Sevelamer, has been shown to have many pleiotropic actions on lipid panel, various inflammatory markers, and blood glucose levels in chronic kidney disease patients.We conducted a systematic review and meta-analysis to compare these pleiotropic effects of sevelamer to other phosphate binders used in chronic kidney disease patients. The relevant randomized controlled trials published from 1 January 2001 to 31 November 2019 on the following databases: Cochrane Central Register of Controlled Trials published in The Cochrane Library, PubMed, Scopus and Google Scholar were identified. All the included studies were independently assessed for eligibility and risk of bias. The modified data extraction form of Cochrane was used. This review included 44 studies for qualitative analysis and 28 reports for quantitative analysis. A meta-analysis of three studies (n = 180) showed that glycated haemoglobin had significantly decreased in sevelamer-treated patients (MD: 0.5%; p = <.001). Compared with calcium-based phosphate binders, sevelamer showed a significant reduction in low-density lipoprotein (MD: À19.43 mg/dL; p = <.001) and total cholesterol (MD: À19.98 mg/dL; p < .001). A significant increase in high-density lipoprotein (MD: 1.29 mg/dL; p = .05) was also prominent in sevelamer treated patients. However, we were not able to observe a significant change in other biochemical parameters such as TG, CRP, hs-CRP, FGF-23, IL-6 and albumin as, no statistically significant difference was observed.

Background COVID-19 pandemic has affected the pregnant women both physically and mentally. This study is conducted to assess, the impact on COVID-19 pandemic on psychiatric symptoms among pregnancy and to compare them with non-pregnant women. Methods An observational study was conducted at Govt. Medical College & Hospital, Ooty (Udhagamandalam). A validated Edinburgh Depression Scale was used to screen the mental health status. Categorical variables were analysed using Chi-square test and continuous variables by independent t test. A Pearson’s correlation analysis was performed to check the association of Edinburgh postnatal depression scores with the demographic characteristics. Paired t test was conducted to find the difference in EPDS scores at baseline and study conclusion visit. Regression analysis was conducted to predict the outcome variables. Results The Edinburgh Depression scores were significantly higher in the pregnant women group, (12.48 ± 3.753 vs. 8.00 ± 2.436; p value = 0.001; 95% CI 3.340–5.627), when compared to non-pregnant women (12.90 ± 3.731 vs. 9.20 ± 2.973; p value = 0.001; 95% CI 2.480–4.920). The Edinburgh Depression scores at the study conclusion visit was statistically significant, (11.05 ± 3.839 vs. 10.24 ± 3.872; p value = 0.008; 95% CI −1.40 to −0.213). Education, income, duration of marriage, body mass index, and suicidal ideation are some of the predictors identified in this study to cause depression among pregnant women. Conclusion The findings of the study indicate a clinically significant increase of depressive symptoms among pregnant women. It is recommended to include routine psychological screenings and interventions during pregnancy.

Background: Iron plays a significant role in the pathogenesis of gestational diabetes mellitus. Aim: To determine whether elevated haemoglobin levels during the second trimester of pregnancy is associated with the risk of gestational diabetes mellitus. Methods: A nested case-control study was conducted among 216 pregnant women who were in their second trimester. The categorical variables and continuous variables were analysed by using Chi-square and Independent sample T test respectively. The haematological parameters were correlated with blood glucose values at 3 distinct times and oral glucose tolerance test using Pearson's correlation. The outcome prediction analysis was performed by binary logistic regression and ROC curve analysis was done to evaluate the accuracy of the regression model. Results:The haematological parameters significantly varied between the groups. The haemoglobin was significantly higher in the gestational diabetic mellitus group (13.96 ± 0.55 vs 11.95 ± 0.86; p = 0.001; 95% CI 1.82 to2.21). The odds of developing gestational diabetes mellitus in pregnant women with haemoglobin greater than 12.6 g/dL was 5 times greater at p = 0.001 (95% CI 5.54, 28.18). The ROC curve analysis was performed and 88.9% sensitivity and 58.3% specificity were found with an AUC of 0.841. The other haematological parameters were moderately and weakly correlated with blood glucose levels and oral glucose tolerance test. Conclusion:The findings suggest when the haemoglobin levels are greater than 12.6 g/dL during early pregnancy play a role in predicting the risk of developing gestational diabetes mellitus. Awareness must be created among clinicians for early diagnosis and treatment.

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Hypersensitivity reactions with antiepileptic drugs (AEDs) are generally associated with aromatic AEDs. We present a case of hypersensitivity reactions followed by administration of phenytoin with diazepam and ranitidine in a patient with generalized tonic-clonic seizures. Antigen-antibody reactions or decreased levels of epoxide hydrolase are well known with phenytoin. Increased level of serum phenytoin causing toxicities due to competitive inhibition with diazepam on co-administration was also reported in the literature. Prevention of the adverse effects with AEDs is a multi-stage process, which requires implementation of preventive measures through careful monitoring and prompts interventions.