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Digoxin, a cardiac glycoside derived from the foxglove plant (Digitalis spp.), has been utilized for centuries in managing various cardiac conditions due to its ability to increase myocardial contractility and regulate heart rate. This comprehensive review explores the historical context, pharmacological properties, clinical applications, efficacy, safety profile, challenges, and future perspectives of digoxin. Tracing its journey from traditional medicine to modern cardiovascular therapeutics, we delve into its mechanism of action, therapeutic indications, and clinical guidelines. While digoxin remains a cornerstone therapy for heart failure and atrial fibrillation, its narrow therapeutic index and individual variability in response pose challenges in clinical practice. Nevertheless, ongoing research efforts aim to elucidate its role in emerging therapeutic areas and technological advancements in drug delivery. Despite the advent of newer pharmacological agents, digoxin's enduring relevance lies in its established efficacy, affordability, and global accessibility. This review underscores the symbiotic relationship between tradition and progress in cardiovascular medicine, highlighting the timeless pursuit of medical innovation to optimize patient care.
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This comprehensive review thoroughly examines the historical evolution, physiological foundations, and contemporary advancements in the application of phototherapy for neonatal hyperbilirubinemia. Neonatal hyperbilirubinemia, a common condition resulting from the immature hepatic processes in newborns, poses potential risks, including neurotoxicity, if left untreated. The review traces the historical progression from early recognition of neonatal jaundice to the development of various phototherapy modalities, showcasing the dynamic landscape of neonatal care. Emphasizing the physiological intricacies of bilirubin metabolism in neonates, the study underscores the vulnerability of newborns to hyperbilirubinemia due to delayed hepatic maturation. Phototherapy is a cornerstone in managing hyperbilirubinemia, demonstrating consistent efficacy in reducing unconjugated bilirubin levels. The implications for clinical practice are significant, offering healthcare professionals insights into tailoring treatment strategies based on individual neonatal characteristics and the severity of jaundice. Integrating advanced monitoring and control systems enhances the precision and safety of phototherapy. Recommendations for future research emphasize the need to investigate long-term outcomes, explore adjunctive therapies, and address resource limitations to ensure global access to effective neonatal care. Overall, this review contributes to the ongoing refinement of neonatal care practices, offering a comprehensive understanding of neonatal hyperbilirubinemia and its evolving treatment landscape.
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This case presentation details the clinical journey of a three-year-old male child presenting with fever, abdominal distention, and loose stools. The child's symptoms, unresponsive to initial treatment at two hospitals, led to the discovery of elevated liver enzymes and subsequent referral to a tertiary care center. Clinical examination revealed hepatomegaly, abdominal distension, and non-palpable spleen. Laboratory findings confirmed acute hepatitis, prompting further investigation into the child's dietary history and revealing a potential foodborne infection. The child was diagnosed with hepatitis-associated severe vitamin A deficiency, manifested by Bitot's spots on ophthalmic examination. Prompt initiation of antiviral therapy, nutritional supplementation, and supportive care resulted in a positive clinical response, with resolution of symptoms and normalization of liver enzymes. This case underscores the importance of recognizing nutritional deficiencies in the context of infectious diseases, emphasizing the need for a comprehensive approach to patient care. The successful management of this complex case highlights the significance of interdisciplinary collaboration in ensuring optimal outcomes in pediatric patients with overlapping infectious and nutritional etiologies.
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Bariatric surgery (BS) has emerged as an efficient approach for addressing obesity, offering long-term benefits encompassing substantial weight loss and improving metabolic disorders. Many women of childbearing age opt for BS to enhance their health and well-being. The weight loss achieved through these procedures can positively impact pregnancy outcomes, but it's crucial to consider potential drawbacks. Micronutrient deficiencies, such as anemia resulting from iron or vitamin B12 deficiency, are a legitimate concern. Making the decision to have a BS is a complex process with many possible obstacles. The complicated nature of this decision is highlighted by worries about dumping syndrome, surgical complications that could include the risk of internal hernias, and the possibility that infants could be labeled as small for gestational age because of maternal undernourishment. Furthermore, there is a notable absence of international consensus regarding the ideal timing for conceiving after undergoing BS. Therefore, this narrative review extensively explores the existing body of literature, offering insights into the prevailing challenges encountered before and during pregnancy following BS. These challenges encompass a wide range of considerations, commencing with fertility-related issues. The study will cover strategies for addressing vitamin and nutritional deficiencies through supplementation, subtleties of post-BS altered glucose metabolism and how it affects the detection and treatment of gestational diabetes, how dumping syndrome progresses, various surgical problems, and how different bariatric procedures affect pregnancy and fetal outcomes. These include a tendency to give birth to children considered undersized for gestational age, nutritional deficits, anemia, and abnormal maternal glucose metabolism. This review offers a comprehensive exploration of the multifaceted landscape of pregnancy in the context of BS. It aims to provide a valuable resource for healthcare professionals and women considering pregnancy after undergoing BS, enabling them to make well-informed decisions and receive appropriate care during this critical phase of life.