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Digital Interventions in Type 2 Diabetes Mellitus 2型糖尿病的数字化干预
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.5
Lucía Salgueiro, Keiry Pereyra-Bencosme, Cristian Vargas-Martínez, Jorge Ortega-Márquez, Santiago Callegari-Osorio, Amanda Robasini-dos Santos, Alberto Castro Molina, Allan Vásquez-Bolaños, Diego Olavarría-Bernal, Gabriel Soares-de Sousa, Elaine Cristina Marqueze, Cecília Mendes-de Sousa
Introduction: Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic disease with an increasing mortality rate over the last decade. Diabetes self-management education (DSME) programs have been reported as essential to improve survival; however, patient adherence rates are very low. Therefore, digital devices have been created to deliver DSME at a distance and enhance program attendance. This study aims to assess the effects of digitally delivered DSME programs on the glycosylated hemoglobin (HbA1C) of patients with prediabetes and T2DM. Methods: We researched PUBMED databases for randomized controlled trials (RCT) and observational studies (OS) published between 2012-2022 in English, Portuguese, or Spanish. The selected articles tested digital DSME interventions against treatment as usual (TAU) on adults (>18 years) previously diagnosed with T2DM or prediabetes. The result was measured by determining the HbA1c levels. Results: Out of 261 articles, 14 RCTs were selected based on eligibility criteria. Digital DSME technologies have different objectives, including monitoring glycemic fluctuation, insulin titration, nutritional guidance, sleeping assessment, enhancement of physical activity, control of comorbidities, relevant task notifications, personalized treatment recommendations, educational content, and patient/medical staff remote interaction. Some of the technologies combined machine learning techniques for different functions, including detecting adverse glycemic events, physical activity, and blood pressure, among others. Although the level of adherence varied among the various trials, 4 of the 14 RCTs analyzed reported a significant reduction of HbA1c levels using these digital devices compared to TAU. Discussion: Programs providing digital DSME education is a potentially cost-effective tool to improve diabetes care worldwide by overcoming distance barriers, facilitating physician-patient communication, and reducing HbA1c levels. Future improvements in implementing these technologies could enhance user compliance and contribute effectively to diabetes management.
引言:2型糖尿病(T2DM)是一种高度流行的慢性疾病,在过去十年中死亡率不断上升。据报道,糖尿病自我管理教育(DSME)项目对提高生存率至关重要;然而,患者的依从性很低。因此,已经创建了数字设备来远距离提供DSME并提高节目出席率。本研究旨在评估数字化DSME程序对糖尿病前期和T2DM患者糖化血红蛋白(HbA1C)的影响。方法:我们研究了2012年至2022年间以英语、葡萄牙语或西班牙语发表的随机对照试验(RCT)和观察性研究(OS)的PUBMED数据库。所选文章对先前诊断为T2DM或糖尿病前期的成年人(>18岁)进行了数字DSME干预,以对抗常规治疗(TAU)。通过测定HbA1c水平来测量结果。结果:在261篇文章中,根据资格标准选择了14篇随机对照试验。数字DSME技术有不同的目标,包括监测血糖波动、胰岛素滴定、营养指导、睡眠评估、加强体力活动、控制合并症、相关任务通知、个性化治疗建议、教育内容和患者/医务人员远程互动。其中一些技术结合了机器学习技术,实现了不同的功能,包括检测血糖不良事件、身体活动和血压等。尽管不同试验的依从性水平各不相同,但在分析的14项随机对照试验中,有4项报告称,与TAU相比,使用这些数字设备的HbA1c水平显著降低。讨论:提供数字DSME教育的项目是一种潜在的成本效益高的工具,可以通过克服距离障碍、促进医患沟通和降低HbA1c水平来改善全球糖尿病护理。未来在实施这些技术方面的改进可以提高用户的依从性,并有效地促进糖尿病管理。
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引用次数: 0
Effects of Neuromuscular Electrical Stimulation in Patients with Post-Stroke Related Dysarthria: A Double-Blinded, Phase-II Randomized Sham-Controlled Trial Protocol - ULYSSES Trial 神经肌肉电刺激对卒中后相关构音障碍患者的影响:一项双盲、ii期随机假对照试验方案- ULYSSES试验
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.9
Mustafa Reha Dodurgali, Roser Coll-Fernández, Fernanda Queiroz Petrus, Márcio Kawano, Franziska Schreiber, Nayara de Lima Froio, Guilherme Jose Machado Lacerda, Edilin Lopez, Adrielly Martins, Angélica Flores- Flores, Belen Machado, Bethânia Soares dos Santos, Bianca Parron, Christiany Marilinn Tapia Argudo, Claudia Renata dos Santos Barros, Cristina Stephan, Daniela Bouzas Rodeiro, Gustavo Mucci, James Alfonso Carvajal Acosta, Larrie Rabelo Laporte, Laura De Leon Benedetti, Luis Morales Ojeda, Paula Raso Bastos, Regina Villalobos, Vinicius Trindade Gomes da Silva, Abdul Haseeb, Mariana Gasparoto Pereira Valério, Renata Junqueira Moll-Bernardes, Roseanne Ferreira de Freitas Euzébio, Gabriel Rangel Olivera, Caio Cesar dos Santos Kasai, Fathima Minisha, Juan Carlos Silva Godinez
Introduction: Post-stroke individuals with dysarthria experience difficulties in producing speech due to muscle dysfunction. Neuromuscular electrical stimulation (NMES) can stimulate motor units and enhance their functionality. The objective of this study is to investigate the effects of NMES on speech intelligibility in patients with persistent dysarthria 3-6 months post-ischemic stroke. Methods: This study will be designed as a phase II, double-blinded, randomized, two-arm, parallel-group, superiority trial conducted at a single center. The target population will consist of post-stroke individuals with dysarthria, who will undergo randomization to receive either neuromuscular electrical stimulation (NMES) or sham-NMES. Both intervention groups will receive treatment sessions 5 days a week over a 4-week period. The sample size for this study will be 154 patients, recruited exclusively from a Rehabilitation Unit located in the United States. The primary outcome measure will focus on determining the mean difference in the FDA-2 intelligibility score between the two treatment groups. Secondary outcomes will involve evaluating the mean difference in the full FDA-2 score, as well as various subsets of the score, alongside an assessment of the participants’ health-related quality of life, utilizing the Stroke Impact Scale (SIS). Conclusion: To the best of our knowledge, this will be a comprehensive assessment of the potential benefits of NMES for post- stroke patients with dysarthria. Considering the positive impact of NMES on enhancing muscle functionality, it is plausible to anticipate its potential benefits in improving speech outcomes as well. Despite early studies indicating the safety and tolerability of NMES for various motor muscle conditions, there is limited data on its use in patients with dysarthria.
简介:中风后患有构音障碍的个体由于肌肉功能障碍而产生语言困难。神经肌肉电刺激(NMES)可以刺激运动单元并增强其功能。本研究的目的是探讨NMES对缺血性卒中后3-6个月持续性构音障碍患者言语清晰度的影响。方法:本研究将被设计为在单中心进行的II期、双盲、随机、双臂、平行组、优势试验。目标人群将包括中风后患有构音障碍的个体,他们将随机接受神经肌肉电刺激(NMES)或假NMES。两个干预组将在4周的时间内每周接受5天的治疗。本研究的样本量为154例患者,专门从位于美国的康复部门招募。主要结果测量将侧重于确定两个治疗组之间FDA-2可理解性评分的平均差异。次要结果将包括评估FDA-2评分的平均差异,以及评分的各个子集,以及使用卒中影响量表(SIS)评估参与者的健康相关生活质量。结论:据我们所知,这将是对NMES对卒中后构音障碍患者潜在益处的全面评估。考虑到NMES对增强肌肉功能的积极影响,我们有理由预测它在改善语音结果方面的潜在益处。尽管早期研究表明NMES对各种运动肌肉状况的安全性和耐受性,但其在构音障碍患者中的应用数据有限。
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引用次数: 0
From Referee to Reviewer: The Evolution and Impact of Peer Review in Scientific Publications 从推荐人到审稿人:科学出版物中同行评议的演变及其影响
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.1
Mustafa Reha Dodurgali, K. Pacheco-Barrios, Felipe Fregni
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引用次数: 0
Umbilical Cord-Mesenchymal Stem Cell Therapy for COVID-19 Related Acute Respiratory Distress Syndrome: A Mini-Review 脐带-间充质干细胞治疗COVID-19相关急性呼吸窘迫综合征:一项小型综述
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.6
Bryan Monterroso Yancor, Roselyn Lemus Martin, Daniela Alonso-Ruiz, Nicole A. Sanchez-Iriarte, Lucas Maffioletti Gonçalves, Mónica Rosales-Salán, J. Bustos, Aisha Aladab, Dahiana Garcia De La Rosa, Emilio Israel Wong-Valenzuela, Krista Cano
Introduction: Acute respiratory distress syndrome (ARDS) is the leading cause of death among coronavirus disease 2019 (COVID-19) patients, mainly due to the cytokine storm and the rearrangements in coagulation and immune responses. Accordingly, the immunomodulatory and regenerative properties of umbilical mesenchymal stem cells (UC-MSCs) have been studied for the treatment of COVID-19. Methods: This mini-review evaluated adults with moderate-severe COVID-19 infection and compared the results of placebo plus standard of care (SOC) therapy with those obtained from the administration of umbilical cord mesenchymal cells (UC-MSCs). We searched the following databases: Cochrane, Central Register of Controlled Trials, and PubMed; subsequently, 8 clinical trials were included in this mini-review. Some statistically significant difference was found in the levels of clinical and inflammatory markers between the intervention and the control groups. Conclusion: Early phase trials have shown the promising efficacy and safety of UC-MSC therapy for COVID-19-associated moderate-to-severe ARDS. Large multicenter phase III randomized controlled clinical trials will further confirm these findings.
急性呼吸窘迫综合征(ARDS)是2019冠状病毒病(COVID-19)患者的主要死亡原因,主要是由于细胞因子风暴和凝血和免疫反应的重排。因此,脐带间充质干细胞(UC-MSCs)的免疫调节和再生特性被研究用于治疗COVID-19。方法:这项小型综述评估了中重度COVID-19感染的成人,并比较了安慰剂加标准护理(SOC)治疗与脐带间充质细胞(UC-MSCs)治疗的结果。我们检索了以下数据库:Cochrane、Central Register of Controlled Trials和PubMed;随后,8个临床试验被纳入这一小型综述。干预组和对照组在临床和炎症标志物水平上有统计学上的显著差异。结论:早期试验显示UC-MSC治疗covid -19相关中重度ARDS的疗效和安全性良好。大型多中心III期随机对照临床试验将进一步证实这些发现。
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引用次数: 0
Editorial - The Secret Life of Retractions in Scientific Publications. 社论-科学出版物撤回的秘密生活。
Pub Date : 2023-07-10 DOI: 10.21801/ppcrj.2023.91.2
Bianca Barros Parron Fernandes, Mustafa Reha Dodurgali, Carlos Augusto Rossetti, Kevin Pacheco-Barrios, Felipe Fregni
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引用次数: 0
N-acetylcysteine Effects on Inflammatory Markers in Animal Models Exposed to Air Pollutants N-乙酰半胱氨酸对暴露于空气污染物的动物模型炎症标志物的影响
Pub Date : 2023-07-10 DOI: 10.21801/ppcrj.2023.91.9
Maria Jose Hernandez Woodbine, Daniel Romero, Cristal Roman, Juan Rene Delgado Cornejo, Richard Vaca, Francisca Jaime, Donghyun Ko, Pragati Sureka, Erica V. Stelmaszewski, Maria Simon, Lucero G. Flores
Introduction: Air pollution (AP) significantly contributes to morbidity and mortality worldwide. N-acetylcysteine (NAC) is a potent antioxidant with potential health benefits to people residing in poor air quality areas. Our study aimed to analyze animal studies conducted on rats and mice to assess the anti-inflammatory effects of NAC during exposure to air pollutants. Methods: A systematic search on two large databases was performed. Nineteen studies were included in this review following a screening of duplicates and a full-text review. Results: We found that NAC successfully ameliorates some pollution-associated inflammatory pathways. Discussion: NAC is a potential therapeutic drug against inflammatory pathologies caused by AP, although its role in human models requires further studies.
引言:空气污染(AP)在全球范围内显著增加了发病率和死亡率。N-乙酰半胱氨酸(NAC)是一种强效抗氧化剂,对居住在空气质量差地区的人有潜在的健康益处。我们的研究旨在分析对大鼠和小鼠进行的动物研究,以评估NAC在暴露于空气污染物期间的抗炎作用。方法:对两个大型数据库进行系统检索。在筛选重复项和全文综述后,本综述纳入了19项研究。结果:我们发现NAC成功地改善了一些与污染相关的炎症途径。讨论:NAC是一种潜在的治疗AP引起的炎症病理的药物,尽管它在人体模型中的作用需要进一步研究。
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引用次数: 0
The Efficacy of Deep Breathing Techniques in Patients with Elevated Blood Pressure and Hypertension: A Review of the Literature 深呼吸技术在高血压和高血压患者中的疗效:文献综述
Pub Date : 2023-07-10 DOI: 10.21801/ppcrj.2023.91.5
Kelsie Lizbeth Pereyra-Bencosme, Diana Arango, Flavio Lichtenstein, Gabriela Alexandra Mateo, Alonso S Gormaz-Bravo, Ángel Jael Acosta, Bruno Antonio de Oliveira, Temidayo Olasinbo Avwioro, Adriano Fernandes Teixeira, G. Guinto-Nishimura, Laura Marie Bourget, Marta Figueral, Rodrigo Uribe-Pacheco
Introduction: Increased blood pressure (BP) is among the top modifiable causes of cardiovascular disease risk. Non- pharmacological interventions in the prevention and management of elevated BP and hypertension have increased in popularity in recent years. Deep breathing techniques (DBT) are mindfulness stress reduction strategies that target the autonomous nervous system, increase vagal tone, and reduce BP levels. Inconsistent evidence exists in the efficacy of DB techniques in BP control. This review of the literature aims to assess the overall BP lowering efficacy of DBT in hypertension, compare the efficacy of device-guided versus non-device-guided DBT, and assess the safety and adherence rate of DBT, through systematic search and review of randomized controlled trials. Methods: We searched Randomized clinical trials (RCT) in PubMed and Cochrane databases. The search terms were divided into three-term groups: a) hypertension, b) deep breathing techniques, and c) trials. Then, the list of articles was divided into five groups, each with two to three reviewers, to verify every study met the inclusion and exclusion criteria by reading the title and the abstract. Whenever necessary, we downloaded articles to verify adherence by reading the methods, results, and discussions. Studies having two or more votes were selected. Next, all selected articles were downloaded and read to analyze findings and effect sizes and to confirm a correct methodology and statistical analysis. Results: We selected 4 of 119 articles. There is a conflict in the literature; one study affirms no overall difference between DBT and control, two studies affirm that there are statistically significant differences, and one study reports no difference in office BP but statistical difference in “awake, at home” monitoring in the control group. Thus large-scale, high-quality clinical trials are needed to critically assess the effectiveness of long-term DBT in the management of HTN.
简介:血压升高(BP)是心血管疾病风险的主要可改变原因之一。近年来,预防和管理血压升高和高血压的非药物干预越来越受欢迎。深呼吸技巧(DBT)是一种专注力减压策略,针对自主神经系统,增加迷走神经张力,降低血压水平。DB技术在血压控制中的有效性存在不一致的证据。本文献综述旨在通过对随机对照试验的系统检索和回顾,评估DBT治疗高血压的总体降压效果,比较器械引导与非器械引导DBT的降压效果,评估DBT的安全性和依从性。方法:检索PubMed和Cochrane数据库中的随机临床试验(RCT)。搜索词被分成三个词组:a)高血压,b)深呼吸技巧,c)试验。然后,将文章列表分为五组,每组有2 - 3名审稿人,通过阅读标题和摘要来验证每一项研究是否符合纳入和排除标准。必要时,我们下载文章,通过阅读方法、结果和讨论来验证依从性。有两票或两票以上的研究被选中。接下来,下载并阅读所有选定的文章,以分析结果和效应大小,并确认正确的方法和统计分析。结果:我们从119篇文章中筛选出4篇。文献中有一个矛盾;一项研究证实DBT与对照组之间没有总体差异,两项研究证实有统计学显著差异,一项研究报告办公室血压无差异,但对照组“清醒,在家”监测有统计学差异。因此,需要大规模、高质量的临床试验来严格评估长期DBT治疗HTN的有效性。
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引用次数: 0
Editorial - The Use of Large Language Models in Science: Opportunities and Challenges. 社论 - 大型语言模型在科学中的应用:机遇与挑战。
Pub Date : 2023-07-10 DOI: 10.21801/ppcrj.2023.91.1
Bassel Almarie, Paulo E P Teixeira, Kevin Pacheco-Barrios, Carlos Augusto Rossetti, Felipe Fregni
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引用次数: 0
The Benefits of Probiotics on Depression: A Systematic Mini-Review 益生菌对抑郁症的益处:一项系统的小型综述
Pub Date : 2023-07-10 DOI: 10.21801/ppcrj.2023.91.6
R. Caruso, Jose Luis Chamba Rospigliosi, Mariana Checo, Lilia Maria Lima de Oliveira, Giovani Schulte Farina, Karen Barros Parron Fernandes, Angelica Valeria Jaldin-Pinto, Naira Link, Aimee Mercado Dominguez, Joyce Meza-Venegas, I. Mohamed, Lauren Nirta, T. Nishizawa, Ibrahim Antonio Radi-Zahran, P. Urja, Celso Francisco Pimentel Vespasiano, Arturo Tamayo
Introduction: Evidence from randomized controlled trials investigating the effects of probiotics on depression published in the last four years has not yet been synthesized. The current systematic mini-review aimed to summarize the impact of probiotics in adults diagnosed with major depression with mild, moderate, or severe symptoms using studies published after May 2018. Methods: A systematic literature search was conducted in PubMed, Web of Science, and Embase databases to identify randomized controlled trials that investigated the effect of any strain of probiotics alone or as an add-on therapy for the treatment of adult patients with mild, moderate, or severe symptoms of major depression and without other neurological and/or psychiatric disorders, published between May 2018 and August 2022. Data were extracted and qualitatively reviewed to determine the treatment effect. In addition, the quality of the methodology and risk of bias was assessed using the Cochrane risk-of-bias tool (RoB 2). Results: Five studies met the inclusion criteria. All were randomized, parallel-group, placebo-controlled, double-anonymized trials with probiotics administered as an add-on therapy for treating mild and moderate symptoms of major depression only. In total, 303 patients (18–65 years) were randomized and treated with probiotics for 1–3 months. Four studies showed positive treatment effects, while one showed no difference between groups. Discussion: There is encouraging evidence showing the potential beneficial effect of probiotics as an add-on treatment for patients with major depression with mild-to-moderate symptoms. However, future phase III trials are required to corroborate these results.
引言:过去四年中发表的研究益生菌对抑郁症影响的随机对照试验的证据尚未合成。目前的系统小型综述旨在利用2018年5月后发表的研究,总结益生菌对诊断为轻度、中度或重度抑郁症的成年人的影响。方法:在PubMed、Web of Science和Embase数据库中进行系统的文献检索,以确定随机对照试验,这些试验调查了任何菌株的益生菌单独或作为附加疗法对患有轻度、中度或重度抑郁症症状且无其他神经和/或精神障碍的成年患者的治疗效果,发表于2018年5月至2022年8月。提取数据并进行定性审查,以确定治疗效果。此外,使用Cochrane偏倚风险工具(RoB2)评估方法的质量和偏倚风险。结果:5项研究符合纳入标准。所有这些都是随机、平行组、安慰剂对照、双重匿名试验,使用益生菌作为附加疗法,仅治疗轻度和中度重度抑郁症症状。总共有303名患者(18-65岁)被随机分组,并接受益生菌治疗1-3个月。四项研究显示了积极的治疗效果,而一项研究显示两组之间没有差异。讨论:有令人鼓舞的证据表明,益生菌作为轻度至中度症状的重度抑郁症患者的附加治疗药物,具有潜在的有益效果。然而,未来的第三阶段试验需要证实这些结果。
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引用次数: 0
Anti-inflammatory Effects of Topical Hypericum perforatum: A Systematic Review 局部贯叶连翘的抗炎作用:系统综述
Pub Date : 2023-07-10 DOI: 10.21801/ppcrj.2023.91.8
Mónica M. Estrada, R. Chávez-Nomberto, A. Crestani, Ana Paula Tsuneto, C. Awad, Carlos Takahiro Chone, D. Kimura, Devy Quiroz, Erivelton de Azevedo Lopes, Habiba Ibrahim Abdullah, Jacob Eli García Torres, J. Díaz-Schmidt, Levi H Jales Neto, Luís Fernando López, Maria Bazan, Matteo Guidetti, Piero Larco-Castilla, Santiago Sucre, S. Bola-Oyebamiji, Jimena Vizarreta Rosas, Alessandra Carvalho
Introduction: Many inflammatory conditions directly impact the skin through different pathways, the understanding of which should be a priority to develop new medications to treat patients suffering from these conditions. Some studies have demonstrated the anti-inflammatory properties of Hypericum perforatum (HP), but no previous systematic reviews have described all the mechanisms by which topical HP may act on inflammation. Therefore, the purpose of this review was to assess the effects of topical HP on inflammatory markers in inflammatory skin conditions or models involving epithelial cells that have been described so far. Methods: The databases PubMed, Scopus, Research4Life (HINARI), and SciELO were used to retrieve experimental and observational studies, from inception to September 25, 2022, reporting the effects of HP on inflammatory markers in inflammatory skin conditions or models involving epithelial cells. We used the following keywords: Hypericum perforatum, H. perforatum, Saint John’s wort, hypericin, hyperforin, inflammation, pro-inflammatory, inflammatory, inflammatory biomarkers, chemokine, prostaglandin, inflammation mediators, TNF, and tumor necrosis factor. Results: From 348 articles screened, 11 were selected based on inclusion and exclusion criteria: two in vitro studies, eight animal studies, and one human pilot trial. A reduction in proliferation and proinflammatory pathways, IL-8 modulation, and a decrease in TNF expression were the main findings reported in the included studies. Discussion: HP has shown promising effects in reducing inflammatory biomarkers in inflammatory skin diseases and experimental models of epithelial cells. Further studies should confirm this herb’s clinical significance and future applications.
引言:许多炎症疾病通过不同的途径直接影响皮肤,了解这些途径应该是开发治疗这些疾病患者的新药的优先事项。一些研究已经证明了贯叶金丝桃(HP)的抗炎特性,但之前没有系统综述描述局部HP可能作用于炎症的所有机制。因此,这篇综述的目的是评估局部HP对炎症性皮肤状况或涉及上皮细胞的模型中炎症标志物的影响,迄今为止已经描述过。方法:使用PubMed、Scopus、Research4Life(HINARI)和SciELO数据库检索从开始到2022年9月25日的实验和观察性研究,报告HP对炎症性皮肤状况或涉及上皮细胞的模型中炎症标志物的影响。我们使用了以下关键词:贯叶金丝桃、贯叶H.、圣约翰草、金丝桃素、金丝桃苷、炎症、促炎、炎症生物标志物、趋化因子、前列腺素、炎症介质、TNF和肿瘤坏死因子。结果:从筛选的348篇文章中,根据纳入和排除标准选择了11篇:两项体外研究、八项动物研究和一项人体试验。增殖和促炎途径的减少、IL-8的调节以及TNF表达的减少是纳入研究中报告的主要发现。讨论:HP在减少炎症性皮肤病和上皮细胞实验模型中的炎症生物标志物方面显示出良好的效果。进一步的研究应该证实这种草药的临床意义和未来的应用。
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引用次数: 0
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Principles and practice of clinical research (2015)
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