Pulmonary hypertension (PH) is a chronic, complex and challenging disease. Advances in treatment are for the subset of patients with pulmonary arterial hypertension. Selected review of the literature was conducted incorporating the European Society of Cardiology/European Respiratory Society 2015 guidelines and recommendations from the Sixth World Symposium on Pulmonary Hypertension. PH is classified into five groups based on WHO classification. Echocardiography remains the initial test of choice, and careful assessment of the right system aids in the diagnosis and prognosis of the disease. Right heart catheterization remains the gold standard of diagnosis and key guidance of treatment. Multidisciplinary approach is recommended for the care of patients with PH. Treatment selection is based on individual risk stratification of patients, and early referral to specialized PH centers improves outcomes of patients. Treating PH is complex and is best carried out in PH centers and with multidisciplinary approach. Early diagnosis and referral to those centers are key not to delay treatment.

BACKGROUND Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life. AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed. METHODS We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain. RESULTS Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health , smoking, cancer, and transplant. CONCLUSION Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.

Background: Diabetes is the leading cause of end-stage renal disease (ESRD) worldwide. Also, diabetes is prevalent in kidney transplant recipients for nondiabetic reasons. Methodology: We used a mixed method methodology, including a case report, surveys of physicians’ opinions, and a review of the literature. Results: (A) A 58-year-old retired police officer was seen at the diabetes clinic in October 2015. His care was transferred from another physician who had relocated elsewhere. The patient’s medical history included type 2 diabetes for over 25 years, hyperlipidemia, hypertension, diabetic neuropathy, diabetic nephropathy, and diabetic retinopathy in addition to vitamin D deficiency and morbid obesity. He had received a renal transplant from a nonrelated live donor 7 years previously. His medications included sitagliptin 50 mg/day, gliclazide (modified release) 60–90 mg/day, metformin (extended release) 750 mg twice daily, and dapagliflozin 10 mg/day. We focus on the off-license use of dapagliflozin in a patient with a history of ESRD and renal transplantation. The lack of published experience with sodium-glucose cotransporter 2 (SGLT2) inhibitors in renal transplant recipients was discussed with him. “But I came to no harm,” was his reply. His records on renal function, hydration status, and glycemic control all seemed unaffected over the previous 2.5 years. He remains well till the time of this report. Serum electrolytes, creatinine, plasma albumin, hemoglobin, packed cell volume, and estimated glomerular filtration rate (eGFR) were not adversely affected. Glycated hemoglobin and fasting blood glucose were stable. Urine was consistently negative for ketones but loaded with glycosuria. It was agreed to continue with the same medication, observe the patient carefully, and seek for opinions of other physicians. (B) An online survey was conducted; the responses revealed that many physicians would use SGLT2 inhibitors in renal transplant recipients provided the renal function was satisfactory with an eGFR > 60. We have learned of an ongoing trial on SGLT2 inhibitors in renal transplant recipients. (C) A case series of 10 patients treated with canagliflozin showed reassuring findings. Conclusions: Despite the lack of formal trial evidence, the index case suggested the safe use of SGLT2 inhibitors by renal transplant recipients for a remarkably extended period of 2.5 years. Physicians seem willing to use SGLT2 inhibitors in this group of patients provided renal function is satisfactory.

Background: Ensuring medical fitness to drive is an important safety measure for people with diabetes and is a prerequisite for a driving licence in many countries. Objectives: To ascertain the current regulatory restrictions on drivers with diabetes currently being applied internationally. Methods: An electronic survey (in English) was sent to contacts of member organisations of the International Diabetes Federation and to selected specialists in diabetes. Questions addressed the regulations in place for insulin-treated drivers. Results: Information on licensing was obtained from 85 countries. No restrictions on drivers with insulin-treated diabetes existed in 59 countries (69.4%). Medical assessment of some type was required in 29 countries (34.5%). They were performed by different people and at different time intervals. Emphasis was placed on conditions causing potential risk to driving safety. When insulin is introduced to a licensed driver's treatment, in most countries the driver is permitted to continue driving without any change in licensing entitlement (n=68; 80%); in 16 countries (19%) a driver can retain their driving licence subject to special conditions and in one country the driver will have the driving licence revoked permanently. With respect to large goods vehicles and passenger-carrying vehicles, no restrictions or assessments are required for drivers with insulin-treated diabetes in most responding countries (n=56; 66%); licensing is permitted with some restriction in 23 countries (27%) and prohibited in six countries (7%). Conclusions: There is a wide variation between different countries and global regions in the statutory requirements and policies used to regulate and assess drivers with diabetes. The lack of regulation in many countries may adversely affect public safety.