Disseminated Melioidosis Presenting as Sepsis, Neurological Melioidosis, Liver and Prostate Abscess in United Arab Emirates.

Background: Melioidosis is an infection caused by Burkholderia pseudomallei, a Gram-negative bacterium. It is a disease endemic to Southeast Asia and northern Australia although its global incidence has been rising. It most commonly infects people with certain identified risk factors such as diabetes, alcoholism, thalassemia, and underlying chronic disease involving lungs, kidney and liver. This bacterium is capable of producing a wide array of clinical manifestations ranging from asymptomatic disease to localised infections such as in the lung, bone or skin to disseminated infection. Case description: This is a case, from United Arab Emirates, of a 40-year-old male recently diagnosed with diabetes who presented with multiple abscesses and was eventually diagnosed with disseminated melioidosis. He was treated successfully with antibiotics and drainage of abscesses. Conclusion: In non-endemic regions, melioidosis can be easily missed in common diagnostic approaches. This gap of awareness could delay the diagnosis and allow further deterioration of the patient due to complications. Thus, case reports like this can enlighten internists about changing incidences and complexity of clinical presentations, thus preparing them to better handle such patients in the future. LEARNING POINTS: Owing to its considerably rare incidence in non-endemic regions including the United Arab Emirates, melioidosis can easily be overlooked or misdiagnosed.Moreover, due to similarity with multiple other diseases and infections as well as significant absence from standard medical curricula, melioidosis is rarely on the differential list of an internist.This report aims to enhance awareness and alertness to aid earlier detection and avoid severe complications.

Full title- acceptability and feasibility of HIV self-testing (HIVST) among MSM and transgender women (hijra) in Bangladesh: A mixed-method study.

Background: HIV testing coverage among males having sex with males (MSM) and transgender women (locally known as hijra) is low in Bangladesh. Oral fluid-based HIV self-testing (HIVST) may improve coverage due to its convenience and privacy but is yet to be tested in Bangladesh. Therefore, the acceptability and feasibility of supervised HIVST was examined. Methods: A cross-sectional study was conducted among 379 MSM and hijra selected from five geographical regions from February-October 2020. Semi-structured questionnaire was used to examine socio-demographics, risk behaviors, and perception to acceptability and feasibility (correct completion) of HIVST. Both bivariate and multivariable logistic regression analyses were performed. Qualitative data collection encompassed in-depth interviews (N = 19), key informant interviews (N = 10), and two focus group discussions (N = 12). Line-by-line content, contextual and thematic analysis were done and triangulated to explore facilitators and challenges of HIVST among MSM and hijra. Results: Among 379 participants, the acceptability of HIVST was 99.5 % (n = 377). Reasons for acceptability included interest in independent testing (84.3 %), peer influence (57.3 %), quicker-easier procedure (54.9 %), and painless procedure (52.5 %). Qualitative findings revealed participant's risk perceptions, empowering feelings, social stigma, complementing working hours, and convenience during COVID-19 lockdowns. Around 92 % of the participants correctly completed HIVST. In multivariable analysis, the likelihood of correct test conduction was found higher among metropolitan, younger, married, educated, and participants who felt confident during HIVST process. Qualitative findings underscored the importance of supervising the use of HIVST for first-time users. Participants, particularly the less educated groups, highlighted the video demonstration as a useful tool in the context of difficulties in reading the textual instructions. However, most participants pointed out the result interpretation as the trickiest part of HIVST. All participants demonstrated willingness for future HIVST, were interested in social media-based approaches (84 %), were willing to purchase subsidized kits, and preferred conducting future tests alone at home (83.2 %). Conclusion: Oral fluid-based HIVST was an acceptable and feasible approach for MSM and hijra in Bangladesh who were willing to do future tests independently after the supervised approach. Willingness to purchase kits and interest for social media-based approaches indicate scalability and sustainability potential of HIVST.

Association of Red Cell Distribution Width and Mean Platelet Volume With Disease Activity in Rheumatoid Arthritis Patients.

BACKGROUND: The inner layer of the synovial joints is the primary target of rheumatoid arthritis, or RA, a chronic systemic inflammatory disorder that is linked to increasing disability, early mortality, and economic hardships. The objective is to determine the association of red cell distribution width (RDW) and mean platelet volume (MPV) with disease activity in RA. MATERIAL AND METHODS: A retrospective study was conducted between July 2021 and January 2022 in the outpatient rheumatology clinics at Gulab Devi Teaching Hospital. In this study, 100 consecutive participants with a diagnosis of RA fulfilling the ACR/EULAR 2010 classification criteria were enrolled. Patient's records were reviewed for age, gender, length of illness, smoking status, treatment history, current treatment regimen, concomitant medications, rheumatoid factor (RF), anti-cyclic citrulline peptide (anti-CCP) antibodies, and extra-articular manifestations. Laboratory investigations were reviewed for complete blood count including RDW and MPV, ESR, CRP, liver, and renal functions. Disease activity score DAS 28-ESR was used to quantify disease activity. To determine the relationship between different parameters and the RDW and MPV, linear regression research was conducted. RESULTS: According to the DAS28 score, 12% of patients were in remission, 9% had low, 34% had moderate, and 45% had high disease activity. DAS28 score was 5.01±1.72 (2.45-9.32) and RDW was 16.18±4.42. There was a strong positive correlation (r = 0.653) of RDW with the DAS28 score and it was statistically significant (p<0.001). MPV was 11.30±2.09 fL. There was a moderately positive correlation (r = 0.366) of MPV with the DAS28 score and it was statistically significant (p<0.001). CONCLUSION: Conclusively, both RDW and MPV are positively related to disease activity in patients with RA. These can be used as a simple tool for assessing disease activity and guiding the treatment.

Exploring the association between early childhood caries, malnutrition, and anemia by machine learning algorithm.

OBJECTIVE: The objective of this study was to determine the prevalence of early childhood caries in children with severe acute malnutrition (SAM) and also the hierarchy of association if any with malnutrition, anemia, and other risk factors with ECC using machine learning algorithms. METHODS: A hospital-based preventive and interventional study was conducted on SAM children (age = 2 to <6 years) who were admitted to the malnutrition treatment unit (MTU). An oral examination for early childhood caries status was done using the deft index. The anthropometric measurements and blood examination reports were recorded. Oral health education and preventive dental treatments were given to the admitted children. Three machine learning algorithms (Random Tree, CART, and Neural Network) were applied to assess the relationship between early childhood caries, malnutrition, anemia, and the risk factors. RESULTS: The Random Tree model showed that age was the most significant factor in predicting ECC with predictor importance of 98.75%, followed by maternal education (29.20%), hemoglobin level (16.67%), frequency of snack intake (9.17%), deft score (8.75%), consumption of snacks (7.1%), breastfeeding (6.25%), severe acute malnutrition (5.42%), frequency of sugar intake (3.75%), and religion at the minimum predictor importance of 2.08%. CONCLUSION: Anemia and malnutrition play a significant role in the prediction, hence in the causation of ECC. Pediatricians should also keep in mind that anemia and malnutrition have a negative impact on children's dental health. Hence, Pediatricians and Pediatric dentist should work together in treating this health problem.

The dark side of being a pathologist: Unravelling the health hazards.

Background: Pathologists are indispensable to the practice of medicine. Awareness of health hazards among pathologists is a crucial aspect of today's time. Numerous occupational health risks are prevalent which are mostly ignored; for example, the association of microscope use for prolonged durations leading to the development of chronic pain syndromes has been acknowledged for nearly three decades, yet most pathologists are unaware about this hazard until after it transforms into a chronic health issue. The purpose of this study is to learn its prevalence in working pathologists, make them aware of the risks, discuss and encourage them to proactively integrate strategies which are preventive in nature into their daily routine lives. Objective: The aim of the study was to analyze the level of risk, knowledge, awareness and biosafety measures taken by the pathologists in their routine daily work life. Materials and Methods: The study was conducted in a developing country, Northern India, using a standard online 50-item questionnaire enquiring about routine practices. 450 participants were enrolled consisting of 360 pathologists and 90 residents of pathology. Results: Among the 450 enrolled study participants, 84.8% complained of musculoskeletal disorders (MSD), with the neck being the commonest location of pain. Furthermore, 74.8% reported visual refractive errors, among which myopia took the highest place. Work injuries were reported in 60% of participants. Intolerance reactions to chemicals especially formaldehyde was observed in 63.1%. Depression and burnout were reported in 42%. Conclusions: Although knowledge seems to be near adequate, there is a lack of implementation and a noticeable risk of health hazards namely musculoskeletal problems, injuries, visual disorders, and ergonomic issues in routine daily activities of pathologists.

Analysis of Reapplicants to Ophthalmology Residency: Factors Associated with Successful Matching.

BACKGROUND: Ophthalmology residency programs are highly competitive and each year there are many unmatched reapplicants who must make time-sensitive decisions on how to prepare for their reapplication. Our analysis of reapplication factors will be the first evidence-based guide to reapplying ophthalmology. OBJECTIVE: To determine the components of a reapplicants application that contribute and that do not contribute to ophthalmology residency match success. METHODS: Eighty-eight total reapplicants to Dell Medical School's Department of Ophthalmology residency program for the year of 2022 and 2023 were analyzed in a retrospective review in 2023 based on their San Francisco match applications. We assessed match success in the context of demographics, academic performance, cognitive measures, letters of recommendation, personal statements, and extracurricular activities. RESULTS: Of 84 reapplicants who completed the San Francisco Match, 41 matched successfully (48.8%). Factors that significantly affected match success include quantity of LORs written by ophthalmologists (P = .0143), choice of interim year activity (p = .0019), and Step 2 Clinical Knowledge score (P = .0017). Our findings demonstrate that noncontributory factors to reapplicant match rate include number of publications during research years, demographics, clinical grades, Alpha Omega Alpha (AOA) membership, LOR qualities, and Step 1 score. CONCLUSIONS: Ophthalmology residency reapplicants should focus their efforts on finding a research year or established pre-ophthalmology residency program for their interim year and bolstering their letters of recommendations within the field. The quality of in-specialty relationships and letters of recommendation are more impactful than the number of publications during a research gap year. Step 2 CK score is a significant factor but would have already been determined by the time of reapplication. Metrics such as Step 1 scores, AOA status, number of volunteering experiences, and LOR and personal statement qualities had no effect on a reapplicant's chance of matching.

A systematic review of caries risk in children <6 years of age.

BACKGROUND: For caries risk assessment (CRA) tools for young children to be evidence-based, it is important to systematically review the literature to identify factors associated with the onset of early childhood caries (ECC). AIM: This updated systematic review aimed to identify current evidence on caries risk in young children. DESIGN: A comprehensive and systematic literature search of relevant databases was conducted to update a previous systematic review and identify risk factors associated with ECC. Potential risk factors were identified based on strength of association using odds ratios, hazard ratios, relative risk, etc. GRADE was used for rating quality evidence through consensus. RESULTS: Twenty-two studies met inclusion criteria for the search from mid-2017 to 2021. Twenty-five publications from the prior systematic review, from 1997 to mid-2017, were also included. Several socioeconomic, behavioral, and clinical variables were identified as ECC risk factors. Factors included the following: age, socioeconomic status, frequency of and supervised toothbrushing, fluoride exposure, breast- and bottle-feeding, feeding habits, absence of a dental home, past caries experience, active non-cavitated lesions, visible plaque, enamel defects, and microbiome. CONCLUSION: This study provides updated evidence of risk factors for ECC that could be included in CRA tools.

Comparison of the Efficacy of Metformin and Lifestyle Modification for the Primary Prevention of Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.

This meta-analysis aimed to compare the effectiveness of metformin versus lifestyle interventions in preventing diabetes in individuals with prediabetes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted a comprehensive search of databases (PubMed, Cochrane Library, EMBASE) up to September 1, 2023. Five eligible studies were included. The results showed that there was no significant difference in the risk of developing diabetes between the metformin and lifestyle intervention groups (RR: 1.14, 95% CI: 0.77-1.68). Similarly, when comparing metformin with lifestyle intervention, the risk of diabetes was slightly higher in the metformin group, but this difference was not statistically significant (RR: 1.31, 95% CI: 0.93-1.86). When comparing metformin with lifestyle intervention to lifestyle intervention alone, no significant difference was observed in the incidence of diabetes (RR: 0.88, 95% CI: 0.74-1.04). In conclusion, our analysis found that the incidence of type 2 diabetes was slightly higher in patients receiving metformin alone compared to lifestyle intervention, but this difference did not reach statistical significance. Further trials are necessary to better evaluate these interventions for preventing type 2 diabetes in high-risk individuals.

Role of Parenting and Psychosocial Correlates Contributing to Social Anxiety in Asian Adolescents: A Systematic Review.

Background: The purpose of the study was to explore social anxiety in adolescents as well as associated factors, such as parenting styles, self-esteem, quality of life, emotional intelligence, and brain activity, in social anxiety. Methods: A systematic review of articles related to social anxiety in adolescents, associated factors, and brain activity from 2012 to 2022 was performed. Google Scholar, PubMed, and Science Direct were used as research gates to find the relevant articles. Results: Ten articles were sorted among 50 articles according to inclusion criteria. The included studies were based in Pakistan, India, and China, which indicated similar results. Social anxiety was directly related to low self-esteem, authoritarian parenting style, interbrain synchrony between parents and adolescents, low quality of life, weak emotional intelligence, and higher activity in the amygdala of the brain. Conclusion: Social anxiety is common in male-dominant (patriarchal) societies where authoritarian parenting is practiced, which leads to low self-esteem, weak emotional intelligence, and low quality of life in adolescents. Social anxiety is also associated with higher activity in the amygdala and lower gamma interbrain synchrony.

Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients.

Aim: To evaluate the effectiveness of the audiovisual distraction (AVD) technique and filmed modeling (FM) on anxiety and fear in pediatric dental patients. Materials and methods: This experimental in vivo study was conducted on 80 subjects of age-groups 5-8 years coming to the Department of Pediatric and Preventive Dentistry for their first dental visit. Study subjects were subjected to noninvasive restorative treatment under AVD in group I, FM in group II, and a combination of AVD and FM in groups III and IV (control 0). To assess the level of pre and postoperative anxiety and fear, various biological parameters like pulse rate, oxygen saturation, body temperature, respiratory rate, and salivary cortisol estimation along with facial image scale (FIS), and fear assessment picture scale (FAPS) were used. Results: Group III (a combination of AVD and FM) came out to be better than other experimental groups and control groups in reducing dental anxiety and fear in pediatric dental patients. Conclusion: A combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique. Clinical significance: A child's disruptive behavior due to dental anxiety causes difficulty in delivering effective dental treatment. Thus, a child's behavior management is of paramount importance in the pediatric dental setup. Nonpharmacological behavior management techniques, that is, a combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique to reduce dental anxiety and fear in pediatric dental patients. How to cite this article: Jamil F, Khan SY, Jindal MK. Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients. Int J Clin Pediatr Dent 2023;16(4):598-602.

Toxin-Antitoxin system of Mycobacterium tuberculosis: Roles beyond stress sensor and growth regulator.

The advent of effective drug regimen and BCG vaccine has significantly decreased the rate of morbidity and mortality of TB. However, lengthy treatment and slower recovery rate, as well as reactivation of the disease with the emergence of multi-drug, extensively-drug, and totally-drug resistance strains, pose a serious concern. The complexities associated are due to the highly evolved and complex nature of the bacterium itself. One of the unique features of Mycobacterium tuberculosis [M.tb] is that it has undergone reductive evolution while maintaining and amplified a few gene families. One of the critical gene family involved in the virulence and pathogenesis is the Toxin-Antitoxin system. These families are believed to harbor virulence signature and are strongly associated with various stress adaptations and pathogenesis. The M.tb TA systems are linked with growth regulation machinery during various environmental stresses. The genes of TA systems are differentially expressed in the host during an active infection, oxidative stress, low pH stress, and starvation, which essentially indicate their role beyond growth regulators. Here in this review, we have discussed different roles of TA gene families in various stresses and their prospective role at the host-pathogen interface, which could be exploited to understand the M.tb associated pathomechanisms better and further designing the new strategies against the pathogen.

Investigation of the structural, electronic, mechanical, and optical properties of NaXCl3 (X = Be, Mg) using density functional theory.

In our pursuit of enhancing material performance, our focus is centered on the investigation of sodium-based halide perovskites, specifically NaXCl3 (where X = Be & Mg). We are utilizing first-principles methods based on density functional theory (DFT) to delve into these materials' properties and potential improvements. This investigation is executed using the WIEN2K code, aiming to uncover a deeper understanding of these materials' properties and potential enhancements. In this study, we utilize the Full Potential Linear Augmented Plane Wave (FP-LAPW) approach to analyze the structural, mechanical, electronic, and optical properties of cubic perovskite materials NaXCl3 (X = Be, Mg). We employ the Birch-Murnaghan fitting curve to assess the structural stability of these compounds, and in each case, the compound demonstrates structural stability in its optimal or ground state. The existence of real frequencies serves as confirmation of the phonon stability for both compounds. To determine the elastic characteristics, the IRelast Package is used. This involves calculating the elastic constants, which demonstrates that the compounds have anisotropic, ductile properties and demonstrate mechanical stability. We investigate the electronic properties by analyzing the density of states and the band structure. Both compounds exhibit an indirect band gap energy of 4.15 eV for NaBeCl3 and 4.16 eV for NaMgCl3. We analyze both the total and partial density of states to gain insight into the contributions of different electronic states to the band structure. Furthermore, optical characteristics, including the dielectric function, absorption coefficient, refractive index, and reflectivity, are investigated across an energy spectrum ranging from 0 to 15 eV. These findings can offer a comprehensive insight into the development of advanced electronic devices with improved efficiency and enhanced capabilities. Furthermore, they have the capacity to inspire experimental researchers to delve further into this field for subsequent explorations.

Spinal Myxopapillary Ependymoma: A Rare Case and Review of Management Strategies.

Intramedullary myxopapillary ependymomas are rare spinal cord tumors primarily affecting young adults. Grade 2 tumors are associated with a higher proliferative index and potentially more aggressive behavior compared to grade 1 tumors. We present a case of a 30-year-old male who presented with a three-month history of progressive unilateral lower back pain that was refractory to analgesics. Neurological examination revealed bilateral lower limb weakness and sensory impairments in the L2 region. MRI confirmed a well-defined, enhancing intramedullary lesion at the L2 level, causing cord enlargement and edema. Diagnosis of grade 2 intramedullary myxopapillary ependymoma was made. Complete surgical resection was performed, confirming a grade 2 myxopapillary ependymoma. Postoperatively, the patient demonstrated significant improvement in lower limb function and sensation, with no tumor recurrence during long-term follow-up. Rehabilitation therapy was initiated, while close monitoring for complications and tumor progression was maintained. This case explores the etiology and features of intramedullary myxopapillary ependymomas and underscores the importance of early recognition, accurate diagnosis, and aggressive surgical management.

Readability and Suitability of Online Uveitis Patient Education Materials.

PURPOSE: This study assesses readability, suitability, and accountability of online uveitis patient education materials (PEMs). METHODS: Two uveitis specialists reviewed the top 10 websites on Google for keyword "uveitis," with a PubMed review control. Readability was assessed using an online calculator, suitability using the Suitability Assessment of Materials (SAM) tool, and accountability using JAMA benchmarks. RESULTS: The mean SAM score was 21.05, indicating that websites were on average adequately suitable to educate patients. WebMD Uveitis website scored the highest at 25.5, while allaboutvision.org scored the lowest at 18.0. The average Flesch Reading Ease (FRE) score was 44.0 (95% CI: 34.2, 53.8). The average reading grade score was 11.0 (95% CI: 9.4, 12.6). WebMD Uveitis page scored highest on readability. The average accountability score among sites was 2.36 out of 4. CONCLUSIONS: Uveitis websites are only adequately suitable as PEMs, and all are above the recommended reading level. Uveitis specialists should advise patients on quality of online PEMs.

Beneficial Impacts of Fenoldopam on Patients With or at Risk for Acute Renal Failure and Undergoing Surgery: A Meta-Analysis of Randomized Clinical Trials.

This meta-analysis aims to determine the beneficial impacts of fenoldopam on patients with or at high risk of acute kidney injury (AKI) and undergoing surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed while performing the present meta-analysis. Two investigators searched electronic databases including PubMed, EMBASE, and the Cochrane library, from inception until January 10, 2023, for relevant studies. The key terms used to search for relevant articles included "fenoldopam", "acute kidney injury" and "surgery". The primary outcome was the incidence of new AKI. Secondary outcomes included change in serum creatine from baseline (mg/dl), length of stay in ICU (days), renal replacement therapy (RRT), and all-cause mortality that included mortality before or at 30 days. A total of 10 studies involving 1484 patients were included in the present meta-analysis. The risk of AKI was lower in the fenoldopam group compared to the control group [risk ratio (RR): 0.73, 95% CI: 0.57-0.95]. The length of ICU stay was also shorter in the fenoldopam group [mean difference (MD): -0.35 days, 95% confidence interval (CI): -0.68, -0.03]. No significant differences were reported in terms of all-cause mortality, change in serum creatinine, and RRT. In conclusion, our meta-analysis of studies on the use of fenoldopam in adult patients undergoing major surgery showed that fenoldopam significantly reduces the risk of AKI and shortens ICU stays. However, there was no significant impact on all-cause mortality or RRT.

Acute central corneal haze and thinning with atypical keratitis presentation.

A 24-year-old woman presented with a 7-day history of blurry vision, redness, and extreme pain in her right eye. She had no pertinent medical or ocular history and did not use spectacles or contacts. Uncorrected distance visual acuity (UDVA) was 20/40 in the right eye and could not be improved with refraction. Slitlamp examination revealed a 1.5 × 1.5 mm central epithelial defect with surrounding white blood cell recruitment. Confocal microscopy (Figure 1JOURNAL/jcrs/04.03/02158034-202304000-00020/figure1/v/2023-03-24T200747Z/r/image-tiff) was performed, and she was treated with chlorhexidine 0.02% drops every hour in the right eye. 2 weeks later, the cornea had completely re-epithelialized; however, persistent corneal haze, decreased visual acuity, and corneal thinning and flattening was noted. Pachymetry was 484 µm in the right eye and UDVA was 20/40 (Supplemental Figure 1, available at http://links.lww.com/JRS/A836). In the following 2 weeks, UDVA improved to 20/25. 6 months after the initial presentation, UDVA was unchanged and faint central corneal haze was noted on examination (Figure 2JOURNAL/jcrs/04.03/02158034-202304000-00020/figure2/v/2023-03-24T200747Z/r/image-tiff). Of interest, her family history is significant for her younger 16-year-old brother with 3 prior episodes of a similar type of keratitis/keratopathy over the course of 2 years in both eyes with similar central paracentral corneal haze, thinning, and flattening and similar confocal findings (Figure 3JOURNAL/jcrs/04.03/02158034-202304000-00020/figure3/v/2023-03-24T200747Z/r/image-tiff). He also was unresponsive to topical antibiotics and antivirals except topical chlorhexidine. Her brother has been our patient for the last several years prior to her first visit to our clinic. What is your diagnosis? What medical diagnostic tests, if any, would you recommend? Is this an infectious or simply an inflammatory response? Is there any genetic or familial predisposition?

Implementing evidence-based telephone coaching for health behavior program enrollment: A quality improvement project.

INTRODUCTION: This program evaluation describes the use of implementation facilitation to support uptake of a telephone-based engagement coaching intervention, ACTIVATE, using paraprofessional staff, to support health behavior program enrollment. METHOD: The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework guided the formative evaluation. A mixed-methods approach was used to integrate qualitative (i.e., rapid analysis approach) and quantitative (i.e., descriptive statistics, chi-square test of independence, logistic regression) analyses for each outcome. RESULTS: Most patients (95%; 319 of 335) were offered ACTIVATE, and 82 patients completed ACTIVATE. Delivery with paraprofessional staff was feasible with adaptations for translation from research to a clinical setting, which are described. External facilitation (a form of implementation facilitation) was associated with higher reach. DISCUSSION: Delivery of telephone-based coaching by paraprofessional staff to support health behavior program enrollment was feasible. External facilitation was important to the translation of ACTIVATE from research to clinical practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Efficacy and Safety of Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors in Patients With Diabetes and Chronic Kidney Disease (CKD): A Meta-analysis of Randomized Control Trials.

The current meta-analysis aims to assess the efficacy and safety of sodium glucose cotransporter 2 (SGLT2) inhibitors in individuals with diabetes and chronic kidney disease (CKD). The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted to identify all relevant studies related to the efficacy and safety of SGLT2 inhibitors in individuals with diabetes and CKD. The search was undertaken in PubMed, EMBASE, and Cochrane Library from January 2000 to September 2022. The primary efficacy outcome assessed in the current meta-analysis included major adverse cardiovascular events (MACE). Other efficacy outcomes included all-cause mortality and change in hemoglobin A1c (HbA1c) (%). Safety outcomes included serious adverse events, acute kidney injury, hypoglycemia, and hyperkalemia. In total 11 articles met the inclusion criteria and were included in the final analysis enrolling 27520 patients (14491 in the SGLT2 inhibitors and 13029 in the placebo group). The findings of this meta-analysis have shown that the risk of MACE and all-cause mortality was significantly lower in patients receiving SGLT2 inhibitors. Additionally, Hb1AC change was also significantly greater in SGLT2 inhibitors group. In relation to safety outcomes, serious adverse events, risk of acute kidney injury, and hyperkalemia were significantly lower in the SGLT2 inhibitors group. The SGLT2 inhibitors significantly decreased the risk of major cardiovascular events and all-cause mortality in patients with CKD and diabetes. Furthermore, SGLT2 inhibitor is also effective in reducing Hb1Ac levels in patients.

An Unusual Association Between Metformin and Nightmares: A Case Report.

Metformin remains the oral drug of choice for patients with type 2 diabetes mellitus (T2DM). It is an ideal anti-diabetic drug for maintaining good glycemic control in diabetics. However, the side effect profile of metformin varies from minor or no effects to substantial impact on the GI tract. In addition, metformin is rarely known for its association with nightmares. Here we present the case of a newly diagnosed 40-year-old diabetic who developed recurrent nightmares within a week of starting metformin treatment. The patient had no previous history of psychiatric or sleep disorders. However, it was the first time he had experienced such recurrent nightmares, especially after the start of 500 mg metformin thrice a day. Based on the Naranjo Adverse Drug Reaction (ADR) Probability Scale, and sudden onset and disappearance of nightmares after metformin initiation and discontinuation made metformin the primary cause of his nightmares.