RESUMEN
This systematic review elucidates the complex interplay between gastroesophageal reflux disease (GERD) and diabetes mellitus, integrating findings from various studies to highlight pathophysiological connections and effective clinical management strategies. Our examination reveals that mechanisms such as delayed gastric emptying and autonomic neuropathy significantly contribute to the exacerbation of GERD symptoms in diabetic patients, influencing clinical outcomes and treatment efficacy. The review underscores the necessity of multidisciplinary approaches in treating these comorbid conditions and advocates for therapeutic strategies that simultaneously address GERD and diabetes, such as the use of prokinetic agents and tailored surgical interventions like laparoscopic Roux-en-Y gastric bypass. This synthesis advances our understanding and proposes a foundation for future research and clinical practice, aiming to improve the quality of life and treatment outcomes for affected patients. This work contributes significantly to gastroenterology and endocrinology, providing a comprehensive resource for clinicians and researchers alike.
RESUMEN
Renal tubular acidosis type 1 (RTA-1) is a disorder where kidneys are unable to acidify urine, which ultimately results in normal anion gap metabolic acidosis. Its initial presentations and subsequent clinical manifestations can vary depending on the underlying cause and severity of the disease. We report a case of a 26-year-old female with a recent history of complicated pregnancy. She presented to a tertiary care hospital with quadriplegia and shortness of breath and required ventilator support. The extensive workup revealed that the patient had RTA-1 in association with Sjögren's syndrome. There are only a few cases of RTA-1 reported where the diagnosis was made during the pregnancy. By reporting this case of RTA-1 with rare initial clinical presentation and a recent complicated pregnancy, we propose that further research studies should be carried out in this area to explore a possible statistically significant association between pregnancy (and its complications) and RTA-1 exacerbation.
RESUMEN
Acute myocardial infarction (MI) is one of the leading global healthcare emergencies, contributing to over three million global deaths. The purpose of this study is to investigate further the efficacy of sacubitril/valsartan over angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in reducing the risk of heart failure (HF) in post-MI patients and providing a clear evidence-based medicine guideline for future use. An electronic database search was conducted on English databases. Eight articles were included, fulfilling our inclusion criteria, i.e., adult patients of ≥18 years with a recent diagnosis of acute MI. Pooled analysis was done using Review Manager version 5.4.1 (Cochrane Collaboration, London, England), and the data for each outcome were analyzed as dichotomous variables. A total of eight clinical trials were included in the meta-analysis. Six studies analyzed the sacubitril/valsartan and ACEI combination. The pooled analysis reported a significant increase in the risk of hypotension (relative risk {RR}: 1.29 {1.18, 1.41}) in the sacubitril/valsartan compared to the ACEI alone group. In addition, a significant increase was observed in the left ventricle ejection fraction (LVEF) after using the sacubitril/valsartan combination compared to using ACEI alone (RR: 3.08 {2.68, 4.48}). Furthermore, no significant difference was observed between the groups in terms of mortality rate (RR: 0.86 {0.73, 1.02}), the risk of heart failure (RR: 0.62 {0.39, 1.00}), the frequency of recurrent MI (RR: 0.86 {0.27, 2.76}), and the mean difference of N-terminal pro-B-type natriuretic peptide (NT-proBNP) (weighted mean difference {WMD}: -174.36 {-414.18, 65.46}) between both the groups. However, the sacubitril/valsartan combination proved to be beneficial in significantly reducing the risk of major adverse cardiac events (MACE) (RR: 0.64 {0.48, 0.84}) and rehospitalizations (RR: 0.53 {0.39, 0.71}) as compared to ACEI post MI. Additionally, sacubitril/valsartan and ARB's combination was reported in two studies. This led to a significant decrease in NT-proBNP concentration (WMD: -71.91 {-138.43, -5.39}) post MI in the sacubitril/valsartan combination group compared to the ARB usage alone. However, no significant difference was observed in the improvement of LVEF (WMD: 0.88 {-5.11, 6.87}) between both groups. Although the sacubitril/valsartan combination has no difference in mortality and outcomes compared to ACEI, there is evidence that using it proves to be more beneficial post MI compared to ACEI and ARB usage alone.