Exploring the Impact of Iron Deficiency Anaemia on Glycated Haemoglobin A1c Levels in Pregnant and Non-Pregnant Women: A Systematic Review.

Haemoglobin A1C (HbA1c) is fundamental in monitoring glycaemic control during pregnancy. However, several conditions could affect this test's accuracy, including iron deficiency anaemia (IDA). Hence, this systematic review delves into the underexplored connection between IDA, iron replacement therapy (IRT), and haemoglobin A1C (HbA1c) during pregnancy. An electronic search of the Cochrane, MEDLINE, and Embase databases was conducted by six authors. From a comprehensive search strategy, 968 records were obtained. After applying the inclusion and exclusion criteria, seven studies were included, comprising 365 women selected for analysis. Six studies indicated a positive correlation between IDA and HbA1c levels, while one found no correlation. The average HbA1c level of the included studies in pregnant women was 5.64%. In comparison, it was found that non-pregnant women had lower HbA1c levels. Among the included studies, the mean HbA1c levels decreased from 5.1% to 4.89% after treating pregnant women with IRT. The review emphasises the complexity of interpreting HbA1c levels in pregnant women with IDA, highlighting the influence of pregnancy-induced physiological changes. In addition, this suggests that HbA1c should not be the sole criterion for diabetes management in pregnant women with IDA. Future research should focus on alternative glycaemic monitoring methods unaffected by IDA.

The Prevalence of Sleep Disorders in People with Type 2 Diabetes and Obesity in Saudi Arabia: A Cross-Sectional Study.

Purpose: Difficulty falling or staying asleep are considered sleep disorders, and these are common among people with type 2 diabetes mellitus (T2DM) and obesity. The presence of sleep disorders may cause poor glycemic control among this population. We therefore designed this study to assess sleep disorders among patients with T2DM and obesity. Patients and Methods: This cross-sectional study examined the prevalence of sleep disorders in 148 patients with T2DM and obesity at a hospital in Taif, Saudi Arabia using a validated questionnaire. Results: Among those patients who have been involved in this study, we found a moderate level of sleep disorders and disturbances. The average sleep disorder assessment score for the patients with T2DM and obesity was 2.8 ± 1.4. Additionally, the average score for the sleep pattern assessment was 2.7 ± 1.3 and 2.9 ± 1.5 for symptoms of lack of sleep. Our study also revealed that those patients also had suboptimal weight and glycemic control. Conclusion: These findings demonstrate that patients with T2DM and obesity are at a higher risk of developing sleep disorders. Therefore, these patients need to be screened for sleep disorders to avoid further diabetes-related complications and to have an early lifestyle intervention.

Diagnostic accuracy of intrathecal fluorescein versus other radiological modalities in evaluating non-congenital skull base defects: a systematic review and meta-analysis.

PURPOSE: The intraoperative detection of cerebrospinal fluid (CSF) leaks during endoscopic skull base surgery is critical to ensure watertight sealed defects. Intrathecal fluorescein (ITF) is a valuable adjunct to intraoperative investigation. Hence, our aim is to summarize the evidence of the efficacy of ITF as an accurate diagnostic modality and reconstruction guide for non-congenital skull base defects. METHODS: Using the Cochrane Central, MEDLINE, and Embase databases, we identified studies involving the use of ITF in non-congenital CSF leaks which were published until November 2023. The STATA 18 software was used for meta-analysis. RESULTS: Fourteen studies met the inclusion criteria, in which seven studies were included in the meta-analysis. ITF was used in 1898 (90.3%) of patients, with a detection rate of 88.1%. The overall detection rate of non-congenital CSF leaks among ITF concentrations of 5% and 10% had a statistically significant pooled effect size of 2.6 (95% CI = 2.25, 2.95), while when comparing the ITF to other alternative radiological tests, it was not statistically significant with a mean difference of 0.88 (95% CI = - 0.4, 2.16). Moreover, the pooled prevalence was statistically significant in regards of the complications associated with ITF with an effect size of 0.6 (95% CI = 0.39, 0.82), indicating that 60% of patients who underwent ITF would experience at least one of the measured complications. CONCLUSION: ITF is considered as an efficient tool in localizing skull base defects. However, there was no significant results when comparing the ITF to other alternative radiological tests. Accordingly, if the ITF intervention is indicated, patients should be carefully selected based on their clinical need.

A Case of Late-Onset Neutropenia in Relapsing-Remitting Multiple Sclerosis Following Ocrelizumab Therapy.

Ocrelizumab, a monoclonal antibody, has proven effective in treating both primary progressive and relapsing-remitting multiple sclerosis. Common adverse effects observed in clinical studies include flushing, sore throat, pruritus, and rash. This abstract discusses a case of severe, late-onset neutropenia in a patient with relapsing-remitting multiple sclerosis undergoing ocrelizumab treatment. The neutropenia emerged 46 days following the patient's most recent ocrelizumab dose. The patient responded well to treatment with intravenous meropenem and filgrastim. This rare and unforeseen adverse effect highlights the importance of regular blood monitoring for early detection of severe neutropenia in patients treated with ocrelizumab.

Lemierre's Syndrome in a Pediatric Patient: A Case Report.

Lemierre's syndrome (LS) is a rare and potentially life-threatening complication of an oropharyngeal infection, resulting in the presence of septic thrombophlebitis in the internal jugular vein. This condition is most commonly caused by Fusobacterium necrophorum, with a prevalence of one case per million people annually. LS is more commonly seen in adolescents or young adults, but it can also occur in children. Despite its rare occurrence, prompt diagnosis of this condition and the initiation of treatment are crucial to preventing fatal complications. In this study, we report a unique case of a previously healthy seven-year-old male with LS who presented with fever, left-sided neck pain, and swelling.

The Effect of Iron Replacement Therapy on HbA1c Levels in Diabetic and Nondiabetic Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Several studies have reported that iron-deficiency anemia (IDA) and its treatment might lead to a distorted reading of glycated hemoglobin (HbA1c) value. Hence, this review aims to systematically investigate the effect of iron replacement therapy (IRT) on HbA1c levels, as the literature is deficient in assessing this clinical phenomenon. METHODS: An electronic search of the Cochrane, MEDLINE, and Embase databases was conducted by four independent authors. RESULTS: Among the 8332 articles identified using the search strategy, 10 records (with a total of 2113 participants) met the inclusion criteria and were analyzed. In nine of the studies, IRT was found to decrease HbA1c levels; in the remaining study, IRT was found to increase HbA1c levels. The effect size of the pooled standardized mean difference in HbA1c levels between the treatment and control groups with IDA was 1.8 (95% CI = -0.5, 2.31). Heterogeneity was assessed using the I2 and χ2 tests, and the resultant values were 98.46% and p = 0.09, respectively. Additionally, the mean difference between the HbA1c levels (pre-IRT and post-IRT) showed a drop in the HbA1c levels which ranged from 1.20 to 0.43 mg/dL. CONCLUSIONS: The results suggest that IRT decreases HbA1c levels, and it is helpful in treating IDA patients with poor glycemic control. Accordingly, the results provide an added perspective on antidiabetic medication dosing and physicians' interpretation of initially elevated HbA1c values.

Non-obstetric Acute Abdomen in Pregnancy: a Review of Literature.

Background: Acute abdomen in pregnancy (AAP) is defined as intensive abdominal pain lasting less than 24 hours that may require urgent surgery. It is a challenging situation to diagnose and manage, as it is associated with pain due to the normal anatomical and physiological changes that occur during pregnancy. Objective: Therefore, understanding these changes and their effect on almost every system, will help us appreciate the upcoming causes of AAP, mainly the non-obstetric surgical emergencies (e.g., appendicitis, cholecystitis). Methods: This article highlights the importance of the well-rounded care that should be offered to every pregnant patient presenting to any center with a Non-obstetric Acute Abdomen. The causes are discussed separately (for surgical pearls), laparoscopic approach and radiologic modality decision-making in pregnancy, which is an academic and a practice-based helpful summary. Results and Discussion: This article highlights the importance of the well-rounded care that should be offered to every pregnant patient presenting to any center with a Non-obstetric Acute Abdomen. The causes are discussed separately (for surgical pearls), laparoscopic approach and radiologic modality decision-making in pregnancy, which is an academic and a practice-based helpful summary. Results and Discussion: In addition, the sequence of ideas and language used in the article was based to help the reader understand the topic, rather than inform them about it. In addition, the utility of laparoscopy in pregnancy remains a concern due to the possible risk of injury to the fetus and fetal acidosis. Although, trials showed that laparoscopy was associated with less blood loss and a shorter hospital stay. Moreover, in some cases radiographic imaging is necessary, posing a diagnostic dilemma. Conclusion: AAP is a major concern that requires early interventions to pinpoint the cause and manage the patient, properly.

Temporal Relationship of Acute Rheumatic Fever Following COVID-19 Infection: A Pediatric Case Report.

Coronavirus disease 2019 (COVID-19) has the potential to trigger the onset of autoimmune disorders, one of which is acute rheumatic fever (ARF). ARF is an immune system response that can manifest after an individual has been infected with Streptococcus pyogenes. In this study, we document a unique case involving a previously healthy child who exhibited symptoms of fever, polyarthritis, and ankle swelling after history of COVID-19 infection one month ago. This rare pediatric case report discussed the occurrence of ARF after a one-month period of COVID-19 infection, and we observed significant improvement in our patient after a three-month treatment regimen.