Brit J Hosp Med
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Editorial Review
Once-Weekly Insulin: A Breakthrough in Diabetes Management or an Unresolved Challenge?
The advent of once-weekly insulin icodec is a promising development in the care of individuals with diabetes. These once-weekly formulations aimed to improve patient adherence and quality of life for patients who find daily injection administration challenging. Insulin icodec has demonstrated comparable glycemic control to conventionally used daily basal insulins, such as insulin glargine and degludec, in the ONWARDS clinical trials. ⋯ Moreover, logistical hurdles, including production costs and supply chain complexities need to be addressed especially in low-resource settings. Future studies should evaluate the broader health impacts of weekly insulin, including cardiovascular outcomes, quality of life, and personalized dosing strategies. Making weekly insulin safe, affordable, and widely available is important to fully realize its potential in diabetes management.
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Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are commonly prescribed in diabetes mellitus and increasingly for cardiorenal protection. They carry the risk of euglycaemic diabetic ketoacidosis (eDKA). Guidelines around the perioperative handling of these medications are limited and some evidence suggests that withholding them can lead to more surgical complications and poorer glycaemic control. This article gives an overview of arguments for and against withholding SGLT-2 inhibitors in the perioperative period.
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The burdens of cardiovascular (CV) diseases and cardiotoxic side effects of cancer treatment in oncology patients are increasing in parallel. The European Society of Cardiology (ESC) 2022 Cardio-Oncology guidelines recommend the use of standardized risk stratification tools to determine the risk of cardiotoxicity associated with different anticancer treatment modalities and the severity of their complications. The use of the Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) is essential for assessing risk prior to starting cancer treatment, and validation of these methods has been performed in patients receiving anthracyclines, human epidermal receptor 2 (HER2)-targeted therapies and breakpoint cluster region-abelson oncogene locus (BCR-ABL) inhibitors. ⋯ This review summarizes the key points of risk stratification in these patients. The steps include identifying the target population, assessing nonmodifiable and modifiable CV risk factors, reviewing previous oncologic therapies and CV histories, and performing baseline investigations. In summary, this review aims to provide general physicians with a simple 7-step guide that will help steer and navigate them through cardiac risk evaluation of potentially cardiotoxic oncologic treatment strategies.
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Aims/Background Atopic dermatitis (AD) is a common chronic inflammatory skin disorder globally. Crisaborole, a nonsteroidal topical phosphodiesterase 4 inhibitor (PDE4i), has been utilized in treating AD. Crisaborole regulates the production of inflammatory cytokines, which are usually overactive among AD patients. ⋯ Furthermore, the safety profiling of the treatments was insignificant, demonstrating no statistical difference in the treatment-emergent adverse events (TEAEs) between the two groups with high heterogeneity (OR 0.53, 95% CI 0.14 to 1.98; I2 = 99%; p = 0.35). Conclusion Crisaborole demonstrates substantial efficacy in treating mild to moderate AD compared to vehicle therapies, as it reduces the signs and symptoms of the disease. Furthermore, crisaborole is well tolerated and has an acceptable safety profile in treating mild to moderate AD patients.
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Advanced life support certification has traditionally been the gold standard of resuscitation training for doctors and has been shown to improve outcomes from cardiac arrest. In 2021, Health Education England removed named courses from mandatory Foundational Programme competencies, which has resulted in capping of reimbursement and reduced access to courses. This represents a drop in educational standards which is particularly concerning when the medical school curriculum has been shown to deliver inconsistent, poor-quality resuscitation training. Here we review the benefits and negatives of life support training, looking at both junior and senior clinicians with differing educational requirements.