Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 5 Articles
Background: Glucocorticoid-induced hyperglycemia is common amongst hospitalized patients. Isophane insulin has been proposed as part of the optimal insulin regimen for managing this, but there are few randomized controlled trials to support this. Our aim was to determine if the addition of a morning dose of isophane insulin would improve glycemic control amongst patients with COVID-19 who had dexamethasone-induced hyperglycemia (DIH) in hospital. Methods: Patients with diabetes admitted to hospital with COVID-19 respiratory infection and treated with dexamethasone were cluster-randomized by ward to receive either basal bolus insulin (BBI) or isophane-augmented BBI (IaBBI) in equipotent doses. Insulin commencement and titration were guided by standardized protocols. The primary outcome was overall finger-prick blood glucose (BG) levels, with predefined secondary outcomes of BGs on day 3 and the final day of admission. Results: A total of 40 patients were included, 25 in the IaBBI group and 15 in the BBI only group, for a duration of 5.4 ± 2.2 days. Both recruitment and the trial were terminated early because of a rapid decline in COVID-19 admissions. There were no differences in overall mean BG levels (IaBBI 11.9 ± 2.5 mmol/L vs. BBI 12.6 ± 2.4 mmol/L, p = 0.193) between the groups. Mean day 3 BGs were lower in the IaBBI group than in the BBI group (11.1 ± 3.5 mmol/L vs. 12.7 ± 3.5 mmol/L, p = 0.029) and on the final day (9.6 ± 2.8 mmol/L vs. 10.7 ± 2.5 mmol/L, respectively, p = 0.011). Conclusions: The restricted sample size in this study limits any conclusions that can be made regarding the effectiveness of the addition of isophane insulin to a BBI insulin regimen for diabetes patients with COVID-19 infection and DIH. However, some improvements in glycemic control were observed, suggesting that this is a glucose management strategy that warrants further evaluation....
Background: This study examines the clinical efficacy of daratumumab when combined with other therapeutic agents in patients with multiple myeloma, with a focus on key outcomes including overall response, progression-free survival (PFS), and stringent complete response (sCR). Methods: A systematic literature search was conducted using PubMed, Web of Science, Scopus, and the Cochrane Library. Statistical analyses were performed with R software (version 4.2.2). Between-study heterogeneity was assessed using the Cochrane Q test and the I2 statistic, while potential publication bias was evaluated through Egger’s regression test and visual inspection of funnel plots. Results: The meta-analysis revealed that daratumumab-containing regimens were associated with a 54.4% reduction in the risk of disease progression or death (hazard ratio[HR] 0.4558; 95% confidence-interval [CI]: 0.4031–0.5154). Similar results were observed using a random-effects model (HR 0.4667; 95% CI: 0.3771–0.5776), despite moderate heterogeneity (I2 = 66.7%). Moreover, patients treated with daratumumab were approximately 2.4 times more likely to achieve a stringent complete response (odds-ratio[OR] 2.38; 95% CI: 1.80–3.15), with moderate heterogeneity across studies (I2 = 58.2%). Conclusions: Incorporating daratumumab into standard therapy for multiple myeloma significantly enhances progression-free survival and the rate of stringent complete response. Despite some heterogeneity, the consistent positive outcomes support its use as an effective treatment option in clinical practice....
Background: Hormonal fluctuations across the menstrual cycle may influence cognitive and neuromuscular performance in female athletes. Caffeine (CAF) is a widely used ergogenic aid, yet its phase-specific effects remain unclear. This study investigated the acute effects of CAF supplementation on cognitive and physical performance across menstrual cycle phases in eumenorrheic female athletes. Methods: Twelve trained female athletes with regular menstrual cycles participated in a randomized, double-blind, placebo-controlled study. Each participant completed a battery of cognitive (reaction time [RT], vigilance test [VT]) and physical performance tests (countermovement jump [CMJ], repeated sprint test [RST], and time to exhaustion test [TTE]) during the early follicular (EFP), late follicular (LFP), and mid-luteal (MLP) phases. CAF (400 mg) or a placebo (PLA) was ingested one hour before the testing session. Results: CAF supplementation significantly improved VT performance across all menstrual cycle phases compared with PLA (p < 0.05), with no phase-dependent effect. RT was significantly reduced following CAF ingestion (p < 0.05), with no significant condition × phase interaction. CMJ performance varied across menstrual phases under placebo conditions, with higher values observed during the LFP (p < 0.05); a trend toward enhanced jump performance was observed following CAF ingestion, particularly during the MLP. During RST, performance declined across sprints in all conditions (p < 0.05), and CAF supplementation attenuated fatigue-related performance declines during later sprints, irrespective of menstrual cycle phase. Time to exhaustion was not significantly influenced by CAF supplementation or menstrual cycle phase (p > 0.05). Conclusions: CAF supplementation was associated with consistent improvements in vigilance and reaction time across the menstrual cycle. However, effects on neuromuscular performance were less consistent and not clearly phase-dependent. These findings highlight that while CAF can enhance certain aspects of cognitive performance in female athletes, responses in physical performance may vary and require further investigation. CAF may contribute to improvements in selected neuromuscular outcomes, although evidence for phase-specific ergogenic effects remains limited....
Background and Objectives: Overactive bladder (OAB) is frequently associated with impaired quality of life and sleep disturbances, particularly in women with refractory symptoms. Non-invasive neuromodulation targeting autonomic regulation has emerged as a potential therapeutic approach. The purpose of this pilot trial is to assess the efficacy and safety of NESA non-invasive neuromodulation in the treatment of patients with overactive bladder. Materials and Methods: Triple-blind, randomized, sham-controlled pilot trial. Women ≥ 18 years with refractory OAB were randomized to active NESA or sham using an identical protocol (10 sessions, 60 min, twice weekly). Outcomes were collected at baseline, after session 5, and after session 10. The primary outcome was mean daily micturitions, assessed using a 3-day voiding diary. Secondary outcomes included other diary variables, urinary questionnaires (ICIQ-UI SF, ICIQ-QoL, B-SAQ), and sleep measures (PSQI, ISI). Results: Per-protocol analysis included 43 women (NESA n = 24; sham n = 19). At session 10, mean daily micturitions decreased from 9.19 to 8.07 with NESA and increased from 10.56 to 11.03 with sham (between-group p = 0.043; d = −0.97). Sleep improved with NESA versus sham (PSQI p = 0.001; d = −0.63; ISI p = 0.001; d = −0.59). Between-group differences in urinary symptom questionnaires were not significant. No device-related adverse events occurred. Conclusions: In this pilot trial, NESA neuromodulation was safe and showed preliminary signals of benefit, particularly for mean daily frequency and sleep outcomes. However, given the exploratory design, small sample size, and per-protocol analysis, these findings should be interpreted cautiously and confirmed in larger adequately powered trials before clinical implementation....
Background and Objectives: Remimazolam and remifentanil are ultra-short-acting agents that are used for sedation and analgesia, respectively. Their combined effect on respiratory function is unclear. We evaluated whether co-administration produced dose-dependent respiratory depression and loss of consciousness (LOC) preceded oxygen desaturation. Materials and Methods: A randomized, double-blind trial was conducted from May to July 2024. Female patients (20–65 years; n = 108; American Society of Anesthesiologists physical status I–II) undergoing elective gynecological surgery were selected. Patients received remifentanil via target-controlled infusion (TCI) at effect-site concentrations (Ce) of 1.0, 1.5, or 2.0 ng/mL (Groups 1.0, 1.5, and 2.0) combined with a fixed Ce of 500 ng/mL remimazolam. Respiratory variables, timing of LOC, bispectral index, and adverse events were recorded. Results: Respiratory depression increased in a dose-dependent manner. Jaw thrust was required in 52.8% of Group 1.0 and 91.7% of Group 2.0 (p < 0.001). The need for 100% oxygen increased from 30.6% to 69.4% (p = 0.001). Minute ventilation decreased only in Group 2.0 (p = 0.008). Involuntary movements were frequent in Group 1.0 (p = 0.005). Conclusions: Remimazolam–remifentanil co-administration via TCI induced dose-dependent respiratory depression and pre-LOC desaturation. Therefore, continuous monitoring and careful titration are essential....
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