Introduction
Sodium-glucose cotransporter-2 inhibitors (SGLT2-Is) have emerged as standard therapy for heart failure. We aim to assess the safety of SGLT2-Is in patients with a high risk of cardiovascular disease.
Areas covered
An electronic database search was conducted for randomized control trials comparing SGLT2-Is to placebo in patients with a high risk of cardiac disease or heart failure. Data were pooled for outcomes using random-effect models. The odds ratio (OR) and 95% confidence interval (CI) were used to compare eight safety outcomes between the two groups. The analysis included ten studies with 71 553 participants, among whom 39 053 received SGLT2-Is; 28 809 were male and 15 655 were female (mean age, 65.2 years). The mean follow-up period was 2.3 years with the range being 0.8–4.2 years. The SGLT2-Is group had a significant reduction in AKI (OR = 0.8;95% CI 0.74–0.90) and serious adverse effects (OR = 0.9; 95% CI 0.83–0.96) as compared to placebo. No difference was found in fracture (OR = 1.1; 95% CI 0.91–1.24), amputation (OR = 1.1; 95% CI 1.00–1.29), hypoglycemia (OR 0.98;95% CI 0.83–1.15), and UTI (OR = 1.1; 95% CI 1.00–1.22). In contrast, DKA (OR = 2.4; 95% CI 1.65–3.60) and volume depletion (OR = 1.2; 95% CI 1.07–1.41) were higher in SGLT2-Is group.
Expert opinion/commentary
The benefits of SLGT2-Is outweigh the risk of adverse events. They may reduce the risk of AKI but are associated with an increased risk of DKA and volume depletion. Further studies are warranted to monitor a wider range of safety outcomes of SGLT2-Is.
Hemosuccus pancreaticus is a rare cause of upper gastrointestinal bleeding that is often associated with chronic pancreatitis. The bleeding usually manifests as melena because the source originates superior to the ligament of Treitz. We present a patient who was admitted for acute-on-chronic pancreatitis and ultimately developed hematochezia. Endoscopy revealed active oozing at the minor duodenal papilla. Computed tomography angiography identified active contrast extravasation at the gastroduodenal artery, and it was managed successfully with angioembolization. Our case emphasizes clinicians to consider hemosuccus pancreaticus as an alternative differential in a patient with a history of chronic pancreatitis manifesting with hematochezia.One week after the endoscopy, the patient developed multiple episodes of bright red blood per rectum. Her hemoglobin dropped to 6.9, which was below her baseline of 9 g/dL. Colonoscopy performed because of suspected lower GI bleeding only revealed polyps and
Introduction:
Pulmonary embolism (PE) is a life-threatening condition with variable severity that results from dysregulation of complex inflammatory and hematologic processes. Current risk stratifications suffer from a low positive predictive variable. Complete blood count data offers a relatively low cost and easily accessible opportunity to supplement current risk models. We aim to identify trends in blood indices in patients with pulmonary embolism to stratify all-cause mortality.
Materials and Methods:
Patients with acute PE (n=231) confirmed on diagnostic imaging were followed during a three-year period for all-cause mortality. Complete blood count with differential was obtained within 24 hours of PE diagnosis through the electronic medical records system. SPSS Statistics was used to conduct bivariate analysis to identify correlations and interquartile ranges of selected indices against mortality.
Results:
Platelet count (PCC=-0.241, p &It0.001) and platelets/mean platelet volumes (PCC=-0.229, p &It0.001) were found to be negatively correlated with all-cause mortality, while platelets/neutrophils (PCC=0.160, p &It0.021) and neutrophils/lymphocytes (PCC=.244, p &It0.001) had a positive correlation. Values with a p value &It0.05 were declared statistically significant. Patients with active infection, malignancy, or undergoing immunosuppressive therapy were excluded from analysis due to potential confounding.
Conclusion:
Our study concludes lower levels of platelets are associated with increased mortality in patients with pulmonary embolism. We hypothesize the large clot burden in PE consumes platelets, which results in thrombocytopenia. By leveraging these findings in a clinical setting, we can supplement scoring criteria for pulmonary embolisms to create a more comprehensive model to predict all-cause mortality.
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