"Past Knowledge, Present Know How and Future Endeavors"

The prevalence of type 2 Diabetes has been increasing at a fast pace with the potential of becoming one of the major health hazards worldwide. It is inducing a heavy burden on health providers, on health organizations and on patients alike. Etiology, pathogenesis and long term complications are well registered and explained and have been recognized for the past two millennia. The following study summarizes the presently known regimens of treatment, describes the drugs that have been historically used and lists the ones that are being prescribed. The modalities of treatment for each drug, its composition and its method of action are also outlined. The narration consolidates the present practices, available knowledge and investigates present research attempts for curbing the disease.MSc/MAáltalános orvosango

Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery

Background Data regarding permanent pacemaker (PPM) implantation following tricuspid valve surgery (TVS) are limited. We sought to evaluate its incidence, risk factors, and outcomes. Methods and Results Medicare beneficiaries who underwent TVS from 2013 to 2020 were identified. Patients who underwent TVS for endocarditis were excluded. The primary exposure of interest was new PPM after TVS. Outcomes included all‐cause mortality and readmission with endocarditis or heart failure on follow‐up. Among the 13 294 patients who underwent TVS, 2518 (18.9%) required PPM placement. Risk factors included female sex (relative risk [RR], 1.26 [95% CI, 1.17–1.36], P<0.0001), prior sternotomy (RR, 1.12 [95% CI, 1.02–1.23], P=0.02), preoperative second‐degree heart block (RR, 2.20 [95% CI, 1.81–2.69], P<0.0001), right bundle‐branch block (RR, 1.21 [95% CI, 1.03–1.41], P=0.019), bifascicular block (RR, 1.43 [95% CI, 1.06–1.93], P=0.02), and prior malignancy (RR, 1.23 [95% CI, 1.01–1.49], P=0.04). Tricuspid valve (TV) replacement was associated with a significantly higher risk of PPM implantation when compared with TV repair (RR, 3.20 [95% CI, 2.16–4.75], P<0.0001). After a median follow‐up of 3.1 years, mortality was not different in patients who received PPM compared with patients who did not (hazard ratio [HR], 1.02 [95% CI, 0.93–1.12], P=0.7). PPM placement was not associated with a higher risk of endocarditis but was associated with a higher risk of heart failure readmission (HR, 1.28 [95% CI, 1.14–1.43], P<0.001). Conclusions PPM implantation frequently occurs after TVS, notably in female patients and patients undergoing TV replacement. Although mortality is not increased, it is associated with higher rates of heart failure rehospitalization

Oral arginine improves intestinal recovery following ischemia-reperfusion injury in rat

Arginine and nitric oxide are critical to the normal physiology of the gastrointestinal tract and maintain the mucosal integrity of the intestine in various intestinal disorders. In the present study, we evaluate the effects of oral arginine (ARG) supplementation on intestinal structural changes, enterocyte proliferation, and apoptosis following intestinal ischemia–reperfusion (IR) in the rat. Male Sprague–Dawley rats were divided into three experimental groups: sham rats underwent laparotomy and superior mesenteric artery mobilization, IR rats underwent superior mesenteric artery occlusion for 30 min following by 24 h of reperfusion, and IR-ARG rats were treated with enteral arginine given in drinking water (2%) 48 h before and following IR. Intestinal structural changes, enterocyte proliferation, and enterocyte apoptosis were determined 24 h following IR. A nonparametric Kruskal–Wallis ANOVA test was used for statistical analysis with p <0.05 considered statistically significant. IR rats demonstrated a significant decrease in bowel weight in duodenum and jejunum, mucosal weight in jejunum and ileum, and villus height in jejunum and ileum compared with control animals. IR rats also had a significantly lower cell proliferation index in jejunum and ileum and a higher apoptotic index in ileum compared with control rats. IR-ARG animals demonstrated greater duodenal and jejunal bowel weight; duodenal, jejunal, and ileal mucosal weight; and jejunal and ileal cell proliferation index compared with IR animals. In conclusion, oral ARG administration improves mucosal recovery following IR injury in the rat.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47172/1/383_2004_Article_1318.pd