Emerging evidence for glucagon-like peptide-1 agonists in slowing chronic kidney disease progression.

PURPOSE OF REVIEW: Diabetic kidney disease continues to increase, and several novel therapeutic agents have been shown to slow the progression of chronic kidney disease in those with diabetes. This review summarizes more recent data on the role of glucagon-like peptide-1 (GLP-1) receptor agonists and kidney outcomes. RECENT FINDINGS: Posthoc analysis of cardiovascular outcome trials, as well as several retrospective studies, demonstrate benefits of GLP-1 receptor agonist therapy for chronic kidney disease progression in diabetics. Although limited randomized clinical trials evidence assessing the effects of GLP-1 receptor agonists on kidney outcomes in diabetic chronic kidney disease patients have been published, FLOW-CKD trial was halted based on interim data for efficacy, and results are awaited. SUMMARY: GLP-1 receptor agonism is a promising therapy for slowing the progression of diabetic chronic kidney disease. Recent studies support kidney benefits GLP-1 receptor agonists over insulin and dipeptidyl peptidase-4-inhibitors, and the FLOW-CKD trial would inform the potential benefits for reducing the need for dialysis and kidney-disease related mortality in those with kidney disease.

Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review.

BACKGROUND: The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies. PURPOSE: Therefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA. METHODS: This systematic review of the literature used, PRISMA to guide the search. FINDINGS: The review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces. DISCUSSION: There were gaps in the interventions that have been proven successful in other global settings. CONCLUSION: In SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.

Radiologic anatomic study of the humeral medullary canal.

Hypothesis/Background: Patient-specific implants have become an increasingly researched area to improve surgical outcomes. Patient-specific implants have been suggested to provide advantages for better implant alignment and thus improve surgical outcomes. One such area for application is in the use of intramedullary nails for humeral fracture stabilization. However, the anatomy of the canal is not well defined, especially in a larger scale demographic study. Methods: In this observational cross-sectional study, axial computed tomography scans of 150 humeri were used to measure the cortical thickness and canal width in both coronal and sagittal orientations. Measurements were made at 7 evenly spaced levels along the humerus from the surgical neck to the point immediately superior to the supracondylar ridge. X-rays were used to measure the valgus, recurvatum, and procurvatum angles, along with their associated locations. Demographic data recorded included age, gender, body mass index (BMI), race, and ethnicity. Results: The mean coronal canal widths decreased inferiorly from the surgical neck to midshaft before increasing to the supracondylar fossa. Mean sagittal widths decreased along the complete course of the canal. The ratio of coronal to sagittal canal widths decreased from 1.09 at level 1 to 0.83 at level 5 before increasing to 1.30 at level 7. Females had significantly smaller canal widths and cortex thicknesses in both the sagittal and coronal planes throughout the course of the canal. There were no significant differences in canal widths among ethnicities. Age was positively correlated with the canal width in the coronal and sagittal orientations but was negatively correlated with cortical thickness in all 7 levels. BMI was not significantly correlated with canal width. Conclusion/Discussion: The data included in this study may be used to determine standard widths and measurements of the humerus. However, there are notable patterns or differences in the shape of the medullary canal of the humerus between subgroups. This study is the first to conduct a larger scale demographic investigation comparing the humeral canal characteristics among sex, ethnicity, age, and BMI. These data may serve as a platform to further investigate the course of the medullary canal.

Self-management of the Dual Diagnosis of HIV/AIDS and Diabetes During COVID-19: A Qualitative Study.

The purpose of this qualitative secondary analysis research was to describe the impact of the COVID-19 pandemic on self-management behaviors and practices for people living with the dual diagnoses of HIV/AIDS and type 2 diabetes mellitus and to identify early pandemic-specific disruptions or changes to their self-management practices. In-depth interviews conducted in May-June 2020 with 9 participants, and analyzed using content analysis, revealed 5 themes: adjusting to living with HIV/AIDS and diabetes impacts beliefs about COVID-19 risks; COVID-19 information seeking and accuracy; trade-offs in self-managing multiple chronic conditions; balance between safety, relationships, and the society at large; and discordant perceptions and actions. Some participants were resilient from previous experiences. Many received mixed messages about their risk for COVID-19, resulting in inaccurately or inconsistently applying guidelines for social isolation.