PRISMA-A's findings indicated that a substantial 339% of items were documented, yet crucial details regarding registration, limitations, and funding remained absent from numerous publications. Applying the Grading of Recommendations, Assessment, Development, and Evaluation methodology to the evidence, it was determined that more than half (52 studies out of 83) showed either a low or very low level of evidence. Systematic reviews/meta-analyses concerning traditional Chinese medicine for ischemic stroke exhibit a deficiency in abstract reporting quality, impeding the timely dissemination of reliable data to clinical practitioners. The methodological rigor, although at an intermediate level, does not guarantee the reliability of the evidence, especially with the high risk of bias observed in the separate investigations.
In traditional Chinese herbalism, Radix Rehmanniae Praeparata (RRP), also called Shu Dihuang, plays a significant role in remedies for Alzheimer's disease (AD). Despite this, the intricate process of RRP within the framework of Alzheimer's Disease is still poorly understood. This study aimed to explore the therapeutic impact of RRP on streptozotocin-induced Alzheimer's disease (AD) model mice via intracerebroventricular injection, along with its underlying mechanisms. For 21 days, ICV-STZ mice were orally gavaged with RRP on a continuous basis. Pharmacological efficacy of RRP was examined by employing behavioral assays, histological evaluations of brain tissue (H&E stain), and measurement of hippocampal tau protein phosphorylation. Through Western blotting, the levels of insulin receptor (INSR), IRS-1, pSer473-AKT/AKT and pSer9-GSK-3/GSK-3 proteins were assessed within the hippocampal and cortical tissues. To examine modifications in the intestinal microbiota of mice, 16S rRNA gene sequencing was utilized. Mass spectrometry was used to analyze the compounds in RRP, followed by molecular docking to assess their binding affinity to INSR proteins. The findings revealed that RRP mitigated cognitive impairment and brain tissue neuronal pathologies in ICV-STZ mice, decreasing hyperphosphorylation of tau protein, INSR, IRS-1, pSer473-AKT/AKT, and pSer9-GSK-3/GSK-3 levels within hippocampal and cortical tissues. RRP reversed the ICV-STZ-induced dysregulation of intestinal microbiota observed in AD mice. Mass spectrometry examination demonstrated the RRP's principal components to be seven compounds: Acteoside (Verbascoside), 5-Hydroxymethyl-2-furaldehyde (5-HMF), Apigenin7-O-glucuronide, Icariin, Gallic acid, Quercetin-3-D-glucoside, and Geniposide. Molecular docking studies provided additional evidence of RRP compounds' ability to interact with the INSR protein, potentially leading to multiple synergistic effects. RRP treatment demonstrably reduces cognitive impairment and brain tissue abnormalities in AD mice models. The manner in which RRP mitigates AD symptoms could involve a complex interplay between the INSR/IRS-1/AKT/GSK-3 signaling pathway and the intestinal microbiota. This study provides evidence supporting the potential anti-Alzheimer's drug efficacy of RRP, simultaneously shedding light on the pharmacological mechanism of RRP, thus establishing a theoretical framework for future clinical trials of RRP.
The antiviral drugs, encompassing Remdesivir (Veklury), Nirmatrelvir with Ritonavir (Paxlovid), Azvudine, and Molnupiravir (Lagevrio), can minimize the threat of severe or fatal cases of Coronavirus Disease (COVID-19). Chronic kidney disease, a common risk factor for severe and fatal COVID-19, was frequently overlooked in most clinical trials involving these medications, thereby excluding patients with compromised renal function. Advanced CKD is frequently accompanied by a secondary immunodeficiency (SIDKD), which boosts susceptibility to severe COVID-19, its complications, and the risk of hospitalization and death among those infected with COVID-19. Patients who have chronic kidney disease (CKD) are at a considerably higher risk of developing acute kidney injury as a consequence of COVID-19 infection. Selecting appropriate treatments for COVID-19 in patients exhibiting compromised kidney function poses a considerable problem for healthcare providers. This paper investigates the pharmacokinetic and pharmacodynamic aspects of COVID-19-related antiviral agents, highlighting their potential utility and appropriate dosing strategies for COVID-19 patients experiencing different stages of chronic kidney disease. In addition, we elaborate on the negative side effects and the precautions to observe when prescribing these antivirals to COVID-19 patients with compromised kidney function. Finally, we also delve into the application of monoclonal antibodies in COVID-19 patients exhibiting kidney ailments and their associated complications.
Potentially inappropriate medications (PIMs) negatively impact the health of elderly individuals, contributing to a widespread healthcare problem. Researchers explored the incidence of PIM in hospitalized patients with diabetic kidney disease (DKD), including the elderly, and explored if their use of numerous medications was related to the issue. MT-802 A retrospective analysis was conducted on patients with DKD, aged 65 and older, diagnosed from July to December 2020. The assessment of PIM was based on the 2019 American Beers Criteria. Factors exhibiting statistical significance in the initial univariate analysis were selected for further investigation using multivariate logistic regression, examining potential risk factors for PIM. Data included 186 patients, with 65.6% experiencing PIM, and confirmed 300 items. Drugs that should be used with caution by older adults presented the most prevalent PIM rate, at 417%, followed by a 353% incidence of drugs best avoided during hospitalization periods. The frequency of PIMs in renal insufficiency patients linked to disease or symptoms, unavoidable drug interactions, and the necessity to alter or avoid certain medications were 63%, 40%, and 127% respectively. Diuretics, benzodiazepines, and peripheral 1 blockers exhibited a high incidence of PIM, with increases of 350%, 107%, and 87%, respectively. Patients released from the hospital showed a 26% rise in post-discharge patient important measures (PIM). MT-802 Analysis using multivariate logistic regression demonstrated that multiple medications during hospitalization were an independent predictor of PIM, with an odds ratio of 4471 (95% confidence interval 2378-8406). The substantial incidence of PIM in hospitalized older DKD patients underscores the need for heightened attention to polypharmacy in this group. Pharmacists, by pinpointing the subtypes and risk factors of PIM, may create an environment for decreased risk among older DKD patients.
Due to the swelling number of older adults and the proliferation of multiple diseases, polypharmacy and chronic kidney disease (CKD) are showing an upward trend in prevalence. Managing CKD and its complications, as per therapeutic guidelines, often requires prescribing multiple medications, increasing the patient's susceptibility to polypharmacy. The aim of this systematic review and meta-analysis is to characterize the prevalence of polypharmacy in CKD patients and to examine global patterns of contributing factors to any discrepancies in prevalence estimations. PubMed, Scopus, the Cochrane Database of Systematic Reviews (CDSR), and Google Scholar were utilized for a literature search spanning the period from 1999 to November 2021. MT-802 Two independent reviewers collaboratively but separately ensured thoroughness in study selection, data extraction, and critical appraisal. Employing a random effects model, the pooled prevalence of polypharmacy was determined, applying the default double arcsine transformation. Fourteen studies, forming the basis of this review, included a total of 17,201 participants, a considerable percentage of whom identified as male (56.12%). Based on the reviews, the mean age of the population was 6196 years, with a standard deviation of 1151 years. The overall prevalence of polypharmacy in patients with chronic kidney disease (CKD) was 69% (95% CI 49%-86%), particularly higher in North America and Europe than in Asia (I2 = 100%, p < 0.00001). This meta-analysis's findings indicated a substantial aggregate prevalence of polypharmacy observed across the various CKD patient groups. Future, thorough, prospective, and systematic studies are required to determine the exact interventions capable of meaningfully mitigating its effect, which currently remains uncertain. The registration of the systematic review, CRD42022306572, is documented on the [https//www.crd.york.ac.uk/prospero/] platform.
A global public health crisis, cardiac fibrosis is deeply intertwined with the progression of various cardiovascular diseases (CVDs), detrimentally affecting both the disease's trajectory and clinical predictions. Research findings consistently support the TGF-/Smad signaling pathway's fundamental role in driving the progression of cardiac fibrosis. Hence, the purposeful interruption of the TGF-/Smad signaling pathway might be a therapeutic approach to cardiac fibrosis. A growing body of research on non-coding RNAs (ncRNAs) is revealing various ncRNAs that have been identified as targeting TGF-beta and its downstream Smad proteins, prompting considerable attention. In addition, Traditional Chinese Medicine (TCM) has been frequently employed in addressing cardiac fibrosis. The growing body of evidence on the molecular mechanisms of natural products, herbal formulas, and proprietary Chinese medicines supports the therapeutic action of Traditional Chinese Medicine (TCM) in regulating cardiac fibrosis by modulating multiple targets and signaling pathways, most notably the TGF-/Smad pathway. Consequently, this study provides a comprehensive overview of TGF-/Smad classical and non-classical signaling pathways' roles in cardiac fibrosis, along with a review of recent advancements in non-coding RNA (ncRNA) targeting of the TGF-/Smad pathway and Traditional Chinese Medicine (TCM) for cardiac fibrosis treatment. Through this avenue, a new understanding of the prevention and treatment of cardiac fibrosis is sought.