Objective: This systematic review aimed to assess the types and effectiveness of interventions that sought to reduce anticholinergic burden (ACB) in people with dementia (PwD) in primary care. Methods:One trial registry and eight electronic databases were systematically searched to identify eligible English language studies from inception until December 2021. To be eligible for inclusion, studies had to be randomised controlled trials (RCTs) or non-randomised studies (NRS), including controlled before-and-after studies and interrupted time-series studies, of interventions to reduce ACB in PwD aged ≥65 years (either community-dwelling or care home residents). All outcomes were to be considered. Quality was to be assessed using the Cochrane Risk of Bias tool for RCTs and ROBINS-I tool for NRS. If data could not be pooled for meta-analysis, a narrative synthesis was to be conducted. Results:In total, 1880 records were found, with 1594 records remaining after removal of duplicates. Following title/abstract screening, 13 full-text articles were assessed for eligibility. None of these studies met the inclusion criteria for this review. Reasons for exclusion were incorrect study design, ineligible study population, lack of focus on reducing ACB, and studies conducted outside the primary care setting. Conclusions: This 'empty' systematic review highlights the lack of interventions to reduce ACB in PwD within primary care, despite this being highlighted as a priority area for research in recent clinical guidance. Future research should focus on development and testing of interventions to reduce ACB in this patient population through high-quality clinical trials.
Paracetamol (acetaminophen, APAP) is the most common non-prescription analgesic drug used during pregnancy. The aim of this study was to investigate the effect of vitamin E on acute APAP toxicity in pregnant rats. Toxicity in the liver, kidney, and brain (hippocampus, cerebellum, and olfactory bulb) was examined. Twenty pregnant female Wistar rats at gestational day 18 were used. Pregnant rats were divided into four groups: Control, APAP, E + APAP, and APAP + E. The Control group was treated with 0.5 mL p.o. corn oil. The APAP group received 3000 mg/kg p.o. APAP. The E + APAP group received 300 mg/kg p.o. vitamin E one hour before 3000 mg/kg APAP. The APAP + E group received 3000 mg/kg paracetamol one hour before 300 mg/kg p.o. vitamin E. Twenty-four hours after the last treatment administration, rats were euthanized and blood, brain, liver, and kidney samples were collected. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), creatinine levels, uric acid (UA), and superoxide dismutase (SOD) levels, as well as the relative mRNA expression of Cyp1a4, Cyp2d6, and Nat2, were determined. Acute APAP treatment upregulated ALT, AST, BUN, and creatinine levels. APAP treatment downregulated UA and SOD levels. APAP treatment upregulated the relative mRNA expression of Cyp1a4 and Cyp2d6, but downregulated Nat2 expression. Vitamin E treatment, either before or after APAP administration, attenuated the toxic effects of APAP. In conclusion, the results showed that an acute toxic APAP dose in late pregnancy can cause oxidative stress and dysregulation in Cyp isoform expression, and that vitamin E treatment attenuates these effects.
Paracetamol (Acetaminophen) is the most common nonprescription analgesic and antipyretic drug used. It can be found in different pharmaceutical dosage forms such as syrup, capsule, suppositories and intravenous (I.V) infusion solution. The intake frequency and the dose of paracetamol usually varied during pregnancy with a tendency toward higher doses in the last trimester. The effect of Paracetamol overdose was extensively studied on hepatocyte and nephrocyte of laboratory animals. The aim of this study is to focus on the effect of paracetamol overdose on Neurotoxicity (within Hippocampus, Cerebellum, and Olfactory Bulbs) of Paracetamol in the last trimester of pregnant rats. And this will be done through studying oxidative stress markers, the biochemical and antioxidant tests that indicate the presence of Hepatotoxicity and Nephrotoxicity, along with the protective effect of Vitamin E as antioxidant in pre‐ and post‐single toxic dose administration. Twenty female pregnant Wistar rats (average weight 200 gm ± 10) at gestational day 18 (GD18) were used. The pregnant rats were divided into four groups; the first (control) group received a 0.5 ml p.o of corn oil. The second group (paracetamol) group received a 3000 mg/kg p.o paracetamol dissolved in corn oil. The third (E + paracetamol) group received a 3000 mg/kg paracetamol one hour after 300 mg/kg p.o vitamin E. The fourth (paracetamol + E) group received a 3000 mg/kg paracetamol one hour before 300 mg/kg p.o vitamin E dissolved in corn oil. Twenty‐four hours After Paracetamol administration the rats were anesthetized and the brain, the liver, the kidney, and the blood were collected. Various biochemical tests were performed to show the effect of paracetamol overdose on liver including Alanine aminotransferase (ALT), Aspartate aminotransferase (AST). Additionally, the effect of paracetamol on Blood urea nitrogen (BUN) and Creatinine levels were determined to detect nephrotoxicity, and the results showed significant elevation within the paracetamol treated group and levels were restored to the normal levels with vitamin E treated groups. Uric acid (UA) and superoxide dismutase (SOD) were used to detect the oxidative stress within the Liver, the Kidney, the Hippocampus, the Cerebellum, and the Olfactory Bulbs. Support or Funding Information This research is supported form Al‐Zaytoonah University of Jordan
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