Unlocking the Therapeutic Symphony: A Systematic Review Exploring the Role of Levosimendan in the Management of Heart Failure.

Levosimendan, a novel drug, a calcium-sensitizing inotrope, has emerged as a potential therapeutic modulator for heart failure (HF). This review appraises the efficacy and safety of levosimendan in managing HF, in different clinical settings. The study aims to examine the clinical outcomes reported in the selected trials to determine the effectiveness of levosimendan in improving key parameters related to HF. Seven relevant studies encompassing 1200 participants were identified from three databases. Inclusion criteria included clinical trials that investigated the therapeutic efficacy of levosimendan in the treatment of HF, and studies involving both adult and pediatric participants. Exclusion criteria involved studies with insufficient data, studies other than clinical trials, case reports, letters to the editor, conference papers, grey literature, and studies published in a language other than English. Upon evaluating the included studies, it was found that levosimendan shows improved hemodynamics and clinical efficacy in patients with severe septic cardiomyopathy. Levosimendan enhanced right ventricular (RV) function in patients with RV dysfunction after mitral valve (MV) surgeries and decreased the amount of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) in non-ST elevated myocardial infarction (NSTEMI) patients with elevated NT-proBNP, all without increasing the overall cost or duration of hospitalization. Despite variations in study designs and participant characteristics, evidence suggests levosimendan significantly improves left ventricular ejection fraction (LVEF) and exercise tolerance measured by a six-minute walk distance. Notably, its safety profile appears favorable with minimal arrhythmic events and comparable rates of adverse effects to a placebo. This systematic review highlights levosimendan's promising potential for HF management, warranting further research to solidify its clinical role.

Methicillin-Resistant Staphylococcus Aureus And Its Antibiotic Sensitivity Pattern In Patients With Vesiculobullous Disorders.

BACKGROUND: Vesiculobullous disorders are among the leading causes of admission to dermatology. These are characterized by distinct mucocutaneous involvement and by the development of vesicles and bullae (i.e. blisters). Methicillin-resistant Staphylococcus aureus (MRSA) is a group of gram-positive bacteria distinct from other strains of Staph aureus. As the susceptibility of bacteria to antibiotics varies from region to region and from time to time, this study will determine the pattern of antimicrobial susceptibility of MRSA isolates to the commonly prescribed antibiotics in our population. The objective is to determine the frequency of methicillin-resistant Staphylococcus aureus and its antibiotic sensitivity pattern in patients with vesiculobullous disorders admitted to the Dermatology unit of Lady Reading Hospital (LRH), Peshawar. It was Cross-sectional and carried out in study Department of Dermatology, Lady Reading Hospital, Peshawar from Oct 23, 2020, to Apr 22, 2021. METHODS: This study was carried out over 132 patients. After consent, Swabs of pus from the Vesiculobullous disorders were taken from all the patients and sent to a laboratory for culture. Staphylococcus aureus (MRSA) was labelled as Staphylococcus aureus bacteria by Kirby-Bauer disc diffusion method using oxacillin (1 µ gm.) disc on Mueller-Hinton agar (HiMedia Labs, Mumbai) with 24 hours incubation at 35 °C. RESULTS: In this study, 132 patients were observed. The average age was 44.44 years ±13.74 SD. Male to female ratio was 1.30:1. There were 44(33.33%) patients who showed Methicillin Resistant Staphylococcus aureus (MRSA) in vesiculobullous disorders patients. CONCLUSIONS: In our population, the frequency of staphylococcus aureus bacteria in vesiculobullous disorders is high so it will be considered while treating such patients.

Uncertainty in Medical and Dental Students of Pakistan Regarding Their Future Career and Its Major Causes: A Cross-Sectional Study.

OBJECTIVES: This study aimed to evaluate the extent of confidence in medical and dental students regarding their careers after being enrolled in their germane institutes and to identify the magnitude of uncertainty in medical and dental students about their careers and the important causes of this uncertainty. METHODS: This study was conducted among enrolled students in different medical and dental colleges and universities of Pakistan, including the public and private sectors, from March 1 to March 15, 2023. The level of confidence in their career was evaluated using a close-ended questionnaire of a three-point Likert scale developed and tested by the investigators and approved by the Ethical Review Board (ERB) along with the synopsis. Data were managed and analyzed using Microsoft Excel 19 (Microsoft Corporation, USA) and IBM SPSS Statistics for Windows, version 27 (released 2020; IBM Corp., Armonk, New York, United States). RESULTS: This study included 1,126 students from public and private medical and dental institutes. The majority of participants 965(85.7%) were satisfied with their chosen profession, and 1,042 (92.5%) students believed they could make a positive contribution to society. Out of the total participants, 246 (21.8%) students showed their intention of changing careers if provided with a comparable/alternative opportunity. A very small proportion, 154 (13.7%), were dissatisfied with their current clinical training and studies. The study also revealed that extra and unjustified academic pressure from institutions is the leading cause of uncertainty among students. Moreover, the lack of psychological support and counseling provided during the academic years adds to the magnitude of uncertainty. CONCLUSION: In Pakistan, a staggering number of medical and dental students are unsure of their future careers and career prospects. The main causes of this uncertainty are the extra, unwarranted academic pressure that institutions place on students and the dearth of psychological support and counseling offered during the course of studies. This study not only highlights the prevailing uncertainty among medical students but also identifies the causes behind it. Addressing these causes can alleviate the prevailing uncertainty and bring about satisfactory and productive academic achievements without suffering from worries about the future.