The risk of cutaneous mucormycosis associated with COVID-19: A perspective from Pakistan.

As a developing country, Pakistan reports a high burden of fungal diseases, of which cutaneous mucormycosis remains a prominent infection, presenting as a highly invasive disease with significant mortality. Apart from a high population of at-risk individuals, multiple factors have precipitated an increment in mucormycosis cases in the country following the COVID-19 pandemic. These include increased use of corticosteroids, immunosuppression following the viral infection, prolonged stays in the intensive care unit and sub-optimal laboratory testing available in the country. This article aims to assess the potential implications of a mucormycosis epidemic on a healthcare system already strained under the COVID-19 pandemic, and provides subsequent recommendations to weather the dual challenge of two deadly pathogens.

Obstructive Sleep Apnea and Hypertension: A Review of the Relationship and Pathogenic Association.

Obstructive sleep apnea (OSA) is defined as episodes of hypopnea or apnea, which leads to a partial or complete block of airways. Hypertension, on the other hand, is defined as an increase in systemic arterial blood pressure to a certain threshold. OSA and hypertension share many common factors in pathophysiology, such as gender, obesity, unhealthy lifestyle, impaired quality of sleep, renin-angiotensin system, and increased fluid distribution. In order to manage our patients effectively, we need to explore further the correlation between the two conditions.

Therapeutic potential of melatonin as a chronobiotic and cytoprotective agent in diabetes mellitus.

PURPOSE: Diabetes mellitus is a complex metabolic disorder characterized by hyperglycemia occurring as a result of dysregulation and balance of various metabolic pathways. In recent years, circadian misalignment (due to altered sleep/wake, feeding/fasting cycles), has been intimately linked with the development of diabetes mellitus. Herein, we review our knowledge of oxidative stress, circadian rhythms control of metabolism, and the effects of its disruption on homeostasis while emphasizing the importance of melatonin, a nocturnally peaking, pineal hormone, as a potential therapeutic drug for the prevention and treatment of diabetes. METHODS: PubMed database was systematically searched for related articles and data from all types of studies, including clinical trials, review articles, and case reports were considered without limiting the study to one specific category. RESULTS: Experimental and epidemiological evidence indicate melatonin's multifaceted effects in intermediary metabolism via resynchronization of the circadian rhythms and its deficiency is associated with metabolic derangements. As a chronobiotic, it cures insomnia and sleep disorders caused by shift work or jet lag. The antagonistic relationship between melatonin and insulin highlights its influence in regulating insulin secretion, its action, and melatonin treatment successfully improved glucose homeostasis, energy balance, and overall health in diabetes mellitus. Melatonin's cytoprotective role as an antioxidant and free radical scavenger, proved useful in combating oxidative stress, preserving beta-cell function, and influencing the development of diabetic complications. CONCLUSION: The therapeutic application of melatonin as a chronobiotic and cytoprotective agent is of promising significance in diabetes mellitus. Future investigations are encouraged to fully explore the efficacy of this ubiquitous molecule in various metabolic disorders.