9814 research outputs found
Sort by
GLP-1 Agonists for Pediatric Obesity: A Clinical Review
Full text linkIntroduction: Pediatric obesity is a chronic disease with multiple complex causes and many potential consequences if carried into adulthood. Lifestyle modifications alone have not been effective for all patients in the treatment of pediatric obesity. GLP-1 RAs already being prescribed in the adult population were also recently approved for pediatric patients. The purpose of this clinical review is to analyze the efficacy of GLP-1 RAs in decreasing markers associated with obesity, such as BMI, cholesterol, etc. in pediatric patients diagnosed with obesity.
Methods: PubMed was first searched using synonyms of the keywords “pediatric obesity,” “GLP-1 agonists,” “lifestyle modifications,” and “biomarkers of obesity.” Boolean terms and parentheses were also used. A second search was conducted, omitting the terms related to lifestyle modifications. A total of 137 articles were found, and this was narrowed down to 15 articles with filters. Six systematic reviews/meta-analyses were selected for review based on study characteristics.
Results: Results were inconclusive as treatment with the GLP-1 agonists studied had varying effects on body weight, waist circumference, BMI, HbA1c, FPG, lipid profiles, and blood pressure. The greatest reductions in body weight and BMI were observed in studies where lifestyle modifications were used concurrently with GLP-1 RAs.
Discussion: Although some results analyzed in these studies were promising in decreasing the biomarkers of obesity in pediatric patients, the varying effectiveness found necessitates further research, specifically with larger sample sizes and longer duration of therapy. Consideration should be given to the use of GLP-1 RAs, and shared decision-making will continue to play a vital role in treating pediatric obesity
The Role of Conjunctive Hyperbaric Oxygen Therapy in Decreasing Amputations in those with Diabetic Foot Ulcers: A Clinical Review
Full text linkDiabetic Foot Ulcers (DFU) are a common complication of Diabetes Mellitus, which is the most common cause of amputations in the US. The purpose of this clinical review is to analyze the impact of Hyperbaric Oxygen Therapy on reducing amputations and improving healing rates in DFUs. PubMed was searched using the key terms “Diabetic Foot Ulcer,” “Amputation,” and “Hyperbaric Oxygen Therapy.” With the addition of filters, Mesh terms, and Boolean operations, 18 results were yielded. The inclusion and exclusion criteria narrowed the search to 6 articles, which were used for this review. The 6 articles included in this study were meta-analyses, comparing adjunctive HBOT to standard wound care. Primary endpoints included wound size, infection, amputation, and mortality. Collectively, the adjunctive use of the Hyperbaric Oxygen Chamber to standard wound care shows superior healing rates and a decrease in major amputation rates in chronic wounds compared to standard wound care alone. Future research is needed to determine the adverse effects and increase the sample size
Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on COVID-19 Outcomes in Severely Ill Patients
Full text linkIntroduction: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the virus SARS-CoV-2 and can cause debilitating illness in vulnerable patient populations. The purpose of this clinical review is to analyze the effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the clinical course and severity in COVID-19 adult patients.
Methods: PubMed was searched with a specific search strategy using key terms “adult,” “COVID-19,” and “RAAS inhibiting medications.” Specific operators and filters narrowed the results to a total of five relevant, quality articles for review.
Results: Two articles were randomized controlled trials that directly compared the continuation of ACEI or ARB use to the discontinuation of ACEI or ARB use in COVID-19 patients. One article was a randomized controlled trial that directly compared the initiation of ACEI or ARB therapy versus no initiation of ACEI or ARB therapy in COVID-19 patients. Two articles were meta-analyses that discussed findings of RAS inhibition in patients with COVID-19. Results overall support no significant effects of ACEI or ARB drug therapy on COVID-19 severity or outcomes.
Discussion: The articles reviewed generated largely neutral results, in that both the continuation or discontinuation of RAS inhibition do not appear to significantly affect the course or severity of COVID-19. Some results were mixed, in that some did suggest that outcomes could be improved with RAS inhibition use, while others suggested outcomes would be worsened. Additional research including longer term follow-up and high-quality studies is needed, but the evidence of this review largely does not support standard discontinuation or initiation of ACEIs or ARBs in patients with COVID-19
The Effects of a Gluten-Free Diet on Patients with Hashimoto’s Thyroiditis
Full text linkIntroduction: Hashimoto’s thyroiditis is a chronic autoimmune inflammatory condition of the thyroid gland. Hashimoto’s occurs in five percent of the American population and is the most common cause of hypothyroidism in the US. There are various comorbidities associated with Hashimoto’s, which treatment can help mitigate some of those risks. The purpose of this paper is to evaluate if a gluten-free diet, as an adjunct treatment, can lower autoimmune related antibodies while improving thyroid labs levels.
Methods: PubMed was searched for clinical reviews using key terms “Hashimoto’s disease”, “hypothyroidism”, “gluten”, and “anti-TPO antibodies”. Operators and additional filters narrowed down search results to four appropriate articles for review.
Results: Two articles agree that a decrease in thyroid antibodies, anti-TPO and anti-TG, can occur with a gluten-free diet when a patient has both Hashimoto’s and gluten-related conditions or celiac. The other two articles did not find any significant changes in anti-TPO with a gluten-free diet. Only one reported a lowered TSH and fT4 in the setting of gluten-related conditions.
Discussion: The articles reviewed have varied results. A gluten-free diet is recommended for patients who have both Hashimoto’s and celiac. Further research needs to be conducted in larger patient populations who only have Hashimoto’s before making a definitive recommendation. There is some current research that suggests a gluten-free diet in a non-celiac patient with Hashimoto’s may cause more long-term harm by causing additional metabolic problems
Understanding the Efficacy of Photodynamic Therapy in Comparison to Topical Therapies in Treating actinic Keratosis in those at Increased Sun Exposure Risk
Full text linkIntroduction: Actinic keratoses are precancerous skin lesions that arise secondary to increased sun exposure. These lesions have a propensity to transform into non-melanoma skin cancers, mainly squamous cell carcinoma, if left untreated. There are a multitude of different treatment options for the prevention and clearance of these lesions. Among these options is photodynamic therapy (PDT). The purpose of this paper is to investigate the effectiveness of PDT when compared to other options for AK treatment.
Methods: A search was conducted using PubMed for studies to analyze the efficacy of PDT when compared to other treatment options. 3 articles were selected for use in this review.
Results: In 2 of the 3 selected studies; PDT was shown to have superior efficacy when compared to other treatment options in terms of both prevention and clearance rate of AKs. In the remaining study, PDT was ranked 3rd in patient complete clearance and lesion specific clearance, ranking just behind cryosurgery and topical agent, Ingenol Mebutate. PDT was shown to be superior to placebo in all 3 of the studies. In one study, the prophylactic capabilities were emphasized and recognized as greater than alternative treatment options in preventing formation of new AKs in photodamaged areas of skin. Side effects of the treatment were limited in each, consisting mainly of skin sensitivity after treatment and minor pain reported during treatment.
Conclusion: PDT is an efficacious treatment option when determining what the best approach is to not only treating but preventing AKs from forming and transforming into skin cancer. The frequency of necessary treatments needs to be further investigated to determine how often, and for how long treatments need to continue to see positive clinical results
Labor Induction versus Expectant Management in Postterm Pregnancy: A Clinical Review
Full text linkIntroduction: Postterm pregnancy is associated with increased morbidity and mortality of infant and mother. Current practice varies in the management of late- and postterm pregnancies, with much discussion surrounding the risks and benefits of the intervention options provided to pregnant patients. This study aims to review literature comparing the effectiveness of induction of labor (IOL) with elective management (EM) in reducing adverse perinatal and maternal outcomes for pregnant patients approaching postterm.
Methods: A literature search was performed on PubMed using key terms “late term pregnancy,” “induction of labor,” and “expectant management.” Operators and additional search filters narrowed results to 4 eligible articles for review.
Results: One article directly compared IOL at 41 0/7 weeks with EM. Three articles were meta-analyses of randomized controlled trials which compared IOL with EM. Reported primary outcomes included perinatal morbidity and mortality and delivery outcomes. Secondary outcomes included maternal morbidity and mortality.
Discussion: This review found that labor induction of pregnancies approaching postterm overall reduces the risk of perinatal morbidity and mortality when compared to EM. However, when compared with EM, IOL does not appear to reduce the risk of maternal morbidity and mortality. Further investigation among this important patient population of postterm pregnancies is needed in order to provide tailored recommendations for labor induction
Beyond Steroids: A Head-to-Head Review of Hyaluronic Acid and PRP in Knee Osteoarthritis
Full text linkIntroduction: Osteoarthritis of the knee is one of the most common primary complaints in the US. Newer injectable therapies that target specific cartilage degeneration are being developed. The purpose of this review is to compare the efficacy of PRP and HA injections for the management of knee osteoarthritis.
Methods: PubMed was searched using the key terms “osteoarthritis of the knee,” “hyaluronic acid,” “platelet-rich plasma,” and “management of pain.” This search was refined using MeSH terms, Boolean operators, and applied filters (English, free full-text, publication date between 2020-2025). Four articles were selected for in-depth review of the efficacy of platelet-rich plasma and hyaluronic acid for knee osteoarthritis.
Results: Three studies were meta-analyses, and one study was a randomized controlled trial. Three studies focused primary endpoints of WOMAC total and WOMAC pain scores comparing PRP and HA injections. One study analyzed the WOMAC total and WOMAC pain scores comparing PRP, HA, PRGF, and ozone injection among participants in the randomized control trial. All four studies evaluated the safety of the selected injectables for analysis.
Discussion: Intra-articular PRP showed better overall outcomes in terms of WOMAC total scores and WOMAC pain scores compared with HA for patients with knee osteoarthritis at 6 and 12 months post-intervention. However, there were no differences at short-term follow-up between PRP and HA. Future studies can aim to specify formulation and concentration for standardization, as well as conduct more studies on HA due to the limited studies available in the current literature
Pharmacologic Therapy versus Catheter Ablation for Atrial Fibrillation
Full text linkIntroduction- Atrial fibrillation is a common type of cardiac arrythmia that affects many people across the world. Patients with atrial fibrillation are at high risk for complications and poor outcomes. Stroke is the most prominent complication of atrial fibrillation if left untreated. The purpose of this clinical review is to analyze which modality is a better first line treatment, antiarrhythmic drug therapy or catheter ablation for long term management of this arrythmia.
Methods- Pubmed was searched with a specific search strategy using key terms “cardiac”, “Arrythmia”, “Antiarrhythmic agents”, “radiofrequency ablation”, and “surgical operation”. Operators and filters such as ((atrial fibrillation) OR (afib) OR (AF)) AND ((rhythm control) OR (antiarrhythmic)) AND ((ablation) OR (Radiofrequency ablation) OR (Cryoablation) OR (Pulsed Field Ablation) OR (Laser Ablation) OR (Catheter Ablation)) AND (Recurrence) narrowed results to 81 articles. These articles were further investigated for direct correlation to the intended question and four quality articles were selected to be included in this review.
Results- The four articles compared antiarrhythmic drugs to catheter ablation techniques for the treatment of atrial fibrillation. The studies collected data to track effectiveness of ablation therapy versus antiarrhythmic drug therapy in reducing the recurrence of atrial fibrillation. Data was gathered in most studies over a span of six months to two years. Results supported the use of catheter ablation over drug therapy for first line treatment. This was a consistent finding in all studies with each using 95% confidence intervals and statistically significant P values (P\u3c .001).
Discussion: The articles reviewed lean strongly in favor of ablation therapy for the initial management of atrial fibrillation. Less reoccurrences of atrial tachycardias were reported when utilizing ablation therapy. Antiarrhythmic drug therapy continues to be the initial treatment of choice due its convenience despite current research. Data from the articles included in this review show low risks of adverse events with ablation procedures. Further research and diverse sample groups is necessary for ablation therapy to move towards initial treatment of choice. Benefit of this procedure must be backed by significant data over longer periods of time. This will alleviate potential weaknesses of the study and show how ablation therapy is most effective for patient outcomes and efficient for our healthcare system
Hyaluronic Acid for the Treatment of Knee Osteoarthritis: A Clinical Review
Full text linkIntroduction: Osteoarthritis of the knee (KOA) is a progressive degenerative disease of the knee joint characterized by knee pain and limited knee function which negatively impacts activities of daily living. Effective and safe IA treatments are needed to meet the needs of an ever-increasing population of those living with KOA. This clinical review aims to assess the effectiveness of IA hyaluronic acid compared to corticosteroids for pain management in KOA.
Methods: PubMed was searched using the key terms “hyaluronic acid injection”, “knee osteoarthritis”, “corticosteroid injection”, and “pain relief”. Modifiers and operators were applied, and results were narrowed to four relevant articles for review.
Results: One meta-analysis directly compared HA and CS, three articles conducted meta-analyses comparing HA, CS, and additional IA treatments. Each study utilized different statistics for comparison, however all utilized 95% confidence intervals. Discussion: The studies in this review provided overall mixed results in the effectiveness of IA HA compared to IA CSC for the treatment of KOA. Two studies suggested high molecular weight HA significantly improved pain and functional scores compared to CSC. Two studies analysis did not show significant difference between the two treatment groups. There is no significant difference in safety profiles and adverse events for either treatment. Further meta-analyses are needed reviewing trials with standardized data and comparison of specific HA and CSC formulations to further guide best practice in the management of knee OA
Extracorporeal Shockwave Therapy for Plantar Fasciitis Pain Reduction
Full text linkIntroduction: Plantar fasciitis (PF), aka plantar heel pain (PHP), is a degenerative and debilitating musculoskeletal condition that is prevalent across various populations. There is some debate concerning the hierarchy of second-line treatment options. The purpose of this article is to compare the efficacy, as it relates to pain reduction, of extracorporeal shockwave therapy (ESWT) and other invasive, non-surgical interventions (injections, dry needling, etc.).
Methods: PubMed was searched using a specific search strategy with key terms extracorporeal shockwave therapy and plantar fasciitis . Operators and filters were then applied to narrow results to 4 relevant and quality articles for review.
Results: One review assessed various modalities for treating PF and compared results to expert interviews and patient surveys. Two reviews assessed numerous interventions for PF and evaluated pain reduction as well as the tolerability of treatment and the effect on function. One study directly compared ESWT to small needle-knife therapy for PF treatment.
Discussion: The articles reviewed generated results suggesting ESWT is equivalent or superior to the invasive, non-surgical modalities for which adequate evidence was available. However, studies included in these reviews were limited by significant heterogeneity and varying levels of evidence quality. Further research is needed under more homogeneous conditions to provide quality evidence regarding second-line treatment options for PF/PHP