Retrospective, observational study to see the effect of evogliptin on continuous glucose monitoring (CGM) in T2DM Indian patients: A real-world experience

This study aimed to assess effectiveness of Evogliptin 5 mg through continues glucose monitoring (CGM) in patients with T2DM in retrospective observational real world settings. Overall 6 patients who received Evogliptin as routine clinical practice in management of T2DM were analyzed retrospectively from single center. Data collected from past medical records. FreeStyle Librepro 1.0.6 was used for CGM. CGM was done 15 days prior to adding Evogliptin and repeated immediately after that for next 15 days. Mean BG level, Percentage time in target range (80-140mg/dl), Percentage time above target and Percentage time below target were assessed prior and after adding Evogliptin in existing treatment regimen. Significant reduction in Mean blood glucose level seen after adding Evogliptin in existing treatment regimen from 215 mg/dl to 138 mg/dl (-77 mg/dl P=0.006). Significant improvement seen in Percentage time in target range (80-140mg/dl) from 17% to 44% (27% P value 0.007) and in Percentage time above target from 81% to 43% (- 38%, P valve 0.003). 13.5 % of the patients seen below target. Evogliptin was found to be effective when added to the patients who were uncontrolled on other oral anti-diabetic medications. It effectively showed improvement in continues glucose monitoring (CGM) parameters like Mean blood glucose, more number of patients were in Time in Target range i.e (80-140mg/dl) after adding Evogliptin to existing anti-diabetic medications & well tolerated. Small sample size and retrospective study

Effect of mulmina mango as an adjunct to standard of care treatment on COVID-19 positive subjects undergoing treatment for COVID-19 in hospital quarantine (Dedicated Covid Health Centre)

There are no approved drugs to treat COVID-19, and the vaccine is likely to be ready by early 2021. Many clinical studies are ongoing around the globe to find a cure or prevention of the disease. The objective of the proposed study is to determine the efficacy and safety profile of Mulmina Mango as an adjunct to standard of care treatment on COVID-19 positive subjects undergoing treatment for COVID-19 in Hospital Quarantine. Settings and Design: The enrolled subjects were randomized into either of the two treatment arms in the ratio of 1:1. The freshly diagnosed (24-48 hrs.) COVID-19 positive Male or Female is aged 20 to 65 years (both inclusive) hospitalized patients were approached and checked for their eligibility. They were recruited after signing the written informed consent form. The number of patients included in the study is 48. In efficacy, both the treatment arms and the reduction in clinical symptom scale value and ordinal scale value are seen on day 7. On the ordinal scale, 41.7% of subjects in Treatment arm A showed a reduction of 2 points on the day, and 16.7% of subjects show 2 points reduction in Treatment arm B. In Safety results, there was no clinically significant finding in safety parameters in Treatment arm B. Mulmina Mango showed encouraging results concerning RTPCR, CRP, Dopamine, IgG, CD4, and CD8 parameters. The properties of Mulmina Mango are highlighted below, along with the parameters for each property. Mulmina Mango, COVID-19, Treatment Arm A, Treatment Arm B, MoHFW (Ministry of Health and Family Welfare)

Treatments after Immune Checkpoint Inhibitors in Patients with dMMR/MSI Metastatic Colorectal Cancer

Background: Several studies reported improved outcomes with conventional treatments (CT, i.e., chemotherapy ± targeted therapy) administered after immune checkpoints inhibitors (ICI) in certain tumor types. No data are available concerning patients (pts) with metastatic colorectal cancer (mCRC) harboring mismatch repair deficiency/microsatellite instability (dMMR/MSI). We aimed to assess the outcomes of dMMR/MSI mCRC pts receiving CT after ICI failure. Methods: We conducted a retrospective multicenter study investigating the outcomes of all dMMR/MSI mCRC pts who received post-ICI CT between 2015 and 2020. Results: 31 pts (male 61%, median age 56 years) were included. ICI was an anti-PD(L)1 monotherapy in 71% of pts, and 61% received >2 lines before post-ICI CT. The overall response rate and disease control rate were 13% and 45%, with a median progression-free survival (PFS) and overall survival of 2.9 and 7.4 months, respectively. No association of the outcomes with either ICI efficacy or anti-angiogenic agents was observed. Prolonged PFS (range 16.1–21.3 months) was observed in 4 pts (13%). Conclusions: Although conducted on a limited number of patients, our results do not support an association of previous ICI treatment with an enhanced efficacy of CT in dMMR/MSI mCRC. However, prolonged disease control was observed in several cases, suggesting that some pts might derive an unexpected benefit from post-ICI treatments.

Outcome of acute kidney injuries following chronic kidney disease: A systematic review in Nawaz Sharif kidney hospital Swat

Background: Acute kidney injury may increase the risk for CKD and end-stage renal disease. In an attempt to summarize the literature and provide more compelling evidence, we conducted a systematic review comparing the risk for CKD (chronic kidney disease), AKI (Acute kidney injury), Acute gastroententeritis, postnatal AKI, Acute MI (myocardial infarction), AKI 2ndry to chemotherapy, AKI 2ndry to abstractive Nephropathy, AKI 2ndry to sepsis, AKI 2ndry to Drugs (NSAIDS and ARBS), AKI 2ndry to AGN (acute Glomerulonephritis), AKI 2ndry to Rhabdomyolysis, and lest AKI 2ndry to Malaria, death in patients with AKI,HD, CKD (chronic kidney disease). There have been several important developments in the literature recently regarding the association between acute kidney injury (AKI) and chronic kidney disease (CKD). First, when the National Kidney Foundation promulgated their highly influential Kidney Disease Outcomes Quality Initiative CKD guidelines in 2002, six chapters were devoted to the complications associated with decreased glomerular filtration rate (GFR) including hypertension, anemia, nutritional status, bone disease/disorders of calcium, and phosphorus metabolism, neuropathy Objective: To study the outcomecute kidney injury following chronic kidney disease; systematic review. Methods: This was a prospective observational study from January 2018 to December 2020. Patients visiting department of Nephrology Nawaz Sharif Kidney center Swat, number of patients included study 351. All ages and both sexes were considered. Patients treated elsewhere or who has undergone in this study. Complete medical history, detailed examination like age, sex, diagnosis, and outcome, of AKI, examination under microscope and investigations, and necessary blood investigations were carried out. Results: Three fifty one (351) patients were included in this study. The age distribution showed (75%) patients between 40-95 years and 25(25%) between 32-39 years. Mean age was 43 years with Standard Deviation of ± 35.66. Among 351 patients 162 (45%) patients were male and 189 (55%) patients were female. Duration of symptoms in 24(17%) was <4 months and 112(75%) had >4 months, with mean of 4 months and SD ± 2.315. Total 351 participants AKI 45(12%) postnatal AKI 33(9%) Acute MI 18(6%) AKI 2ndry chemotherapy 15(5.72%) AKI 2ndry to abstractive Nephropathy 55 (14%) AKI 2ndry to sepsis 63 (17%) AKI 2ndry to Drugs (NSAIDS and ARBS) 54 (14%) CKD (chronic kidney disease) 48 (15%) AKI 2ndry to Rhabdomylysis 18(6%) Conclusions: The study concludes that the acute kidney injury following CKD systematic reviewing among patients presenting with AKI,CHD ,AKI sepsis, ,AKI Drugs(NSIAD) in local hospital settings This can be reduced with proper health education in general public regarding prevention of the disease and hence its complications.

Whole-Exome Sequencing in 10 Unrelated Patients with Syndromic Hidradenitis Suppurativa: A Preliminary Step for a Genotype-Phenotype Correlation

<b><i>Background:</i></b> The genetics of syndromic hidradenitis suppurativa (HS), an immune-mediated condition associated with systemic comorbidities such as inflammatory bowel diseases and arthritis, has not been completely elucidated. <b><i>Objective:</i></b> To describe clinical features and genetic signature of patients with the main syndromic HS forms, i.e., PASH, PAPASH, and PASH/SAPHO overlapping. <b><i>Methods:</i></b> Whole-exome sequencing (WES) approach was performed in ten patients with syndromic HS. <b><i>Results:</i></b> Three clinical settings have been identified based on presence/absence of gut and joint inflammation. Four PASH patients who had also gut inflammation showed three different variants in <i>NOD2</i> gene, two variants in <i>OTULIN</i>, and a variant in <i>GJB2</i>, respectively. Three PAPASH and three PASH/SAPHO overlapping patients who had also joint inflammation showed two different variants in <i>NCSTN</i>, one in <i>WDR1</i> and <i>PSTPIP1</i>, and two variants in <i>NLRC4</i>, one of whom was present in a patient with a mixed phenotype characterized by gut and joint inflammation. <b><i>Limitations:</i></b> Limited number of patients that can be counterbalanced by the rarity of syndromic HS. <b><i>Conclusion:</i></b> Syndromic HS can be considered as a polygenic autoinflammatory condition; currently WES is a diagnostic tool allowing more accurate genotype-phenotype correlation.

Severe Primary Open-Angle Glaucoma and Agricultural Profession: A Retrospective Cohort Study

While exposure to pesticides is a known risk factor for neurodegenerative brain diseases, little is known about the influence of environment on glaucoma neuropathy. We aimed to determine whether farmers are at higher risk of developing severe primary open-angle glaucoma (POAG). This retrospective cohort study (tertiary referral center, Reims University Hospital, France) included patients diagnosed with POAG in the last two years. Univariate analysis and adjusted multivariate logistic regression were performed to evaluate the association between agricultural profession and all recorded data. Glaucoma severity (primary outcome) and the number of patients who underwent filtering surgery (secondary outcome) were analyzed. In total, 2065 records were screened, and 772 patients were included (66 in the farmer group and 706 in the nonfarmer group). The risk of severe glaucoma was higher in the farmer group (adjusted odds ratio (aOR) 1.87, p = 0.03). More patients underwent filtering surgery in the farmer group in univariate analysis (p = 0.02) but with no statistical significance after adjustment (p = 0.08). These results suggest pesticide exposure may be a factor accelerating the neurodegeneration in POAG, although a direct link between the agricultural profession and the disease requires further extended studies to be demonstrated.

A Clinical Case of COVID-19-Associated Pulmonary Aspergillosis (CAPA), Illustrating the Challenges in Diagnosis (Despite Overwhelming Mycological Evidence)

The COVID-19 pandemic has resulted in large numbers of patients requiring critical care management. With the established association between severe respiratory virus infection and invasive pulmonary aspergillosis (7.6% for COVID-19-associated pulmonary aspergillosis (CAPA)), the pandemic places a significant number of patients at potential risk from secondary invasive fungal disease. We described a case of CAPA with substantial supporting mycological evidence, highlighting the need to employ strategic diagnostic algorithms and weighted definitions to improve the accuracy in diagnosing CAPA.

Pancreatic metastasis of invasive ductal breast carcinoma: A potential diagnostic pitfall

The 42-year-old patient, diagnosed with Stage IIA breast cancer, completed the postoperative adjuvant chemotherapy and radiotherapy. At the 11th year of diagnosis, a 3 cm tumor was detected in the pancreas and pancreatectomy was performed. Although the diagnosis of primary pancreatic adenocarcinoma was made at first, then the pancreatic metastasis of breast cancer was discovered. Pancreatic metastasis of breast cancer is extremely rare, and a limited number of patients have been reported in the literature. Here, we report an additional case of this rare tumor and the problems correlating with its diagnosis.

The Role of MRI Pancreatic Protocol in Assessing Response to Neoadjuvant Therapy for Patients With Borderline Resectable Pancreatic Cancer

BackgroundBorderline Resectable Pancreatic Cancer (BRPC) remains a unique entity that is difficult to categorize due to variance in definitions and the small number of patients. The ultimate goal is to achieve a free resection (R0) after a favorable response to neoadjuvant therapy that is somewhat difficult to assess by current radiological parameters.AimTo evaluate the role of Magnetic Resonance Imaging (MRI) pancreatic protocol, including Diffusion-Weighted Imaging (DWI), in patients with BRPC receiving neoadjuvant therapy, and further compare it to RECIST criteria and outcome.MethodsHistologically confirmed BRPC patients were prospectively included. DWI-MRI was performed pre- and post-therapy. Clinical characteristics with ensuing operability were recorded and correlated to radiological RECIST/apparent diffusion coefficient (ADC) change, preoperative therapy administrated, surgical resection status, and survival.ResultsOut of 30 BRPC cases, only 11 (36.7%) ultimately underwent pancreaticoduodenectomy. Attaining a stationary or stable disease via ADC/RECIST was achieved in the majority of cases (60%/53.3% respectively). Of the 12 patients (40%) who achieved a regression by ADC, 11 underwent surgery with an R0 status. These surgical cases showed variable RECIST responses (PR=5, SD=4, PD=3). Responders by ADC to neoadjuvant therapy were significantly associated to presenting with abdominal pain (p =0.07), a decline in post-therapy CA19-9 (p&lt;0.001), going through surgery (p&lt;0.001), and even achieving better survival (p&lt;0.001 vs. 0.66).ConclusionDWI-MRI ADC picked up patients most likely to undergo a successful operative procedure better than traditional RECIST criteria. An algorithm incorporating novel radiological advances with CA19-9 deserves further assessment in future studies.

Risk and benefits of temporary pacemaker electrodes in adult open-heart surgery—a systematic review

Background To assess the achieved risk and benefits of inserting temporary epicardial pacemaker electrodes after open-heart surgery for potential treatment of postoperative cardiac arrhythmias, and to investigate the extent of its use in clinical practice. Main text A systematic search was conducted in PubMed and repeated in Embase and Scopus using the PRISMA guidelines. The search identified 905 studies and resulted in 12 included studies, where the type of surgery, study design, total number of included patients, number of patients having temporary pacemaker electrodes inserted, number of patients requiring temporary pacing, primary reason for pacing, significant factors predicting temporary pacing, registered complications and study conclusion were assessed. Eight papers concluded that routine insertion of temporary pacemaker electrodes in all postoperative patients is unnecessary. One paper concluded that they should always be inserted, while three papers concluded that pacing is useful in the postoperative period, but did not recommend a frequency of which they should be inserted. Conclusions The literature suggests that the subgroup of younger otherwise healthy patients without preoperative arrhythmia having isolated coronary artery bypass grafting surgery or single valve surgery should not routinely have temporary pacemaker electrodes inserted.