Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized cont...Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.展开更多
Cardiac output(CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractili...Cardiac output(CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractility and afterload. Moreover it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods and thermodilution method using pulmonary artery catheter(PAC) is till date considered as gold standard method. Complications associated with PAC led to development of newer methods which are minimally or non-invasive. Newer methods fulfil other properties like continuous and reproducible reading, cost effective, reliable during various physiological states and have fast response time. These methods are validated against the gold standard with good level agreement. In this review we have discussed various newer methods of CO monitoring and their effectiveness in clinical use.展开更多
The 21^(st) century has started with several innovations in the medical sciences,with wide applications in health care management.This development has taken in the field of medicines(newer drugs/molecules),various too...The 21^(st) century has started with several innovations in the medical sciences,with wide applications in health care management.This development has taken in the field of medicines(newer drugs/molecules),various tools and technology which has completely changed the patient management including abdominal surgery.Surgery for abdominal diseases has moved from maximally invasive to minimally invasive(laparoscopic and robotic)surgery.Some of the newer medicines have its impact on need for surgical intervention.This article focuses on the development of these emerging molecules,tools,and technology and their impact on present surgical form and its future effects on the surgical intervention in gastroenterological diseases.展开更多
Fasting during the month of Ramadan is one of the five fundamental principles of Islam,and it is obligatory for healthy Muslim adults and adolescents.During the fasting month,Muslims usually have two meals a day,suhur...Fasting during the month of Ramadan is one of the five fundamental principles of Islam,and it is obligatory for healthy Muslim adults and adolescents.During the fasting month,Muslims usually have two meals a day,suhur(before dawn)and iftar(after dusk).However,diabetic patients may face difficulties when fasting,so it is important for medical staff to educate them on safe fasting practices.Prolonged strict fasting can increase the risk of hypoglycemia and diabetic ketoacidosis,but with proper knowledge,careful planning,and medication adjustment,diabetic Muslim patients can fast during Ramadan.For this review,a literature search was conducted using PubMed and Google Scholar until May 2023.Articles other than the English language were excluded.Current strategies for managing blood sugar levels during Ramadan include a combination of patient education on nutrition,regular monitoring of blood glucose,medications,and insulin therapy.Insulin therapy can be continued during fasting if properly titrated to the patients’needs,and finger prick blood sugar levels should be assessed regularly.If certain symptoms such as hypoglycemia,hyperglycemia,dehydration,or acute illness occur,or blood glucose levels become too high(>300 mg/dL)or too low(<70 mg/dL),the fast should be broken.New insulin formulations such as pegylated insulin and medications like tirzepatide,a dual agonist of gastric-inhibitory peptideand glucagonlike-peptide 1 receptors,have shown promise in managing blood sugar levels during Ramadan.Non-insulin dependent medications like sodium-glucose-cotransporter-2 inhibitors,including the Food and Drug Administration-approved ertugliflozin,are also being used to provide additional cardiovascular benefits in patients with type 2 diabetes.展开更多
Pancreatic carcinoma(PC)is one of the leading causes of cancer-related deaths worldwide.Despite early detection and advances in therapeutics,the prognosis remains dismal.The outcome and therapeutic approach are depend...Pancreatic carcinoma(PC)is one of the leading causes of cancer-related deaths worldwide.Despite early detection and advances in therapeutics,the prognosis remains dismal.The outcome and therapeutic approach are dependent on the stage of PC at the time of diagnosis.The standard of care is surgery,followed by adjuvant chemotherapy.The advent of newer drugs has changed the landscape of adjuvant therapy.Moreover,recent trials have highlighted the role of neoadjuvant therapy and chemoradiotherapy for resectable and borderline resectable PC.As we progress towards a better understanding of tumor biology,genetics,and microenvironment,novel therapeutic strategies and targeted agents are now on the horizon.We have described the current and emerging therapeutic strategies in PC.展开更多
Aim: To analyse the increasing burden of coronary artery disease (CAD) in tropical and subtropical belts of the Equator since it remains blurred and carries a grim prognosis. Introduction: Endomyocardial fibrosis [EMF...Aim: To analyse the increasing burden of coronary artery disease (CAD) in tropical and subtropical belts of the Equator since it remains blurred and carries a grim prognosis. Introduction: Endomyocardial fibrosis [EMF] is a tropical febrile disorder, confined to peculiar and limited geographical areas. Plaque buildup in endocardium and coronary arteries, causing ischemic injury and arrhythmic episodes, is a vanishing mystery in its pathogenesis and emphasizing alternative routes for understanding and treatment of this enigmatic disease. Case Report: 15 cases in various age groups were reported with potential complications of coronary artery disease and arrhythmias, associated with endocardial lesions, the characteristic feature of endomyocardial fibrosis. Conclusion: The narrowing of coronary arteries as a result of thickening of the walls, spasm, inflammation, plaques and its rupture produce ischemic episodes which can occur slowly or suddenly in a devastating pattern with arrhythmogenic potentials. The important steps to prevent and decrease the risk of CAD is to reduce the chance of getting this disorder by epidemiological measures with an advice of blood thinning medications such as small daily dose aspirin, antibiotics in susceptible individuals and revascularization in established myocardial infarction.展开更多
AIM:To investigate the efficacy,safety,and cost of treatment of direct acting antivirals(DAAs) with and without peg interferon alfa2a(P),and/or ribavirin(R) in treating hepatitis C virus(HCV) genotype 1 patients.METHO...AIM:To investigate the efficacy,safety,and cost of treatment of direct acting antivirals(DAAs) with and without peg interferon alfa2a(P),and/or ribavirin(R) in treating hepatitis C virus(HCV) genotype 1 patients.METHODS:MEDLINE was searched for randomized controlled trials(RCT) using DAAs for HCV treatment.Phase 1 trials and studies with investigational drugs on genotype 2 or 3,and on human immunodeficiency virus patients were excluded.Data were pooled for sustained virologic response(SVR),serious adverse effects,and drug discontinuation rate on various treatment arms in trials:P + R;1st generation DAA(telaprevir or boceprevir) + P + R;2nd generation DAA(sofosbuvir or simeprevir) + P + R;2nd generation DAA + R;two 2nd generation DAA + R;and two 2nd gen DAA.Data were analyzed separately for each arm for treatment naive and non-responders(NR) to previous treatment.The cost of treatment with each regimen for achieving one SVR was also compared.RESULTS:Twenty three RCTs(n = 9354,62% male,11% cirrhosis) were analyzed.All oral(P free) regimens with combination of 2 DAA achieved SVR above 95%.The cost of treatment to achieve an SVR with DAA based regimens was lower for NR compared to P+R regimen.However,the cost per SVR remained higher for treatment naive patients.CONCLUSION:Second generation and emerging DAAs are promising agents in HCV treatment,with a very high level of safety and efficacy.An important drawback is their high cost.However,the present meta-analysis shows that the cost per SVR for non responders(but not for naive patients) was lower compared to P + R.This finding together with the superior safety profile and better compliance makes these drugs highly attractive.It is possible that further reduction in treatment duration may make them even more cost effective.展开更多
文摘Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.
文摘Cardiac output(CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractility and afterload. Moreover it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods and thermodilution method using pulmonary artery catheter(PAC) is till date considered as gold standard method. Complications associated with PAC led to development of newer methods which are minimally or non-invasive. Newer methods fulfil other properties like continuous and reproducible reading, cost effective, reliable during various physiological states and have fast response time. These methods are validated against the gold standard with good level agreement. In this review we have discussed various newer methods of CO monitoring and their effectiveness in clinical use.
文摘The 21^(st) century has started with several innovations in the medical sciences,with wide applications in health care management.This development has taken in the field of medicines(newer drugs/molecules),various tools and technology which has completely changed the patient management including abdominal surgery.Surgery for abdominal diseases has moved from maximally invasive to minimally invasive(laparoscopic and robotic)surgery.Some of the newer medicines have its impact on need for surgical intervention.This article focuses on the development of these emerging molecules,tools,and technology and their impact on present surgical form and its future effects on the surgical intervention in gastroenterological diseases.
文摘Fasting during the month of Ramadan is one of the five fundamental principles of Islam,and it is obligatory for healthy Muslim adults and adolescents.During the fasting month,Muslims usually have two meals a day,suhur(before dawn)and iftar(after dusk).However,diabetic patients may face difficulties when fasting,so it is important for medical staff to educate them on safe fasting practices.Prolonged strict fasting can increase the risk of hypoglycemia and diabetic ketoacidosis,but with proper knowledge,careful planning,and medication adjustment,diabetic Muslim patients can fast during Ramadan.For this review,a literature search was conducted using PubMed and Google Scholar until May 2023.Articles other than the English language were excluded.Current strategies for managing blood sugar levels during Ramadan include a combination of patient education on nutrition,regular monitoring of blood glucose,medications,and insulin therapy.Insulin therapy can be continued during fasting if properly titrated to the patients’needs,and finger prick blood sugar levels should be assessed regularly.If certain symptoms such as hypoglycemia,hyperglycemia,dehydration,or acute illness occur,or blood glucose levels become too high(>300 mg/dL)or too low(<70 mg/dL),the fast should be broken.New insulin formulations such as pegylated insulin and medications like tirzepatide,a dual agonist of gastric-inhibitory peptideand glucagonlike-peptide 1 receptors,have shown promise in managing blood sugar levels during Ramadan.Non-insulin dependent medications like sodium-glucose-cotransporter-2 inhibitors,including the Food and Drug Administration-approved ertugliflozin,are also being used to provide additional cardiovascular benefits in patients with type 2 diabetes.
文摘Pancreatic carcinoma(PC)is one of the leading causes of cancer-related deaths worldwide.Despite early detection and advances in therapeutics,the prognosis remains dismal.The outcome and therapeutic approach are dependent on the stage of PC at the time of diagnosis.The standard of care is surgery,followed by adjuvant chemotherapy.The advent of newer drugs has changed the landscape of adjuvant therapy.Moreover,recent trials have highlighted the role of neoadjuvant therapy and chemoradiotherapy for resectable and borderline resectable PC.As we progress towards a better understanding of tumor biology,genetics,and microenvironment,novel therapeutic strategies and targeted agents are now on the horizon.We have described the current and emerging therapeutic strategies in PC.
文摘Aim: To analyse the increasing burden of coronary artery disease (CAD) in tropical and subtropical belts of the Equator since it remains blurred and carries a grim prognosis. Introduction: Endomyocardial fibrosis [EMF] is a tropical febrile disorder, confined to peculiar and limited geographical areas. Plaque buildup in endocardium and coronary arteries, causing ischemic injury and arrhythmic episodes, is a vanishing mystery in its pathogenesis and emphasizing alternative routes for understanding and treatment of this enigmatic disease. Case Report: 15 cases in various age groups were reported with potential complications of coronary artery disease and arrhythmias, associated with endocardial lesions, the characteristic feature of endomyocardial fibrosis. Conclusion: The narrowing of coronary arteries as a result of thickening of the walls, spasm, inflammation, plaques and its rupture produce ischemic episodes which can occur slowly or suddenly in a devastating pattern with arrhythmogenic potentials. The important steps to prevent and decrease the risk of CAD is to reduce the chance of getting this disorder by epidemiological measures with an advice of blood thinning medications such as small daily dose aspirin, antibiotics in susceptible individuals and revascularization in established myocardial infarction.
文摘AIM:To investigate the efficacy,safety,and cost of treatment of direct acting antivirals(DAAs) with and without peg interferon alfa2a(P),and/or ribavirin(R) in treating hepatitis C virus(HCV) genotype 1 patients.METHODS:MEDLINE was searched for randomized controlled trials(RCT) using DAAs for HCV treatment.Phase 1 trials and studies with investigational drugs on genotype 2 or 3,and on human immunodeficiency virus patients were excluded.Data were pooled for sustained virologic response(SVR),serious adverse effects,and drug discontinuation rate on various treatment arms in trials:P + R;1st generation DAA(telaprevir or boceprevir) + P + R;2nd generation DAA(sofosbuvir or simeprevir) + P + R;2nd generation DAA + R;two 2nd generation DAA + R;and two 2nd gen DAA.Data were analyzed separately for each arm for treatment naive and non-responders(NR) to previous treatment.The cost of treatment with each regimen for achieving one SVR was also compared.RESULTS:Twenty three RCTs(n = 9354,62% male,11% cirrhosis) were analyzed.All oral(P free) regimens with combination of 2 DAA achieved SVR above 95%.The cost of treatment to achieve an SVR with DAA based regimens was lower for NR compared to P+R regimen.However,the cost per SVR remained higher for treatment naive patients.CONCLUSION:Second generation and emerging DAAs are promising agents in HCV treatment,with a very high level of safety and efficacy.An important drawback is their high cost.However,the present meta-analysis shows that the cost per SVR for non responders(but not for naive patients) was lower compared to P + R.This finding together with the superior safety profile and better compliance makes these drugs highly attractive.It is possible that further reduction in treatment duration may make them even more cost effective.
