No abstract

There is an increasing indication of bariatric surgery for metabolic diseases irrespective of body weight. Diabetic retinopathy is a serious disease; it is the leading cause of registered visual loss globally. Previous literature reported the deterioration of lifethreatening diabetic retinopathy after bariatric surgery. Few studies assessed the same. Our aim of the study is to assess this metaanalysis for the effects of bariatric surgery on diabetic retinopathy remission. In addition, we assessed the effects of bariatric surgery on diabetic retinopathy deterioration. We systematically searched PubMed, Cochrane Library, and the first 100 articles in Google Scholar. The search engine was limited to articles published in English from the first published article up to June 2022. The following keywords were used, bariatric surgery, metabolic surgery, diabetic retinopathy, retinopathy remission, and retinopathy deterioration. The retrieved data were entered in a datasheet detailing the author's name, year and country of publication, the methodology, and the number of patients who deteriorated was stable or improved after bariatric surgery. The most recent RevMan (version 4.4.) was used for data analysis. From our study, we found that, out of the 386 studies screened, only 26 full texts were eligible and eleven studies fulfilled the inclusion and exclusion criteria. A lower deterioration rate was observed than stability, odd ratio, 0.05, 95% CI, 0.04-0.07, P-value, <0.001. Significant heterogeneity was observed, I2=54%, P-value, 0.02, and Chi-square=21.76. in addition, a lower regression was found compared to stable retinopathy, odd ratio, 0.06, 95% CI, 0.03-0.13, P-value, <0.001. Significant heterogeneity was observed, I2=73%, P-value, 0.0002, and Chi-square=29.67. Thus, Diabetic retinopathy remains stable among patients who underwent bariatric surgery. Few remissions were observed in the short term, while few patients deteriorated. Further randomized controlled studies comparing the effect of bariatric surgery and usual diabetic care are needed.

Objective: To summarize the evidence regarding the association between subclinical thyroid dysfunctions and chronic kidney disease (CKD) in adults. Methods:The literature was searched for English-published studies from inception till the 16th of December 2022. The search included MEDLINE/PubMed, Academic Search Complete (EBSCOhost) and Web of Science using the terms ('subclinical hypothyroidism and thyroid dysfunction') AND ("chronic kidney disease or chronic renal failure or ckd or esrd'). Results: Eleven studies were included. Subclinical hypothyroidism was significantly associated with a higher risk of CKD compared to euthyroid individuals (Odds ratio (OR): 1.43, (95% CI: 1.23-1.65), P<0.001, n=11).Subgroup analyses by adjusting for confounders or diabetes mellitus did not alter the results significantly. However, the ORs were significantly lower with longitudinal studies compared to cross-sectional studies (OR: 1.17 vs. 1.68, respectively, p<0.001). Subclinical hyperthyroidism was associated with a higher risk of CKD than euthyroid individuals, but the association was not significant (OR: 1.19, (95% CI: 0.92-1.53), P=0.18, n=3). Conclusions: Subclinical hypothyroidism is significantly associated with an increased risk of CKD.However, more longitudinal studies are required to confirm the effect of subclinical hypothyroidism as an exposure on the outcome of newly diagnosed CKD. The association between subclinical hyperthyroidism and CKD is understudied and warrants more research to ascertain its effect on the risk of CKD.

Hormone replacement therapy (HRT) is defined as a therapy that could allow women to free themselves from the malediction of estrogen loss and conserve their femininity. The study aims to summarize the updated evidence regards types, indication, contraindication, and untoward effects of hormonal replacement therapy among menopausal women. There are several different drug classes comprising estrogens, progestogens, and estrogen + progestogen combinations. Estrogen is the primary active component of HRT, treating menopausal symptoms, particularly vasomotor symptoms. There are several adverse effects of hormone replacement therapy that manifest in many different ways depending on the route of administration, and whether that route has local or systemic effects. Further research is needed to study the risks of menopausal HRT and pharmacological studies are needed to lower these risks and make its use safer with less side effects.

Juvenile idiopathic arthritis (JIA) is a broad term that refers to a clinically heterogeneous group of arthritis that develops before the age of 16 and has no recognized cause. JIA treatment has evolved during the last two decades. Clinical trials research has been directed at more specific therapeutics based on what has been discovered about the biology of disease. Pediatric rheumatologists now have many more medications to offer patients, with the expectation that their disease will be managed, thanks to advances in immune system research and the introduction of biologic drugs in the twenty-first century. Continuing development in these biological agents and discoveries new drugs as long as developing current gene analysis techniques is the best method to treat JIA and provide best quality of life.