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Psilocybin Treatment for Refractory Depression: A Clinical Review
Full text linkIntroduction:
Depression is a widespread mental illness that affects a large portion of the world population and many of those who suffer from depression are resistant to treatment currently available. The purpose of this review is to compare the efficacy of psilocybin to the current available methods for the treatment of refractory depression.
Methods:
PubMed was searched with the key search terms: resistant depression, psilocybin therapy, and adults. Operators and filters narrowed down the search to 43 results. Four articles were then chosen based on quality and specificity with this review.
Results:
The articles included in this review compare the effectiveness of psilocybin to the currently available treatment methods for depression. Each of these articles found psilocybin to be a fast acting, effective treatment for treatment resistant depression.
Discussion:
Early results regarding psilocybin as a treatment for treatment resistant depression suggest psilocybin is efficacious. Due to the hallucinogenic nature of psilocybin and the current stigma surrounding the drug, more research is needed to determine safety profile and effective doses
Prevention of the Recurrence of Skin Cancer with the Use of Nicotinamide
Full text linkIntroduction: Skin cancer is the most common form of cancer worldwide, caused by the accumulation of UV ray exposure that people are exposed to daily. The treatment options for skin cancer are costly and inconvenient, with a high chance of recurrence in different sun-exposed areas. Nicotinamide, a form of vitamin B3, has shown promising outcomes in reducing the chance of recurrent in high-risk individuals. The purpose of this review is to examine recent literature on the effectiveness of nicotinamide supplementation in lowering the risk of skin cancer recurrence compared to individuals who do not take it.
Methods: A comprehensive PubMed search was conducted to identify clinical trials and reviews evaluating the efficacy of nicotinamide in reducing the recurrent of skin cancer in high-risk individuals. Four studied met the inclusion criteria and were selected for this paper.
Results: Two analyses and two randomized controlled trials favored a significant reduction in non-melanoma skin cancer (NMSC). One study concluded that the possible increased infection risk outweighed the effectiveness of the supplement in some patients’ decision-making process, while another study found that nicotinamide may be more beneficial on a histologic or genetic level rather than the reduction of active lesions.
Discussion: Across four studies, there was an overall significant reduction in NMSC recurrence with the use of oral nicotinamide. Further investigation is needed to determine the long-term side effects of nicotinamide and whether adjunct treatment may be the most effective management
Post-Surgical Prognostic Outlook Comparison of Off-Pump vs. On-Pump CABG Procedures
Full text linkIntroduction: Coronary artery disease in the United States had 680,981 deaths in 2023 alone with 400,000 CABG procedures being done. Coronary artery bypass grafting is a procedure in which coronary arteries occluded by fatty plaques are revascularized to restore blood flow to the myocardium. There are two effective options for this procedure, one being the on-pump approach, and the other being off-pump. Both methods carry risks, such as stoke and MI, as well as benefits, but the question of which carries the better outlook on mortality and complications is up for debate. The purpose of this paper is to study and determine which option truly has an edge of the other when it comes to decreased rates of mortality, stroke, and other perioperative complications.
Methods: PubMed was searched for clinical trials, meta-analyses, and studies using the terms “coronary artery bypass,” “off-pump,” and “outcomes” to determine if the on-pump CABG or off-pump carries the better prognosis. 15 resulted and 4 articles were selected for clinical review.
Results: The study resulted in two articles showing no significant statistical difference between the two options with an OR of 0.876, while the other two stated that the off-pump approach carried the better prognosis. Patient comorbidities and age were noted in each of the four studies while one study found significantly higher rates of MI, without regard to type of CABG in the 51-60 year-old age group. Adverse complications were more common in the short-term (less than 90 days) when looking at the on-pump procedure, but the risk for complication from mid- to late-term (3 months and beyond) was relatively the same for both surgical methods.
Conclusion: Off-pump coronary artery bypass showed statistical evidence for being the more efficacious of the two procedures. Further research is needed to determine the better of the two methods with a larger sample size and studies that follow patients over a longer period of time
The Gut Microbiome’s Effect on Metabolic Syndrome
Full text linkIntroduction: Metabolic Syndrome (MetS) is a chronic condition characterized by insulin resistance and low-grade inflammation. The purpose of this review is to focus on pre-/pro/symbiotic supplementation as a means of improving MetS parameters in place of pharmacological intervention.
Methods: PubMed was searched with the terms “metabolic syndrome”, “obese”, “obesity”, “overweight”, “insulin resistance”, “insulin sensitivity”, “probiotic”, “symbiotic”, and “bifidobacter*”. Operators and filters narrowed the results down to 55 results, 4 of which were picked due to their relevance and quality.
Results: The 4 articles chosen were RCT and a systematic review that explored the Bifidobacterium genus in relationship to the MetS parameters. One systematic review focused on all interventions on the gut microbiome that impacted dysbiosis. The second systematic review focused on different types of pre-/pro-/symbiotic. The RCT either used a probiotic or symbiotic with the Bifidobacterium bacteria and measured the markers of MetS before and after the trial period. Specifically, one of the RCTs used a symbiotic plus dietary intervention’s impact on MetS.
Discussion: The articles that were reviewed yielded mixed results. Pre/pro/symbiotic supplementation containing Bifidobacteria seems to be safe for treating, but does not appear to be equivalent or superior to the current standard of care. More research should be conducted to determine what type of pre-/pro/symbiotics should be used for the improvement of MetS
Deep Brain Stimulation for the Management of Non-motor Symptoms Related to Parkinson’s Disease
Full text linkIntroduction: Deep brain stimulation (DBS) is a modern neurosurgical technique where electrodes are implanted in specific brain areas and deliver electrical impulses in order to help regulate abnormal brain activity. DBS is used for the management of several neurological conditions and was approved by the FDA for the treatment of Parkinson’s disease in 2003. The purpose of this review is to analyze the effectiveness of DBS for the management of the non-motor symptoms related to Parkinson\u27s disease.
Methods: PubMed was searched using the key terms “Parkinson disease,” “deep brain stimulation,” “voice,” “sleep,” “mood,” “cognition,” and “dysphagia.” Operators and filters narrowed results to 87 articles. The top six most relevant, quality articles were chosen for review.
Results: One study was a meta-analysis, one study was a systematic review, and one study was a randomized controlled trial. Three studies were combined meta-analyses and systematic reviews. Standard mean differences, 95% confidence interval (CI), and significant P-value of \u3c 0.05 were used to evaluate the data.
Discussion: The articles reviewed showed that DBS has a positive effect on depression, anxiety, sleep quality, and quality of life in PD patients. DBS was seen to have minimal effect on dysphagia and speech and voice quality. Results may imply that DBS has a negative effect on memory, executive function, and cognitive decline. Further research is needed to explore the long-term effect of DBS and specific DBS stimulation techniques most effective for non-motor PD symptoms
The Efficacy of CGRP Antagonists versus Other Non-Migraine Specific Medications as Prophylactic Treatment for Episodic and Chronic Migraine
Full text linkIntroduction: Migraines are a disabling neurological condition affecting 12-15% of the population. Migraines are characterized by a unilateral throbbing headache lasting between 4 and 72 hours, often accompanied by photophobia, phonophobia, nausea, or vomiting. Until the approval of the first CGRP antagonist, Erenumab, in May 2018, the prophylactic treatment for migraines relied on non-migraine-specific medications, such as antihypertensives and antiepileptics. Studies have been done to determine the efficacy and safety of the new medications, but few have directly compared them to older non-migraine-specific medications used for prevention. The purpose of this paper is to compare the efficacy of CGRP antagonists to older and commonly prescribed prophylactic medications for the prevention of migraine.
Methods: A PubMed search using the keywords “migraine” AND “CGRP antagonists” AND [other prophylactic medications] AND “migraine prevention” with additional specifiers resulted in 17 articles. Five studies were selected for review after thorough evaluation of the content. These studies included four systematic reviews with meta-analyses and one randomized controlled trial (RCT) comparing the efficacy of the different medications.
Results: Results of the reviewed data favored the efficacy and tolerability of CGRP antagonists over other non-migraine-specific prophylactic medications for the prevention of migraines. The studies reported their results based on the reduction of monthly migraine days in the form of relative risk (RR), odds ratio (RR), or mean change from baseline.
Discussion: This review suggests that while the efficacy of the newer CGRP antagonists and the older commonly prescribed medications may be comparable, CGRP antagonists appear to be better tolerated. The improvement in tolerability would ultimately lead to increased compliance and a reduction of the migraine burden worldwide
Efficacy and Safety of Semaglutide in Adults without Diabetes who are Overweight or Obese
Full text linkINTRODUCTION:
Obesity is associated with an increased risk of cardiovascular and metabolic disorders and contributes to the leading cause of death in the US — heart disease. Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have recently emerged as a treatment option for obesity. The purpose of this clinical review is to evaluate the efficacy and safety of semaglutide in adults without diabetes who are overweight or obese.
METHODS:
PubMed was searched using a precise search strategy and the key terms “semaglutide,” “weight loss,” and “without diabetes.” Results were filtered and narrowed using specific inclusion and exclusion criteria. Four high-quality studies were selected for review. This included two RCTs and two systematic reviews and meta-analyses.
RESULTS:
The two RCTs compared semaglutide to placebo and studied a combined total of 17,908 participants. The two systematic reviews and meta-analyses studied a total of 12 RCTs and over 8,000 participants. These studies evaluated the efficacy and safety of semaglutide by measuring outcomes such as percent weight loss, BMI, waist circumference, blood pressure, HbA1c, and adverse events.
DISCUSSION:
The data was equivocal across all studies. Semaglutide led to increased weight loss compared to the placebo. There were increased adverse events with semaglutide. The most common were gastrointestinal effects with most being mild to moderate. There was some concern for potential bias in three of the four studies due to affiliation with pharmaceutical companies. Overall, the results suggest semaglutide is a safe and effective treatment for obesity in adults without diabetes who are overweight or obese but further studies are needed to address long-term efficacy, discontinuation, obesity relapse, and accessibility
Hyaluronic Acid versus Corticosteroids in Osteoarthritis of the Knee
Full text linkIntroduction: Osteoarthritis is a very common degenerative disease seen in older adults that is typically due to repetitive movements of the joints over time. Without treatment, osteoarthritis can progress and cause individuals to have decreased function and quality of life. The purpose of this review is to evaluate the effectiveness of hyaluronic acid injections compared to corticosteroid injections in treating osteoarthritis of the knee.
Methods: PubMed was searched with a specific search strategy using key terms “knee osteoarthritis”, “hyaluronic acid”, and “corticosteroids”. Operators and filters were applied to narrow 572 results down to 40. 15 articles were reviewed and 4 relevant, quality articles were chosen for final clinical review.
Results: Three of the studies directly compared hyaluronic acid injections to corticosteroid injections in osteoarthritis of the knee. One study compared corticosteroid injections, hyaluronic acid injections, and platelet rich plasma injections in osteoarthritis of the knee.
Discussion: The studies in this review showed that hyaluronic acid injections were more effective in pain reduction for osteoarthritis of the knee. The studies also showed that both corticosteroid injections and hyaluronic acid injections were equally as safe for use in osteoarthritis of the knee with no difference statistically in adverse effects
Safety and Efficacy of Stroke Prevention with Warfarin vs. Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Clinical Review
Full text linkIntroduction: Atrial fibrillation is one of the most common cardiac arrhythmias in adults. This condition greatly increases a patient’s risk for ischemic stroke and is responsible for one-third ischemic strokes. Current international guidelines recommend the use of oral anticoagulants for stroke prevention in patients with atrial fibrillation. The purpose of this review is to analyze the current literature directly comparing the safety and efficacy of direct oral anticoagulants and warfarin at preventing stroke.
Methods: The PubMed database was searched for the following key terms: vitamin k antagonist, direct oral anticoagulants, stroke, and atrial fibrillation. Boolean operators and MeSH terms related to these key words were added to the search. These results were then filtered only to include free full text articles, meta-analyses, and systematic reviews between 2020 – 2025. These studies were further screened for methodology and relevance to my PICO question, leading to four high-quality meta-analyses for review.
Results: The authors of the four meta-analyses, comparing direct oral anticoagulants and warfarin, demonstrated significant increases in efficacy of direct oral anticoagulants versus warfarin at preventing stroke in patients with atrial fibrillation. The statistical analyses performed in the studies suggested a decreased risk for hemorrhagic stroke and intercranial bleeding with direct oral anticoagulants.
Discussion: Results from the four meta-analyses demonstrated that direct oral anticoagulants are more effective than warfarin at stroke prevention and safer as they do not increase patient risk for major bleeding. This evidence suggests that direct oral anticoagulants are superior to warfarin for stroke prevention in patients with atrial fibrillation. Further research is required to standardize dosages and evaluate which direct oral anticoagulant is the most effective
Injection or ingestion: A Comparative Review of Antipsychotic Delivery Methods and Patient Outcomes in Schizophrenia
Full text linkIntroduction: Schizophrenia is a chronic psychiatric disorder that causes significant functional impairment and decreased quality of life for those who suffer from it. The purpose of this review is to compare the use of long-acting injectable (LAIs) antipsychotics with oral antipsychotic medications and to evaluate which treatment modality provides more favorable outcomes in terms of symptom control, adherence, and relapse prevention.
Methods: PubMed was searched to find articles examining the efficacy of both long-acting injectables and oral antipsychotics, and why long-acting injectables are becoming the preferred method of delivering treatment to patients suffering from schizophrenia. Four articles were selected for this review.
Results: In two systematic reviews, it was found that LAIs have a better overall outcome on patient symptoms, hospitalization rate, and treatment adherence when compared to its oral-formulation counterparts. One systematic review concluded that while LAIs and oral antipsychotics are similar in the treatment of schizophrenia symptoms, LAIs were more efficacious in treating symptoms in patients who can be categorized into specific subgroups. The RCT that was reviewed found that oral antipsychotics were slightly more effective than LAIs at reducing patient symptoms over 10 weeks, but not statistically significant enough to claim superiority of one over the other.
Conclusion: While quantitative data does not find a definitive superior formulation for the treatment of schizophrenia, research does consistently show that LAIs show more favorable outcomes in certain clinical scenarios and when aiming to achieve certain goals of treatment in patients with schizophrenia. As more research is performed to examine these subgroups, more data will be found to further solidify the benefits of LAIs, potentially making them the clear superior formulary for treating schizophrenia