Iron therapy in pregnant women with iron deficiency anemia: a meta-analysis

Background: Pregnancy significantly increases the need for iron. The prevalence of anemia in pregnant women is high, affecting 41.8% of all pregnant women worldwide. In patients with low tolerance to oral iron, it is recommended to start them on parenteral iron therapy but with variable degree of efficacy. Hence this meta-analysis was done with the following aim. This study aimed to assess the efficacy of various iron preparations in pregnant women with iron deficiency anemia (IDA).Methods: Randomised controlled trials (RCTs) (available as full free text) which included iron therapy in pregnant women with iron deficiency anemia were retrieved from electronic databases viz. PubMed, Google scholar and IndMed, with specific search terms. Qualities of RCTs were assessed using JADAD score and four RCTs with high score were included for analysis using RevMan 5.3 software. Outcome measures were change in hemoglobin levels and serum ferritin concentration after one month of therapy.Results: In the four RCTs included, a total of 267 patients were treated with oral iron and 267 patients were treated with parenteral iron therapy. Change in the hemoglobin levels between the 2 groups had a standard mean difference of 0.73, 95% CI (-0.05-1.52), with the p-value of 0.07. To assess the change in the serum ferritin concentration a total of 188 patients in oral iron and 197 patients in parenteral iron therapy were included. There was a standard mean difference of 0.88, 95% CI (0.60-1.66), with a p value of<0.00001.Conclusions: In the present meta-analysis we found that oral and parenteral iron therapy showed similar efficacy in improving the hemoglobin level in pregnant women

Recent advances in pain management

Pain is one of the most common complaints for which patients approach physicians. In spite of this there is a huge unmet need for developing medications for pain that are safe and efficacious. Owing to the heterogeneity of clinical pain and complex pathophysiology, target identification for drug development is difficult. Preclinical models have also proven unreliable for the development of novel analgesics. Recent advances in understanding the physiology of nociception has enabled the development of novel analgesics including abuse deterrent opioids, drugs targeting several receptors, ion channels and enzymes. This review will attempt to cover the physiology of nociception focusing on the novel targets, the challenges in development of novel analgesics and give an overview of the recently developed drugs and those in the pipeline for the management of pain

Implications of epigenetic modulation for novel treatment approaches in patients with schizophrenia

Schizophrenia is a heterogeneous and complex mental disorder with high rates of disability, non-recovery, and relapse. the primary pharmacological treatments for schizophrenia are antipsychotics. Notwithstanding the efficacy of antipsychotics in ameliorating positive symptoms and reducing relapse rates, cognitive deficits and negative symptoms are not sufficiently treated with available pharmaceutical agents. Moreover, schizophrenia is associated with consistent, replicable, and clinically significant deficits in cognition. the importance of cognitive deficits in schizophrenia is emphasized by reports indicating that the severity of cognitive deficits is predictive of treatment compliance, adherence, and risk of relapse among first-episode individuals. Taken together, this review highlights epigenetic modulations involving histone deacetylase (HDAC) inhibitors as a potential avenue for novel treatment toward improvements in cognition and functional outcomes in patients with schizophrenia. the combination of epigenetic modulation with pharmacological interventions that engage multiple disparate physiological systems implicated in schizophrenia are discussed, and may represent a more effective strategy in ameliorating cognitive deficits and mitigating symptoms for improved functionality. (C) 2013 Elsevier B.V. All rights reserved.Univ Hlth Network, Mood Disorders Psychopharmacol Unit, Toronto, ON M5T 2S8, CanadaUniv Toronto, Inst Med Sci, Toronto, ON, CanadaUniv Toronto, Dept Psychiat, Toronto, ON, CanadaQueens Univ, Ctr Neurosci Studies, Kingston, ON, CanadaUniversidade Federal de São Paulo, Interdisciplinary Lab Clin Neurosci LINC, Dept Psychiat, São Paulo, BrazilUniv Toronto, Dept Pharmacol, Toronto, ON, CanadaUniversidade Federal de São Paulo, Interdisciplinary Lab Clin Neurosci LINC, Dept Psychiat, São Paulo, BrazilWeb of Scienc

Advancing biomarker research: utilizing 'Big Data' approaches for the characterization and prevention of bipolar disorder

Objective: To provide a strategic framework for the prevention of bipolar disorder (BD) that incorporates a 'Big Data' approach to risk assessment for BD.Methods: Computerized databases (e. g., Pubmed, PsychInfo, and MedlinePlus) were used to access English-language articles published between 1966 and 2012 with the search terms bipolar disorder, prodrome, 'Big Data', and biomarkers cross-referenced with genomics/genetics, transcriptomics, proteomics, metabolomics, inflammation, oxidative stress, neurotrophic factors, cytokines, cognition, neurocognition, and neuroimaging. Papers were selected from the initial search if the primary outcome(s) of interest was (were) categorized in any of the following domains: (i) 'omics' (e. g., genomics), (ii) molecular, (iii) neuroimaging, and (iv) neurocognitive.Results: the current strategic approach to identifying individuals at risk for BD, with an emphasis on phenotypic information and family history, has insufficient predictive validity and is clinically inadequate. the heterogeneous clinical presentation of BD, as well as its pathoetiological complexity, suggests that it is unlikely that a single biomarker (or an exclusive biomarker approach) will sufficiently augment currently inadequate phenotypic-centric prediction models. We propose a 'Big Data'-bioinformatics approach that integrates vast and complex phenotypic, anamnestic, behavioral, family, and personal 'omics' profiling. Bioinformatic processing approaches, utilizing cloud-and grid-enabled computing, are now capable of analyzing data on the order of tera-, peta-, and exabytes, providing hitherto unheard of opportunities to fundamentally revolutionize how psychiatric disorders are predicted, prevented, and treated. High-throughput networks dedicated to research on, and the treatment of, BD, integrating both adult and younger populations, will be essential to sufficiently enroll adequate samples of individuals across the neurodevelopmental trajectory in studies to enable the characterization and prevention of this heterogeneous disorder.Conclusions: Advances in bioinformatics using a 'Big Data' approach provide an opportunity for novel insights regarding the pathoetiology of BD. the coordinated integration of research centers, inclusive of mixed-age populations, is a promising strategic direction for advancing this line of neuropsychiatric research.Stanley Medical Research InstituteNational Alliance for Research on Schizophrenia and DepressionNational Institute of Mental HealthAstraZenecaBristol-Myers SquibbEli Lilly Co.ForestJanssen-OrthoLundbeckPfizerSepracorShireNational Institute of HealthNeuropsychopharmacology Research GroupSunnybrook Research InstituteToronto Rehabilitation InstituteHeart and Stroke Foundation Centre for Stroke RecoveryEli Lilly Fellowship AwardConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Toronto, Dept Psychiat, Toronto, ON M5T 2S8, CanadaUniv Toronto, Dept Pharmacol, Toronto, ON M5T 2S8, CanadaUniv Hlth Network, Mood Disorders Psychopharmacol Unit, Toronto, ON, CanadaUniv Toronto, Inst Med Sci, Toronto, ON M5T 2S8, CanadaUniv S Carolina, Sch Med, Dept Neuropsychiat, Columbia, SC USASunnybrook Res Inst, Toronto, ON, CanadaUniv Fed Rio Grande do Sul, Psychiat Residents Hosp Clin Porto Alegre, Porto Alegre, RS, BrazilQueens Univ, Ctr Neurosci Studies, Kingston, ON, CanadaUniversidade Federal de São Paulo, Dept Psychiat, Program Recognit & Intervent Individuals At Risk, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci, São Paulo, BrazilMt Sinai Hosp, Samuel Lunenfeld Res Inst, Toronto, ON M5G 1X5, CanadaUniversidade Federal de São Paulo, Dept Psychiat, Program Recognit & Intervent Individuals At Risk, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci, São Paulo, BrazilWeb of Scienc