Measurements of blood cholinesterase (ChE) activities, including those of erythrocytes (EChE), plasma or serum (PChE), and whole blood (WBChE), are used to assess exposure to ChE-inhibiting pesticides. The purpose of this review was to report normal reference ChE activities in the blood of healthy adult humans, as determined by a modified electrometric method. We performed a systematic review following PRISMA guidelines. Single-group meta-analysis of means of PChE, EChE, and WBChE activities of adult healthy subjects was conducted using the random effects model. The programs used were Open-Meta Analyst and Meta-Essentials Version 1.5. Studies selected for analysis comprised 21, 19, and 4 reports of normal reference/baseline PChE, EChE, and WBChE activities in 690, 635, and 121 healthy adult males and/or females, respectively. The meta-analysis showed normal reference values of the means (effect sizes) with 95% CI of PChE, EChE, and WBChE activities of healthy adult subjects, which were 1.078 (1.015, 1.142), 1.075 (1.024, 1.125) and 1.331 (1.226, 1.436), respectively. By the subgroup analysis, heterogeneity (I2>89%) was considerably reduced in females to 4.4% and 30.1% for PChE and EChE, respectively. Funnel plots indicated no publication bias. However, Egger's regression confirmed the symmetry of the data points for PChE and WBChE activities with a significant effect on EChE. This meta-analysis showed normal reference values of PChE, EChE, and WBChE activities, measured by a modified electrometric method, in healthy adult humans.
Background and Aim: Diphenhydramine is an H1-antihistamine that counteracts the toxic effects of organophosphate and carbamate insecticides that inhibit cholinesterase (ChE) activity. This meta-analysis aimed to investigate the effects of diphenhydramine on ChE inhibition induced by these insecticides in the plasma, erythrocytes, or whole brain of experimental animals. Materials and Methods: A data search was performed on erythrocyte, plasma, and brain ChE inhibition caused by organophosphate and carbamate insecticides in experimental animals (mice, rats, and chicks) treated with the antihistamine diphenhydramine in accordance with preferred reporting items for systematic reviews and meta-analysis, which was done by the two-group random-effects model meta-analysis. The meta-analysis included 18 records extracted from six studies that appeared from 1996 to 2022. Results: Using the random-effects model, a two-group meta-analysis revealed that the combined effect size (ChE inhibition) was significantly more favorable in the control group than in the diphenhydramine intervention, as shown by a forest plot. The combined effect size (standardized mean difference) was 0.67, with a standard error of 0.3, a lower limit of 0.04, and an upper limit of 1.29 (p = 0.025). The heterogeneity was moderate, as I2 of the combined effect size was 74%, with a significant Cochrane Q-test result (Q = 65, p < 0.0001). Subgroup analysis indicated that, with brain ChE inhibition, the heterogeneity (I2) became 5%, which was lower than ChE inhibition in plasma (84%) and erythrocytes (78%). No publication bias was identified using the funnel plot and Egger's test. Conclusion: This meta-analysis suggests that, in addition to its documented antidotal action against ChE-inhibiting insecticides, diphenhydramine can also reduce the extent of ChE inhibition, especially in the brain, which is the main site of toxicity of these insecticides. There is a need for additional studies to assess such enzyme inhibition in different parts of the brain.
Background and Aim: Anterior colporrhaphy means plication of the anterior vaginal wall fibromuscular layer to correct the prolapse and to support the bladder, and is considered a traditional procedure. Urinary symptoms may associate cystocele like irritative urinary symptoms and stress incontinence and these symptoms may be relieved upon cystocele correction. However, cystocele repair may lead to urinary symptoms due to extensive local dissection of the anterior vaginal wall that results in bladder denervation injury. The aim of this study is to study the urinary symptoms before and after cystocele repair. Patients and Methods: A prospective cross-sectional study was performed including 100 patients referred for anterior colporrhaphy surgery from March 2018 through December 2019 at the departments of Urology and gynecology at Azadi Teaching Hospital and Duhok Maternity Hospital in Duhok City, Kurdistan Region/Iraq. Pre and postoperative urological symptoms were evaluated. Results: One hundred female patients subjected to anterior colporrhaphy, the mean patient's age was 39.42 years, the mean parity was 5.57 and BMI was 28.60. Seventy-five 75% of patients had history of vaginal delivery, while 25% of them had history of both vaginal delivery and cesarean section. The results show significant improvement of vaginal bulge by 92%, Stressincontinence(SI) 71.4%, urge incontinence 67%, frequency 59%, urgency 57.3%, nocturia 57% and dyspareunia 60%. Meanwhile, urinary tract infection and obstructive urinary symptoms were not significantly improved. Conclusion:The study showed that women with coexistent irritative urinary symptoms and stress urinary incontinence with POP will show significant improvement after surgery.
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