Meta-analysis of new intervention measures for preventing side effects of artificial joint replacement

BACKGROUND Intertrochanteric fracture of the femur occurs mostly among older people,and seriously affects daily life and quality of life.At present,physical intervention,drug treatment,routine intervention and rehabilitation training are widely used for prevention of side effects,but it is still inconclusive which intervention has the best effect.AIM To compare the effects of new intervention measures for preventing side effects of artificial joint replacement.METHODS We searched the Chinese and English literatures for comparative studies on the prevention of side effects of new interventions for artificial joint replacement from July 2013 to June 2023 in China HowNet,PubMed,Wanfang,Weipu and other databases.Study quality was evaluated by improved Jadad scoring standard,and the effects of different interventions on preventing different complications were analyzed by meta-analysis of evidence-based medicine with Review Manager 5.0 software.RESULTS Ten articles,including 869 cases,were finally included.The preventive effects of different interventions on the side effects of artificial joint replacement were studied,and valid data were extracted.There were two articles on the preventive effects of drug intervention,four on comparison of the preventive effects of combined and single interventions,and three on the preventive effects of physical intervention,rehabilitation training and routine intervention.Meta-analysis showed that the preventive effect of rivaroxaban was significantly better than low molecular weight heparin calcium[mean difference(MD)=-0.16,95%CI:-0.28 to-0.04,P<0.05].The effect of combined intervention was significantly better than that of single intervention(MD=-0.08,95%CI:-0.16 to-0.01,P<0.001).Physical intervention was significantly better than routine intervention and rehabilitation training(MD=0.26,95%CI:0.16–0.36,P<0.001).CONCLUSION Rivaroxaban combined with rehabilitation training is preferred for preventing deep vein thrombosis after artificial joint replacement.In the prevention of pulmonary embolism,rivaroxaban drug intervention is given priority.The effect of combined intervention is better than that of single intervention.

Gynecological Side Effects of Tamoxifen among Sudanese Women, Khartoum, Sudan, 2020

Background: In Sudan, the common endocrine therapy tamoxifen is prescribed to HR-positive patients, which is associated with a variety of complications such as hot flashes, vaginal discharge, and vaginal dryness. Objective: This study aimed to determine the gynecological side effects of tamoxifen among Sudanese women who have been diagnosed with breast cancer in Khartoum, Sudan. Methods: A retrospective cross-sectional study was conducted at Alzara Hospital in Al Amal Toure Revere, Sudan. A convenience sample of individuals previously diagnosed with breast cancer attended refer clinic. From October 2020 to September 2021, all patients attending were checked for eligibility. Results: A total of 100 patients were enrolled in the study;60% of patients reported increased vaginal secretions after taking the drug, 28% reported normal vaginal secretions with no change, and 11% reported decreased secretions after taking the medication, while 22% developed vaginal bleeding, and 22% of the ultrasound results revealed endometrial masses among the study patients. Also, 54 percent of female patients experienced hot flashes after taking the medication, and 12% of women missed some doses of treatment. Conclusion: Tamoxifen results in several gynecological side effects in women with breast cancer. A high percentage of women in the study developed hot flashes, vaginal bleeding, and discharge, in addition to having ultrasound results showing endometrial masses among them.

Gastrointestinal and hepatic side effects of potential treatment for COVID-19 and vaccination in patients with chronic liver diseases

The outbreak of coronavirus disease 2019(COVID-19)is a global pandemic.Many clinical trials have been performed to investigate potential treatments or vaccines for this disease to reduce the high morbidity and mortality.The drugs of higher interest include umifenovir,bromhexine,remdesivir,lopinavir/ritonavir,steroid,tocilizumab,interferon alpha or beta,ribavirin,fivapiravir,nitazoxanide,ivermectin,molnupiravir,hydroxychloroquine/chloroquine alone or in combination with azithromycin,and baricitinib.Gastrointestinal(GI)symptoms and liver dysfunction are frequently seen in patients with COVID-19,which can make it difficult to differentiate disease manifestations from treatment adverse effects.GI symptoms of COVID-19 include anorexia,dyspepsia,nausea,vomiting,diarrhea and abdominal pain.Liver injury can be a result of systemic inflammation or cytokine storm,or due to the adverse drug effects in patients who have been receiving different treatments.Regular monitoring of liver function should be performed.COVID-19 vaccines have been rapidly developed with different technologies including mRNA,viral vectors,inactivated viruses,recombinant DNA,protein subunits and live attenuated viruses.Patients with chronic liver disease or inflammatory bowel disease and liver transplant recipients are encouraged to receive vaccination as the benefits outweigh the risks.Vaccination against COVID-19 is also recommended to family members and healthcare professionals caring for these patients to reduce exposure to the severe acute respiratory syndrome coronavirus 2 virus.

Side Effects of Pfizer-BioNTech COVID-19 Vaccine among Libyan Young Adults: Observational Study

Purpose: Since the mRNA technology used to manufacture Pfizer-BioNTech COVID-19 Vaccine is new, it is still difficult to predict its consequences. However, many young people, especially in developing countries, think that they are less susceptible to severe infection with the Coronavirus 2 (SARS-CoV-2), Therefore, they do not prefer to take the COVID-19 vaccines. Accordingly, studies in this aspect are necessary to increase people’s awareness of the acceptance of vaccination, especially for the youth. Patients and Methods: This study was conducted on healthy young adults of both sexes. Participants (n = 81) were received two doses of the Pfizer-BioNTech COVID-19 Vaccine. A paper questionnaire was prepared, the survey asks about the side effects related to receiving the Vaccine. All participants completed the questionnaire twice, once after the first dose and again after the second dose. Data were collected and statistically analyzed. Results: The most common side effects were Muscle pain, Tiredness, Headache, and Fever. Less common side effects were Chills, Fainted, Breathlessness, and Coughing. Rare side effects include nausea and vomiting, Diarrhea, Anaphylactic Reaction, and Swollen Lymph Nodes. Side effects that are strongly associated with females are Headache, and Joint pain, for males, Anaphylactic reaction. The study revealed a significant difference between the number of females (96.5%) and males (85%) who suffered from the side effects of the Pfizer-BioNTech COVID-19 Vaccine (P = 0.033). Conclusion: Most of the side effects reported in our study were consistent with Pfizer’s fact sheet for recipients and caregivers. Through our follow-up to the participants in the study, we noticed that the reported side effects were not too bad, and they were able to carry out their daily activities, so we recommend taking the vaccine, especially for young people.

Progestogen-Only Injectable Contraceptives: The Profile of the Acceptors, Side Effects and Discontinuation in a Low Resource Setting, Nigeria

Progestogen-only injectable contraceptive is a highly effective, long lasting and reversible agent of fertility control. The objective is to determine the profile of the acceptors, side effects and indication for discontinuation of progestogen-only injectable contraceptives at UCTH, Calabar. This was a retrospective study of the clients who used progestogen-only injectable contraceptives at the family planning unit between 1st January 2008 and 31st December 2014. A total of 1392 clients used the injectable progestogen-only contraceptive out of 5986 total contraceptive users giving the prevalence rate of 23.3% over the period. Of these, 60.4% of the clients accepted the depot medroxyprogesterone acetate, while 39.6% accepted the norethisterone enanthate. It was mostly utilized by multiparous women, clients with tertiary education and those in their third decade of life. Secondary amenorrhea was the commonest side effect in 47.7% of the clients. Over the study period, 243 (19.8%) discontinued the method and 48.1% discontinued due to secondary amenorrhea while 31.4% was due to desire to get pregnant. Progestogen-only injectable contraceptive was associated with multiple side-effects, with secondary amenorrhea being the most common, and menstrual irregularity was the main reason for discontinuation. Providing adequate information to clients about this method of contraception and its probable side effects, supportive counseling during initiation of contraception and re-enforcement during follow-up visit can go a long way in enhancing patient satisfaction and hence continuation of progestogen-only injectable contraceptive despite minor side effects.

Arava Treatment,between Beneficial Action on Joint Inflammation and Side Effects on Liver,Myocardium and Kidney in Experimental Murine Arthritis

The purpose of the experiment was the follow-up in time of the course of joint inflammation phenomena in laboratory animals (white female adult Wistar rats) by determining particular biological, hematological, radiological, osteodensitometric, immunological and anatomic-pathological parameters and by assessing the effects of Leflunomide (Arava) on the course of the disease. ARAVA&reg;(Leflunomide) is a pyrimidine synthesis inhibitor. The experimental study was conducted for 8 weeks. We have also assessed the side effects of the therapy on their liver, myocardium and kidney. Leflunomide therapy improved the course of the clinical and paraclinical parameters, but it did not cure the condition. The positive results in the joints were accompanied by many histological alterations. The experiment revealed the toxic visceral effects of Leflunomide on the liver, heart and kidney.

Herbal medicine use in Republic of Korea to alleviate side effects of COVID-19 vaccines:A cross-sectional study

Objective:Coronavirus disease 2019(COVID-19)has spread worldwide,and several virus variants have emerged.Vaccines are administered to help prevent the infection.In Republic of Korea,most people take herbal medicine.This study investigated the use of herbal medicine to counter the side effects of COVID-19 vaccines.Methods:This cross-sectional study was conducted using an online survey.Chi-square tests were used to determine differences in the use of herbal medication according to sociodemographic characteristics.Independent two-sample and paired t-tests were performed to examine the effect and satisfaction of herbal medicine use for countering the side effects of COVID-19 vaccines.One-way analysis of variance was used to determine vaccine-related differences.Results:A total of 233 and 181 participants received the first and second doses of COVID-19 vaccines,respectively.The majority of herbal medicine users were in their thirties,had a bachelor’s degree,suffered from side effects of vaccination,and received Vaxzevria for their first COVID-19 vaccine dose and Comirnaty for their second dose.The herbal medicine group had a higher satisfaction level of postvaccination side effects than the non-herbal medicine group(P<0.0001).The numeric rating scale scores for vaccination side effects were lower among participants who took herbal medication to alleviate those symptoms(P<0.0001).The most commonly used herbal formula was Shuanghetang.Conclusion:A third of participants receiving COVID-19 vaccines used herbal medication to counter the side effects of vaccination.The use of herbal medicine was associated with age,education level,vaccine brand,and whether side effects of vaccination occurred.Herbal medication use was associated with greater satisfaction compared to vaccine recipients not using herbal medication.

Network-based method to infer the contributions of proteins to the etiology of drug side effects

Studying the molecular mechanisms that underlie the relationship between drugs and the side effects they produce is critical for drug discovery and drug development. Currently, however, computational methods are still unavailable to assess drug-protein interactions with the aim of globally inferring the contributions of various classes of proteins toward the etiology of side effects. In this work, we integrated data reflecting drug-side effect relationships, drug- target relationships, and protein-protein interactions to develop a novel network-based probabilistic model, SidePro, to evaluate the contributions of proteins toward the etiology of side effects. For a given side effect, the method applies an expectation--maximization algorithm and a diffusion kernel-based approach to estimate each protein＇s contribution. We applied this method to a wide range of side effects and validated the results using cross-validation and records from the Side Effect Resource database. We also studied a specific side effect, nephrotoxicity, which is known to be associated with the irrational use of the Chinese herbal compound triptolide, a diterpenoid epoxide in the Thunder of God Vine, Tripterygium wilfordii （Lei-Gong-Teng）. Using triptolide as an example, we scored the target proteins of triptolide using our model and investigated the high-scoring proteins and their related biological processes. The results demonstrated that our model could differentiate between the potential side effect targets and therapeutic targets of triptolide. Overall, the proposed model could accurately pinpoint the molecular mechanisms of drug side effects, thus making contribution to safe and effective drug development.

Side Effects of Large-Scale Assessments in Education

Purpose:In line with a recent call for side effects research in education,this article aims to synthesize the major concerns that have been raised in the literature concerning large-scale assessments(LSAs)in education.Design/Approach/Methods:The researchers endeavored to complete a deep review of the literature on LSAs to synthesize the reported side effects.The review was synthesized thematically to understand and report the consequences of the ongoing push for the use of LSA in education.Findings:Thematic analysis indicated overarching side effects of LSA in education.We discuss why negative side effects exist and present evidence of the most commonly observed side effects of LSA in education,including distorting education,exacerbating inequity and injustice,demoralization of professionals,ethical corruption,and stifling of innovation in education.Originality/Value:While concerns about the use and misuse of LSA in education are not new and have been discussed widely in the literature,rarely have they been discussed as inherent qualities and consequences of LSAs that can do harm to education.

Chinese Herbal Medicine for Chemotherapy Induced Gastrointestinal Side Effects: A Systematic Review of Randomized Controlled Trials

Objective: To determine how safe and effective Chinese Herbal Medicine(CHM) is in alleviating the nausea, vomiting, oral ulceration,diarrhea and constipation for cancer patients with chemotherapy.Methods: Data sources: A systematic review of Chinese and English articles using Ovid SP, CNKI, VIP Database and Traditional Chinese Medicine Database System. Study selection: Only randomized controlled trials(RCTs) for the prevention or treatment of any one of gastrointestinal side effects, namely nausea, vomiting, oral ulceration, diarrhea and constipation, of CHM with or without western medicine(WM) vs WM, placebo or no treatment were included. Data Extraction: Independent extraction of articles was first performed by four medical students using predefined data fields. Then, all data, including study quality indicators, was checked by two authors.Results: Eighty-six RCTs involving 7076 cancer patients were found and analyzed in this review. Because of the heterogeneity of study design and low overall methodological quality, only descriptive summaries were performed. Beneficial effects were found in some CHM interventions,regardless of being taken alone or taken with WM. Moreover, none of serious adverse effect was reported. However, same intervention had not been repeatedly investigated by different research teams.Conclusions: Implications of the analysis support the efficacy and safety of CHM for the management of gastrointestinal side effects.However, definite clinical recommendation for particular CHM intervention still cannot be made due to low methodological quality of included studies and lack of duplicated verification. Further large scale and high quality RCTs on the same CHM interventions are suggested.

An efficient etherification of Ginkgol biloba extracts with fewer side effects in a micro-flow system

In this study, etherification of ginkgolide B and dimethylaminoethyl chloride hydrochloride was investigated as a model reaction in a micro-flow system （MFS）, providing the resulting ethers in high yield with fewer side effects. Meanwhile, this novel process in MFS worked well for other ginkgolides from Ginkgol biloba and halides, giving moderate yields.

Patient reported outcome of tyrosine kinase inhibitor related side effects and their impact on daily life in Chinese patients with chronic myeloid leukemia in the chronic phase

Objective To explore the impact of patient reported outcome of tyrosine kinase inhibitor(TKI)related side effects on daily life in Chinese patients with chronic myceloid leukemia(CML)in the chronic phase(CP).Methods From May to November in 2014。

Pembrolizumab autoimmune related diabetes:Moving forward,keep learning

Immune checkpoint inhibitors(and more specifically programmed cell death 1/programmed cell death ligand 1 inhibitors as Pembrolizumab)initiated a revolution in the field of melanoma and have now expanded to several tumor subtypes and in increasingly broader clinical contexts,including the adjuvant and neoadjuvant setting,with potentially curable patients and prolonged survival.The side effects related to these drugs include a wide spectrum of manifestations,with endocrinological adverse events being some of the most frequent.Pembrolizumab-induced type 1 diabetes mellitus is an infrequent but potentially serious and not clearly reversible side effect that possesses characteristic clinical features and has high morbidity and mortality,with a chronic impact on quality of life.The etiopathogenesis of this phenomenom needs to be further investigated and a collaborative effort through the involvement of oncologists and other medical specialists is necessary for the correct identification and management of patients at risk.

Measuring Cognitive and Psychosocial Accessibility to Modern Contraception: A Comprehensive Framework

Nowadays, more than ever, the improvement of access to family planning (FP) has become an international goal. What constitutes access to FP? Current human rights-based contraceptive guidelines indicate that access begins as soon as women or couples express a desire to avoid pregnancy and their risk of unintended pregnancy is established. However, few studies have sought to define and measure cognitive and psychosocial access to contraception. To propose a comprehensive framework for the cognitive and psychosocial accessibility of contraception, we critically analyzed the literature on attitudes toward FP. The main dimensions that emerged were knowledge about FP, fear of side effects, approval of contraception, and contraceptive agency. We then identified and adjusted some questions that can capture these dimensions more comprehensively. As a result, we developed a questionnaire module comprising 15 questions, which was integrated into the 6th round of the PMA2020 survey in Burkina Faso in 2019. This research highlighted that previous studies have collected separate dimensions of contraceptive access, and the psychosocial dimension tended to be neglected. Our results demonstrate that it is possible to collect comprehensive data on cognitive and psychosocial dimensions of access to family planning.

Azathioprine monotherapy withdrawal in inflammatory bowel diseases: A retrospective mono-centric study

BACKGROUND There is no consensus on the recommended duration of and optimal time to stop azathioprine(AZA)therapy in inflammatory bowel disease(IBD).Determining the optimal duration and cessation time can help to balance the risks of long-term intake with the possibility of relapse after cessation.AIM To describe the events following AZA cessation.METHODS Retrospective analysis was performed to examine data from adult patients affected by IBD who were followed at the University of Padua and had started but then discontinued AZA between 1995 and 2022.Data on therapy duration,reasons for cessation,and type of relapse after cessation were collected.Cox regression models were used to estimate the risk of relapse in different subgroups.RESULTS A total of 133 ulcerative colitis patients and 141 Crohn’s disease patients were included.Therapy with AZA was stopped in the 1st year in approximately 34%of patients but was continued for more than 10 years in approximately 10%of cases.AZA discontinuation was due to primary failure or disease relapse in 30%of patients and due to disease remission in 25.2%of patients.Most of the remaining cases stopped AZA therapy due to side effects(primarily clinical intolerance,cytopenia,and pancreatic disease).Patients who stopped AZA for clinical remission had an 83%lower risk of relapse during the observation time than other groups,with a relapse-free rate of 89%after 1 year and 79%after 2 years.CONCLUSION AZA administration is effective and safe,but it requires careful monitoring for potential minor and major side effects.Only 10%of patients who achieved remission with AZA needed a new treatment within 1 year of drug interruption.

The natural course of bacillus Calmette-Guerin induced bladder lesions:A long-term follow-up study and systematic review

Objective:Bacillus Calmette-Gue´rin(BCG)instillation is the standard adjuvant treatment for intermediate-and high-risk non-muscle-invasive bladder cancer after transurethral resection.Nevertheless,its toxicity often causes bladder complications.On follow-up cystoscopy,post-BCG bladder lesions can be pathologically benign,urothelial carcinoma recurrence,or other types of bladder malignancy.Only a small number of case reports have been published on post-BCG bladder lesions.Their clinical features,natural course,and management remain unknown.Methods:We retrospectively studied cystoscopic videos and medical records of BCG-treated bladder cancer patients at our center.During a long-term follow-up,we took biopsies on tumor-like lesions and described their changes.In addition,we summarized previous studies on post-BCG bladder lesions by systematic literature searching and review.Results:We described a series of three cases with post-BCG bladder lesions mimicking tumor recurrence from a total of 38 cases with follow-up data for more than 5 years.Those lesions could last,grow,or disappear spontaneously,and remain pathological benign for years.In systematic review,we identified and analyzed a total of 15 cases with post-BCG bladder lesions with detailed clinical information.Eleven of the 15 were benign and have a good prognosis with nephrogenic adenoma being the most common pathological type.Conclusion:Based on previous studies and our experience,benign lesions after BCG instillation cannot distinguish with cancer recurrence by cystoscopy alone,even under narrow band imaging mode.Nonetheless,given most of them have a good prognosis,random biopsy or transurethral resection might be spared in the patients with long-term negative biopsy and urine cytology.

Should gastroenterologists prescribe cannabis? The highs, the lows and the unknowns

Cannabis,commonly known as marijuana,is a drug extracted from the Cannabis plant known for its psychotropic and medicinal properties.It has been used for healing purposes during ancient times,although its psychoactive components led to its restricted use in medicine.Nonetheless,cannabis is found to have modulatory effects on the endocannabinoid system exhibiting its medicinal role in the gastrointestinal(GI)system.Emerging animal and human studies demonstrate the influential effects of cannabis on a variety of GI diseases including inflammatory bowel disease,motility disorders and GI malignancies.It also has a regulatory role in GI symptoms including nausea and vomiting,anorexia,weight gain,abdominal pain,among others.However,both its acute and chronic use can lead to undesirable side effects such as dependency and addiction,cognitive impairment and cannabinoid hyperemesis syndrome.We will discuss the role of cannabis in the GI system as well as dosing strategies to help guide gastroenterologists to assess its efficacy and provide patient counseling before prescription of medical marijuana.

Cognitive and Psychosocial Accessibility to Modern Contraception: Subscales Validation

While studies have examined physical access to services, cognitive and psychosocial barriers to contraceptive use have received less attention, despite their impact on access. Research shows that fours main dimensions exist under the broad concept of cognitive and psychosocial access. This study aims to validate the construction of these dimensions and measure the relation between them and their links with modern contraceptive use. We utilized a questionnaire module to collect 15 questions measuring these dimensions through the 6th round of the Performance monitoring and accountability 2020 (PMA2020) survey in Burkina in 2019. We employed the scale validation technique to choose appropriate measures (observable indicators or items) for constructing each latent dimension (unobservable) in our study. The items consisted of questions that utilized a 5-point Likert scale or dichotomous responses to capture various psychosocial aspects. To assess the validity, reliability, convergence, and divergence of the latent dimensions and items, we utilized the validscale command in Stata. The validation process confirmed the reliability of all the dimensions. Contraceptive approval is more aligned with birth spacing rather than birth limiting, reflecting prevailing social perceptions. Women’s contraceptive agency was found to be more associated with their ability to discuss and negotiate with their partners rather than independent decision-making. Correlations between dimensions were generally weak, but the levels of knowledge, agency, and approval of contraception are positively correlated with contraceptive use and intention to use. Giving women more decision-making power and providing information to address side-effect concerns can enhance contraceptive approval.

Labetalol versus Hydralazine in the Management of Severe Pre-Eclampsia at Tertiary Hospitals in a Low-Resource Setting: A Randomised Controlled Trial

Objective: Intravenous labetalol and hydralazine are both considered first-line medications for the management of acute-onset, severe hypertension in pregnant and postpartum women. The study compared the efficacy and safety profile of intravenous labetalol and hydralazine in the control hypertension in severe pre-eclampsia. Materials and Methods: One hundred patients who presented with severe pre-eclampsia were randomized into two study groups. The fifty patients in each arm of the study received either intravenous labetalol or intravenous hydralazine for the control of blood pressure. Results: The mean age of the labetalol subjects was 28.6 ± 5.47 years while that of their hydralazine counterparts was 29.12 ± 5.77 years. The majority of respondents in both groups were primigravidae (76% vs. 78%) (P = 0.813). The number of doses of drug needed to significantly lower the mean systolic blood pressure was slightly lower in the labetalol group (2 doses) compared to the hydralazine group (5 doses) (t = 0.803Y, P = 0.977). The incidence of headaches which were the commonest complaints was comparable in both groups 8% and 10% of respondents respectively (P > 0.05). Conclusion: Although both intravenous labetalol and hydralazine are useful in patients with severe pre-eclampsia, the response to labetalol was better with comparable side effects.