Role of Morphological and Hemodynamic Factors in Predicting Intracranial Aneurysm Rupture: A Review.

Intracranial aneurysms (IAs) carry the risk of rupture, which will lead to subarachnoid hemorrhage, which has a high mortality and morbidity risk. However, the treatment of IA's carries mortality and morbidity risks too. There are well-known risk factors for the rupture of IAs like age, size, and site. However, choosing patients with unruptured IAs for treatment is still a big challenge. This review article aimed to find out the relationship between morphological and hemodynamic characters of IAs with their rupture and incorporate these factors with well-known factors to yield an accurate module for predicting the rupture of IAs and decision-making in the treatment of unruptured IAs. We searched in PubMed and Medline databases by using the following keywords: IAs, subarachnoid hemorrhage, and risk of rupture, morphology, and hemodynamic "mesh." A total of 19 studies with 7269 patients and 9167 IAs, of which 1701 had ruptured, were reviewed thoroughly. Some modules like population, hypertension, age, size, earlier subarachnoid hemorrhage, and site (PHASES) score that involve well-known risk factors can be used to assess the risk of rupture of IAs. However, decision making for treating unruptured IA needs more detailed and more accurate modules. Studying morphological and hemodynamic factors and incorporation of them with well-known risk factors to yield a more comprehensive module will be very helpful in treating unruptured IA. Among morphological factors, aspect ratio (AR), size ratio (SR), aneurysm height, and bottle-neck factor showed significant effects on the growth and rupture of IA. Besides, wall shear stress (WSS), oscillatory shear index (OSI), and low wall shear stress area (LSA) as hemodynamic factors could have a substantial impact on the formation, shape, growth, and rupture of unruptured IA.

Inhaled Corticosteroids as an Associated Risk Factor for Asthmatic Pneumonia: A Literature Review.

Asthma patients have commonly been prescribed inhaled corticosteroids (ICSs) as the first line of control therapy. ICSs are associated with an increased risk of pneumonia in chronic obstructive airway disease (COPD) patients. However, the evidence remains controversial in asthma patients. Several observational studies reported an increased risk of pneumonia; however, COPD patients were not excluded clearly in these studies. In observational studies that excluded COPD patients and in randomized controlled trials, ICS use was not found to be associated with the risk of pneumonia. Hence, COPD patients should be excluded in future studies, and the currently available evidence demonstrates that ICS use is not associated with an increased risk of pneumonia in asthma patients.

The Effect of Anemia and the Goal of Optimal HbA1c Control in Diabetes and Non-Diabetes.

Hemoglobin A1c (HbA1c) is the gold standard for the diagnosis of diabetes; however, many clinical conditions affect the HbA1c level, including anemia. And, the most common causes of anemia worldwide include iron deficiency anemia (IDA). We performed a systematic search using different combinations of MeSH words from the electronic database for the last 10 years (2011 to 2020). Articles included in the study were observational, randomized controlled trial (RCT), and review/systematic review. A total of 18 articles were included in the study. The majority of the studies showed the association between hemoglobin (Hb) and HbA1c. Large-scale studies showed that the HbA1c level increases in IDA and some studies showed its correction after the treatment with oral iron supplementation. Our study indicates the need for screening for anemia in patients before commencing the treatment of diabetes diagnosed via the HbA1c level. Furthermore, anemia should be corrected before setting the treatment goal of optimal HbA1c control, especially when the level is in the diagnostic threshold. Also, the purpose of strict HbA1c control is not recommended in the anemic patient before it is corrected. However, further large-scale interventional studies are needed to know precisely the goal of optimal HbA1c control in diabetic and non-diabetic individuals.

Future of Bariatric Embolization: A Review of Up-to-date Clinical Trials.

Obesity is a significant health issue with an overall rise in mortality; it has multiple risk factors, including hormonal effects, which play a significant role in the balance of food intake and weight gain. Ghrelin is an anabolic hormone secreted from stomach fundus and plays a significant role in this regulation. Management of obesity involves multiple interventions, including lifestyle adjustment, pharmacotherapy, and bariatric surgery. Bariatric embolization is a relatively new procedure; several animal studies show that embolization of the left gastric artery reduces serum ghrelin and induces weight loss.  Also, several clinical studies were conducted in the past ten years which have shown bariatric embolization's effectiveness in inducing weight loss: a meta-analysis of 47 patients included in six different clinical studies of left gastric artery embolization resulted in 8% total weight loss from baseline body weight. Many studies also show this procedure's effect on lowering the HgA1C level and lipid profile. Clinical studies mostly reported minor adverse effects such as transient abdominal discomfort, nausea and vomiting, gastric ulcers, and major adverse effects were uncommon, suggesting the procedure is well tolerated. It may be an alternative line of management in patients who are not suitable candidates for bariatric surgery. Although future clinical studies will provide an answer to several questions like the exact effects of the procedure on diabetes and metabolic syndrome, future studies are also needed to establish particular guidelines to match different patient characteristics with their optimal procedural techniques and pre- and post-procedure evaluation tests.