Effect of acetyl-l-carnitine in the treatment of diabetic peripheral neuropathy : A systematic review and meta-analysis

Background/aim: Deficiency of acetyl-L-carnitine (ALC) and L-carnitine (LC) appears to play a role in peripheral diabetic neuropathy, although the evidence in humans is still limited. We conducted a systematic review and meta-analysis investigating the effect of ALC on pain and electromyographic parameters in people with diabetic neuropathy. Methods: A literature search in major databases, without language restriction, was undertaken. Eligible studies were randomized controlled trials (RCTs) or pre-and post-test studies. The effect of ALC supplementation on pain perception and electromyographic parameters in patients with diabetic neuropathy was compared vs. a control group (RCTs). The effect of ALC/LC on electromyographic parameters were also calculated vs. baseline values. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were used for summarizing outcomes. Results: Six articles, with a total of 711 diabetic participants, were included. Three RCTs (340 treated with ALC vs. 203 placebo and 115 with methylcobalamine) showed that ALC reduces pain perception (SMD = -0.45; 95% CI: -0.86 to -0.04; P = 0.03; I-2 = 85%). Compared to controls, ALC supplementation improved nerve conduction velocity and amplitude response for ulnar nerve (both sensory and motor component). Compared to baseline values, ALC/LC supplementation improved nerve conduction velocity for all the sensory and motor nerves (except ulnar and peroneal) investigated and the amplitude of all nerves. The onset of adverse events was generally limited to minor side effects. Conclusion: ALC appears to be effective in reducing pain due to diabetic neuropathy compared to active or placebo controls and improving electromyographic parameters in these patients. (C) 2017 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.Peer reviewe

Functional parameters indicative of mild cognitive impairment: a systematic review using instrumented kinematic assessment

Background: Patients with mild cognitive impairment (MCI) experience alterations of functional parameters, such as an impaired balance or gait. The current systematic review set out to investigate whether functional objective performance may predict a future risk of MCI; to compare functional objective parameters in patients with MCI and a control group; and to assess changes in these parameters after different physical activity interventions. Methods: Electronic databases, including PubMed, AMED, CINAHL, EMBASE, PEDro and Web of Science as well as grey literature databases, were searched from inception to February 2020. Cohort studies and Randomized Controlled Trials (RCTs) were included. The risk of bias of the included studies was assessed independently by reviewers using quality assessment checklists. The level of evidence per outcome was assessed using the GRADE criteria. Results: Seventeen studies met inclusion criteria including patients with MCI. Results from RCTs suggested that gait speed, gait variability and balance may be improved by different physical activity interventions. Cohort studies showed that slower gait speed, above all, under Dual Task (DT) conditions, was the main impaired parameter in patients with MCI in comparison with a Control Gorup. Furthermore, cohort studies suggested that gait variability could predict an incident MCI. Although most of included cohort studies reported low risk of bias, RCTs showed an unclear risk of bias. Conclusions: Studies suggest that gait variability may predict an incident MCI. Moreover, different gait parameters, above all under DT conditions, could be impaired in patients with MCI. These parameters could be improved by some physical activity interventions. Although cohort studies reported low risk of bias, RCTs showed an unclear risk of bias and GRADE criteria showed a low level of evidence per outcome, so further studies are required to refute our findings

Geriatric day hospital: what evidence ? A systematic review

peer reviewe

Etude des disparités de la chirurgie élective en Belgique

La chirurgie élective recouvre les interventions qui peuvent normalement être programmées calmement sans danger immédiat pour la santé du patient. Naïvement, on pourrait s’attendre à ce que cette caractéristique contribue à des décisions d’intervention mûrement réfléchies et donc à peu de disparités entre les pratiques. Et pourtant on découvre dans la littérature internationale que le lieu de résidence du patient influence nettement la probabilité de subir certaines interventions. Ces différences sont-elles aussi observées en Belgique ? Quelle intervention, de la cataracte, du syndrome du canal carpien ou de la sténose carotidienne, présente la plus grande variabilité ? Où fait-on le plus d’arthroscopies en Belgique ? La prothèse totale de hanche et la prothèse totale de genou sont-elles liées géographiquement ? Et qu’en est-il de la césarienne, dont on a encore récemment beaucoup entendu parler dans l’actualité, pour la proportion inquiétante de césariennes dans certains hôpitaux ? Illustrer simplement les différences de pratique ne suffit pas. Classiquement, il s’agit ensuite d’essayer d’éliminer l’effet de plusieurs variables qui pourraient objectivement expliquer les différences observées, comme des comorbidités, des variables socioéconomiques, des facteurs d’offre médicale, … Mais les disparités de pratique subsistent en Belgique même après avoir éliminé l’effet de ces variables. Ceci avait déjà été mis en évidence dans des études précédentes. On débouche alors inévitablement sur un questionnement à propos de l’opportunité des soins. Cette recherche démontre que pour certaines interventions, il est possible de mettre en évidence une association entre « trop de soins donnés » et des « soins médicalement inopportuns ». Mais ce n’est pas toujours le cas, le questionnement reste alors entier et l’instauration de mesures qui viseraient à diminuer des différences non justifiées reste à l’ordre du jour. Une collaboration de fond avec les acteurs de terrain pour chaque domaine spécifique est un « must », comme le prouve cette étude. En outre, cette étude a montré une fois de plus que la Belgique est riche en bases de données qui ne demandent qu’à être exploitées, pas seulement par le KCE mais aussi par tous les autres acteurs qui cherchent à utiliser le plus efficacement possible les moyens disponibles pour offrir à tous les patients les meilleurs soins

Normal values for urinary N-acetyl-beta-glucosaminidase excretion in preterm and term babies.

Urinary N-acetyl-beta-glucosaminidase (NAG) excretion was measured in 14 healthy, preterm, male neonates with gestational ages between 32 and 35 weeks. Daily NAG excretion increased significantly during the first four weeks of life. No correlation was observed between urinary NAG:creatinine ratio and postnatal age regardless of whether measurements were taken from the whole 24 hour urine collection or from an isolated urine spot sample at the same time on each day. When the preterm infants were compared with a group of 20 healthy, full term, male infants at a postnatal age of 7 days the NAG:creatinine ratio was significantly higher in the preterm group, the measurements having been taken from single urine spot samples. We suggest that this variable be used in the evaluation of renal tubular integrity during the neonatal period

The macrocyclic lactone "Spinosad", a promising insecticide for tsetse fly control

The susceptibility of tsetse flies (Diptera: Glossinidae), Glossina palpalis gambiensis (Vanderplank), and G. m. morsitans (Westwood) to topically applied spinosad, a mixture of insecticidal molecules from the actinomycete Saccharopolyspora spinosa, is almost as high as to deltamethrin. However, susceptibility to spinosad does not differ significantly between teneral and gravid flies, contrary to deltamethrin. Spinosad might be a promising candidate for future tsetse control by the sequential aerial technique