Treatment of Mood and Depressive Disorders With Complementary and Alternative Medicine: Efficacy Review

There has been a steady increase in people with symptoms of depression over the past several years (since 2011). The further increase in stress and depression in the early part of the COVID-19 pandemic was accompanied by an increase in unmet mental health needs. Many have turned to complementary and alternative medicine (CAM) therapies such as bright-light therapy, yoga, meditation, and dietary supplements like St. John's wort or folic acid. The reliability of evidence for use of CAM therapies for depression has remained low. There are few randomized controlled trials (RCTs) in the current literature and poor methodology in many of the trials that are available. This state of the science review examines current published guidelines, meta-analyses, systematic reviews, and RCTs regarding use of CAM therapies in the management of depression.

Using an Advanced Practice Pharmacist in a Team-Based Care Model to Decrease Time to Hemoglobin A1c Goal Among Patients With Type 2 Diabetes, Florida, 2017-2019

Collaborative practice models that use an advanced practice pharmacist (APP) have been shown to improve outcomes for patients with chronic diseases. Few studies have evaluated the effects of team-based practice models involving an APP for time needed to attain glycated hemoglobin A_1c (HbA_1c) goals in patients with diabetes mellitus (type 2 diabetes). Ours is a retrospective cohort study, involving patients with type 2 diabetes who worked with a pharmacist in an academic family medicine clinic. These patients experienced a shorter time to achieve an HbA_1c of less than 7%, as compared with patients who did not work with a pharmacist. Future studies should evaluate the length of time patients can sustain an HbA_1c of less than 7% with team-based care involving an APP and the influence of such care on diabetes-related complications.

Systematic Review of Randomized Controlled Trials Evaluating Glycemic Efficacy and Patient Satisfaction of Intermittent-Scanned Continuous Glucose Monitoring in Patients with Diabetes

Introduction: Intermittent-scanned continuous glucose monitoring (isCGM) has the ability to allow for greater personalization of diabetes self-management. The purpose of this systematic review is to provide an updated analysis of the efficacy and patient satisfaction of isCGM in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Methods: A research librarian searched PubMed, EMBASE, and Cochrane Library using keywords and subject headings to identify studies assessing efficacy and use of isCGMs in patients with T1DM and T2DM. Results: Nine randomized controlled trials (RCTs) involving patients with T1DM and T2DM using isCGM were included. Based on available RCT evidence investigating isCGM in patients with diabetes, isCGM may lead to a small decrease hemoglobin A1c (HbA1c) in certain subgroups of patients with uncontrolled T2DM (those using multiple daily insulin injections and aged 65 years or younger). Patients with uncontrolled T1DM using insulin may also benefit from isCGM, when combined with a structured diabetes education program. Evidence is mixed regarding isCGM impact on improving time in glycemic range, glycemic variability, and hypoglycemia. isCGM has demonstrated greater patient satisfaction and lower diabetes distress compared with usual care. Conclusions: isCGM may lead to improvements in HbA1c in certain subgroups of patients. Additional benefit with isCGM on time in glycemic range, glycemic variability, and hypoglycemia is unclear at this time. Future clinical trials are warranted to investigate the role of isCGM in patients with uncontrolled T2DM using insulin and oral antidiabetic drugs.

Polyprotein processing in cis and in trans by hepatitis A virus 3C protease cloned and expressed in Escherichia coli

To determine the P3 region protein-processing sites cleaved by the hepatitis A virus 3C protease, a nested set of constructs containing a portion of 3A (3A* [the asterisk denotes an incomplete protein]), 3B and 3C and various amounts of 3D, fused in frame to Escherichia coli TrpE-coding sequences under control of the tryptophan promoter, was made. Additional plasmids that encoded a portion of 2C (2C*) and the P3 proteins, including complete or incomplete 3D sequences, were constructed. After induction, E. coli containing these recombinant plasmids produced high levels of fusion proteins as insoluble aggregates. 3C-mediated cleavage products were identified by comparison of expression with a matching set of plasmids, containing an engineered mutation in 3C. Cleavage products were detected by immunoblot analyses by using antisera against the TrpE protein, against 3D*, and against 3CD*. Scissile bonds were determined by N-terminal amino acid sequencing of the proteins formed by cleavage. The results showed that when a portion of 2C was present, the primary cleavage by the 3C protease was between 2C and 3A, and the cleavage site was QG, as predicted by J. I. Cohen, J. R. Ticehurst, R. H. Purcell, A. Buckler-White, and B. M. Baroudy, J. Virol. 61:50-59, 1987. Very little further cleavage of the released P3 protein was detected. When the fusion protein contained no 2C and included only 3A*-to-3D sequences, efficient cleavage occurred between 3B and 3C, at the QS pair, also as predicted by Cohen et al. (J. Virol. 61:50-59, 1987). The latter proteins were also cleaved between 3C and 3D, but less efficiently than between 3B and 3C. Extracts of bacteria expressing proteins from 3A* to 3D also cleaved a radiolabelled hepatitis A virus substrate containing VP1*2ABC* sequences in trans.

Translation of hepatitis A virus RNA in vitro: aberrant internal initiations influenced by 5' noncoding region

Hepatitis A virus (HAV) RNAs were translated in vitro in rabbit reticulocyte lysates. The pattern of proteins synthesized from full-length HAV RNA was highly complex, consisting of a continuous spectrum of polypeptides ranging from less than 20,000 to greater than 200,000 Da. The pattern was not significantly altered by varying incubation times, ion, or other reaction parameters, or by the addition of HeLa or BS-C-1 cell extracts to the translation reactions. Plasmids engineered with mutations in the 3C coding region produced transcripts which directed the synthesis of the same overall pattern of polypeptide products as those transcribed from wild-type sequences, suggesting that protein processing by 3C did not generate the complex set of protein products. Translation of RNA containing only the P3 coding region of HAV, directly adjacent to the HAV 5' noncoding region, generated a set of protein products which precisely matched a subset of those synthesized from full-length HAV RNA. The translation products of P3 RNA, full-length RNA, and mutant 3C-containing RNAs were analyzed by immunoprecipitation with antisera specific for 3D, VP1, and 2C sequences; several products were subjected to N-terminal sequence analysis. All together, the results demonstrate that translation of HAV RNA in rabbit reticulocyte lysates initiates predominantly at a large number of internal AUG codons, especially those in the P3 coding region. A minor population of products is initiated from sites in the P1 and P2 regions. The latter proteins undergo some proteolytic processing, at unidentified sites, catalyzed by 3C protein sequences. Replacement of the HAV 5' noncoding region with encephalomyocarditis virus 5' end sequences increased initiation at the correct polyprotein start site and both reduced and altered the products generated by internal initiation.