RESUMO
Type II diabetes mellitus (T2DM) is a global epidemic affecting people of all ages in developed and developing countries. The disease is usually characterized by insulin resistance and glucose intolerance; therefore, oral antidiabetic drugs such as thiazolidinediones (TZDs) and biguanide metformin are used to counter these defects. Due to the varied action mechanisms of TZDs and Metformin, their effects on insulin sensitivity and glucose tolerance may differ. Therefore, the current study was carried out to compare the effects of Metformin and TZDs on insulin sensitivity and glucose tolerance among patients with T2DM. Two methods, including using a well-outlined search strategy in 5 electronic databases including ScienceDirect, Google Scholar, PubMed, Scopus, and Embase, and a manual search which involved going through the reference lists of studies from the electronic databases were used to retrieve studies published between 2000 and 2022. Additionally, data analysis of outcomes retrieved from the studies eligible for inclusion and the methodological quality was carried out using the Review Manager software (RevMan 5.4.1) and STATA. The meta-analysis has shown that TZDs have a significantly better overall effect on fasting plasma glucose (FPG) (SMD:0.61; 95% CI:0.06, 1.16: p = 0.03) and insulin sensitivity than Metformin (Mean QUICKI: 0.306 ± 0.019 vs. 0.316 ± 0.019, respectively; p=0.0003). However, the TZDs and Metformin offer the same effect on glycemic control as assessed using HBA1c levels (MD: 0.10; 95% CI: -0.20, 0.40; p = 0.52). TZDs offer better insulin sensitivity and glucose tolerance improvements compared to Metformin. This evidence contradicts the current guidelines by the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) and the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE), which recommend the use of Metformin as the first-line drug monotherapy for patients with T2DM.
RESUMO
Lacerations are common injuries managed by emergency department practitioners and are mostly witnessed in children. These lacerations usually require wound closure, which may result in one of the most unpleasant and painful childhood experiences. The pain can be minimized through topical anesthesia, such as a combination of lidocaine, epinephrine, and tetracaine (LET) and a eutectic mixture of local anesthetics (EMLA). The current study was carried out to demonstrate the efficacy of EMLA and LET in pediatric wound management. A thorough literature search was carried out without any time limitation on five electronic databases, including PubMed, Medline, Web of Science, Embase, and Google Scholar. Relevant studies from these databases and their references were scoured for additional studies. Study quality appraisal and data analysis were conducted using Review Manager software (RevMan 5.4.1). The literature search yielded 1651 articles of which only eight were eligible for inclusion in the present study. A meta-analysis of results from 3 studies showed that LET had a significant pain reduction than the control interventions (SMD: -0.46; 95% CI: -0.69, -0.23: p<0.0001). However, the pooled effect size of data from 3 studies showed EMLA had an insignificant difference with the control interventions (SMD: -0.79; 95% CI: -1.82, -0.24: p = 0.13). Similarly, no significant difference in the number of adverse reactions was reported in either EMLA (OR: 2.31; 95% CI: 0.67, 7.93; p = 0.18) or LET (OR: 0.99; 95% CI: 0.15, 6.50; p = 0.99) Our study suggests that the topical application of EMLA and LET effectively offers pain-free wound management among pediatric patients. However, the interventions are subject to adverse reactions that should be considered when managing the wounds.
RESUMO
Carpal tunnel syndrome (CTS) is the most common upper extremity neuropathy. The disease initially manifests as a sensory disorder in the form of paresthesia, numbness, or tingling of the fingers. The diagnosis is usually made based on history and clinical symptoms, which are confirmed using nerve conduction studies (NCS) and electromyography. More recently, ultrasound has gained more use in CTS diagnosis due to its advantages, which include patients' comfort during diagnosis, better visualization of anatomy and nerve forms directly, and cost-effectiveness. However, a literature review shows that the diagnostic accuracy of ultrasound over NCS is still in question; therefore, the present systematic review was carried out to compare the diagnostic accuracy of ultrasound to NCS and electromyography. A systematic literature search was performed on five electronic databases: PubMed, Medline, Web of Science, Embase, and Google Scholar. The search strategy limited the retrieval of literature published between 2000 and 2022. Of the 1098 articles retrieved from the electronic databases, only 12 met the inclusion criteria. A meta-analysis of outcomes from the included studies showed that the pooled sensitivity and specificity of the ultrasound were 0.80 (95% CI: 0.73, 0.88) and 0.90 (0.83, 0.96), respectively. On the other hand, combing the outcomes of electromyography and NCS resulted in sensitivity and specificity values of 0.89 (95% CI: 0.84, 0.95) and 0.77 (95% CI; 0.64, 0.90), respectively. The results show that ultrasound has comparable sensitivity and slightly higher specificity than NCS and electromyography; therefore, ultrasound can be used as an alternative diagnostic test for CTS. However, it cannot replace NCS and electromyography since more research needs to be done on doubtful and secondary cases of CTS.