Practical guide:Glucagon-like peptide-1 and dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus

Practical guide:Glucagon-like peptide-1 and dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus common second-line choice after metformin for treating T2DM.Various considerations can make selecting and switching between different GLP-1 RAs challenging.Our study aims to provide a comprehensive guide for the usage of GLP-1 RAs and dual GIP and GLP-1 RAs for the management of T2DM.

Acute Appendicitis Pathways: A Systemic Review

Background: Clinical pathways are effective in reducing healthcare cost and standardizing management protocol for diseases and conditions. However, there are no standardized pathways for appendicitis. This study aims to determine whether implementation of a standardized clinical pathway for managing appendicitis may lead to improved patient care. Materials and Methods: We searched for articles published in PubMed, MEDLINE, and Cochrane library between 1974 and 2015. Thirty-seven papers published in English that met inclusion criteria were included and analyzed in this review. A total of 37 studies met inclusion criteria and were analyzed for the purpose of this study. Results: A clear definition for appendicitis pathway was observed in 30 articles. Appendicitis was diagnosed based on clinical and laboratory findings;however, 34% of the studies included radiological investigations. Sixteen studies provided clear definitions for discharge criteria. Time of follow-up (5 - 28 days) was reported in 10 studies. Operative time was the most commonly used outcome measure. The mean length of stay for non-complicated appendicitis was 1.3 days, and 6.26 days for complicated appendicitis. Most of the studies concluded that the accuracy of a clinical pathway for appendicitis diagnosis can be achieved by assessing the incidence of a normal appendix. The mean cost for patient care was $4874.14 (SAR 18,278.03). Conclusion: There was no standardized definition for appendicitis clinical pathway components. Studies suggested that establishing a clinical pathway for appendicitis improves the outcome and minimizes the cost.

A Simple Approach of Low Back Pain

Low back pain (LBP) is primarily managed in general practice and commonly underestimated or misdiagnosed by physicians. This article presents comprehensive review for diagnosis and evaluation of LBP according to current clinical studies guidelines. Our objectives are to define LBP, to establish how to take a detailed history and how to physically examine it in order to enable physicians to make an appropriate differential diagnosis for LBP, and to identify relevant investigations and referrals of patients with LBP. The article first offers a quick description of inflammatory back pain then discusses the importance of screening red flag patients with LBP and the importance of its early detection. Finally, we summarize how to outline a primary plan for managing and treating LBP. The article is prepared in the format of question and answer to make it targeted and accessible.

Laryngotracheal Stenosis Following Intubation for COVID-19 Pneumonia: A Report of Two Cases

Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.

The Precautions Efficacy Taken among Health Care Workers While Performing Tracheostomies on COVID-19 Patients: Systematic Review

Background & objectives: Coronavirus disease 19 (COVID-19) has been declared by World Health Organization as a global pandemic disease in March 2020. Acute respiratory distress syndrome is frequent complication of COVID-19 disease. Tracheostomy is needed in cases of prolonged mechanical ventilation (7 - 10 days) in patients with acute respiratory distress syndrome. Tracheostomies are highly aerosol generating procedures, Otorhinolaryngologists and Health Care Workers (HCWs) are at high risk of virus exposure. The aim of this review is to evaluate the risk of transmission of COVID-19 during tracheostomy procedure, and to review the practical recommendation and scope of the timing to reduce risk of transmission to HCW. Methods: PubMed database was searched between April 2020 to Jan 2021 using the terms “Tracheostomy AND COVID-19 AND Health Care Workers”. All the articles that shared the same aim were screened which resulted in 243 references without duplicates. The title and abstract screening excluded further 202 studies. Eventually 9 full-text studies were included. Results: Five hundred and two COVID-19 patients underwent tracheostomies during the study period. Sixty-three percent of the procedure were done through open technique, while 37% of them were done through percutaneous technique. Seventy-eight percent of them used full Personal Protective Equipment (PPE) and 44.4% used Powered Air Purifying Respirator (PAPR). Negative Pressure Rooms (NPR) were used in 67%. Conclusion: The studies showed similar negative results on HCW infection despite much variance in using PPE. However, there should be global unified recommendations and guidelines regarding tracheostomies in COVID-19 patients to prevent future HCW infection.

Effects of wet-cupping on blood pressure in hypertensive patients:a randomized controlled trial

BACKGROUND： Although cupping remains a popular treatment modality worldwide, its efficacy for most diseases, including hypertension, has not been scientifically evaluated. OBJECTIVE： We aimed to determine the efficacy of wet-cupping for high blood pressure, and the incidence of the procedure＇s side effects in the intervention group. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a randomized controlled trial conducted in the General Practice Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between May 2013 and February 2014. There were two groups （40 participants each）： intervention group undergoing wet-cupping （hijama） in addition to conventional hypertension treatment, and a control group undergoing only conventional hypertension treatment. Three wet-cupping sessions were performed every other day. MAIN OUTCOME MEASURE： The mean systolic and diastolic blood pressures were measured using a validated automatic sphygmomanometer. The follow-up period was 8 weeks. RESULTS： Wet-cupping provided an immediate reduction of systolic blood pressure. After 4 weeks of follow-up, the mean systolic blood pressure in the intervention group was 8.4 mmHg less than in the control group （P = 0.046）. After 8 weeks, there were no significant differences in blood pressures between the intervention and control groups. In this study, wet-cupping did not result in any serious side effects. CONCLUSION： Wet-cupping therapy is effective for reducing systolic blood pressure in hypertensive patients for up to 4 weeks, without serious side effects. Wet-cupping should be considered as a complementary hypertension treatment, and further studies are needed.