Exenatide efficacy and safety: a systematic review.

OBJECTIVE: To examine the efficacy, effectiveness and side effects of exenatide when compared with oral glucose-lowering agents or insulin therapy. RESEARCH DESIGN AND METHODS: Relevant citations were identified from searches of multiple bibliographic databases supplemented with searches of the US Food and Drug Administration website and other sources. A qualitative synthesis was performed, with a random effects meta-analysis when appropriate. RESULTS: We identified 17 studies. In placebo-controlled trials of subjects with poorly controlled diabetes (with both groups receiving various oral glucose-lowering agents), exenatide 10 microg twice daily improved glycated haemoglobin (HbA(1c)) by approximately 1.0% over 30 weeks [pooled estimate -0.97%, 95% confidence interval (CI), -1.16 to -0.79%, P < 0.0001] and exenatide treatment over 16-30 weeks was associated with weight loss of 1.0-2.5 kg. Exenatide appeared to confer a similar benefit to various insulin regimes for glycaemic control at follow-up between 16 and 52 weeks (pooled estimate HbA(1c)-0.04%, 95% CI, -0.14 to 0.06%, P = 0.41), but was advantageous over insulin with respect to weight loss (3-6 kg loss at up to 52 weeks of follow-up). Nausea was the most common adverse event in placebo- and active-controlled trials. Rates of hypoglycaemia were similar in exenatide and insulin groups, but were higher with exenatide 10 microg twice daily compared with placebo and hypoglycaemia was most frequent when a sulphonylurea was administered. CONCLUSIONS: In subjects with poorly controlled diabetes, exenatide was associated with a reduction in HbA(1c) that was similar to introducing another oral agent or insulin. Weight loss may be an advantage with exenatide. Long-term studies in diverse and unselected populations are needed to clarify the benefit vs. harm profile of this drug.

Ruptured aneurysm sinus of Valsalva and Gerbode defect with severe tricuspid and aortic regurgitation. A case report and its surgical correction.

An unusual early, childhood presentation in a case with reputured non-coronary sinus of Valsalva aneurysm with Gerbode defect and severe pulmonary hypertension is described. The reasons for early rupture are discussed and anatomically important relations of membranous septum, fibroskeleton of heart and conduction system are schematically elucidated. Associated severe tricuspid and aortic regurgitation are explained to be secondary effects following the rupture of aneurysm. A technique of surgical correction of this rare association of anomalies using single PTFE patch is illustrated, cautiously safeguarding the closely related conduction system. Regurgitant aortic and tricuspid valves were also successfully repaired. In retrospect, early repair before rupture of aneurysm and onset of severe pulmonary hypertension may be more beneficial, which would also prevent the leakage of semilunar and atrioventricular valves.