Heidi N. Artz Schmaltz
Anticholinergic medications cause a therapeutic or negative effect in the human body by blocking neuronal cholinergic receptors, thereby inhibiting the binding of acetylcholine in the central nervous system and the peripheral nervous system. These medications have short-term side effects including dry mouth, constipation, visual impairments, or delirium; however, research regarding the long-term side effects is limited. The purpose of this systemic literature review is to determine the correlation between prolonged exposure to anticholinergic medications and the development of dementia. The literature databases PubMed, Cochrane Review, Science Direct (Elsevier), and DynaMed were utilized in this review. Journal articles published within the years 2010-2020 were considered in the literature search. Only 11 journal articles qualified for this study by eliminating articles that did not specifically address a populationaged ≥65 years, use of anticholinergic medications, and symptoms including dementia, impaired cognition, or Alzheimer’s disease. The results of this review concluded the Anticholinergic Cognitive Burden and Anticholinergic Drug Scale were superior at quantifying the anticholinergic burden of anticholinergic medication exposure compared to other scales. Employing these anticholinergic scales, it was determined that individuals using a medication with a higher anticholinergic activity of 2 or 3 have been found to be at greater risk for developing dementia compared to those who are not taking them. An increased anticholinergic burden was also associated with a risk for fall. Further research needs to be conducted regarding the rating system of anticholinergic medications by medical professionals and how to accurately measure the cumulative effects of anticholinergic medications
According to the National Institute of Health (NIH), it is estimated that over 24 million Americans are diagnosed with autoimmune disorders, and the cases are increasing (2005). A significant risk factor that has been linked to the formation of these diseases is the gut microbiome. The gut microbiome of the adult plays a vital role in the efficacy of the immune system. The purpose of this research and systematic literature review is to determine how the gut microbiome can influence autoimmune disorders. In this review, five databases were searched including PubMed, DynaMed, Cochrane Library, Embase, and Clinical Key. A variety of keywords and mesh terms were implemented with searching. The search time frame was limited to the previous fifteen years. Inclusion criteria included peer-reviewed journals, meta-analysis, systematic reviews, randomized controlled trials, and case studies. Exclusion criteria originally included animal studies, pediatric, or geriatric focused research. Much of the research presented shows correlations between gut dysbiosis and autoimmune disorders. Although most research does show trending data, no single definitive conclusion has been made regarding the influence of the gut microbiome and its influence on autoimmune diseases. More research still needs to be completed to possibly use gut dysbiosis as a biomarker or possible treatment tool to prevent autoimmune disorders.
A Comparison of SGLT2 Inhibitors to Current Guideline Directed Medical Therapy for the Treatment of Heart Failure in Non-diabetic Patients
Rebecca R. Beyer
Heart failure remains a complex disease that affects an increasing number of patients annually. For heart failure, most of the research has focused on the hemodynamic changes of the heart chambers and the medications that slow the disease progression. Recent studies have investigated treatment options that may disrupt the neuro-hormonal and pathophysiologic cell changes that lead to further progression of heart failure. Although the mechanisms by which the sodium-glucose cotransporter 2 (SGLT2) inhibitors are not entirely understood, they are believed to directly affect the cardiac electrolyte imbalances that trigger the cellular changes which contribute to the altered contractility, adrenergic receptor changes, and resulting hemodynamic changes seen with heart failure. To evaluate SGLT2 inhibitors in the treatment of heart failure in diabetic and non-diabetic patients, placebo studies for SGLT2 inhibitors and current guideline-directed therapies including betablockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor agonists, and angiotensin receptor-neprilysin inhibitors were compared for each class of medications using the hazard ratios and confidences intervals of the all-cause mortality rates. The results showed that treatment with SGLT2 inhibitors in patients with heart failure with reduced ejection fraction (HFrEF) may be comparable to other guideline-directed therapies. Because of the lack of data specific to patients with heart failure with preserved ejection fraction (HFpEF), further research is needed to assess these medications’ efficacy in this population. When assessing the available pooled data for HFrEF and HFpEF patients, SGLT2 inhibitors appear to be a promising area of research compared to the HFpEF recommended therapies.
The purpose of this literature review is to analyze the use of Buprenorphine and Methadone for the treatment of opioid use disorder. Comparison of overall safety, efficacy, morbidity and mortality between the two treatment options is accomplished throughout this article. The literature review was performed using databases: PubMed, Clinical Key, Cochane and Uptodate. Results were limited to studies completed within the past 7 years. Methadone has been the treatment mainstay of opioid use disorder for decades. Buprenorphine has increased in popularity and prevalence for treatment of opioid use disorder, especially after receiving FDA approval for such use in 2002. Several benefits of Buprenorphine therapy were discovered including a significant reduction in overdose fatalities, more convenient dosing options and easier access to prescribing locations. Retention rates of those receiving Buprenorphine was found to be lower, sometimes quite significantly, than those who received Methadone therapy. A review of the literature showed that those receiving Methadone for the treatment of opioid use disorder have a higher likelihood of hospitalization or fatal overdose during the initiation of therapy. A significantly higher retention rate was shown in those receiving Methadone, in comparison to Buprenorphine. However, Methadone use was found to have an association with occurrences of neonatal abstinence syndrome in those taking the medication during pregnancy. A common negative theme throughout the literature review was the lack of a control population when comparing Buprenorphine and Methadone. Conclusively, neither Methadone nor Buprenorphine were found superior when used for treatment of opioid use disorder. Careful consideration must be given to the patient’s personal situation, drug use history and likelihood of compliance.
Cannabidiol: An Adjunctive Therapy to Risperidone for Autistic Children Experiencing Behavioral Outbursts
The purpose of this systemic literature review was to evaluate the safety, efficacy, and tolerability of medical cannabis in the treatment of aggression, irritability, and self-injurious behaviors in autistic children that are currently receiving risperidone. For this literature review, DynaMed, Cochrane, PubMed, ClinicalKey, and CINAHL were searched using various keywords and phrases. Studies that were included in this review were published after 2005, were peer-reviewed, and included systemic reviews, journal articles, clinical trials, randomized control trials, and meta-analyses. Studies that did not directly discuss autism and behavioral issues; autism treatment with risperidone, medical cannabis, or cannabidiol; that did not specifically address the pediatric or adolescent population; or that did not directly discuss human subjects were excluded. Ten resources were selected for this review. Risperidone treatment effectively decreases symptoms of aggression, irritability, and self-injurious behaviors, by half, in autistic children. However, with long-term use weight gain, extrapyramidal symptoms, and hypersomnia are common. Rare cases of metabolic syndrome have occurred. Research regarding cannabidiol treatment in autism is limited. Recent studies show a lessening of aggression and self-injurious behaviors when treated with cannabidiol; however, decreased appetite, somnolence, and restlessness are common. One case of psychosis has occurred. Current research regarding cannabidiol use in treating behavioral outbursts in autistic children shows promise; however, more large-scale, double-blind studies should be performed before treatment with cannabidiol can be considered a safe and effective adjunctive therapy to risperidone treatment
Asthma is a chronic, non-curable respiratory disease that has multi-factorial effects on the bronchial mucosa. Despite optimal prevention and standardized first line asthma care the symptoms can deteriorate leading into an asthma exacerbation which is a medical emergency. Purpose:
• To determine the efficacy of ketamine use as an adjunctive medication for acutes severe asthma exacerbations that had failed standard guideline directed treatments. Methods: • Relevant databases were searched looking for ketamine use in asthma exacerbations.
• The inclusion material consists of pediatric and adult populations in available systematic reviews, randomized control trials, meta-analysis, pilot studies, case reports, and peer-reviewed journal articles. Findings:
• Preliminary results showed no positive outcomes of improvement in asthma symptoms with low dose ketamine.
• Several findings point to noteworthy positive outcomes with an intravenous ketamine high dissociative dosing administration.
• In a small case report the use of nebulized ketamine showed promise at reversing the airway obstruction promptly. Implications:
• Some experts feel strongly that the dose ranges and duration of treatment play a key role into the efficacy of ketamine used as a pharmacological option.
• More research is needed with larger, high quality, randomized studies that addresses and objectively measures varying dosage regimens to form a consensus on the efficacy of ketamine use in refractory asthma exacerbations.
Male obesity-related secondary hypogonadism (MOSH) is often underdiagnosed in the young male population.
The current standard of care for hypogonadism in the older male population typically includes testosterone replacement therapy (TRT).
• The purpose of this study is to highlight available treatment options for MOSH in the younger population and the various effects on fertility.
• The method utilized was a systematic review of the current literature that targeted studies of obese males below the age of 65 treated for secondary hypogonadism.
• This review highlights some of the current recommendations, including lifestyle changes, and compares the use of TRT and selective estrogen receptor modulators (SERMs) and the effects on reproductive health.
• Promisingly, SERMs were found to be more protective of sperm production than traditional testosterone replacement.
The purpose of this research and literature review is to compare the efficacy of the implantable pulmonary artery pressure monitoring device, CardioMEMS, to traditional heart failure management in terms of reducing hospital readmissions. The data bases of Cochrane Library, PubMed, Clinical Key, and DynaMed Plus were utilized. Because the CardioMEMS device is relatively novel in the treatment of heart failure, the time frame of search results was expanded to 10 years to include research from the original clinical trials. A total of 17 peer reviewed works were chosen for this review which included meta-analyses, systematic reviews, randomized controlled trials, and longitudinal studies. Current literature indicates that the CardioMEMS device promotes earlier detection of worsening congestive heart failure than traditional management methods. Earlier detection of increasing pulmonary artery pressures allows for earlier corrective interventions, making CardioMEMS more effective in reducing heart failure related readmissions. The data also indicates that the device is cost-effective as well. However, CardioMEMS may not be appropriate or cost effective for patients with end stage heart failure or limited life expectancy. Additional studies are currently underway to examine the efficacy of the CardioMEMS device in a broader range of patients as it is currently only FDA approved for New York Heart Association class III heart failure patients
The purpose of this review was to evaluate the diagnostic utility of hemoglobin A1c (HbA1c) compared to oral glucose tolerance testing (OGTT) for diagnosis of type 2 diabetes. Databases ClinicalKey, PubMed, Dynamed, and CINAHL withdrew a total of 17 peer-reviewed cross-sectional and retrospective studies, secondary and pooled data analyses, and meta-analyses. Inclusion criteria included human studies, studies < 10 years old, individuals > 15 years of age, fasting plasma glucose in conjunction with OGTT, and subjects without known diabetes. Exclusion criteria included alternative forms of diabetes, screening and diagnosis of prediabetes, comparisons in relation to specific medical conditions such as heart disease, pregnancy, and gestational diabetes, prior diabetes diagnosis, and children <15 years old. Discrepancies with sole utilization of HbA1c when used to screen and diagnose type 2 diabetes mellitus were found when compared to OGTT standards. Current literature proposes>race, gender, age, and obesity may be related to inaccurately low HbA1c compared to OGTT standards in patients who have not been diagnosed with diabetes. Of those, race and metabolic profiles appear to have the greatest impact in reduction of HbA1c’s sensitivity. An alternative to sole utilization of HbA1c may be increasing utilization of OGTT, especially in those with risk of erroneously low HbA1c and high risk for type 2 diabetes. Longitudinal data is needed to strengthen findings noted in this literature review
P.M. DOSING OUTCOMES OF ACE INHIBITORS OR ANGIOTENSIN II RECEPTOR BLOCKERS IN HYPERTENSION VERSUS P.M. DOSING IN HYPERTENSION WITH COMORBIDITIES
• Introduction: The purpose of this research is to compare P.M. dosing outcomes of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in those with hypertension and hypertension plus chronic kidney disease or diabetes.
• Research Methods: Three databases were searched including PubMed, ClinicalKey, and DynaMed with a time frame of 15 years. Studies chosen for review were peer reviewed, and included randomized control trials, systematic reviews, meta-analyses, and a preclinical animal trial.
• Discussion: The research shows evidence of reduced blood pressures throughout the night and into the next day, decreased proteinuria, and decreased cardiovascular events when dosing ACE inhibitors or ARBs at night, or dosing at least one antihypertensive medication at night. This research shows beneficial evidence and no documented adverse patient reactions when dosing ACE inhibitors or ARBs at night. However, further research needs to be conducted with larger patient populations to make official recommendations in those with hypertension and hypertension plus diabetes or chronic kidney disease.
Atopic dermatitis is a chronic remitting problem faced by many people in our communities of all ages. Atopic dermatitis (AD) presents as an erythematous and pruritic rash. There is no cure, only treatments that help alleviate symptoms. The purpose of this literature review is to help determine the best course of action for treatment for patients who suffer from AD. Phototherapy has been growing in popularity and research as an alternate treatment to systemic and pharmacologic therapies. This review was done using PubMed, Clinical Key, DynaMed, and Cochrane. Studies were included that reviewed the side effects and efficacy of each treatment option, as well as evaluated patient preference and adherence to treatment. There were also meta-analyses used that compared studies done on various treatment modalities safety and efficacy that were included. There were no restrictions on date of articles that were included. The review showed that phototherapy is an effective option to treat symptoms of AD but should be reserved as a second line option after a patient has tried and failed topical therapy. Systemic pharmacologic therapies are also considered a second line option. Systemic therapies have a greater side effect profile than phototherapy does. Phototherapy has been shown effective, but long term it is better and more sustainable to use systemic pharmacologic options to treat and control AD.
Breanna R. Krueger
The purpose of this research and literature review is to evaluate the recently completed literature to provide guidance to medical providers in the safest and most efficacious treatment options for adolescent patients with concussion and post-concussion syndrome. The literature was searched for studies directly related to adolescents and active therapies such as physical therapy, vestibular rehabilitation, exertional therapy, and cognitive behavioral therapy. The search time frame implemented was studies completed within the last ten years. Ten studies met the final criteria. The research shows a substantial benefit for immediate cognitive and physical rest following a mTBI. The research suggests that 24-48 hours of immediate cognitive and physical rest provides the most benefit for patients. In addition, the research reviewed has shown that earlier implementation of active therapies such as aerobic exercise, physical therapy, and cognitive behavioral therapy can benefit patients recovering from a mTBI and those with post-concussion syndrome.
Myofascial pain syndrome (MPS) is one of the most common musculoskeletal conditions characterized by tight bands of fascia and muscle fibers known as myofascial trigger points (MTrP’s). Empirical evidence suggests that deactivation of MTrP’s is best accomplished with invasive needling therapy such as dry needling, trigger point injections (TPI’s), and botulinum toxin (BTX-A) injections. The objective of this systemic review is to compare the efficacy of various needling therapies on pain intensity and additionally determine if ultrasound guidance and obtaining an LTR improves clinical outcomes. A comprehensive search of five databases including PubMed, Science Direct, Google Scholar, Cochran, and CINHAL was completed using a variety of key terms. The 15 selected studies were peer-reviewed and included randomized control trials, pilot studies, quasi-experimental studies, retrospective cohorts, systemic reviews, and meta-analysis. Research suggests that all three therapies are effective for decreasing pain intensity associated with MPS, however, superiority is inconclusive. Dry needling and local anesthetics have similar short-term efficacy and are best indicated for treating regions of the shoulder and cervical muscles. Analgesic effects of BTX-A are delayed but tend to be longer-lasting and are more effective when treating regions of highly active muscles. Ultrasound guidance improves clinical outcomes by reducing localization errors and adverse events. Obtaining a local twitch response (LTR) inconsistently correlates with short-term pain relief but is not dependent upon it
The Impact of Hormone Therapy on Cardiovascular and Bone Health in Women with Premature or Early Menopause
Traci L. Leitheiser
Objective: • The Women's Health Initiative (WHI) studies were a catalyst for the dramatic decline in the number of postmenopausal women being prescribed hormone therapy (HT). • The WHI published the largest randomized, double-blind, placebocontrolled trial regarding the use of HT in postmenopausal women with a mean age of 63 years. • One group of women thought to benefit from HT but have often been denied HT based on the WHI studies’ results is premature and early menopausal women. • The purpose of this literature review was to compare the WHI studies’ results to studies that reviewed coronary heart disease (CHD) benefits, bone health benefits, and risks of HT in premature and early menopause.
Methods: • Articles published in the last 22 years were initially incorporated to include the WHI studies. • Articles were then further eliminated if they did not discuss CHD or osteoporosis in postmenopausal women less than the age of 45 years.
Results: • This literature review recommends individualizing the use of HT in premature and early menopausal women by evaluating their risk factors and performing a thorough review of their family history. • Further randomized controlled trials and longitudinal studies need to be completed specifically on premature and early menopausal women to confidently substantiate the benefits of HT in the prevention of chronic diseases.
Effectiveness of Diet/Exercise in Prevention of Gestational Diabetes Mellitus and Associated Cesarean Section Delivery
Gestational diabetes mellitus (GDM) is becoming a more common diagnosis during pregnancy. GDM is defined as glucose intolerance diagnosed during pregnancy. Women diagnosed with GDM during pregnancy are at an increased risk for emergent or planned cesarean section delivery and the development of overt diabetes mellitus post pregnancy. Complications related to GDM include eclampsia, macrosomia, shoulder dystocia, stillbirth, and cesarean section delivery. Initial treatment consists of diet and exercise and if glucose can not be controlled then pharmacotherapy is introduced. A literature review was performed utilizing scientific databases, mesh terms, and keywords to gather statistically relevant research to analyze the effects of diet and exercise on the prevention of GDM and cesarean section delivery. Studies that met criteria for inclusion analyzed the effects of diet and exercise individually, as well as, combined on GDM prevention and cesarean section delivery. The current data available indicates that exercise is safe during pregnancy and when combined with diet prove beneficial in prevention of GDM and cesarean section delivery
The purpose of this literature review is to determine the efficacy and safety of pharmacologic treatments for orthostatic hypotension (OH), with an emphasis on researching the elderly population. In this review, three electronic search databases were utilized including PubMed, Google Scholar, and Dynamed from the years 1997 to 2019. Several keywords were used during the search. The specific pharmacologic agents researched for the treatment of OH included midodrine, droxidopa, pyridostigmine, and fludrocortisone. Although midodrine is the most researched and utilized pharmacologic treatment of OH, this drug may not be the best option when it comes to treatment in the elderly population due to an increase in supine hypertension. Pyridostigmine in combination with low-dose midodrine was found to be effective in relieving OH symptoms without increasing supine hypertension, but this evidence is based on limited randomized trials. More research is needed in order to evaluate the efficacy and safety of these pharmacologic measures in the treatment of OH specifically in the elderly population and over a long period of time.
With the increasing rate of patients diagnosed with type 2 diabetes mellitus (T2DM) and the serious complications associated with this disease, there continues to be controversy surrounding the most effective way to manage glycemic control in this population. The intention of this meta-analysis is to determine the effect of a ketogenic diet as a first-line treatment option on glycemic control in type 2 diabetic patients. Effectiveness was determined by comparing the ketogenic diet to other popular diets recommended to diabetics by practitioners following guidelines set forth by the American Diabetes Association. Several high-quality studies were selected utilizing PubMed, Dynamed plus, Cochrane Library, CINAHL, and Clinical Key databases with keyword and MeSH terms to narrow search results. These studies provide data of the diet's effects on HbA1c along with other parameters such as body weight, lipids, blood glucose levels of which can increase the risk of complications and associated diseases in T2DM patients. According to several studies, initiation of a ketogenic diet does not improve health parameters more than the current recommended diets for T2DM patients. With multiple diet plans providing health benefits in type 2 diabetics, the main component of success was adherence. The research does show promise, but the treatment plan will need to be individualized based on the patient’s readiness and willingness to implement lifestyle changes.
Postpartum depression is a mood disorder that includes depressive symptoms during the time period following childbirth. There are various possibilities for what may cause this disorder, but the drastic change in hormones after delivery can play a role. With the chance this disorder may be fatal to both the mother and child, an appropriate, effective, and safe treatment is necessary to control depressive symptoms. The standard, first line pharmacotherapeutic option is a selective serotonin reuptake inhibitor (SSRI) antidepressant. SSRI antidepressants are well understood, but these medications may take time to become effective. Knowing this, medical professionals can find a more rapid option that would be appropriate; thus, hormone replacement therapy is an alternative. In this review, numerous scientific databases were evaluated, including PubMed, Cochrane, and DynaMed. Keywords and mesh terms were searched to obtain a total of 384 studies. After various exclusion criteria were evaluated, a final total of 19 research articles were included. The results of this literature review showed that both treatment options of SSRI antidepressants and hormone replacement therapy are effective, and various side effects, risks, and contraindications are present with both therapy options. Currently, Brexanolone, an endogenous hormone, is the only FDA approved indicated medication for postpartum depression. Clinically, psychotherapy and SSRIs are used as first line options. Further research is necessary to evaluate the effectiveness and possible adverse effects with all options of antidepressants, hormone replacement therapy, and the possibility of a bridge therapy to decrease depressive symptoms.
The purpose of this scholarly project is to determine if the integration of palliative care (PC) into COPD management provides an improvement in symptom burden associated with quality of life and end of life care when compared to the standard of care. A review of the literature was performed using the following electronic databases, and the use of keywords and mesh terms were used to define the set of literature that would be critically analyzed. A total of 16 articles achieved the necessary criteria for review and critical assessment. The literature reviewed various aspects related to symptom burden and symptom management associated with the disease, advanced care planning documentation, integration of palliative home care, and challenges surrounding integrating palliative care into standard care plans. The data shows that there was little statistical support for integrating palliative care to improve quality of life through more appropriate management of symptom burden associated with the disease. The literature did find support for the addition of palliative home care for improvements in advanced care planning. The scholarly project concluded that more research is needed to truly assess if palliative care has increased benefits in COPD management because there continues to be challenges that surround the integration of this specialty.
Comparison of Functional Capacity and Outcomes of Patients with Rotator Cuff Injury: Surgery Versus Non-Invasive Methods
Rotator cuff tears are acute or chronic tears of one or more of four specific muscles that encompass the glenohumeral joint. These tears can cause pain, decrease range of motion, and affect an individual for many years if not treated appropriately. The purpose of this literature review is to assess the most appropriate means of treatment between surgery, physical therapy, and injection therapies. The literature review was performed using electronic search databases CINAHL, PubMed, Clinical Key, Cochrane Library, Embase, SPORTDiscus and Research Gate.Studies were included if they directly evaluated the efficacy of surgical rotator cuff methods, physical therapy, corticosteroid injections, mesenchymal stem cell injections, or platelet rich plasma injections. Studies were excluded if they compared different variations of repairs (single row versus double row, etc.). Other non-operative methods of treatment including acupuncture, alternative therapies, or experimental solutions were also not considered. No anecdotal reports or single case studies were included. Studies were narrowed down by currency, only taking literature from 2015 to current date. The review showed that there are specific variables to consider that will aid in which management route will be most effective. Age, tear size, and patient activity level are three factors which influence outcomes. Conservative measures in chronic rotator cuff tear cases are first line, these include physical therapy and corticosteroid injections. If these therapies fail, then surgery is warranted and is an effective treatment for this injury.
Decreasing Suicidal Risks among Military Veterans with Posttraumatic Stress Disorder or Major Depression
Manpreet k. Sheabat
Suicide is a major cause of death in US. Military personnel are at a higher risk of committing suicide compared to the general population. The risk is exacerbated by Posttraumatic Stress Disorder (PTSD) and major depression.
• Few reviews have explored the effects of the recommended psychotherapeutic interventions on suicidal ideations and suicide rates for these two disorders, focusing on the veteran population. To address this, a literature search was performed through electronic databases to identify appropriate journal articles.
• Treatment with CPT and PE for PTSD has been found effective in decreasing suicidal thoughts, intents, and attempts. On the other hand, CBT has been found effective in decreasing suicidal thoughts among veterans with various symptoms of depression. It is important for clinicians to always assess the risk of suicide for veterans diagnosed with these conditions.
• Future research should seek to explain the mechanism by which the explored psychotherapeutic interventions decrease suicidal thoughts, intents, and attempts in patients with PTSD or depression
Comparison of Conjunctive Probiotic Use Versus No Probiotic Use in Outcomes of Antibiotic-Associated Diarrhea
Antibiotics are utilized in the medical community for the treatment of bacterial infections. Consequently, the use of antibiotics may result in certain gastrointestinal side effects. Antibiotic-associated diarrhea is one side effect that can be seen in patient populations that are on an antibiotic regimen. Due to this side effect profile, patient compliance on an antibiotic regimen may be compromised. This lack in patient compliance led to increased interest to determine if there are treatment options available to prevent or reduce instances of antibiotic-associated diarrhea. One treatment option of interest includes the use of probiotics. The purpose of this literature review is to determine if conjunctive use of probiotic supplementation during an antibiotic regimen demonstrates protective effects in preventing or reducing the instance of antibiotic-associated diarrhea. Studies that were included analyzed probiotic use versus a placebo in treatment of antibiotic-associated diarrhea in pediatric, adult, and elderly populations in an outpatient or inpatient clinical setting. The data available at this time suggests that supplementing with probiotics during an antibiotic regimen may be effective in prevention and reduction of antibiotic-associated diarrhea in pediatric and adult populations
The Efficacy of Testosterone Replacement vs Aromatase Inhibitors and SERMs in the Presence of Hypogonadism
Tobias C. Steen
The prevalence of male hypogonadism increases with age, although it can occur in any age group. Patients with hypogonadism can experience a wide range of symptoms, including mood changes, decreased libido, decreased muscle mass, erectile dysfunction, and bone loss. Most men with hypogonadism are commonly treated with testosterone replacement therapy (TRT). While TRT has proven effective at attenuating the symptoms of hypogonadism, it is not without side effects. TRT can be expensive, painful, cause gynecomastia, acne, water weight gain, and infertility. Recently, medications such as selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) have gained favor as alternative treatments for secondary hypogonadism. After a thorough literature review that included searches of Clinical Key, Dynamed Plus, Cochrane Library, PubMed, and CINAHL databases, multiple studies were reviewed to determine the aforementioned treatment modalities' effectiveness. Works chosen for the review were published after 2007 and included randomized control trials (RCTs) and metanalyses. After all exclusions, this literature review included 9 journal articles. The literature review results discovered that TRT and SERMs are efficacious at raising testosterone levels, improving libido, lean muscle mass, strength, and endurance. SERMs appear to have one advantage over TRT in that they preserve male fertility. The efficacy of the co-administration of AIs and TRT results lacked enough evidence to determine its efficacy. With the addition of off-label therapies such as SERMs, providers can customize a treatment plan for their patients that provides a continuous steady level of testosterone while preserving fertility with the same benefits as TRT.
One of the most challenging health conditions primary care providers face is combating the ever-rising incidence of obesity, especially among children. The objective of this literature review is to determine the effects of metformin implemented in addition to lifestyle modification for the treatment of childhood obesity. Efficacy, to include change in weight, BMI, insulin resistance, and overall safety of metformin was studied. The online databases searched in this review were PubMed, Cochrane Library, Embase, and CINAHL. Literature chosen for review included randomized control trials, meta-analysis, and systematic reviews published between 2015 and 2020. Much of the studied research indicates positive effects of metformin for weight loss when added to a structured lifestyle modification plan, however, improvement in insulin resistance remains controversial. Safety analysis reveals metformin to be mostly well-tolerated among pediatric patients, with known gastrointestinal side effects being the most common adverse event. While some current research exhibits promising results for weight management, more research must be done to determine the most effective dose and treatment program length.
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