Sodium-Glucose Cotransporter 2 Inhibitors and the Risk of Pneumonia and Septic Shock.

CONTEXT: Individuals with type 2 diabetes mellitus (DM) have an increased risk of pneumonia and septic shock. Traditional glucose-lowering drugs have recently been found to be associated with a higher risk of infections. It remains unclear whether sodium-glucose cotransporter 2 inhibitors (SGLT2is), which have pleiotropic/anti-inflammatory effects, may reduce the risk of pneumonia and septic shock in DM. METHODS: MEDLINE, Embase, and ClinicalTrials.gov were searched from inception up to May 19, 2022, for randomized, placebo-controlled trials of SGLT2i that included patients with DM and reported outcomes of interest (pneumonia and/or septic shock). Study selection, data extraction, and quality assessment (using the Cochrane Risk of Bias Assessment Tool) were conducted by independent authors. A fixed-effects model was used to pool the relative risk (RRs) and 95% CI across trials. RESULTS: Out of 4568 citations, 26 trials with a total of 59 264 patients (1.9% developed pneumonia and 0.2% developed septic shock) were included. Compared with placebo, SGLT2is significantly reduced the risk of pneumonia (pooled RR 0.87, 95% CI 0.78-0.98) and septic shock (pooled RR 0.65, 95% CI 0.44-0.95). There was no significant heterogeneity of effect size among trials. Subgroup analyses according to the type of SGLT2i used, baseline comorbidities, glycemic control, duration of DM, and trial follow-up showed consistent results without evidence of significant treatment-by-subgroup heterogeneity (all Pheterogeneity > .10). CONCLUSION: Among DM patients, SGLT2is reduced the risk of pneumonia and septic shock compared with placebo. Our findings should be viewed as hypothesis generating, with concepts requiring validation in future studies.

Evaluating the Impact of Medical Student Inclusion Into Hands-On Surgical Simulation in Congenital Heart Surgery.

OBJECTIVE: Over the last decade medical students' interest in pursuing surgery as a career has declined. This is more apparent in high-specialized specialities such as congenital heart surgery (CHS). Early hands-on simulation has shown to have a positive impact on medical students' interest in pursuing surgery, however, its incorporation into medical school curricula is lacking. This study aimed to evaluate the impact of incorporating medical students as surgical assistants during the Hands On Surgical Training course in CHS. METHODS: Local preclinical medical students were invited to participate as surgical assistants during the 5th annual Hands On Surgical Training course in CHS. Among those who responded to the invitation, students were randomly selected and allocated to assist a congenital heart surgeon. All selected students attended an assistants' session prior to the course to familiarize themselves with assisting and to practice basic surgical skills. At the end of both courses students completed a questionnaire based on Likert 5-point scale to evaluate the courses' usefulness. RESULTS: Fifteen medical students completed the questionnaires. All reported a beginner level of understanding of congenital heart disease. All students were highly satisfied with using 3D-printed models to help their understanding of congenital heart disease (4.80 ± 0.41) and agreed that the sessions improved their assisting skills (4.93 ± 0.26). All expressed a desire to attend similar sessions in the future and agreed that surgical simulation inclusion into medical school curricula would enhance learning (5.00 ± 0.00). Interest in pursuing a career in CHS increased from 33% (5) to 87% (13) by the end of the course. CONCLUSIONS: Integration of preclinical medical students into surgical simulation increases interest in pursuing highly specialised surgical specialities such as CHS. Early exposure and the incorporation of such simulation programs into medical school curricula will likely improve surgical skill acquisition and may enable students to be better informed when selecting future career choices.