RESUMO
Fecal Microbiota Transplantation (FMT) is the process of transferring the fecal microbiome from a healthy donor to an individual with repeated multiple episodes of Clostridium difficile infection. It is also known as stool transplant. Fecal microbiota transplant is effective and safe in various studies, the approval from the Food and Drug Administration (FDA) remains pending. The main objective of this systemic review is to evaluate the efficacy and safety of stool transplant in studies with only treatment groups (FMT) and studies with treatment (FMT) and antibiotic (AB) groups and previous studies. Online databases PubMed, PubMed Central, Science Direct, Google Scholar, and Embase were searched for relevant articles in the last five years (2016 to 2021) using automation tools. Following the removal of duplicates, screening of eligibility criteria, titles/abstracts, and quality appraisal were done by two authors independently. In total, seven observational studies are in this review article. Out of the seven observational studies, five are retrospective and two prospective. Two of the five retrospective and one of two prospective studies have a control group. In both the prospective studies and one retrospective study, FMT efficacy of (68% to 93%) was demonstrated in the elderly population despite high index comorbidities. In the younger individuals with inflammatory bowel disease, and efficacy of 90% or above was found. The most common side effects were minor such as fever, abdominal pain, bloating, and flatulence. In one study, two cases of aspiration events occurred attributed to the gastroscopy route of donor feces delivery. There was no statistical significance in the incidence of diseases such as (allergies, autoimmune diseases, cancer, inflammatory bowel diseases, and neurological diseases like dementia and migraine). Fecal microbiota transplantation has shown to be effective and safe in recurrent Clostridium difficile infections. Since very few pragmatic studies have demonstrated its efficacy and safety, their application is not well established. Robust studies, both observation and experiment, are required in the future to well-establish its effectiveness, safety in the treatment of recurrent Clostridium difficile infection.
RESUMO
Dual antiplatelet therapy (DAPT) is used in patients after drug-eluting stent (DES) implantation to prevent stent thrombosis and ischemic events. The ideal duration of DAPT in patients after DES implantation is a topic of debate among clinicians. In the past, many research studies were published related to an optimal duration of DAPT after DES implantation. In common practice, DAPT should be continued for one year or more after percutaneous coronary intervention (PCI) followed by DES implantation. The duration of DAPT is significant as long-term DAPT has beneficial effects but is associated with side effects like bleeding. On the other hand, short-term DAPT has a lower risk of bleeding, but it increases the rate of stent thrombosis or ischemic events. Our aim in this systematic review is to solve the dispute regarding the duration of DAPT after DES implantation. So, we tried to find the efficacy and safety of short-term (six months) DAPT by compiling data from randomized control trials (RCTs). We conducted this systematic review following the guidelines defined in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. We searched for our data from multiple databases like PubMed, Web of Science, ScienceDirect, and Google Scholar. We reviewed 10964 studies and then applied inclusion/exclusion criteria and PRISMA guidelines. Finally, we were left with only 21 studies regarding the optimal duration of DAPT after DES implantation. Our systematic review will help determine the non-inferiority of short-term (six months) DAPT to long-term (12 months) DAPT. Furthermore, we also noticed with short-term (six months) DAPT, there was decreased incidence of bleeding as compared to DAPT for long-term. But more studies were required to establish the safety and effectiveness of short-term (six months) DAPT compared to long-term (12 months) DAPT in patients after DES implantation.
RESUMO
Rheumatoid Arthritis (RA) is one of the most common autoimmune diseases present today. Although treatment options may differ among clinicians, a commonly prescribed treatment is hydroxychloroquine (HCQ), alone or in combination with other medications. HCQ has been studied for its immunomodulatory effects as well as its role in treating adverse conditions associated with RA. This systematic review examined the use of HCQ therapy in RA patients. A systematic search for relevant literature through PubMed, National Institute of Informatics, Japan (CiNii), and Science Direct databases were carried out in August 2021. Literature directly related to HCQ therapy for RA patients, RA-associated chronic kidney disease, and cardiovascular disease (including lipid profile) was considered relevant. HCQ associated retinopathic adverse effects were also selected for this review. Thirty-eight articles were found to be relevant, passed quality assessment, and were included in this review. Nine articles discussed HCQ therapy in comparison with other therapies (mainly methotrexate and sulfasalazine), but were contradictory in their outcomes, as were the seven papers that reviewed kidney function in RA patients with and without HCQ. Five articles credited better cardiovascular outcomes to RA patients taking HCQ. Sixteen articles studied the relationship between HCQ and retinal toxicity, providing insights into the risks associated with HCQ therapy. HCQ therapy was found not only to be beneficial in slowing the disease progression in RA patients but enhanced the effects of methotrexate in treating RA as well. Data strongly associates HCQ therapy with the mitigation of RA-related cardiovascular and kidney conditions. However, if HCQ is prescribed, it is imperative to be aware of the possible (although rare) retinopathic adverse effects associated with this therapy.
