Assuntos
Negro ou Afro-Americano , Disparidades nos Níveis de Saúde , Neoplasias Renais , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias Renais/mortalidade , Neoplasias Renais/etnologia , Estados Unidos/epidemiologia , Brancos/estatística & dados numéricosRESUMO
Recent trials have reported sodium-glucose cotransporter 2 (SGLT2) inhibitors to decrease cardiac morbidity and hospitalization in diabetic patients. They have a remarkable ability to modify the cardiorenal axis and have a safer metabolic profile among the existing pharmacotherapy in diabetes. There are multiple proposed mechanisms postulated behind the cardioprotection offered by these drugs as seen in Canagliflozin Cardiovascular Assessment Study (CANVAS) and Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) Trial. The pathophysiological evidence which directly contributes to improve cardiac mechanics remains elusive. We aimed to review all mechanisms hypothesized and present results from recent trials with new therapies. There is also evidence for a reduction in insulin resistance, inflammation, body weight and serum triglyceride levels which all contribute to improving cardiovascular outcomes in diabetes. However, evidence of adverse effects on bone metabolism and increased risk of genital and urinary tract infections limits their current use. Nonetheless, SGLT2 inhibitors with their cardioprotective effects may serve as a promising advancement in type 2 diabetes management.
Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Inibidores do Transportador 2 de Sódio-Glicose , Canagliflozina/efeitos adversos , Doenças Cardiovasculares/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Glucose/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hipoglicemiantes/efeitos adversos , Sódio/metabolismo , Transportador 2 de Glucose-Sódio/metabolismo , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Triglicerídeos/uso terapêuticoRESUMO
Bickerstaff Brainstem Encephalitis, a rare variant of Guillain- Barre Syndrome has an estimated prevalence of eight per 100 million individuals. It presents with the classic triad of ataxia, ophthalmoplegia and altered consciousness. We report the case of a 10-year-old child who presented with low grade fever, hypersomnia and inability to walk. Central nervous system examination revealed ophthalmoplegia and multiple cranial nerve palsies. However, CSF examination showed lack of albuminocytological dissociation with no previous history of respiratory or gastrointestinal tract infection. Unavailability of Anti-GQ1b antibodies led to a diagnosis based on suggestive clinical features, abnormal MRI signals and prompt response to corticosteroid administration. Intravenous Methyl Prednisolone in a dose of 30mg/kg/day was administered for 10 days followed by oral Prednisolone 2 mg/kg/day. After complete recovery the patient was discharged, Prednisolone was tapered gradually and eventually discontinued after four months.
Assuntos
Encefalite , Oftalmopatias , Síndrome de Guillain-Barré , Ataxia , Tronco Encefálico/diagnóstico por imagem , Criança , Encefalite/diagnóstico , Encefalite/tratamento farmacológico , HumanosAssuntos
Depressão Pós-Parto/tratamento farmacológico , Moduladores GABAérgicos/uso terapêutico , Pregnanolona/uso terapêutico , beta-Ciclodextrinas/uso terapêutico , Combinação de Medicamentos , Feminino , Moduladores GABAérgicos/efeitos adversos , Humanos , Pregnanolona/efeitos adversos , beta-Ciclodextrinas/efeitos adversosAssuntos
Catequina/análogos & derivados , Chá/química , Tuberculose , Idoso , Antioxidantes/farmacologia , Catequina/farmacologia , Exposição Dietética , Comportamento de Ingestão de Líquido , Inibidores Enzimáticos/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Paquistão , Fatores de Proteção , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controleAssuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Ibuprofeno , Testículo , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Ibuprofeno/efeitos adversos , Ibuprofeno/uso terapêutico , Masculino , Fatores Sexuais , Testículo/efeitos dos fármacos , Testículo/fisiopatologiaRESUMO
OBJECTIVE: A short pre-hospital delay, from the onset of symptoms to rapid initiation of reperfusion therapy, is a crucial factor in determining prognosis of myocardial infarction (MI). The purpose of this study was to evaluate symptoms and presentation delay times in MI patients with and without diabetes. METHODS: This cross-sectional study was conducted in 3 tertiary care hospitals of Pakistan over a period of 6 months. The study sample consisted of 280 consenting individuals diagnosed with ST-elevation MI (STEMI) or Non-ST elevation MI (NSTEMI), out of which 130 were diabetic and 150 were non-diabetic. Data was collected using a standardized questionnaire, investigating MI symptoms along with causes and duration of pre-hospital delay within 72hours of admission. RESULTS: No significant difference was found in the intensity of chest pain between diabetics and non-diabetics. Atypical symptoms of MI such as anxiety (p<0.001), cold sweats (p=0.034) and epigastric pain (p=0.017) were more frequently reported in diabetics. MI patients with diabetes had a significantly longer presentation delay time with 75% of the patients presenting after elapse of 3h. Only a few patients reported to the hospital within an hour of onset of symptoms (n=23, 8.2%), out of which majority were non-diabetics (n=18). A majority of patients (n=146, 52%) in both groups did not use emergency medical services. CONCLUSION: This study provides an incentive for further research, aiming to reduce pre hospital delay along with investigating the effectiveness of emergency medical services.
Assuntos
Diabetes Mellitus/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Infarto do Miocárdio/diagnóstico , Revascularização Miocárdica , Tempo para o Tratamento/tendências , Idoso , Estudos Transversais , Eletrocardiografia , Feminino , Seguimentos , Hospitalização , Humanos , Incidência , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/cirurgia , Paquistão/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários , Taxa de Sobrevida/tendências , Fatores de TempoRESUMO
Developmental defects in the Mullerian ducts can result in several uterine anomalies including a unicornuate uterus with a rudimentary horn. Pregnancy in a rudimentary horn is extremely rare occurring in 1:76,000-1:160,000 pregnancies. We present a case of an 18-year-old primigravida with a ruptured rudimentary horn pregnancy (RHP) presenting as acute abdomen at 17 weeks of gestation. Hemodynamic instability led us to perform a life-saving emergency laparotomy. A 1.5 liters hemoperitoneum was encountered with a ruptured non-communicating rudimentary horn. Excision of the horn and unilateral salpingectomy was performed. In addition to ectopic pregnancy and appendicitis, rare uterine anomalies must also be considered in patients presenting with an acute abdomen especially after 10 weeks of gestation. Basic diagnostic facilities may not be available in developing countries. Therefore, clinicians must be aware of this rare entity in order to manage such patients efficiently.