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Background: Hypertriglyceridemia is a common cause of acute pancreatitis (AP). This literature review compared the effectiveness and adverse events of insulin therapy, with or without heparin, and plasmapheresis, in reducing triglyceride levels in patients with hypertriglyceridemia-induced AP. Methods: Systematic reviews, meta-analyses, evidence syntheses, editorials, commentaries, protocols, abstracts, theses and preprints were excluded. Review Manager was used to conduct the meta-analysis. The literature search yielded 2765 articles, but only 5 were included in the systematic review and meta-analysis and the total number of participants in the review was 269. Results: From this study's analysis, insulin ± heparin was more successful in reducing triglyceride levels than plasmapheresis (standardized mean difference -0.37, 95% confidence interval [CI] 0.99 to 0.25; P=0.25). Insulin ± heparin therapy had a lower mortality rate than plasmapheresis (risk ratio [RR] 0.70, 95%CI 0.25-1.95). Hypotension, hypoglycemia, and acute renal failure were less common in the plasmapheresis therapy group than in insulin ± heparin therapy (RR 1.13, 95%CI 0.46-2.81, RR 3.90, 95%CI 0.45-33.78, and RR 0.48, 95%CI 0.02-13.98 for hypotension, hypoglycemia, and acute renal failure, respectively). Conclusions: This study found no significant difference in mortality between insulin ± heparin therapy and plasmapheresis used for the reduction in triglyceride levels. It is notable that no substantial differences were observed in the most common side-effects encountered during these therapies, thus indicating non-inferiority.
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Workplace violence (WPV) against doctors is a growing epidemic in India, with at least two-thirds of doctors facing some form of abuse during their careers. Verbal abuse is common, but doctors are also subjected to brutal attacks that endanger their lives. This review lists abusive incidents reported by the media since 2021. Despite increased respect for healthcare professionals during the COVID-19 pandemic, doctors in India are under significant stress due to inadequate medical infrastructure, mismanagement of young doctors, increasing mistrust between doctors and patients, a shortage of doctors, and overworked healthcare workers, leading to delays in attention and treatment. Additional factors contributing to the situation include the lack of proper insurance coverage, weak primary healthcare with overburdened tertiary care, the lack of an effective grievance redressal system, and the poor state of medical education. To combat this epidemic, collaborative efforts are needed between doctors, hospitals, the government, and society. Improving communication skills and treating patients with empathy are essential for healthcare workers. Meanwhile, hospitals should implement an efficient security system, a transparent billing system, and an active complaint system to prevent incidents. Unbiased reporting and adequate documentation are required to further investigate this occupational health hazard. The government should focus on building better medical facilities and passing a strict law against violence against doctors to ensure the safety of medical professionals. This review presents some solutions, along with the current legal coverage provided to healthcare professionals regarding WPV.
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BACKGROUND: Serum leptin has been considered as an important measurable diagnostic and prognostic biomarker for polycystic ovarian syndrome (PCOS), although its evidence for use in clinical practice is limited. We aim to synthesize the available evidence on the clinical use of serum leptin values in PCOS by doing a systematic review and meta-analysis of studies. OBJECTIVE: To conduct a meta-analysis to determine the pooled effect size of the association of leptin levels in patients with PCOS. METHODS: We searched electronic databases, i.e., PubMed, Google Scholar, Web of Science, ClinicalTrials.gov, and Medline from inception to September 2020, keeping filters for human studies and published in the English language. We used the random-effects model if heterogeneity between the studies was > 50%; otherwise, a fixed-effect model was applied to determine the standardized mean difference with 95% CI for comparison of leptin level between cases and controls. All the statistical analyses were completed using software STATA version 13. RESULTS: The meta-analysis included a total of 35 studies involving 2015 cases and 1767 controls that suggested statistically significantly higher leptin levels in the women with PCOS as compared to controls (SMD, 1.76, 95% CI 1.28 to 2.23, P < 0.001). In the stratified analysis when only high methodological quality studies were included, we did not observe a statistically significant difference in the leptin level between PCOS and controls (SMD 0.68, 95% CI -0.09 to 1.46). Analysis restricted to low methodological quality studies observed statistically significant high leptin levels in PCOS women as compared to controls (SMD 2.24, 95% CI 1.65 to 2.83). CONCLUSION: The available evidence suggests that elevated leptin levels may be associated with risk of PCOS as compared to controls; however, failure to observe the similar association in high methodological quality studies demands further well-designed adequately powered studies to validate the findings.
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The success of the sandwich technique depends on the bond strength of composite to glass-ionomer cement (GIC)/resin-modified glass-ionomer cement (RMGIC). Currently used adhesives employ the total-etch and the self-etch techniques. The total-etch system is technique sensitive, whereas the self-etch system is popular for its ease of use. The aim of this systematic review is to compare the effect of total-etch and self-etch adhesives (SEAs) on the bond strength of composite to GIC/(RMGIC) in the sandwich technique. A literature search was conducted using electronic databases (PubMed, Web of Science, Ebscohost, and Scopus) limiting the year of publications from January 1, 2000, to September 30, 2018, to identify the relevant studies. All the cross-references of the selected studies were also screened. In vitro studies on extracted human teeth were selected. A total of 10 articles were included in this review. A conclusion was drawn that SEAs when used in the sandwich technique resulted in greater bond strength in comparison to total-etch adhesives. Moreover, increased bond strength was achieved when the primer was employed on unset GIC as compared to set GIC. Furthermore, the application of SEAs over uncured RMGIC (co-curing technique) resulted in better bond strengths as compared to their application over cured RMGIC.
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BACKGROUND AND AIMS: The entire globe is undergoing an unprecedented challenge of COVID-19 which has affected the lifestyle behaviour of individuals. The present review is an attempt to summarize the effect of pandemic COVID-19 on lifestyle behaviour among the Indian population. METHODS: A review was carried out to summarize the effect of pandemic COVID-19 on lifestyle behaviour focusing on changes in dietary or eating behaviour, stress, sleep pattern, and level of physical activity among the Indian population. Literature searches were conducted in PubMed and Google Scholar from inception till October 2020 to identify all relevant studies. RESULTS: A total of 11 studies (n = 5957, age group 18-70 years, comprising both genders) consisting of 1 hospital and 10 community based, were included in the present review. A change in lifestyle behaviour was observed due to COVID-19. Psychosocial or any kind of mental stress among the participants was found to be prevalent. Weight gain and decline in physical activity were also observed. Not only sleep quantity but sleep quality was also found to be affected due to COVID-19. CONCLUSION: The present review indicates the need for lifestyle behaviour programmes via using the platform of E-media and also for the dissemination of health education.