Dapagliflozin: a potential lifesaver for “heart failure patients with mildly reduced or preserved ejection fraction” in the world

Dear Editor, According to the "World Health Organization (WHO)," approximately 17.9 million people die each year from cardiovascular diseases like heart failure, making it the second-leading cause of death in the world after cancer. (1) Consequently, treatment and care for heart failure patients have been significant concerns among medical professionals for years. Despite the numbers, Pakistan still lacks the primary resources to support heart failure patients. According to the data on the heart attack ratio for 2020, approximately 240,720 people died from heart failure and coronary artery disease (CAD) in Pakistan, accounting for around 16 percent of all fatalities. (2) However, Dapagliflozin, a sodium-glucose transporter inhibitor (SGLTi), along with a healthy diet, exercise, and other medications, improves glycemic control in adults with type 2 diabetes and also reduces the risk of hospitalization for heart failure among adults with type 2 diabetes.(3) In a study published in JAMA Cardiology in 2023, Jhund PS et al. examined the relationship between Dapagliflozin and heart failure and discovered a reduction of the rate of total HF events in patients with mildly reduced or preserved ejection fraction and cardiovascular deaths in the Dapagliflozin group by 3.5 events as compared to the placebo group. (4) Additionally, Scott Solomon et al. indicated that Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure with reduced or preserved ejection fraction by 3.1% in the Dapagliflozin group as compared to the placebo group. (5) These satisfying statistics indicate that Dapagliflozin is the world's potential lifesaver for heart failure patients with mildly reduced or preserved ejection fraction. In order to ensure the safety of heart failure patients, it is imperative to promote and scale up the research, production, and availability of the drug Dapagliflozin in our healthcare systems and pharmacies on a large scale in Pakistan, particularly in rural and remote areas

Psychosocial treatments for substance use disorders

Worldwide use of illicit drugs is increasing, and substance use disorders (SUDs) have become a significant mental health problem in the West. Although the majority of young people do not use illicit drugs and of those who do use illicit substances, only a minority will develop serious problems; however, substance misuse can still be damaging to the developing brain. Continued use of illicit drugs can trigger or exacerbate developmental problems, particularly in those who are at risk or have a pre-existing developmental, physical or mental health conditions. The increased recognition of SUDs, its changing patterns, the impairment it causes and its cost to the society has promoted the interest to evaluate the effectiveness of available treatments. During the last thirty years, numerous pharmacological as well as psychosocial treatments have been developed and validated. Pharmacological treatments usually target withdrawal symptoms while psychosocial treatments are directed at drug use behaviors in general. There is a significant and growing evidence in support of psychosocial therapies on its own as well as in combination with pharmacological treatments for SUDs. In this discussion, we have described the various psychosocial treatments as well as reviewed the available evidence for such treatments and recommendations. © 2022 by Nova Science Publishers, Inc

On Generalized Harmonically ψ-MT-Convex Functions via Local Fractional Integrals and some Applications

In this work, we introduce a new class of harmonically convex functions, namely, generalized harmonically ψ-MT-convex functions established on fractal set techniques, for establishing inequalities of Hermite-Hadamard type and certain related variants with respect to the Raina’s function. With the help of an auxiliary identity associated with Raina’s function, by generalized Holder inequality and generalized power mean, generalized midpoint type, Ostrowski type, and trapezoid type inequalities via local fractional integral for generalized harmonically ψ-MT-convex functions are given. The introduced technique gives the results by establishing some special values for the parameters or applying restrictive suppositions and is entirely practicable for regaining the existing inequalities in the related literature

International perspective on integrated care models in child and adult mental health

The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability