Antithrombotic regimens in patients with percutaneous coronary intervention whom an anticoagulant is indicated: A systematic review and network meta -analysis

Background: Patients undergoing percutaneous coronary intervention (PCI) who require anticoagulant therapy are at increased risk of bleeding. The optimal regimen for these patients is uncertain. This study aimed to compare safety and efficacy of antithrombotic regimens used in patients undergoing PCI with concomitant anticoagulant therapy. Methods: A systematic review and network meta-analysis was performed among studies comparing antithrombotic regimens for anticoagulated patients undergoing PCI. The primary outcome of interest was major bleeding. The secondary outcomes were coronary events. The reference intervention was classic triple therapy (aspirin plus clopidogrel plus VKA). Cluster rank incorporating risk (major bleeding) and benefit (all-cause death) was performed to identify the most appropriate regimen(s). Results: There were 3 RCTs (6 interventions) and 29 non-RCTs (8 interventions) that met the inclusion criteria with 22,179 patients. Network meta-analysis of RCTs indicated that dual therapy (DT), either with vitamin K antagonist (VKA) or direct anticoagulant (DOAC) plus an antiplatelet, significantly reduced the risk of major bleeding compared to triple therapy (TT) [pooled RR of 0.51 (0.30-0.87) and 0.68 (0.49-0.94), respectively]. In addition, VKA-DT significantly reduced the risk of all-cause death compared to TT [pooled RR of 0.40 (0.17-0.93)]. Results from network meta-analysis of non-RCT paralleled that of RCTs. No significant differences of coronary events were found. Conclusions: In conclusion, for anticoagulated patients undergoing PCI, dual therapy, either with warfarin or DOAC plus an antiplatelet, should be considered due to its optimal balance on efficacy and safety

Efficacy and safety of celecoxib on the incidence of recurrent colorectal adenomas: a systematic review and meta-analysis

Background: Celecoxib has previously been shown to be effective in reducing recurrent colorectal adenomas, but its long-term effects are unknown. In addition, safety issues are of major concern. Therefore, we examined the efficacy and safety of celecoxib as a chemopreventive agent along with its posttreatment effect. Methods: We performed a meta-analysis based on a systematic review of randomized controlled trials (RCTs) comparing celecoxib at various doses (400 mg once daily, 200 mg twice daily, and 400 mg twice daily) vs placebo in persons with history of colorectal adenomas. Several databases were searched from inception up to April 2018. Long-term follow-ups of RCTs were also included to evaluate posttreatment effect. Primary outcome was the incidence of recurrent colorectal adenomas. Various safety outcomes were evaluated, especially cardiovascular (CV) events. Risk-benefit integrated analyses were also performed. Results: A total of three RCTs (4,420 patients) and three post-trial studies (2,159 patients) were included in the analysis. Use of celecoxib at any dose for 1-3 years significantly reduced the incidence of recurrent advanced adenomas (risk ratio, 0.42 [95% CI, 0.34-0.53]) and any adenomas (0.67 [95% CI, 0.62-0.72]) compared with placebo. Subgroup analysis on different dosing suggested a greater effect with 400 mg twice daily. However, celecoxib 400 mg twice daily significantly increased the risk of serious adverse (1.2 [95% CI, 1.0-1.5]) and CV events (3.42 [95% CI, 1.56-7.46]), while celecoxib at 400 mg/day, especially with once daily dosing, did not increase CV risk (1.01 [95% CI, 0.70-1.46]). Analysis of post-trial studies indicated that the treatment effect disappeared (1.15 [95% CI, 0.88-1.49]) after discontinuing celecoxib for >2 years. Conclusion: Celecoxib 400 mg once daily dosing could potentially be considered as a viable chemopreventive option in patients with high risk of adenomas but with low CV risk. Long-term trials on celecoxib at a dose of ≤400 mg either once or twice daily are warranted

Use of the CRUSADE Bleeding Risk Score in the Prediction of Major Bleeding for Patients with Acute Coronary Syndrome Receiving Enoxaparin in Thailand

Background: CRUSADE risk score stands out as a simple-to-use bleeding risk model. However, its use is still doubtful for Thai population. The aim of this study was to assess the prognostic value of CRUSADE in predicting risk of major bleeding among Thai patients with acute coronary syndrome (ACS) receiving enoxaparin. Methods: A retrospective cohort study was performed using patients with ACS who were hospitalised at a university hospital in Bangkok between 2006 and 2009 and had received enoxaparin. The CRUSADE risk score was calculated. The model validation was tested by using C statistic and Hosmer-Lemeshow goodness-of-fit. Results: The overall incidence of major bleeding was 18.3%. Median CRUSADE score for entire study population, unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI) were 49, 47, 53, and 39, respectively. Hosmer-Lemeshow goodness of fit revealed no statistical significance in all groups. The CRUSADE model demonstrated a satisfactory discriminatory capacity for the entire study population (C = 0.688), UA (C = 0.591), NSTEMI (C = 0.693), and STEMI groups (C = 0.736). Conclusions: Across the ACS spectrum, CRUSADE risk score was able to estimate in-hospital major bleeding of Thai patients with ACS who received treatment with enoxaparin. The application of these results in Thailand may be helpful in the identification of patients at high bleeding risk and also may lead to implementation of appropriate prevention

Effects of turmeric (Curcuma longa) supplementation on glucose metabolism in diabetes mellitus and metabolic syndrome: An umbrella review and updated meta-analysis.

AimsThis study aims to comprehensively review the existing evidence and conduct analysis of updated randomized controlled trials (RCTs) of turmeric (Curcuma longa, CL) and its related bioactive compounds on glycemic and metabolic parameters in patients with type 2 diabetes (T2DM), prediabetes, and metabolic syndrome (MetS) together with a sub-group analysis of different CL preparation forms.MethodsAn umbrella review (UR) and updated systematic reviews and meta-analyses (SRMAs) were conducted to evaluate the effects of CL compared with a placebo/standard treatment in adult T2DM, prediabetes, and MetS. The MEDLINE, Embase, The Cochrane Central Register of Control Trials, and Scopus databases were searched from inception to September 2022. The primary efficacy outcomes were hemoglobin A1C (HbA1C) and fasting blood glucose (FBG). The corrected covered area (CCA) was used to assess overlap. Mean differences were pooled across individual RCTs using a random-effects model. Subgroup and sensitivity analyses were performed for various CL preparation forms.ResultsFourteen SRMAs of 61 individual RCTs were included in the UR. The updated SRMA included 28 studies. The CCA was 11.54%, indicating high overlap across SRMAs. The updated SRMA revealed significant reduction in FBG and HbA1C with CL supplementation, obtaining a mean difference (95% confidence interval [CI]) of -8.129 (-12.175, -4.084) mg/dL and -0.134 (-0.304, -0.037) %, respectively. FBG and HbA1C levels decreased with all CL preparation forms as did other metabolic parameters levels. The results of the sensitivity and subgroup analyses were consistent with those of the main analysis.ConclusionCL supplementation can significantly reduce FBG and HbA1C levels and other metabolic parameters in T2DM and mitigate related conditions, including prediabetes and MetS.Trial registrationPROSPERO (CRD42016042131)

Self-health care behaviors and knowledge of youth living with HIV

Background: Thailand is facing problems with the increasing number of youths living with the human immunodeficiency virus (HIV). Objective: The objective of this research was to study the self-health care behaviors and knowledge of youths living with HIV who were receiving antiretroviral therapy (ART). Methods: This mixed-methods study consisted of quantitative self-administered online questionnaires and qualitative telephone interviews using a topic guide. Data analysis used descriptive statistics and thematic analysis. Results: A total of 22 youths aged between 15 and 24 years living with HIV who were receiving ART were recruited. Overall self-health care behavior mean scores (out of 4) among the participants were good (3.17 ± 0.41). The mean scores of the 6 self-health care behavior domains in descending order were as follows: spiritual growth (3.35 ± 0.21), health responsibilities (3.26 ± 0.43), stress management (3.10 ± 0.31), nutrition (3.08 ± 0.33), interpersonal relations (3.05 ± 0.36), and physical activity (2.87 ± 0.72). Most of the participants (63.64%) had a good level of knowledge about HIV/Acquired Immune Deficiency Syndrome (AIDS) with a mean score of 16.68 ± 2.21. Conclusion: The majority of individuals maintained healthy habits. However, some domains, such as physical exercise, food, and interpersonal interactions require support. The majority of respondents had a good level of knowledge about HIV/AIDS. In addition, the participants expressed a desire for a system that would support their future career opportunities

Forest plot of subgroup analysis of difference in change of hemoglobin A1C (%) within 4 months between <i>Curcuma longa</i> (CL) supplementation and control group.

(a) Post-intervention values. (b) Change from baseline. Abbreviations: BMI, body mass index; CL, Curcuma longa; DBP, diastolic blood pressure; DM, diabetic mellitus; FBG, fasting blood glucose; HbA1C, hemoglobin A1C; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; MetS, metabolic syndrome; NA, not applicable; pre-DM, pre-diabetic mellitus; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride.</p

Flow diagram of included studies in umbrella review.

Flow diagram of included studies in umbrella review.</p

Subgroup analysis of difference of fasting blood glucose (mg/dL) within 4 months between <i>Curcuma longa</i> (CL) supplementation and control group.

(a) Post-intervention values. (b) Change from baseline. Abbreviations: BMI, body mass index; CL, Curcuma longa; DBP, diastolic blood pressure; DM, diabetic mellitus; FBG, fasting blood glucose; HbA1C, hemoglobin A1C; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; MetS, metabolic syndrome; NA, not applicable; pre-DM, pre-diabetic mellitus; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride.</p

Difference of post-intervention values and change from baseline for glycemic and metabolic outcomes between <i>Curcuma longa</i> (CL) supplementation and control group from previous SRMAs.

Difference of post-intervention values and change from baseline for glycemic and metabolic outcomes between Curcuma longa (CL) supplementation and control group from previous SRMAs.</p

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AimsThis study aims to comprehensively review the existing evidence and conduct analysis of updated randomized controlled trials (RCTs) of turmeric (Curcuma longa, CL) and its related bioactive compounds on glycemic and metabolic parameters in patients with type 2 diabetes (T2DM), prediabetes, and metabolic syndrome (MetS) together with a sub-group analysis of different CL preparation forms.MethodsAn umbrella review (UR) and updated systematic reviews and meta-analyses (SRMAs) were conducted to evaluate the effects of CL compared with a placebo/standard treatment in adult T2DM, prediabetes, and MetS. The MEDLINE, Embase, The Cochrane Central Register of Control Trials, and Scopus databases were searched from inception to September 2022. The primary efficacy outcomes were hemoglobin A1C (HbA1C) and fasting blood glucose (FBG). The corrected covered area (CCA) was used to assess overlap. Mean differences were pooled across individual RCTs using a random-effects model. Subgroup and sensitivity analyses were performed for various CL preparation forms.ResultsFourteen SRMAs of 61 individual RCTs were included in the UR. The updated SRMA included 28 studies. The CCA was 11.54%, indicating high overlap across SRMAs. The updated SRMA revealed significant reduction in FBG and HbA1C with CL supplementation, obtaining a mean difference (95% confidence interval [CI]) of –8.129 (–12.175, –4.084) mg/dL and –0.134 (–0.304, –0.037) %, respectively. FBG and HbA1C levels decreased with all CL preparation forms as did other metabolic parameters levels. The results of the sensitivity and subgroup analyses were consistent with those of the main analysis.ConclusionCL supplementation can significantly reduce FBG and HbA1C levels and other metabolic parameters in T2DM and mitigate related conditions, including prediabetes and MetS.Trial registrationPROSPERO (CRD42016042131).</div