Lowering of random blood sugar on a female obese diabetic subject is the core of this case report. Single bout of high intensity exercises using Physioball helps to induce confidence in the subject.
Statistically speaking,Malawi has achieved the World Health Organisation's target for the elimination of leprosy(<1 case per 10000 people),yet the disease is still considered a leading cause of long term physic...Statistically speaking,Malawi has achieved the World Health Organisation's target for the elimination of leprosy(<1 case per 10000 people),yet the disease is still considered a leading cause of long term physical disability.In this case study the authors discuss the presentation of a 39-year-old gentleman to a district hospital in Malawi with multibacillary,lepromatous leprosy.The condition was initially managed in the community as an‘allergy’which suggests that local barriers currently hinder the detection of leprosy in this developing primary care system.Leprosy is a multi-system disease and this gentleman demonstrated evidence of lepromatous orchitis.Promoting an awareness of these systemic manifestations will increase the the detection of complications and circumvent long term morbidity.Efforts to optimise systems of detection,management and public and professional education are essential to drive eradication in these at-risk populations.At an international level,we must strive to fulfil the objectives outlined by the‘Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy for 2011–2015’.At a national level,local research should delineate community factors that impede the eradication of leprosy.Developing new diagnostic and epidemiologic tools,more efficacious chemoprophylactic regimens and vaccination for endemic regions would facilitate these efforts.展开更多
BACKGROUND Sacubitril/valsartan is a first-in-class angiotensin receptor neprilysin inhibitor(ARNI)which combines an angiotensin receptor blocker(valsartan)with sacubitril,an inhibitor of the enzyme neprilysin.By virt...BACKGROUND Sacubitril/valsartan is a first-in-class angiotensin receptor neprilysin inhibitor(ARNI)which combines an angiotensin receptor blocker(valsartan)with sacubitril,an inhibitor of the enzyme neprilysin.By virtue of combined effect of blocking the action of angiotensin-II and inhibiting the breakdown of natriuretic peptides,ARNIs have beneficial role in heart failure(HF).AIM To evaluate the effect of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide(NT-pro BNP),inflammatory marker[high-sensitivity C-reactive protein(hs-CRP)],and quality of life when given as add-on to standard therapy in patients with HF.METHODS Sacubitril/valsartan as add-on therapy for improvement in HF study was a randomised controlled trial conducted from July 2023 to November 2024 in a public tertiary care hospital in India.Eligible patients were randomised in 1:1 ratio to either of the 2 study arms:(1)Group A(sacubitril/valsartan+standard treatment);and(2)Group B(standard treatment)for 12 weeks.Primary end point was change in NT-pro BNP levels at 12 weeks from baseline.Secondary endpoints included(1)Change in hs-CRP levels;(2)Change in World Health Organisation Quality of Life Questionnaire(WHOQOL-BREF)score;and(3)Incidence of treatment-related adverse events or worsening HF.Statistical analysis was done using Statistical Package for the Social Sciences trial version 29.0 and P<0.05 was considered significant.RESULTS Out of 124 patients screened,80 were enrolled of which 25 patients in each group were available for per-protocol analysis.At baseline,both the groups were comparable.Sacubitril/valsartan group exhibited a statistically significant greater reduction in NT-pro BNP(-35.91±28.01 vs 24.68±31.86;P<0.0001)and hs-CRP(-2.87±3.22 vs 0.76±1.60;P<0.0001)levels at 12 weeks compared to standard treatment group.There was also a greater improvement in quality of life with sacubitril/valsartan group(overall change in WHOQOL-BREF:13.16±8.73 in sacubitril/valsartan vs-4.12±6.25 in standard treatment arm).No major adverse events were reported in two groups.CONCLUSION Sacubitril/valsartan demonstrated significant improvements in HF biomarkers,inflammation,and quality of life without compromising safety supporting its role as an effective addition to standard HF therapy.Further research is needed to evaluate its long-term benefits on mortality and cardiac remodeling.展开更多
文摘Lowering of random blood sugar on a female obese diabetic subject is the core of this case report. Single bout of high intensity exercises using Physioball helps to induce confidence in the subject.
文摘Statistically speaking,Malawi has achieved the World Health Organisation's target for the elimination of leprosy(<1 case per 10000 people),yet the disease is still considered a leading cause of long term physical disability.In this case study the authors discuss the presentation of a 39-year-old gentleman to a district hospital in Malawi with multibacillary,lepromatous leprosy.The condition was initially managed in the community as an‘allergy’which suggests that local barriers currently hinder the detection of leprosy in this developing primary care system.Leprosy is a multi-system disease and this gentleman demonstrated evidence of lepromatous orchitis.Promoting an awareness of these systemic manifestations will increase the the detection of complications and circumvent long term morbidity.Efforts to optimise systems of detection,management and public and professional education are essential to drive eradication in these at-risk populations.At an international level,we must strive to fulfil the objectives outlined by the‘Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy for 2011–2015’.At a national level,local research should delineate community factors that impede the eradication of leprosy.Developing new diagnostic and epidemiologic tools,more efficacious chemoprophylactic regimens and vaccination for endemic regions would facilitate these efforts.
文摘BACKGROUND Sacubitril/valsartan is a first-in-class angiotensin receptor neprilysin inhibitor(ARNI)which combines an angiotensin receptor blocker(valsartan)with sacubitril,an inhibitor of the enzyme neprilysin.By virtue of combined effect of blocking the action of angiotensin-II and inhibiting the breakdown of natriuretic peptides,ARNIs have beneficial role in heart failure(HF).AIM To evaluate the effect of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide(NT-pro BNP),inflammatory marker[high-sensitivity C-reactive protein(hs-CRP)],and quality of life when given as add-on to standard therapy in patients with HF.METHODS Sacubitril/valsartan as add-on therapy for improvement in HF study was a randomised controlled trial conducted from July 2023 to November 2024 in a public tertiary care hospital in India.Eligible patients were randomised in 1:1 ratio to either of the 2 study arms:(1)Group A(sacubitril/valsartan+standard treatment);and(2)Group B(standard treatment)for 12 weeks.Primary end point was change in NT-pro BNP levels at 12 weeks from baseline.Secondary endpoints included(1)Change in hs-CRP levels;(2)Change in World Health Organisation Quality of Life Questionnaire(WHOQOL-BREF)score;and(3)Incidence of treatment-related adverse events or worsening HF.Statistical analysis was done using Statistical Package for the Social Sciences trial version 29.0 and P<0.05 was considered significant.RESULTS Out of 124 patients screened,80 were enrolled of which 25 patients in each group were available for per-protocol analysis.At baseline,both the groups were comparable.Sacubitril/valsartan group exhibited a statistically significant greater reduction in NT-pro BNP(-35.91±28.01 vs 24.68±31.86;P<0.0001)and hs-CRP(-2.87±3.22 vs 0.76±1.60;P<0.0001)levels at 12 weeks compared to standard treatment group.There was also a greater improvement in quality of life with sacubitril/valsartan group(overall change in WHOQOL-BREF:13.16±8.73 in sacubitril/valsartan vs-4.12±6.25 in standard treatment arm).No major adverse events were reported in two groups.CONCLUSION Sacubitril/valsartan demonstrated significant improvements in HF biomarkers,inflammation,and quality of life without compromising safety supporting its role as an effective addition to standard HF therapy.Further research is needed to evaluate its long-term benefits on mortality and cardiac remodeling.
