Adverse Obstetric Outcomes in Pregnant Women Using Natalizumab for the Treatment of Multiple Sclerosis: A Systematic Review.

Multiple sclerosis is a common disease in women of childbearing age, characterized by demyelination of the central nervous system. Among the different treatment options available, disease-modifying therapies (DMTs) are the most efficacious, and natalizumab (NAT) is an injectable DMT best for relapsing-remitting multiple sclerosis. However, it comes under pregnancy category C drug classification. This systematic review aims to analyze the adverse outcomes of using NAT during pregnancy. PubMed/Medline, PubMed Central (PMC), ScienceDirect, and Google Scholar were the databases used to search for articles. Appropriate keywords and Medical Subject Headings (MeSH) strategy were used to identify relevant articles. Articles were then screened using inclusion/exclusion criteria followed by the title and abstract screening. The Joanna Briggs Institute (JBI) quality appraisal tools were used for quality check, and nine articles were finalized for review. NAT suspension during pregnancy is shown to have a high risk of disease relapse. Despite the risk of mild hematological abnormalities in the newborn and the risk of spontaneous abortions at the same rate as that of the general population, NAT use can be considered safe in pregnancy. These adverse outcomes can be minimized by strict monitoring of patients. Studies of better quality with larger sample sizes are needed for further investigation.

Treatment Modalities for Dementia in Down's Syndrome: A Literature Review.

Down's syndrome (DS) is the most well-known chromosomal abnormality characterized by an extra chromosome 21 and multiple systemic issues. The higher production of amyloid precursor protein (APP), the precursor peptide of beta-amyloid, predisposes persons with DS to early Alzheimer's disease (AD). The prevalence of dementia has increased as a function of the extended life expectancy of persons with DS. Because we know little about the treatment of dementia in persons with DS, this review focuses on the pathophysiology and management strategies to improve the overall quality of life.

An Outlook on the Etiopathogenesis of Pulmonary Hypertension in HIV.

Although overall survival rates of patients infected with human immunodeficiency virus (HIV) have been significantly improved by antiretroviral therapy (ART), chronic comorbidities associated with HIV result in a worsening quality of life. Pulmonary arterial hypertension (PAH) is the most prevalent comorbidity associated with HIV infection. Despite low viremia and a non-replicative state maintained by ART, few people develop PAH. Previous data from animal models and human pulmonary microvascular endothelial cells (HPMVECs) suggests a constellation of events occurring during the propagation of HIV-associated PAH (HIV-PAH). However, these studies have not successfully isolated HIV virions, HIV-DNA, protein 24 antigen (p24), or HIV-RNA from the pulmonary endothelial cells (ECs). It provides an insight into an ongoing inflammatory process that could be attributed to viral proteins. Several studies have demonstrated the role of viral proteins on vascular remodeling. A composite of chronic inflammatory changes mediated by cytokines and growth factors along with several inciting risk factors such as Hepatitis C virus (HCV) co-infection, genetic factors, male predominance, illegal drug usage, and duration of HIV infection have led to molecular changes that result in an initial phase of apoptosis followed by the formation of apoptotic resistant hyperproliferative ECs with altered phenotype. This study aims to identify the risk factors and mechanisms behind HIV-PAH pathobiology at the host-pathogen interface at the intracellular level.

A Systematic Review of the Link Between Autism Spectrum Disorder and Acetaminophen: A Mystery to Resolve.

The purpose of this study is to review the published papers investigating maternal acetaminophen (AP) use during pregnancy and its effect on the offspring's neurodevelopment, particularly autism spectrum disorders (ASD). Acetaminophen is an over-the-counter analgesic and antipyretic considered safe in pregnancy. Recent studies have found an association between acetaminophen and immune system alterations like asthma and adverse neurodevelopmental outcomes. We used online databases (PubMed/Medline/PubMed Central, Science Direct, and Google Scholar) to search the studies relevant to our topic. We screened the papers by titles, abstracts, and then full-text availability. The screened articles were checked for eligibility using relevant quality assessment tools for each study design, extracting and analyzing the data. We finalized 30 studies after the screening; 14 were ineligible. Our final selection included 16 high-quality papers - 13 prospective cohort studies, two review articles, and one meta-analysis. We found a wide range of neurodevelopmental outcomes in our data collection. So, we included autism spectrum disorders, intelligent quotient (IQ), attention-deficit/hyperactivity disorder (ADHD), isolated language, attention and executive function, communication, behavior, and psychomotor development. All studies showed an association between acetaminophen use and listed neurodevelopmental outcomes. Long-term use, increased dose, and frequency were associated with a stronger association. We extracted collective evidence from 16 studies suggesting acetaminophen's role in developing adverse neurodevelopmental outcomes. It is urgent to do more research on this association before pregnant women can be cautioned about the precise use of acetaminophen.

Factors Showing the Growing Relation Between Vitamin D, Metabolic Syndrome, and Obesity in the Adult Population: A Systematic Review.

Several theories suggest an inverse association between increasing adiposity, particularly abdominal fat, and low vitamin D levels. As a result, several routes are likely to impact how vitamin D, obesity, and metabolic syndrome (MetS) interact. This systematic study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. A comprehensive PubMed, PubMed Central, Google Scholar, and ScienceDirect database search was conducted for published papers over the previous five years. Studies were identified using the following criteria 1) participants, interventions, and outcomes (PIO) components, 2) free full text, 3) studies published in English, and 4) human studies, including systematic and narrative reviews and cross-sectional, observational studies, were among the inclusion and exclusion criteria. In total, 151 articles were returned, and 16 duplicates were rejected. After verifying the titles and abstracts of these records using the review's PIO components and eligibility criteria, 17 received a 70% or above score. On review of the literature, the release of adiponectin from fatty tissues was inversely correlated with body weight and BMI suggesting a link between vitamin D deficiency and insulin resistance.