International journal of clinical medicine, Dec 31, 2022
According to recent epidemiological data, chronic kidney diseases (CKDs) affect approximately 10%... more According to recent epidemiological data, chronic kidney diseases (CKDs) affect approximately 10% of the global population. Like many countries, CKD is a significant public health issue in Saudi Arabia. The prevalence of CKD in Saudi Arabia is estimated to be around 4.5% of the adult population, with a higher prevalence in older age groups. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a class of oral medications used to treat type 2 diabetes mellitus (T2DM). In addition to their glucose-lowering effects, SGLT2i have been shown to have beneficial effects on kidney function in patients with or without T2DM. Therefore, a Saudi task force gathered to develop an explicit, evidence-based consensus on SGLT2i use in CKD Saudi patients. A panel of 14 experts made up a task force. An initial concept proposal was obtained. The proposal was divided into several topics discussed on 24 May 2023. A literature review was carried out. The literature search was completed on 3 rd
The best anti-diabetic medication does, in fact, have a low propensity to increase body weight an... more The best anti-diabetic medication does, in fact, have a low propensity to increase body weight and rate of hypoglycemia as well as glycemic control. The second-generation basal insulins analogues insulin degludec and insulin glargine 300 units/mL have significantly longer half-life and substantially smoother profiles than firstgeneration. The duration of action of glargine 300 is shorter than that of degludec, and significant residual glycemic variability is still present. Degludec has lower risks of hypoglycemia. Evaluating the therapeutic application in various geographical contexts is necessary, given the inter-country variations in the prescription patterns of glucose-lowering medications for persons with diabetes. A Saudi task force gathered to develop an explicit, evidence-based consensus for insulin degludec utilization in the local setting. This work contains the expert panel's recommendations as a contribution to complement the knowledge gap in this area from the national perspective. Results of the local UPDATES study investigating the treatment effect of degludec in adults with T2DM in Saudi Arabia showed that patients treated with degludec experienced clinically significant improvements in glycaemic control and a lower rate of hypoglycemia compared to baseline, with no new safety concerns. Results confirm that previously published data with degludec are generalizable to a broad population of patients with T2DM in routine clinical practice in Saudi Arabia. Moreover, local cost-utility analyses of degludec versus glargine 300 in T1DM and T2DM showed that it is cost-saving. Degludec was associated with less cost with better quality of life. Thus, the reimbursement of degludec will have a positive impact on the budget.
Obesity and overweight are prevalent in Saudi Arabia (24.95% & 31.80%). Also, childhood obesity i... more Obesity and overweight are prevalent in Saudi Arabia (24.95% & 31.80%). Also, childhood obesity in the country is a challenge, with 6%-10% of preschool and school-age children. The burden of being overweight and obese is disastrous. Therefore, the Saudi Diabetes Scientific Society constituted a team to develop a guideline. The team reviewed the local Clinical Practice Guidelines for the Prevention and Management of Obesity in Saudi Arabia; and conducted a rigorous review of relevant evidence-based scientific literature. After a thorough assessment, a consensus was reached to use the Australian guideline as the main guideline to be adapted and localized to be suitable for the Saudi people. To avoid duplication of efforts, the team adopted the grading of evidence used by the Australian guideline.
GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people... more GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who have failed to control their condition with other oral anti-diabetic drugs (OADs). However, GLP-1RAs are underutilized-as time patients remained on their last oral treatment regimen with inadequate glycemic control prior to GLP-1RA initiation is on average of 19 month-despite evidence supporting their effectiveness, safety, and possible CV outcome advantages. With the new advances in GLP-1 RAs, the first oral form for the semaglutide molecule was developed with proven efficacy, safety, and patient preferences that may help pave the road for more utilization of this class. Therefore, we, a Saudi task force, gathered to develop an explicit, evidence-based consensus on oral semaglutide use in Saudi patients with diabetes. The panel recommends a GLP-1RA in those T2DM patients with or without or at high risk for ASCVD, HF, and/or CKD when there is a need to minimize weight gain or promote weight loss, or when there is a need to minimize hypoglycemia.
Hypothyroidism is a common disorder, potentially severe, often clinically ignored, easily diagnos... more Hypothyroidism is a common disorder, potentially severe, often clinically ignored, easily diagnosed by laboratory tests, and highly treatable. It may cause chronic illnesses if left untreated. Saudi Society of Endocrinology and Metabolism (SSEM) assembled a panel of twelve endocrinologists with experience in thyroid diseases in adults and children and made up a task force. An initial concept proposal that included types of hypothyroidism, population, scope, and prevalence in Saudi Arabia was obtained. The proposal was divided into several topics discussed in February 2022. The panel approved that the consensus will include all types of hypothyroidism in Saudi Arabia, screening, diagnosis, management, and special population. A literature review was carried out. Most of the latest international guidelines were screened in Europe and USA. The literature search was completed in March 2022. They drafted a report that was distributed to the entire panel. Approval of the recommendations required consensus, defined as a majority approval. The recommendations were revised to accommodate any differences of opinion until a consensus was reached. Recommendations were finally formulated on April 2022.
Obesity and overweight are prevalent in Saudi Arabia (24.95% & 31.80%). Also, childhood obesity i... more Obesity and overweight are prevalent in Saudi Arabia (24.95% & 31.80%). Also, childhood obesity in the country is a challenge, with 6%-10% of preschool and school-age children. The burden of being overweight and obese is disastrous. Therefore, the Saudi Diabetes Scientific Society constituted a team to develop a guideline. The team reviewed the local Clinical Practice Guidelines for the Prevention and Management of Obesity in Saudi Arabia; and conducted a rigorous review of relevant evidence-based scientific literature. After a thorough assessment, a consensus was reached to use the Australian guideline as the main guideline to be adapted and localized to be suitable for the Saudi people. To avoid duplication of efforts, the team adopted the grading of evidence used by the Australian guideline.
Background/Aims: Corticosteroids (CSs) are frequently used in coronavirus disease 2019 (COVID-19)... more Background/Aims: Corticosteroids (CSs) are frequently used in coronavirus disease 2019 (COVID-19); however, their utility remains controversial in mild to moderate cases. The timing of CSs initiation during the disease course remains unaddressed. The study aims to evaluate the impact of early CSs in non-severe COVID-19. Methods: A randomized controlled, open-label study was conducted on 754 COVID-19 patients randomized into a study group (n = 377) in which patients received CSs with COVID-19 protocol and a control group (n = 377) in which patients received COVID-19 protocol only. Results: Both groups were comparable regarding baseline characteristics, presenting symptoms, and inflammatory markers. The composite endpoint (need for O 2 , need for hospitalization or 28-day mortality) was significantly (p = 0.004) lower in the CS group 42 (11.14%) versus the control group 70 (18.67%) with odds ratio 0.55 (95% confidence interval [CI], 0.36 to 0.83), absolute risk reduction 7.53% (95% CI, 2.46% to 12.59%) and number needed to treat of 13.29 (95% CI, 7.94 to 40.61). Regarding severity at day 10, only (11.1%) of the study group patients were severe versus (18.7%) of the control group patients (p < 0.001). The median time-to-return to daily activity in the CS group was 8.0 days, while in the control group, it was 22.0 days (p < 0.001). Conclusions: In non-severe COVID-19, CS may decrease hospitalization, severity, and mortality.
Backgrounds and Objectives: The preferences of patients for oral GLP-1 RA treatments, particularl... more Backgrounds and Objectives: The preferences of patients for oral GLP-1 RA treatments, particularly in KSA, have not yet been sufficiently studied. In order to add to the body of knowledge already available in this field, the current study sought to determine the acceptance and preference of various GLP-1 RA formulations (weekly injectable vs. daily oral) among T2DM patients in KSA as well as to investigate how doctors who treat T2DM patients there felt about GLP-1RAs. Methods: The current cross-sectional two-arm (patients-arm and physicians-arm) study was carried out all over KSA using an online survey. Two online surveys were used, one for each arm. The analyses were carried out on 700 T2DM cases and 400 physicians (150 diabetes specialists and 250 general practitioners) who completed the surveys. The primary outcome measure in the patients-arm was the preference for oral GLP-1RA or injectable GLP-1RA. For the physicians-arm, the primary outcome measure was the right time of GLP-1RA prescription or delay. Results: Out of the 700 patient respondents, 588 (84.0%) prefer the daily oral formula of GLP-1RA, while 112 (16.0%) prefer the once-weekly subcutaneous formula. About 40.2% of those who prefer the injectable formula perceive that the injectable formula is more effective, 30.3% reported that it is more convenient for them, and 28.6% stated that they take too many oral medications. On the other hand, reasons for preference for oral formula were perception of injections as a 'last resort' treatment (23.0%), fear of injection (20.2%), fear of hypoglycemia (19.2%), convenience (19.0%), and poor communication with physicians (18.5%). Out of the 400 physicians, 340 (85.0%) were delayed in the prescription of GLP-1RAs for their patients, and only 60 (15.0%) prescribed GLP-1RAs at the right time. Among different criteria of respondents, only specialty affects this delay (Table 2). Interestingly, the delay is only among the general physician group (73.%) of those who delay. Reasons behind hesitance differ among groups (p-value < 0.0001), among those who delay prescription of GLP-1RAs, were injectable (72.6%, followed by time constraints (20.3%), and unavailability (7.1%). However, in those who did not delay, they perceived that the reasons behind hesitance were time constraints (45.0%), followed by unavailability (33.3%), and being injectable (21.7%). Conclusions: In conclusion, the preference for the oral form of GLP-1RAs is self-evident in this two-arm study among patients and physicians. That can help to tackle the problem of underutilization of this group when they are indicated.
Background: Because of the emergence of the pandemic of SARS-Cov2 infection and the Global burden... more Background: Because of the emergence of the pandemic of SARS-Cov2 infection and the Global burden of COVID-19 on the worldwide healthcare systems, it became mandatory for all researchers to search for better preventive as well treatment strategies.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide adequate glycemic control, weight re... more Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide adequate glycemic control, weight reduction, low risk of hypoglycemia, and CV risk reduction. Their usage for type 2 DM (T2DM) is recommended mainly when hypoglycemia or weight gain should be considered, also, whenever initial therapy is failed. There are many recent updates in the treatment paradigm of T2DM. There are many types of GLP-1RAs, with a knowledge gap regarding switching between the different types. A Saudi task force gathered to develop an explicit, evidence-based consensus for switching between GLP-1RAs, when, why, and how? This article contains the expert panel's recommendations as a contribution to complement the knowledge gap in this area from the national perspective. As an alternative to intensifying therapy, switching from one GLP-1RA to another has various advantages. Improvements in glycemic control, weight loss, adherence, and medications with established cardiovascular benefits are among them. Also, switching needs to be individualized upon many discussed factors like the dose of the previous GLP1-RA and gastrointestinal adverse effects. Discussion with patients about the why and how to switch is critical.
Introduction: The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia... more Introduction: The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia mandates the search for each method that can help in better control of diabetes. Methods: The gathered task force gathered to develop an explicit, evidence-based consensus for the use of time-in-range targets as guidance for better glycemic control while using continuous glucose monitoring (CGM). This article has the recommendations of this expert panel. Results: HbA1c and self-monitoring blood glucose (SMBG) are not enough to detect blood glucose (BG) fluctuations on a daily basis. The incorporation of technology like FreeStyle Libre with its applications like Libre View is now used in many institutes in Saudi Arabia. This system is comprehensive and has all the standardized metrics needed. However, training and support are always needed. Barriers and challenges include the awareness & experience of the technology, the time barrier, the patients' barriers, the technical barriers, and of course, the availability barrier. All the barriers and challenges should be dealt with by designing new training programs. Conclusion: The
Objective: To measure the impacts of cervical traction on the uterine artery hemodynamics.Methods... more Objective: To measure the impacts of cervical traction on the uterine artery hemodynamics.Methods: This study was a randomized-controlled trial. The primary outcome measure was the uterine artery hemodynamics indices: end diastolic velocity (EDV) and systolic/diastolic velocity ratio (S/D ratio).Main Results: The study was conducted in one institution in Cairo from January-2017 to March-2017 with 12-month follow up period. Both groups were comparable (p-value > 0.05) with regard to the age, BMI, heart rate, blood pressure, gravidity, parity as well as episiotomy. There was no difference (P> 0.05) between the two groups regarding vital signs after the intervention. All the patients tolerated the procedure with mild sedation. PSV, EDV, S/D, PI & RI were comparable between both groups before the intervention. However, PSV, S/D ratio, RI & PI were significantly higher (p-values < 0.001) in the study group than the control group after the intervention. On the other hand, EDV was...
The aim of this randomized controlled trial was to evaluate U/S guided serratus anterior plane ca... more The aim of this randomized controlled trial was to evaluate U/S guided serratus anterior plane catheter block (SAPB) versus patient‐controlled analgesia (PCA) on the emergence of post‐thoracotomy pain syndrome (PTPS) after thoracotomies for thoracic tumours.
Heart failure (HF) is a common cause of cardiovascular mortality and morbidity. Despite advances ... more Heart failure (HF) is a common cause of cardiovascular mortality and morbidity. Despite advances in treatment, the prognosis remains poor. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors decrease HF events by 27-39% in high-risk patients with type 2 diabetes mellitus (T2DM). Moreover, the DAPA-HF and EMPEROR-Reduced studies randomized patients with HF with reduced ejection fraction (HFrEF) with or without diabetes mellitus to receive guideline-directed medical therapy versus guideline-directed medical therapy plus an SGLT-2 inhibitor. Both studies showed the benefits of SGLT-2 inhibitors. In addition, SGLT-2 inhibitors have shown improvement according to the EMPEROR-Preserved study of HF with preserved ejection fraction (HFpEF). Therefore, a panel of cardiology experts from the Egyptian Atherosclerosis and Vascular Biology Association (EAVA) revised the literature for SGLT-2 inhibitors in HF, along with the recommended indications and contraindications, and this article presents their consensus on the topic. The panel concluded that SGLT-2 inhibitors have significantly benefited patients with chronic HFrEF, as indicated through the DAPA-HF and EMPEROR-Reduced trials. The panel recommended early use of dapagliflozin 10 mg or empagliflozin 10 mg in patients with symptomatic chronic HFrEF, whether diabetic or non-diabetic, to ameliorate HF hospitalization rate, mortality, symptoms, and decline in renal function.
International journal of clinical medicine, Dec 31, 2022
According to recent epidemiological data, chronic kidney diseases (CKDs) affect approximately 10%... more According to recent epidemiological data, chronic kidney diseases (CKDs) affect approximately 10% of the global population. Like many countries, CKD is a significant public health issue in Saudi Arabia. The prevalence of CKD in Saudi Arabia is estimated to be around 4.5% of the adult population, with a higher prevalence in older age groups. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a class of oral medications used to treat type 2 diabetes mellitus (T2DM). In addition to their glucose-lowering effects, SGLT2i have been shown to have beneficial effects on kidney function in patients with or without T2DM. Therefore, a Saudi task force gathered to develop an explicit, evidence-based consensus on SGLT2i use in CKD Saudi patients. A panel of 14 experts made up a task force. An initial concept proposal was obtained. The proposal was divided into several topics discussed on 24 May 2023. A literature review was carried out. The literature search was completed on 3 rd
The best anti-diabetic medication does, in fact, have a low propensity to increase body weight an... more The best anti-diabetic medication does, in fact, have a low propensity to increase body weight and rate of hypoglycemia as well as glycemic control. The second-generation basal insulins analogues insulin degludec and insulin glargine 300 units/mL have significantly longer half-life and substantially smoother profiles than firstgeneration. The duration of action of glargine 300 is shorter than that of degludec, and significant residual glycemic variability is still present. Degludec has lower risks of hypoglycemia. Evaluating the therapeutic application in various geographical contexts is necessary, given the inter-country variations in the prescription patterns of glucose-lowering medications for persons with diabetes. A Saudi task force gathered to develop an explicit, evidence-based consensus for insulin degludec utilization in the local setting. This work contains the expert panel's recommendations as a contribution to complement the knowledge gap in this area from the national perspective. Results of the local UPDATES study investigating the treatment effect of degludec in adults with T2DM in Saudi Arabia showed that patients treated with degludec experienced clinically significant improvements in glycaemic control and a lower rate of hypoglycemia compared to baseline, with no new safety concerns. Results confirm that previously published data with degludec are generalizable to a broad population of patients with T2DM in routine clinical practice in Saudi Arabia. Moreover, local cost-utility analyses of degludec versus glargine 300 in T1DM and T2DM showed that it is cost-saving. Degludec was associated with less cost with better quality of life. Thus, the reimbursement of degludec will have a positive impact on the budget.
Obesity and overweight are prevalent in Saudi Arabia (24.95% & 31.80%). Also, childhood obesity i... more Obesity and overweight are prevalent in Saudi Arabia (24.95% & 31.80%). Also, childhood obesity in the country is a challenge, with 6%-10% of preschool and school-age children. The burden of being overweight and obese is disastrous. Therefore, the Saudi Diabetes Scientific Society constituted a team to develop a guideline. The team reviewed the local Clinical Practice Guidelines for the Prevention and Management of Obesity in Saudi Arabia; and conducted a rigorous review of relevant evidence-based scientific literature. After a thorough assessment, a consensus was reached to use the Australian guideline as the main guideline to be adapted and localized to be suitable for the Saudi people. To avoid duplication of efforts, the team adopted the grading of evidence used by the Australian guideline.
GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people... more GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who have failed to control their condition with other oral anti-diabetic drugs (OADs). However, GLP-1RAs are underutilized-as time patients remained on their last oral treatment regimen with inadequate glycemic control prior to GLP-1RA initiation is on average of 19 month-despite evidence supporting their effectiveness, safety, and possible CV outcome advantages. With the new advances in GLP-1 RAs, the first oral form for the semaglutide molecule was developed with proven efficacy, safety, and patient preferences that may help pave the road for more utilization of this class. Therefore, we, a Saudi task force, gathered to develop an explicit, evidence-based consensus on oral semaglutide use in Saudi patients with diabetes. The panel recommends a GLP-1RA in those T2DM patients with or without or at high risk for ASCVD, HF, and/or CKD when there is a need to minimize weight gain or promote weight loss, or when there is a need to minimize hypoglycemia.
Hypothyroidism is a common disorder, potentially severe, often clinically ignored, easily diagnos... more Hypothyroidism is a common disorder, potentially severe, often clinically ignored, easily diagnosed by laboratory tests, and highly treatable. It may cause chronic illnesses if left untreated. Saudi Society of Endocrinology and Metabolism (SSEM) assembled a panel of twelve endocrinologists with experience in thyroid diseases in adults and children and made up a task force. An initial concept proposal that included types of hypothyroidism, population, scope, and prevalence in Saudi Arabia was obtained. The proposal was divided into several topics discussed in February 2022. The panel approved that the consensus will include all types of hypothyroidism in Saudi Arabia, screening, diagnosis, management, and special population. A literature review was carried out. Most of the latest international guidelines were screened in Europe and USA. The literature search was completed in March 2022. They drafted a report that was distributed to the entire panel. Approval of the recommendations required consensus, defined as a majority approval. The recommendations were revised to accommodate any differences of opinion until a consensus was reached. Recommendations were finally formulated on April 2022.
Obesity and overweight are prevalent in Saudi Arabia (24.95% & 31.80%). Also, childhood obesity i... more Obesity and overweight are prevalent in Saudi Arabia (24.95% & 31.80%). Also, childhood obesity in the country is a challenge, with 6%-10% of preschool and school-age children. The burden of being overweight and obese is disastrous. Therefore, the Saudi Diabetes Scientific Society constituted a team to develop a guideline. The team reviewed the local Clinical Practice Guidelines for the Prevention and Management of Obesity in Saudi Arabia; and conducted a rigorous review of relevant evidence-based scientific literature. After a thorough assessment, a consensus was reached to use the Australian guideline as the main guideline to be adapted and localized to be suitable for the Saudi people. To avoid duplication of efforts, the team adopted the grading of evidence used by the Australian guideline.
Background/Aims: Corticosteroids (CSs) are frequently used in coronavirus disease 2019 (COVID-19)... more Background/Aims: Corticosteroids (CSs) are frequently used in coronavirus disease 2019 (COVID-19); however, their utility remains controversial in mild to moderate cases. The timing of CSs initiation during the disease course remains unaddressed. The study aims to evaluate the impact of early CSs in non-severe COVID-19. Methods: A randomized controlled, open-label study was conducted on 754 COVID-19 patients randomized into a study group (n = 377) in which patients received CSs with COVID-19 protocol and a control group (n = 377) in which patients received COVID-19 protocol only. Results: Both groups were comparable regarding baseline characteristics, presenting symptoms, and inflammatory markers. The composite endpoint (need for O 2 , need for hospitalization or 28-day mortality) was significantly (p = 0.004) lower in the CS group 42 (11.14%) versus the control group 70 (18.67%) with odds ratio 0.55 (95% confidence interval [CI], 0.36 to 0.83), absolute risk reduction 7.53% (95% CI, 2.46% to 12.59%) and number needed to treat of 13.29 (95% CI, 7.94 to 40.61). Regarding severity at day 10, only (11.1%) of the study group patients were severe versus (18.7%) of the control group patients (p < 0.001). The median time-to-return to daily activity in the CS group was 8.0 days, while in the control group, it was 22.0 days (p < 0.001). Conclusions: In non-severe COVID-19, CS may decrease hospitalization, severity, and mortality.
Backgrounds and Objectives: The preferences of patients for oral GLP-1 RA treatments, particularl... more Backgrounds and Objectives: The preferences of patients for oral GLP-1 RA treatments, particularly in KSA, have not yet been sufficiently studied. In order to add to the body of knowledge already available in this field, the current study sought to determine the acceptance and preference of various GLP-1 RA formulations (weekly injectable vs. daily oral) among T2DM patients in KSA as well as to investigate how doctors who treat T2DM patients there felt about GLP-1RAs. Methods: The current cross-sectional two-arm (patients-arm and physicians-arm) study was carried out all over KSA using an online survey. Two online surveys were used, one for each arm. The analyses were carried out on 700 T2DM cases and 400 physicians (150 diabetes specialists and 250 general practitioners) who completed the surveys. The primary outcome measure in the patients-arm was the preference for oral GLP-1RA or injectable GLP-1RA. For the physicians-arm, the primary outcome measure was the right time of GLP-1RA prescription or delay. Results: Out of the 700 patient respondents, 588 (84.0%) prefer the daily oral formula of GLP-1RA, while 112 (16.0%) prefer the once-weekly subcutaneous formula. About 40.2% of those who prefer the injectable formula perceive that the injectable formula is more effective, 30.3% reported that it is more convenient for them, and 28.6% stated that they take too many oral medications. On the other hand, reasons for preference for oral formula were perception of injections as a 'last resort' treatment (23.0%), fear of injection (20.2%), fear of hypoglycemia (19.2%), convenience (19.0%), and poor communication with physicians (18.5%). Out of the 400 physicians, 340 (85.0%) were delayed in the prescription of GLP-1RAs for their patients, and only 60 (15.0%) prescribed GLP-1RAs at the right time. Among different criteria of respondents, only specialty affects this delay (Table 2). Interestingly, the delay is only among the general physician group (73.%) of those who delay. Reasons behind hesitance differ among groups (p-value < 0.0001), among those who delay prescription of GLP-1RAs, were injectable (72.6%, followed by time constraints (20.3%), and unavailability (7.1%). However, in those who did not delay, they perceived that the reasons behind hesitance were time constraints (45.0%), followed by unavailability (33.3%), and being injectable (21.7%). Conclusions: In conclusion, the preference for the oral form of GLP-1RAs is self-evident in this two-arm study among patients and physicians. That can help to tackle the problem of underutilization of this group when they are indicated.
Background: Because of the emergence of the pandemic of SARS-Cov2 infection and the Global burden... more Background: Because of the emergence of the pandemic of SARS-Cov2 infection and the Global burden of COVID-19 on the worldwide healthcare systems, it became mandatory for all researchers to search for better preventive as well treatment strategies.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide adequate glycemic control, weight re... more Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide adequate glycemic control, weight reduction, low risk of hypoglycemia, and CV risk reduction. Their usage for type 2 DM (T2DM) is recommended mainly when hypoglycemia or weight gain should be considered, also, whenever initial therapy is failed. There are many recent updates in the treatment paradigm of T2DM. There are many types of GLP-1RAs, with a knowledge gap regarding switching between the different types. A Saudi task force gathered to develop an explicit, evidence-based consensus for switching between GLP-1RAs, when, why, and how? This article contains the expert panel's recommendations as a contribution to complement the knowledge gap in this area from the national perspective. As an alternative to intensifying therapy, switching from one GLP-1RA to another has various advantages. Improvements in glycemic control, weight loss, adherence, and medications with established cardiovascular benefits are among them. Also, switching needs to be individualized upon many discussed factors like the dose of the previous GLP1-RA and gastrointestinal adverse effects. Discussion with patients about the why and how to switch is critical.
Introduction: The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia... more Introduction: The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia mandates the search for each method that can help in better control of diabetes. Methods: The gathered task force gathered to develop an explicit, evidence-based consensus for the use of time-in-range targets as guidance for better glycemic control while using continuous glucose monitoring (CGM). This article has the recommendations of this expert panel. Results: HbA1c and self-monitoring blood glucose (SMBG) are not enough to detect blood glucose (BG) fluctuations on a daily basis. The incorporation of technology like FreeStyle Libre with its applications like Libre View is now used in many institutes in Saudi Arabia. This system is comprehensive and has all the standardized metrics needed. However, training and support are always needed. Barriers and challenges include the awareness & experience of the technology, the time barrier, the patients' barriers, the technical barriers, and of course, the availability barrier. All the barriers and challenges should be dealt with by designing new training programs. Conclusion: The
Objective: To measure the impacts of cervical traction on the uterine artery hemodynamics.Methods... more Objective: To measure the impacts of cervical traction on the uterine artery hemodynamics.Methods: This study was a randomized-controlled trial. The primary outcome measure was the uterine artery hemodynamics indices: end diastolic velocity (EDV) and systolic/diastolic velocity ratio (S/D ratio).Main Results: The study was conducted in one institution in Cairo from January-2017 to March-2017 with 12-month follow up period. Both groups were comparable (p-value > 0.05) with regard to the age, BMI, heart rate, blood pressure, gravidity, parity as well as episiotomy. There was no difference (P> 0.05) between the two groups regarding vital signs after the intervention. All the patients tolerated the procedure with mild sedation. PSV, EDV, S/D, PI & RI were comparable between both groups before the intervention. However, PSV, S/D ratio, RI & PI were significantly higher (p-values < 0.001) in the study group than the control group after the intervention. On the other hand, EDV was...
The aim of this randomized controlled trial was to evaluate U/S guided serratus anterior plane ca... more The aim of this randomized controlled trial was to evaluate U/S guided serratus anterior plane catheter block (SAPB) versus patient‐controlled analgesia (PCA) on the emergence of post‐thoracotomy pain syndrome (PTPS) after thoracotomies for thoracic tumours.
Heart failure (HF) is a common cause of cardiovascular mortality and morbidity. Despite advances ... more Heart failure (HF) is a common cause of cardiovascular mortality and morbidity. Despite advances in treatment, the prognosis remains poor. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors decrease HF events by 27-39% in high-risk patients with type 2 diabetes mellitus (T2DM). Moreover, the DAPA-HF and EMPEROR-Reduced studies randomized patients with HF with reduced ejection fraction (HFrEF) with or without diabetes mellitus to receive guideline-directed medical therapy versus guideline-directed medical therapy plus an SGLT-2 inhibitor. Both studies showed the benefits of SGLT-2 inhibitors. In addition, SGLT-2 inhibitors have shown improvement according to the EMPEROR-Preserved study of HF with preserved ejection fraction (HFpEF). Therefore, a panel of cardiology experts from the Egyptian Atherosclerosis and Vascular Biology Association (EAVA) revised the literature for SGLT-2 inhibitors in HF, along with the recommended indications and contraindications, and this article presents their consensus on the topic. The panel concluded that SGLT-2 inhibitors have significantly benefited patients with chronic HFrEF, as indicated through the DAPA-HF and EMPEROR-Reduced trials. The panel recommended early use of dapagliflozin 10 mg or empagliflozin 10 mg in patients with symptomatic chronic HFrEF, whether diabetic or non-diabetic, to ameliorate HF hospitalization rate, mortality, symptoms, and decline in renal function.
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