Diabetic heart disease:A clinical update

Diabetes mellitus(DM) significantly increases the risk of heart disease,and DMrelated healthcare expenditure is predominantly for the management of cardiovascular complications.Diabetic heart disease is a conglomeration of coronary artery disease(CAD),cardiac autonomic neuropathy(CAN),and diabetic cardiomyopathy(DCM).The Framingham study clearly showed a 2 to 4-fold excess risk of CAD in patients with DM.Pathogenic mechanisms,clinical presentation,and management options for DM-associated CAD are somewhat different from CAD among nondiabetics.Higher prevalence at a lower age and more aggressive disease in DM-associated CAD make diabetic individuals more vulnerable to premature death.Although common among diabetic individuals,CAN and DCM are often under-recognised and undiagnosed cardiac complications.Structural and functional alterations in the myocardial innervation related to uncontrolled diabetes result in damage to cardiac autonomic nerves,causing CAN.Similarly,damage to the cardiomyocytes from complex pathophysiological processes of uncontrolled DM results in DCM,a form of cardiomyopathy diagnosed in the absence of other causes for structural heart disease.Though optimal management of DM from early stages of the disease can reduce the risk of diabetic heart disease,it is often impractical in the real world due to many reasons.Therefore,it is imperative for every clinician involved in diabetes care to have a good understanding of the pathophysiology,clinical picture,diagnostic methods,and management of diabetes-related cardiac illness,to reduce morbidity and mortality among patients.This clinical review is to empower the global scientific fraternity with up-to-date knowledge on diabetic heart disease.

Auditory symptoms and autistic spectrum disorder:A scoping review and recommendations for future research

Introduction:Auditory symptoms in individuals with Autistic Spectrum Disorder(ASD)are well described within the neurodevelopmental literature,yet there is minimal mention of ASD in Otolaryngology literature.This is surprising considering the potential clinical and diagnostic implications of this link,and the potential for ASD to present to Otolaryngologists in the form of unexplained auditory symptoms.The aims of this literature review were to explore the intersection of auditory symptoms and ASD from the perspective of clinical Otolaryngology,and to outline a clinically focused research agenda based on emerging themes relevant to Otolaryngology.Methods:We searched Pubmed,Embase,Ovid and Cochrane library for studies until November 2021.Four authors independently reviewed 227 publications identified.39 were filtered into the final analysis.The PRISMA 2020 guidelines were followed.The heterogeneity of literature meant that a Systematic Review was not feasible.Included studies were therefore classified thematically,forming the basis of the scoping review.Results:Diagnostic theories for auditory symptoms in ASD include the entire auditory pathway and brain.There is a growing body of literature on auditory symptoms in ASD,suggesting that a primary diagnosis of ASD should be considered in patients presenting with otherwise unexplained auditory symptoms,and indicating a learning need for Otolaryngologists and audiologists,to whom these patients may present.Conclusion:We recommend a research agenda focusing on multidisciplinary collaboration,stakeholder engagement,responsible clinical screening,and clarification of pathophysiological mechanisms and terminology.