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  Citation statistics : Table of Contents
   2016| May-June  | Volume 8 | Issue 3  
    Online since July 11, 2017

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IDF-DAR practical guidelines for management of diabetes during ramadan
Salem A Beshyah
May-June 2016, 8(3):58-60
Full text not available  [PDF] [CITATIONS]
  6 992 173
Use of sodium-glucose co-transporter 2 inhibitors during the fasting of ramadan: Is there cause for concern?
Salem A Beshyah, Muhammad Hamed Farooqi, Sara GI Suliman, Mahmoud Benbarka
May-June 2016, 8(3):81-88
Background: There is some anxiety among physicians about the safety of using sodium-glucose co-transporter 2 (SGLT2) inhibitors in Muslim type 2 diabetes mellitus (T2DM) patients who wish to observe the fast during Ramadan particularly during the summer in hot regions. There is a dearth of research data to help guide physicians and reassure patients. Objectives: To try and extrapolate to the “Ramadan” scenario, we reviewed the pharmacology of SGLT2 inhibitors and those side effects that may be relevant to Ramadan fasting such as osmotic diuresis, dehydration, use in the elderly and concomitant use with diuretics as well as the potential risk of ketoacidosis. We also reviewed the perceptions among physicians along with the currently available expert opinions and recommendations. Approach: The following aspects are addressed 1. Characteristics and pharmacology of SGLT2 inhibition 2. Side effects having a potential relevance to Ramadan fasting 3. Studies of patient outcomes and physician perceptions and 4. Expert opinions and management recommendations. Emerging concepts: 1. SGLT2 inhibitors are a new glucoselowering therapy for T2DM with documented benefits on blood glucose, hypertension, weight reduction and long term cardiovascular benefit. They have an inherent osmotic diuretic effect and lead to some volume loss and possible dehydration. 2. One study confirmed better glycemic control with less risk of hypoglycemia and no marked volume depletion when compared with sulphonylureas. The experiences with their use in the elderly and in combination with diuretics are reassuring for the safety of their use in Ramadan. 3. SGLT2 inhibitor-related diabetic ketoacidosis has not been reported during Ramadan fasting to date. 4. A survey of physicians' opinions revealed that the majority felt that SGLT2 inhibitors are generally safe in T2DM patients during Ramadan fasting but should be discontinued in certain high risk patients. Most respondents also indicated that they would advise taking the SGLT2 inhibitors with the sunset meal (Iftar) and recommend consuming extra clear fluids in the evening. 5. So far, only a few professional groups with interest in Ramadan fasting updated their guidelines and recommendations on management of diabetes to include the SGLT2 inhibitors. These opinions acknowledged the lack of trial data, recommended caution in high risk groups, advised regular monitoring and emphasized pre-Ramadan patients' education and awareness about possible complications. Conclusions: The current knowledge of SGLT2 inhibitors in clinical practice is reviewed with a focus on their use during Ramadan fasting. There are limited data however, extrapolating from their current use, it is likely that stable patients with no high risk of dehydration and with normal kidney functions may safely continue using the SGLT2 inhibitors therapy. It may be prudent that higher risk patients be observed carefully and any decision concerning SGLT2 inhibitors is taken on individual basis. Planned clinical trials, objective observational studies, clinical audits and patients' reports of their own clinical experience should provide ample opportunity to help answer many of the as yet unanswered questions. Results from studies conducted during the current Ramadan period are eagerly awaited.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  6 1,242 166
Effects of simvastatin and omega 3-fatty acids on blood pressure, plasma lipid profiles, liver and renal function in type 2 diabetes
Ragab B Roaeid, Fadya Abdulraof Menesi, Safa Elbadri, Esam Denna, Ghazala Othman, Mustafa YG Younis, Faraj El-Shari, Abdulkader H El Debani, Awad G Abdellatif, Saleh E Meghil
May-June 2016, 8(3):73-80
A group of patients with and hyperlipidemia were divided into male and female groups and further subdivided into 3 groups. These groups received, either simvastatin (20 mg daily), Omega3-fatty acid (2g/day), or both. The blood pressure and lipid profile were measured before and after 4 weeks of treatment. Our data showed that treatment with simvastatin did not produce significant effect on blood pressure, however the blood pressure was significantly reduced in patients received omega 3-fatty acid or simvastatin plus omega3-fatty acid. The total cholesterol (TC), triglycerides (TG), and low density lipoprotein (LDL) significantly decreased in all treated groups. The high density lipoprotein (HDL) significantly increased in all treated groups except in the group of males receiving simvastatin. Alanine transaminase (ALT) increased significantly in female and male groups receiving simvastatin, but significantly decreased in same groups receiving omega 3-fatty acid and in the males receiving simvastatin plus omega3-fatty acid. The aspartate transaminase (AST) levels significantly decreased in all treated groups except in the female group given omega3-fatty acid. The alkaline phosphatase (ALP) significantly increased only in the groups given simvastatin alone. The levels of urea and creatinine were not affected in all groups. In our prospective study we found that simvastatin decreased TC, TG and LDL, and resulted in elevation of liver transaminases. Omega3- fatty acid alone or in combination with simvastatin has similar effect on lipid profile and it significantly reduces blood pressure without affecting liver or renal function.
[ABSTRACT]   Full text not available  [PDF]
  - 1,171 144
Bronchial thermoplasty in asthma: Scrutinizing the current evidence
Wanis H Ibrahim
May-June 2016, 8(3):61-68
Objectives: Severe asthma accounts for 5-10% of all asthma cases and half of asthma-related costs in developed countries. Targeting smooth muscle hypertrophy and hyperplasia using bronchial thermoplasty (BT) represents a novel therapeutic approach to this disease. This review aims to critically examine and appraise the methodology and interpretation of individual clinical trials concerning the use of BT in severe asthma. It is not intended to be a systematic review or a meta-analysis. Methods: PubMed, Ovid MEDLINE, Ovid EMBASE, Google Scholar, and Scopus were searched until August, 31st 2015 for published clinical trials concerning the use of BT in asthma patients. Search titles included BT, severe asthma, BT in asthma, BT and severe asthma and effectiveness and safety of BT in asthma. Results: One published non-randomized, three randomized and three extension trials were identified. The methodology and results of each individual trial were subjected to careful examination and appraisal. A good safety profile of BT as a novel therapeutic approach of severe asthma has been confirmed in multiple clinical trials. However, there are still unanswered questions and concerns regarding the effectiveness of this procedure in severe asthma. The evidence concerning this effectiveness needs to be augmented by further well-designed sham controlled trials. Conclusion: Well-designed controlled trials using hard outcome measures such as asthma control, lung function and ability to withdraw/reduce steroid are desperately needed to confirm the effectiveness of BT in severe asthma cases. Consideration of asthma phenotypes when conducting such trials would be rewarding.
[ABSTRACT]   Full text not available  [PDF]
  - 1,094 125
Biomedical research productivity in dentistry and oral medicine from Libya: A bibliometric analysis
Rahma O Ahmed
May-June 2016, 8(3):69-72
Biomedical research productivity from under developed regions and low income countries are generally low. This has been attributed to multiple reasons even in those relatively rich countries such as Libya. The volume and trends of biomedical publication productivity in the oral medicine and dentistry from Libya was investigated using “PubMed” database with a focus contributions from on Libyan academic institutions. A low quantity and quality of dental and oral research productivity was detected in Libya not matching the wealth of this small nation. Poor distribution of this productivity throughout the geographical landscape of Libya was also evident. Libyan biomedical research infrastructure requires reforms and funding.
[ABSTRACT]   Full text not available  [PDF]
  - 1,184 121