An Update on Betrixaban, The Challenging Anticoagulant Agent for Extended Venous Thromboembolism Prophylaxis.

ABSTRACT: Venous thromboembolism (VTE) is a prevalent yet preventable cause of death, particularly among hospitalized patients. Studies have shown that the risk of VTE remains high for up to 6 months after discharge, highlighting the need for extended thromboprophylaxis as a viable treatment approach. Despite the availability of several anticoagulant drugs such as vitamin K antagonists, heparinoids, rivaroxaban, apixaban, edoxaban, and dabigatran, none of them has received approval from the US Food and Drug Administration for long-term thromboprophylaxis. However, an emerging factor Xa inhibitor called betrixaban has shown promising results in Phase II and phase III trials, positioning itself as the first and only US Food and Drug Administration-approved anticoagulant for extended thromboprophylaxis in hospitalized patients after discharge. Betrixaban offers distinct pharmacological characteristics, including a long half-life, low renal excretion, and unique hepatic metabolism, making it an attractive option for various theoretical uses. Numerous articles have been published discussing the safety and efficacy of betrixaban, all of which have emphasized its usefulness and practicality. However, there has been limited discussion regarding its weaknesses and areas of ambiguity. Therefore, this article aimed to explore the challenges faced during the approval process of betrixaban and provide a comprehensive review of the literature on its advantages and disadvantages as a long-term prophylaxis approach for VTE. Furthermore, we aim to identify the ambiguous points that require further investigation in future studies.

Efficacy of bariatric surgery in COVID-19 patients: An updated systematic review and meta-analysis.

Introduction: Obesity is linked with poor outcomes in patients with SARS-CoV-2 infection. In patients with BMI > 35 kg/m2, increased rates of hospital and subsequently ICU admissions have been noted. Bariatric surgery resulting in sustained weight loss is hypothesized to decrease the morbid outcomes associated with COVID. In this review, we update the evidence on the topic. Methods: An extensive literature search was conducted of electronic databases. Screening of the articles based on the eligibility criteria was followed by relevant data extraction. In addition to articles used in a previous meta-analysis, relevant databases were searched to filter for any new articles. Initially, two independent reviewers screened Pubmed and the Cochrane database followed by a thorough search of additional databases such as Google scholar and Medrxiv. Articles were first screened using title and abstract, followed by a full text read. Duplicates, meta-analysis, letter to the editors, and commentaries were excluded. No language restrictions were applied. Results: A total of nine articles with a population of 1,130,341 were entered into RevMan. Patients with bariatric surgery displayed significantly decreased hospitalization (OR: 0.52, 95% CI [0.45, 0.61]), were less likely to be admitted to the ICU (OR: 0.44, 95% CI [0.29, 0.67]), and had reduced overall mortality (OR: 0.42, 95% CI [0.25, 0.70]). Conclusion: Surgically induced weight loss is beneficial in reducing morbidity and mortality of COVID-19.

Endocrinological Manifestations of Sanjad-Sakati Syndrome.

Sanjad-Sakati syndrome (SSS), also known as hypoparathyroidism-retardation-dysmorphism (HRD) syndrome, is a very rare genetic disorder with an autosomal recessive mode of inheritance, mostly seen in children of Middle Eastern origin. Hypoparathyroidism remains the most characteristic endocrinological feature of SSS; but not the only one. This review outlines and elucidates other endocrinological manifestations that may be seen with this syndrome.

Oral Ondansetron versus Domperidone for Acute Gastroenteritis Associated Vomiting in Young Children.

Introduction The management of vomiting and antiemetic therapy in young children with acute gastroenteritis (AGE) has not been standardized by any management guidelines. Antiemetic drugs including promethazine, prochlorperazine, metoclopramide, ondansetron, and domperidone are readily used in the emergency departments (EDs). The aim of this study was to compare the efficacy of ondansetron with domperidone in cessation of vomiting in pediatric AGE. Methods This open-label, two-arm trial was conducted in a pediatric ED in Pakistan. Children of age 1 to 60 months presenting with acute vomiting and no or mild-to-moderate dehydration associated with AGE were randomized into two groups. Group A children received ondansetron suspension orally at a dose of 0.15 mg/kg body weight. Group B received domperidone suspension orally at a dose of 0.5 mg/kg body weight. The primary outcome was the number of children in each group who did not have any episode of vomiting 24 hours posttreatment. The data were entered and analyzed using Statistical Package for the Social Sciences (SPSS) for Windows version 20.0 (IBM Corp., Armonk, NY). Results At 6 hours, 87% of children in the ondansetron group improved and their vomiting episodes ceased as compared to 81% of children in the domperidone group. The differences were statistically insignificant (p>0.05). At 24 hours, 95% in the ondansetron group had improved and only 85% in the domperidone group. The results were statistically significant favoring the end results of the ondansetron (p=0.01). Conclusions This study concluded that ondansetron is more efficacious than domperidone in cessation of vomiting associated with AGE and no or mild-to-moderate dehydration in children of age three months to five years.

Hyperuricemia Associated with Thiazide Diuretics in Hypertensive Adults.

Introduction Thiazide diuretics are essential first-line anti-hypertensive drugs which not only maintain blood pressure but also reduce stroke and congestive heart failure associated with morbidity and mortality in hypertensive patients. However, thiazide diuretics are associated with elevated serum uric acid (SUA) levels. This study aimed to evaluate the impact of thiazide diuretic use on their SUA levels among hypertensive individuals of Pakistan. Methods In this cross-sectional, prospective study, adult hypertensive patients were recruited. They were divided into two groups - thiazide diuretic group and non-thiazide group. Demographic characteristics, hypertension-related characteristics, and SUA levels were included. Data were then entered and analysed using SPSS for Windows version 22.0 (IBM Corp., Armonk, NY, USA). Results In the thiazide group, 24.5% were hyperuricemic as compared to 15.3% in the non-thiazide group (p=0.03). The overall mean SUA levels in the thiazide group were significantly higher than those in the non-thiazide group (5.9 ± 2.1 vs. 5.3 ± 2.7 mg/dL; p=0.02). Males in the thiazide group also showed a similar pattern (5.9 ± 2.3 vs. 5.1 ± 2.1 mg/dL; p=0.02); however, the differences were insignificant in females. Patients using thiazide diuretics for one to three years were more non-hyperuricemic than hyperuricemic (p=0.000). Among hyperuricemic patients, 36.5% were taking thiazides for three to four years and 46% were taking them for more than four years (p<0.05). Conclusion Hyperuricemia is a more common occurrence in thiazide diuretic users as compared to non-users. The overall sample, and men using thiazide diuretics, reported a higher mean SUA as compared to non-users. As the years of thiazide usage advanced, the number of hyperuricemic participants also significantly increased.

Retrospective Analysis of Complications Associated with Laparoscopic Cholecystectomy for Symptomatic Gallstones.

Introduction Gallstones are the major cause of global morbidity. Laparoscopic approach has well-established advantages as compared to the conventional open procedure. It promises better recovery, lower morbidity, and lower postoperative pain, shortens the duration of hospital stay, and has a lower mortality rate. The aim of this study is to assess the frequency of complications in laparoscopic cholecystectomies indicated for symptomatic gallstones and also evaluate the rate of conversion. Methods In this retrospective analysis, all records of laparoscopic cholecystectomy, in patients of age ≥18 years, for symptomatic gallstones, from January 2015 till December 2018 in one of the largest public tertiary care hospitals in Pakistan were included. Results The rate of complications associated with laparoscopic cholecystectomy was 6.8%. Older age, obesity, and multiple pre-operative risk factors were associated with complications. The most common intra-operative complication was hemorrhage (1.3%) and most common postoperative complication was surgical site infection (2.7%). Our conversion rate was 3.6%. Both intra-operative and postoperative complications were more common in procedures which were converted to open. Conclusion The rate of complication and conversion to open in laparoscopic cholecystectomy is not very high. Older age, obesity, and multi-morbidity was associated with complications. Complicated procedures were more commonly needed to be converted to open.