Critical Comments in Biomedicine

Comparison of the Effectiveness of Metformin with Lifestyle Modification for the Primary Prevention of Type 2 Diabetes: A Protocol for Systematic Review and Meta-Analysis

2023-10-20T18:31:55+00:00

Background: Almost 90% of people with diabetes have type 2 diabetes and the upward trend of this chronic disease is still ongoing, so that after about four decades, this disease is still one of the top 10 causes of death, while half of these deaths occur in people under 60 years of age. Therefore, prevention is essential and the implementation of the most effective intervention approach is required after recognizing at-risk individuals. This study aimed to evaluate the effect of lifestyle modification interventions and metformin on the prevention of type 2 diabetes and improvement in four risk factors related to diabetes.

Methods: The study was conducted by searching PubMed, Scopus, Web of science, and Google Scholar without time and language restrictions. Randomized controlled trials which examined the effect of both lifestyle modification interventions and metformin in a population over the age of 18 years with no history of any type of diabetes were included. After the withdrawal of poor quality studies and those withfollow-up time of less than 6 months, structured review and meta-analysis will be performed to calculate the relative risk of type 2 diabetes incidence and mean difference in weight, body mass index, plasma fasting glucose, and hemoglobin A1c. Data analysis was performed using comprehensive meta-analysis software version 2.2.064.

Conclusion: This study will make it possible to choose between two conventional therapeutic approaches (lifestyle modification and metformin) to prevent type 2 diabetes and its impact on four risk factors.

Effect of Grape and its Derivatives on Cognitive Function: A Systematic Review of Clinical Trials

2023-10-20T18:31:38+00:00

Background: According to the world health organization (WHO), in 2019, around 50 million people suffer from dementia, worldwide; and approximately 60% live in low- and middle-income countries. Dementia has physical, psychological, social, and economic effects on dementia sufferers, their caregivers, families, and the community.

Objectives: This systematic review investigated the effect of short-term and long-term interventions with grapes and their derivatives on different cognitive functions, such as executive function, memory, attention and language in all people.

Methods: Pubmed, Scopus, and Proquest were searched until June 12, 2020 for English studies. Clinical trials in which grapes and its derivatives were considered as an intervention and changes of cognition and its components as an outcome, were selected. Two independent individuals assessed the quality of the articles according to Jadad checklist and extracted the information of the articles with inclusion criteria based on a specific table. The differences were resolved with the discussion and opinion of a third person.

Results: Nine Studies (211 individuals) were included in the content analysis, of which 3 studies had short-term intervention and 6 studies had long-term intervention with grape juice, freeze-dried grape powder, and a syrup made from grapes (Enoant Syrup). It can be said that the consumption of grapes and its derivatives improved various cognitive components (such as attention, executive function, immediate spatial memory, learning, and driving skill) between groups.

Conclusion: In general, long-term intervention with grapes and their derivatives has led to the improvement of some cognitive functions, but its short-term intervention is not very effective and only 2 studies showed improvement in attention speed. However, the included studies were highly heterogeneous and more research is needed using similar cognitive assessment tools.

The Relationship between Obsessive-Compulsive Disorder and Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis

2023-10-20T18:31:22+00:00

Introduction: Irritable bowel syndrome (IBS) might be associated with psychiatric disorders such as obsessive-compulsive disorder (OCD). This meta-analysis was conducted to compare the rate of OCD among patients with IBS and otherwise healthy controls.

Methods: This study was conducted using a meta-analysis approach. International databases including PubMed, Web of Science, and Scopus, as well as the Google Scholar search engine were searched from 1985 to August 2020 to find the related studies. The standardized mean difference (SMD) of OCD between case and control groups was calculated and pooled by using a random-effects model. In addition, meta-regression and sub-group analysis were performed to identify variables that possibly explain the heterogeneity.

Results: A total of 5167 patients including 1451 IBS patients for case and 3716 for control group entered 15 related studies were included in the analysis. Based on the results of the random effects analysis, the rate of obsessive-compulsive disorder in IBS patients in case group was higher than the control group (Pooled standardized mean difference, 0.76, I² = 87.8%; 95% CI, 0.54-0.98; P <0.001). Egger’s (P = 0.083) and Begg’s (P = 0.09) tests did not show significant publication bias. Subgroup analysis also revealed that the type of studies and IBS diagnostic criteria were identified as factors affecting heterogeneity.

Conclusion: The present meta-analysis demonstrated that the obsessive-compulsive disorder score in IBS patients was higher than the control group, regardless of subgroup analysis or meta-regression. Due to the significant relationship between these two disorders, psychiatrists and gastroenterologists can provide strategies and techniques for individual or group treatment of obsessive-compulsive disorder in patients with IBS based on the cognitive-behavioral therapy.

Coronavirus Disease (COVID-19) and Burnout in Nurses

2023-10-20T18:31:05+00:00

The Article Abstract is not available.

The Neglected Role of Lung Microbiota in COVID-19

2023-10-20T18:30:48+00:00

The Article Abstract is not available.

A Novel Drug for Alzheimer's Disease; Future Challenges in Treatment

2023-10-20T18:30:32+00:00

The Article Abstract is not available.

The Case Fatality Rate of Alpha Covid-19 Variant in Patients with Concurrent Diabetes or Chronic Kidney Disease: A Systematic Review and Meta-analysis

2023-10-20T18:30:15+00:00

Background: People with diabetes or chronic kidney diseases (CKD) are vulnerable to Covid-19. Our aim in this study was to estimate the fatality rate among people with diabetes or CKD infected by Alpha Covid-19 variant.

Methods: The authors searched PubMed, Scopus, and Embase from 1/12/2019 to 13/5/2020 to find studies that reported the fatality rate of Alpha Covid-19 variant among patients with diabetes/renal disease. A Random effects model meta-analysis was used to calculate the pooled case fatality rate (CFR). Then, a subgroup analysis was performed according to the sample size to find possible sources of heterogeneity.

Results: In total, 22 papers were studied for diabetes and 10 papers for CKD. The pooled CFR was estimated at 23% (95% CI: 0.18, 0.28) among diabetes patients and 31% (95% CI: 0.16, 0.48) among renal patients. High heterogeneity was observed among the studies (Diabetes: I^2=94%, t^2=0.0173, P<0.01), (CKD: I^2=69%, t^2=0.0457, P<0.01). The subgroup analysis indicated that the sample size had a significant effect on fatality rate estimation. In the diabetes patients, the pooled CFR of Alpha Covid-19 variant was 40% (95% CI: 22%-58%; I^2=91%, t^2=0.0797, P<0.01) among the studies with the sample size of less than 52 hospitalized patients. In the studies with equal or more than 52 patients, the pooled CFR was 14% (95% CI: 11%-17%; I^2=88%, t^2=0.0048, P<0.01). In addition, in renal patients, the pooled CFR was 62% (95% CI: 0.06%-100%; I^2=85%, t^2=0.3745, P<0.01) in the studies with less than six hospitalized patients, and the pooled CFR was 23% (95% CI: 16%-31%; I^2=0%, t^2=0.00, P=0.58) among studies with more than 6 patients.

Conclusions: People with either diabetes or CKD and infected with Alpha Covid-19 variant had a higher fatality rate in the general population. More care and vaccination is recommended for these patients. It is recommended that we calculate pooled estimation of the case fatality rate of the other variant of COVID-19 such as Beta, Delta, and Omicron in patients with chronic disease.

Evaluation of telehomecare Studies in Patients with Chronic Heart Failure: A health Technology Assessment Study

2023-10-20T18:29:59+00:00

Background: Heart failure (HF) is a major complication resulting from a variety of heart diseases. HF is an increasingly important issue, whose prevalence has doubled in the last two decades. This is due to increased life expectancy, treatment and prevention of other heart diseases, and increased life expectancy. Promoting self-care through tele homecare is an emerging strategy for managing chronic diseases.

Objectives: The purpose of this study is to evaluate tele-care studies in patients with chronic heart failure (CHF). This is based evaluating the types of technologies used for patients in this method, effectiveness, cost-effectiveness and safety of these technologies based on the aspects of health technology assessment.

Methods: PubMed, Scopus, Web of Science, Cochrane databases, HTA (Health Technology Assessment), NHS EED (National Health System Economic Evaluation Database), DARE (Database of Abstract of Reviews of Effects), Embase, and (Society for Information Display) SID were searched using medical subject heading (Mesh) keywords. Then, studies were evaluated by two people and disputed by a third party. The quality of the extracted studies was evaluated based on the (Risk of Bias) RoB 2.0 checklist. The difference between the mean and its standard deviation was calculated (which was used as the effect size). To analyze the results, meta-analysis of random effects was performed. In addition, the subgroup and meta-regression analysis were performed to discover possible sources of heterogeneity. Finally, studies were evaluated in terms of Health Problem and Current Use of the Technology (CUR), Description and technical characteristics of technology (TEC), safety (SAF), Clinical effectiveness (EFF), Costs and economic evaluation (ECO) of 9 Aspects of Health Technology Assessment (HTA). Studies were evaluated with respect to the long-distance care in patients with CHF. We approach the method through systematic review and meta-analysis based on the principles of PRISMA-P. This systematic review examined the effectiveness of long-distance care interventions in patients with CHF, compared with conventional care methods. In general, evaluation of studies extracted in this systematic review will try to identify, evaluate and combine the effects of tele-care in patients with HF using meta-analytical methods in the evidence. Evaluating studies conducted in the field of tele-care in patients with CHF will help us to better understand how these methods work in the management of chronic heart disease [effectiveness, safety and cost reduction] and determine which care interventions Distance is more effective in patients with HF based on their characteristics according to clinical outcomes and resource use.

Conclusion: The results of this study can be used as a guide to provide valid evidence for the decision of senior managers of the Ministry of Health and large hospitals to use common technologies used in distance care for patients with CHF and other chronic diseases. This study will also provide a new understanding of the various studies that have been conducted to help patients with chronic failure by different types of remote care technologies in terms of effectiveness, safety, technology, and economic costs.