Randomized controlled trials covering pharmaceutical care and medicines management: A systematic literature review

Objective To review the effects of pharmaceutical care on hospitalizations, mortality and clinical outcomes in patients. Methods Systematic searches were conducted in MEDLINE, EMBASE and International Pharmaceutical Abstracts (IPA) databases to identify studies that were published between 2004 and January 2017. Studies included in this review were randomized controlled trials (RCTs) that spanned across both community and hospital settings. Using strict inclusion/exclusion criteria studies were included if they reported level 1 or 2 outcomes in the hierarchy of outcome measure i.e. clinical and surrogate outcomes (e.g. blood pressure (BP) control, blood glucose level, cholesterol BMI). Each study was assessed for quality using the Jadad scoring system. Results Fifty-four RCTs were included in the present review. Forty-six of these studies ranked high quality according to the Jadad scoring system. Studies were categorized into their general condition groups. Interventions in patients with diabetes, depression, respiratory disorders, cardiovascular disorders, epilepsy, osteoporosis, and interventions in older adults were identified. In the majority of studies pharmaceutical care was found to lead to significant improvements in clinical outcomes and/or hospitalizations when compared to the non-intervention group. Some conditions had a large number of RCTs, for example for cardiovascular conditions and in diabetes. Statistically significant improvements were seen in the majority of the studies included for both of these conditions, with studies indicating positive clinical outcomes and/or hospitalizations rates. Within the cardiovascular condition, a subset of studies, focusing on cardiac heart failure and coronary heart disease, had more mixed results. In other conditions the number of RCTs conducted was small and the evidence did not show improvements after pharmaceutical care, i.e. in depression, osteoporosis, and epilepsy. The majority of interventions were face to face interactions with patients, whilst a smaller number were conducted via the telephone and one via a web-based system. Patient education was a key component of most interventions, either verbal and/or written. Longitudinal data, post intervention cessation, was not collected in the majority of cases. Conclusions RCTs conducted to evaluate pharmaceutical care appear to be effective in improving patient short-term outcomes for a number of conditions including diabetes and cardiovascular conditions, however, other conditions such as depression are less well researched. Future research should attempt to evaluate the conditions where there is a lack of data, whether the positive effects of pharmaceutical care persist in patient populations after the interventions cease and what the long-term clinical outcomes would be of continued pharmaceutical care

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

Implication de la signalisation Ca2 + dans la perception du goût du gras : modulation par plante triterpénoïdes et un agoniste chimique du GPR120

En dépit des efforts déployés, l'incidence de l'obésité est en augmentation dans le monde entier où la consommation d‘aliments moins coûteux et hyperénergétiquesriches en matières grasses, représente la principale cause. Des études récentes ont révélé l'existence d'un goût de gras et que l'envie de le satisfaire pourrait être responsable de l‘excès des prises alimentaires et de l'attirance pour les aliments riches en gras. Différentes stratégies ont été utilisées pour réduire la teneur engraisse des aliments ou pour la remplacer par des mimétiques et des substituts de graisse. Dans cette thèse, nous avons non seulement exploré des mécanismes de signalisation tels que le rôle des canaux TRPC3 Ca2+ dans les cellules du bourgeon gustatif, mais nous avons également tenté de rechercher de nouvelles classes de molécules artificielles et naturelles, d‘origines végétales, qui pourraient agir comme exhausteurs de goût ou comme activateurs du goût. Sur la base des résultats obtenus par des études biochimiques et comportementales au cours de la thèse actuelle, nous proposons que Zizyphine purifié à partir de Zizyphus lotus, d‘acide oléanolique et de TUG891 (un agoniste chimique de GPR120) puissent être un candidat novateur et prometteur pour le traitement et la prévention de l'obésité et du syndrome métabolique qui lui est associé.Despite efforts, the incidence of obesity is on a rise throughout the world andconsumption of less expensive fat rich and high energy diet remains the major cause.Recent studies have successfully unveiled the existence of a fat taste, and that theurge to satisfy it might be responsible for the overeating behaviour and attractiontowards fat rich foods. Different strategies have been used to reduce fat content offood or replace it with fat mimetics and fat replacers. In this dissertation, we have not only explored signalling mechanisms like role of TRPC3 Ca2+ channels in taste bud cells but also tried to search for newer classes of molecules from botanical and chemical origin that might either act as fat taste enhancers, or fat taste activators. Based on the result of various biochemical and behavioural studies during the current dissertation, we propose that Zizyphin purified from Zizyphus lotus,Oleanolic acid and TUG891 (a chemical agonist of GPR120), might be novel andpromising candidates for the treatment and prevention of obesity and associatedmetabolic syndrome

A cross-talk between fat and bitter taste modalities

International audienceThe choice of food is governed largely by the sense of taste. To date, five basic taste modalities have been described; however, there is an increasing agreement on the existence of a 6th fat taste. The taste modalities might interact with each other and also with other senses. The advancements in cellular and molecular biology have helped the characterization of taste signaling mechanisms, down to the receptor level and beyond. CD36 and GPR120 have been shown to be involved in the detection of fat taste while bitter taste is perceived by a number of receptors that belong to a family of taste-type 2 receptors (T2R or TAS2R). Hence, the most common role is played by TAS2R16 and TAS2R38 in bitter taste perception in humans. Increasing evidences from behavioural studies suggest that fat and bitter taste modalities might interact with each other, and this interaction might be critical in obesity. In the current review, we will discuss the evidence from genetic and behavioural studies and propose the molecular mechanism of a cross-talk between fat and bitter tastes

Antiinflammatory and antioxidant activities of a polyphenol‐rich extract from Zizyphus lotus L fruit pulp play a protective role against obesity

IF 1.552International audienceZizyphus lotus (Zl) is used widely as a source of food and for the treatment of various ailments. Therefore, we investigated the biological activities of Zl against obesity and related disorders. Hence, male Wistar rats received either control diet, high fat diet (HFAD), or HFAD supplemented with the Zl pulp (HFADP) for 14 weeks. RAW 264.7 cells were used for the determination of antiinflammatory activities in vitro. It was observed that HFDP resulted in significantly reduced weight, blood sugar, and oxidative stress than HFAD. In addition, Zl extract co‐treatment with LPS reduced the mRNA expression of MCP‐1, pro‐inflammatory cytokines (IL‐6, TNF‐α), and increased the level of IL‐10, an antiinflammatory cytokine, in LPS‐stimulated RAW 264.7 cells. Moreover, nitric oxide synthesis and the expression of iNOS were decreased by Zl extract in RAW 264.7 cells. Zl extract also possessed a significant antioxidant capacity and ferric‐reducing power. Our results validate the traditional use of Zl.Practical applicationsZizyphus lotus is commonly used as food in different countries and is easily available. Scientific validation of the traditional use of plants can be significant in the prevention and treatment of different disorders. Naturally occurring products are generally safe to use, have fewer side effects, and can be self‐administered. Hence, specialized health‐care supervision is not necessary. Our study supports the traditional use of Zizyphus lotus to prevent and decrease obesity and related disorders

Evaluation of the Potential Role of Bacillus altitudinis MT422188 in Nickel Bioremediation from Contaminated Industrial Effluents

The incessant pervasiveness of heavy metals in the environment is one of the precursory factors of pollution. This research study was endeavored upon to investigate the bioremediation potential of a nickel (Ni)-resistant bacterial isolate, identified as Bacillus altitudinis MT422188, whose optimum growth parameters were demonstrated at pH 7, temperature 32 °C, and 1 mM phosphate. Minimal Inhibitory Concentration (MIC) and EC50 for Ni were observed to be 20 and 11.5 mM, respectively, whereas the cross heavy-metal resistance was discerned as Cu2+ (25 mM) > Zn2+ (15 mM) > Cr6+ (10 mM) > Pb2+ (5 mM) > Co2+ (8 mM) > Cd2+ (3 mM) > Hg2+ (0 mM). Ni biosorption studies by live and heat-killed bacterial cells were suggestive of Ni uptake being facilitated by an ATP-independent efflux system. A pilot-scale study displayed the effective removal of Ni (70 mg/L and 85 mg/L) at 4- and 8-day intervals, respectively. Moreover, chemotaxis and motility assays indicated the role of Ni as a chemoattractant for bacterial cells. The presence of Ni reduced the GR (0.001 ± 0.003 Ug−1FW), POX (0.001 ± 0.001 Ug−1FW), and SOD (0.091 ± 0.003 Ug−1FW) activity, whereas Sodium dodecyl sulphate—Polyacrylamide gel electrophoresis (SDS-PAGE) revealed the presence of metallothionein (60 kDa). Kinetic and isotherm studies suggested a pseudo second-order and Freundlich model to be better fitted for our study. The thermodynamic parameters (∆H° = 3.0436 kJ/mol, ∆S° = 0.0224 kJ/mol/K) suggested the process to be endothermic, spontaneous, and favorable in nature. FTIR analysis elucidated the interaction of hydroxyl and carboxyl groups with Ni. Scanning Electron Microscopy (SEM) and Energy Dispersive X-Ray Spectroscopy (EDS) demonstrated changes in the morphological and elemental composition of the bacterial cells, which affirmed their interaction with Ni during biosorption. In summary, our study concludes the efficient role of Bacillus altitudinis MT422188 in removing Ni from polluted industrial effluents

Tongue Leptin Decreases Oro-Sensory Perception of Dietary Fatty Acids

Leptin, an anorectic hormone, regulates food intake, energy expenditure and body weight. We assessed the implication of tongue leptin in the modulation of oro-sensory detection of dietary fatty acids in mice. The RT-PCR analysis showed that mRNA encoding leptin and leptin receptor (Ob-Rb) was expressed in mice taste bud cells (TBC). Confocal microscopic studies showed that the lipid sensor CD36 was co-expressed with leptin in mice TBC. Silencing of leptin or Ob-Rb mRNA in tongue papillae upregulated preference for a long-chain fatty acid (LCFA), i.e., linoleic acid (LA), in a two-bottle paradigm in mice. Furthermore, tongue leptin application decreased the preference for the LCFA. These results suggest that tongue leptin exerts an inhibitory action on fatty acid preference. In isolated mice TBC, leptin decreased LCFA-induced increases in free intracellular calcium concentrations, [Ca2+]i. Leptin and LCFA induced the phosphorylation of ERK1/2 and STAT-3 and there were no additive or opposite effects of the two agents on the degree of phosphorylation. However, leptin, but not the LCFA, induced phosphoinositide-3-kinase (PI-3-K)-dependent Akt phosphorylation in TBC. Furthermore, leptin induced hyperpolarization, whereas LCFA induced depolarization in TBC. Our study demonstrates that tongue leptin exerts an inhibitory action on oro-sensory detection of a dietary fatty acid by interfering with Ca2+ signaling and membrane potential in mice TBC

Alteration in Taste Perception in Cancer: Causes and Strategies of Treatment

IF 4.134International audienceThe sense of taste is responsible for the detection and ingestion of food to cover energetic requirements in health and disease. The change in taste perception might lead to malnutrition that is usually one of the frequent causes of morbidity and mortality in patients with cancer. In this review, we summarize the mechanisms of taste perception and how they are altered in cancer. We also address the question of the implication of inflammation, responsible for the alterations in taste modalities. We highlight the role of radio- and chemotherapy in the modulation of taste physiology. Other several factors like damage to taste progenitor cells and disruption of gut microbiota are also dealt with relation to taste perception in cancer. We further shed light on how to restore taste acuity, by using different preventive methods, dietary modifications and pharmacotherapy in subjects with advanced cancer state

Antioxidant and Anti-Inflammatory Potential of Polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms

Nutrition transition can be defined as shifts in food habits, and it is characterized by high-fat (chiefly saturated animal fat), hypercaloric and salty food consumption at the expense of dietary fibers, minerals and vitamins. Western dietary patterns serve as a model for studying the impact of nutrition transition on civilization diseases, such as obesity, which is commonly associated with oxidative stress and inflammation. In fact, reactive oxygen species (ROS) overproduction can be associated with nuclear factor-κB (NF-κB)-mediated inflammation in obesity. NF-κB regulates gene expression of several oxidant-responsive adipokines including tumor necrosis factor-α (TNF-α). Moreover, AMP-activated protein kinase (AMPK), which plays a pivotal role in energy homeostasis and in modulation of metabolic inflammation, can be downregulated by IκB kinase (IKK)-dependent TNF-α activation. On the other hand, adherence to a Mediterranean-style diet is highly encouraged because of its healthy dietary pattern, which includes antioxidant nutraceuticals such as polyphenols. Indeed, hydroxycinnamic derivatives, quercetin, resveratrol, oleuropein and hydroxytyrosol, which are well known for their antioxidant and anti-inflammatory activities, exert anti-obesity proprieties. In this review, we highlight the impact of the most common polyphenols from Mediterranean foods on molecular mechanisms that mediate obesity-related oxidative stress and inflammation. Hence, we discuss the effects of these polyphenols on a number of signaling pathways. We note that Mediterranean diet (MedDiet) dietary polyphenols can de-regulate nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) and NF-κB-mediated oxidative stress, and metabolic inflammation. MedDiet polyphenols are also effective in upregulating downstream effectors of several proteins, chiefly AMPK