowledge gaps in human and animal epileptology, with the aim of establishing a common framework and the basis for future translational epilepsy research.

Ten controversies in gastroparesis and a look to the future.

Gastroparesis is a complex, challenging gastrointestinal disorder presenting with upper gastrointestinal symptoms, especially nausea and vomiting, with significant impact on patients' quality of life. After ruling out mechanical obstruction, it is essential to identify delay in gastric emptying for definitive diagnosis. The most common causes are idiopathic (no identified etiology), diabetes mellitus, and postsurgical status. Management of gastroparesis focuses on dietary modifications and treatment directed to symptom relief. Unfortunately, approximately one-third of patients are refractory to pharmacological therapy, and the effectiveness of the few nonpharmacological options has been questioned. Extensive review of the literature identifies several uncertainties or controversies regarding the differential diagnosis based on the spectrum of symptoms, the lack of availability of reliable diagnostic test, and questions regarding effective therapeutic options. In this review, we discuss ten controversies regarding gastroparesis: clinical presentation, diagnosis, overlap syndromes, pathophysiology, etiology, as well as pharmacological and nonpharmacological therapeutic options. In addition, we briefly review studies exploring pathological, inflammatory, and molecular disturbances affecting the intrinsic neuromuscular elements that may be involved in the pathophysiology of gastroparesis and may constitute possible therapeutic targets in the future. Finally, we tabulate future research opportunities to resolve these controversies in the management of patients with gastroparesis.

Psychological interventions in behavioral sleep medicine: An overview for clinicians and psychologists

Sleep medicine and psychology has a relatively long story to share. The multidisciplinary nature of sleep medicine requires that different specialists work together to diagnose and treat sleep disorders and improve subspecialty areas. In the last decades, various non-pharmacological therapies have been developed and demonstrated their efficacy. There are many non-pharmacological therapeutic available options for sleep disorders, including cognitive, behavioral, psycho-educational, and psychosocial interventions that could help clinicians to improve the quality of life of adult patients. Obstructive sleep apnea syndrome, insomnias, hypersomnias, circadian rhythm disorders, restless leg syndrome and parasomnias can be effectively taken care of, by an integrated approach with the support of sleep medicine psychologists. The paper aims to give a comprehensive view of psychological interventions for adults, in behavioral sleep medicine.

Exercise order in resistance training – a brief review of the acute effects on cardiovascular response in the post-exercise period

This study aims to review the main effects of the performance order of resistance exercises on cardiovascular response in strength training (ST) sessions. To do so, a search was carried out in PubMed, BIREME, and Google Scholar databases using as descriptors: 'order', 'resistance training order', 'resistance exercise order', 'blood pressure' 'hypotension', 'effect hypotensive', 'post-exercise hypotension' and 'cardiovascular responses'. After applying the inclusion/exclusion criteria, six studies were considered in this review. The results suggest that ST can be considered as a non-pharmacological therapeutic option against arterial hypertension. Although the alternate exercise sequence and the sequence that progresses from multi-joint exercises towards single-joint ones present a longer duration of the hypotensive effect in hypertensive individuals, literature needs more studies that investigate the influence of different exercise orders in the hypertensive audience for further conclusions on the subject.

Non-Pharmacological Therapeutic Options for the Treatment of Alzheimer's Disease.

Alzheimer’s disease is a growing global crisis in need of urgent diagnostic and therapeutic strategies. The current treatment strategy mostly involves immunotherapeutic medications that have had little success in halting disease progress. Hypotheses for pathogenesis and development of AD have been expanded to implicate both organ systems as well as cellular reactions. Non-pharmacologic interventions ranging from minimally to deeply invasive have attempted to address these diverse contributors to AD. In this review, we aim to delineate mechanisms underlying such interventions while attempting to provide explanatory links between the observed differences in disease states and postulated metabolic or structural mechanisms of change. The techniques discussed are not an exhaustive list of non-pharmacological interventions against AD but provide a foundation to facilitate a deeper understanding of the area of study.

The Main Changes in Pregnancy-Therapeutic Approach to Musculoskeletal Pain.

Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, during this period, these changes precipitate the appearance of pain, musculoskeletal pain being the most common. Pregnant women should avoid treating musculoskeletal pain with medication and should choose alternative and complementary methods. Exercise along with rest is the basis for treating chronic musculoskeletal pain. Side effects of physical therapy are rare and, in addition, it is not contraindicated in pregnant women. The benefits of this type of treatment in combating pain far outweigh the risks, being an easy way to improve quality of life. The objective of this article is to discuss the management of musculoskeletal pain during pregnancy, to identify the main musculoskeletal pain encountered in pregnant women along with drug treatment, and to expose the beneficial effects of alternative and complementary methods in combating pain. Materials and Methods: A literature search was conducted using medical databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords “changes of pregnancy”, “musculoskeletal pain”, “pregnancy pain”, “pain management”, “pharmacological approach”, “alternative and complementary treatment” and specific sites. Information was collected from studies whose target population included pregnant women who complained of musculoskeletal pain during the 9 months of pregnancy; pregnant women with other pathologies that could increase their pain were not included in this review. Results: The articles related to the most common non-obstetric musculoskeletal pain in pregnancy along with pharmacological treatment options and alternative and complementary methods for musculoskeletal pain management during pregnancy were selected. Conclusions: The results were used to guide information towards the safest methods of therapy but also to raise awareness of the treatment criteria in order to compare the effectiveness of existing methods. Treatment must consider the implications for the mother and fetus, optimizing non-pharmacological therapeutic options.

Dysmenorrhea and perceived stress in the adolescent girls: Potential role of relaxation techniques

The most common gynecologic issue affecting women, particularly teenage girls, is dysmenorrhea, which is characterized by painful menstruation. Dysmenorrhea can cause varying degrees of pain and discomfort, from minor inconvenience to serious restrictions on daily activities. Additionally, a lower quality of life is connected to it. It is estimated that 15% of female adolescents have significant discomfort, which has a negative effect on their quality of life. The adolescent girls spoke of various symptoms, such as sleep issues, low quality of life, anxiety, losing their appetite, migraines, and affects on general health status, in addition to painful menstruation. Numerous complementary therapies, such as oil massage, pelvic floor exercises, and relaxation methods, may help to alleviate the discomfort. Essential oils, which are aromatics made from extracted plants, are used in aromatherapy to enhance one's physical, emotional, and spiritual well-being. It appears that research has shown that exercising can reduce menstrual cramps. Pelvic floor exercises strengthen pelvic floor muscles by tightening and relaxing them. These exercises are crucial to pelvic floor muscle recovery. Relaxation methods enhance daily life, strengthen the immune system, and lessen depression. Additionally, they are effective in reducing tension and anxiety. Therefore, it is thought that they contribute to people's psychological well-being. Relaxation therapy is one non-pharmacological therapeutic option that may minimize menstrual discomfort. This review study led us to conclude that regular use of the Jacobson relaxation technique, pelvic floor exercises, and oil massage may help to reduce the pain caused by dysmenorrhea.

Psycho-oncology interventions focusing on fatigue and sleep disturbances.

Cancer-related fatigue (CRF) and sleep disturbances are common symptoms among patients with cancer. They are often conceptualized as a part of a larger symptom cluster, also comprising pain and emotional distress. Despite their prevalence and long-lasting effects, CRF and sleep disturbances are still poorly addressed in clinical settings. Specific interventions are needed to manage these symptoms. In addition to conventional pharmacological therapies, other kinds of interventions are increasingly being developed in oncology. This review will discuss three categories of interventions for patients with cancer and their interest in alleviating CRF and sleep disturbances: physical exercises (e.g., aerobic, resistance training, running, free weights), psychological interventions (e.g., cognitive-behavioural therapy, psychoeducational interventions), and mind-body interventions (e.g., yoga, mindfulness, hypnosis). The multicomponent aspect of these interventions seems particularly important to address these symptoms. The findings detailed in this review will allow the scientific community, as well as health professionals working in oncology settings, to be informed about new nonpharmacological therapeutic options to help patients to manage their symptoms. It could eventually help to improve existing interventions for these patients.

Efficacy and Safety of a Polysaccharide-Based Natural Substance Complex in the Treatment of Obesity and Other Metabolic Syndrome Components: A Systematic Review

Introduction: Metabolic syndrome (MetS) is increasingly common in adults as well as in children and adolescents. However, preventing and treating MetS is one of the most pressing challenges for public health services worldwide. At present, the only approved treatments for MetS are dietary changes and physical activity, which are associated with a high rate of non-compliance. On the contrary, no drugs are licensed to treat metabolic syndrome, although a number of drugs are used to treat individual metabolic abnormalities, which increases the risk of adverse events, particularly in children. Policaptil Gel Retard® (PGR), an oral macromolecule complex based on polysaccharides, has been demonstrated to significantly reduce body weight, peak blood glucose (BG) levels, insulin levels, and lipid levels, providing an interesting non-pharmacological therapeutic option for MetS-associated metabolic abnormalities, especially in younger patients.Aims: To review available studies on the use of PGR in children, adolescents, or adults with obesity or metabolic syndrome.Methods: A systematic search of electronic databases for PGR and MetS. A total of six studies were identified and included.Results: Across four randomized clinical studies and one retrospective clinical study including a total of 359 obese children and adolescents with or without MetS and 157 overweight/obese adults with or without MetS and/or T2DM, a single dose of PGR resulted in a reduction in appetite and postprandial triglyceride levels in younger patients and peak postprandial BG levels in adults. Decreased lipid levels were observed in adults following a normocaloric diet who received PGR for 30 days. As a long-term treatment, in combination with a low-glycemic index diet with or without metformin, PGR resulted in reduced body mass index and waist circumference, improved insulin sensitivity with reduction of glucose-metabolism abnormalities, increased insulin reserve and, finally, an improved circulating lipid profile, regardless of age. No safety issues were reported.Conclusion: Policaptil Gel Retard® is an effective and safe non-pharmacological approach to improve the treatment of MetS-associated cardiovascular risk factors in children, adolescents, and adults.

MO602: Combined and Progressive Intradialytic Exercise Training Keeps Stable the Systemic Inflammation, Endothelial Function Markers and Redox State: A Secondary Analysis of a Randomized Controlled Trial

Abstract BACKGROUND AND AIMS Chronic inflammatory conditions and disturbances in oxidative stress are hallmarks of renal damage and may be a trigger to non-pharmacological therapeutic options, such as exercise training, in chronic kidney disease[1,2]. This study aimed to evaluate the effects of 12-week combined and progressive intradialytic exercise training on systemic inflammation, endothelial function markers, and redox state in hemodialysis (HD) patients. METHOD This is a secondary analysis of a randomized controlled trial with HD patients[3] randomly allocated into two groups: exercise group (EXG) (n = 19) and usual care/control group (CON) (n = 19). EXG performed a 12-week combined and progressive intradialytic training period 3 times a week. CON maintained their normal HD routine during the same timeframe. Blood samples were obtained before and after the 12-week period to analyze C-reactive protein (CRP), interleukin (IL)-4, IL-6, IL-10, IL-17A, tumoral necrosis factor-alpha (TNF-α), reactive oxygen species (ROS), total antioxidant capacity (TAC), monocyte chemoattractant protein-1 (MCP-1), interferon-gamma (IFN-γ), vascular endothelial growth factor (VEGF), and nitric oxide (NO). The inflammatory balance was evaluated by IL-6/TNF-α, TNF-α/IL-4 and TNF-α/IL-10 ratios. RESULTS A significant effect was only observed in CON but not EXG, with decreased IL-6 (median of 9.93 [IQR: 8.31–14.79] to 8.86 [7.88–9.61] pg/mL; P = 0.044), IL-17A (62.26 [48.87–102.44] to 53.33 [45.29–59.58] pg/mL; P = 0.044), and IFN-γ (28.19 [26.44–31.15] to 27.09 [25.85–27.89] pg/mL; P = 0.006) and an increase in ROS (485.98 [333.17–604.83] to 507.31 [443.48–637.04]; P = 0.049). CONCLUSION The HD patients who undertook the 12-week combined and progressive intradialytic exercise training did not experience an alteration in systemic inflammation, endothelial function markers and redox state, in contrast with the increased oxidative stress state observed in CON. FUNDING SOURCES Hospital de Clínicas de Porto Alegre–Research Incentive Fund (FIPE) (Grant No. 2015–0151) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).