Effect of Sodium-Glucose Cotransporter 2 Inhibitors on the 24-Hour Ambulatory Blood Pressure in Patients With Type 2 Diabetes Mellitus and Hypertension: An Updated Meta-Analysis.

OBJECTIVE: Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially developed for type 2 diabetes mellitus (DM) treatment, have shown potential benefits beyond glycemic control, including a positive impact on the blood pressure (BP). This meta-analysis aimed to evaluate their effects on patients with type 2 DM and hypertension. METHODS: We searched the PubMed, Google Scholar, and Cochrane databases for relevant randomized controlled trials published until May 31, 2023. Ten randomized controlled trials involving participants with confirmed type 2 DM were selected. The intervention group received SGLT2i, whereas the control group received a placebo or standard care. The primary outcomes were the 24-hour ambulatory systolic BP (SBP) and diastolic BP (DBP). RESULTS: The results showed a significant reduction in the 24-hour ambulatory SBP (weighted mean difference, -5.08 mm Hg; 95% confidence interval, -7.02 to -3.14; P <.00001) and DBP (weighted mean difference, -2.73 mm Hg; 95% confidence interval, -4.25 to -1.20; P =.0005) with the use of SGLT2i compared with that using the placebo. However, a high-heterogeneity level was observed in both analyses (SBP, I2 = 83%; DBP, I2 = 91%). Sensitivity analysis excluding specific studies reduced heterogeneity while maintaining statistically significant and clinically relevant reductions in the BP. CONCLUSION: In conclusion, this meta-analysis proves that SGLT2i significantly reduce the 24-hour ambulatory BP. SGLT2i may be considered an effective treatment option for lowering the BP in addition to standard care in patients with hypertension and type 2 DM.

Effects of COVID-19 pandemic and lockdown on lifestyle and mental health of students: A retrospective study from Karachi, Pakistan.

Introduction: Due to the COVID-19 pandemic, many countries imposed lockdowns on their citizens in an attempt to contain the disease. Pakistan is one of these countries. A government mandated lockdown can have mitigating psychological effects on young adults, out of which a large fraction is made up of students. This study aims to investigate the correlations between changes in sleep pattern, perception of time, and digital media usage. Furthermore, it explores the impact of these changes on the mental health of students of different educational levels. Methods: This cross-sectional study was conducted via a web-based questionnaire, from March 24 to April 26, 2020. The survey was targeted at students and 251 responses were obtained. It was a 5-section long questionnaire. The first section inquired about demographics of participants. Each of the other 4 sections was devoted to changes in sleep pattern, perception of time flow, digital media usage and mental health status of students. Close-ended questions with multiple choice responses, dichotomous, interval and 4-point Likert scales were used in the construction of the survey questionnaire. Chi2 T-tests multinomial and binary logistic regression were used as primary statistical tests. All data were analysed using Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY). Results: Out of 251 adolescents that participated in our study, the majority (70.2%) were females. The mean age of the participants was 19.40 ± 1.62 years. Two-thirds of the respondents did not have much trouble falling asleep (66.5%). The analysis found no significant association between longer sleep periods and procrastination level (P = 0.054). Nearly three-fourths (72.9%) of our participants felt that getting through quarantine would have been more difficult if they did not have any electronic gadgets. Of these, a majority (85.8%) had a general feeling of tiredness and lacked motivation (P = 0.023). Additionally, a large number of students (69.7%) had reported that time is seemingly moving faster. A significant relationship between increased usage of electronic items and longer sleep periods was also noted (P = 0.005). With respect to the level of education, statistically significant values were noted for alarm use both before and after quarantine began (P = 0.021 and P = 0.004, respectively). Further analysis showed that there was a significant difference in the median difference of time spent on social media before the outbreak (3.0 ± 32.46) and time spent on social media after the outbreak (6.0 ± 3.52) in a single day (P = 0.000). Conclusions: Our research has revealed that due to the lockdown imposed by the government in response to COVID-19, the sleeping patterns of the students was affected the most. Our findings show that the increase in use of social media applications led to a widespread increase in the length of sleep, worsening of sleep habits (people sleeping at much later hours than usual), and a general feeling of tiredness. A general lack of recollection regarding what day of the week it was, as well as a change in the perceived flow of time were also notable. All these findings indicate the decline in mental health of students due to the lockdown. Promoting better sleep routines, minimising the use of digital media, and encouragement of students to take up more hobbies could collectively improve the health and mood of students in self-quarantine.

Introduction: En raison de la pandémie de COVID-19, de nombreux pays ont imposé des verrouillages à leurs citoyens pour tenter de contenir la maladie. Le Pakistan est l'un de ces pays. Un verrouillage mandaté par le gouvernement peut avoir des effets psychologiques atténuants sur les jeunes adultes, dont une grande partie est composée d'étudiants. Cette étude vise à étudier les corrélations entre les changements dans les habitudes de sommeil, la perception du temps et l'utilisation des médias numériques. De plus, il explore l'impact de ces changements sur la santé mentale des élèves de différents niveaux d'éducation. Méthodes: Cette étude transversale a été menée via un questionnaire en ligne, du 24 mars au 26 avril 2020. L'enquête visait les étudiants et 251 réponses ont été obtenues. C'était un questionnaire de 5 sections. La première section a posé des questions sur la démographie des participants. Chacune des 4 autres sections était consacrée aux changements dans les habitudes de sommeil, à la perception de l'écoulement du temps, à l'utilisation des médias numériques et à l'état de santé mentale des élèves. Des questions fermées avec des réponses à choix multiples, des échelles dichotomiques, d'intervalle et de Likert à 4 points ont été utilisées dans la construction du questionnaire d'enquête. Le chi carré, les tests T multinomiaux et la régression logistique binaire ont été utilisés comme tests statistiques primaires. Toutes les données ont été analysées en utilisant Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY). Résultats: Sur 251 adolescents qui ont participé à notre étude, la majorité (70,2 %) étaient des femmes. L'âge moyen des participants était de 19,40 ± 1,62 ans. Les deux tiers des répondants n'avaient pas beaucoup de mal à s'endormir (66,5 %). L'analyse n'a trouvé aucune association significative entre des périodes de sommeil plus longues et le niveau de procrastination (p = 0,054). Près des trois quarts (72,9 %) de nos participants ont estimé que passer la quarantaine aurait été plus difficile s'ils n'avaient pas de gadgets électroniques. Parmi ceux-ci, une majorité (85,8 %) avait une sensation générale de fatigue et manquait de motivation (p = 0,023). De plus, un grand nombre d'étudiants (69,7 %) ont déclaré que le temps passe apparemment plus vite. Une relation significative entre une utilisation accrue des articles électroniques et des périodes de sommeil plus longues a également été notée (p = 0,005). En ce qui concerne le niveau d'éducation, des valeurs statistiquement significatives ont été notées pour l'utilisation des alarmes avant et après le début de la quarantaine (p = 0,021 et p = 0,004, respectivement). Une analyse plus approfondie a montré qu'il y avait une différence significative dans la différence médiane entre le temps passé sur les réseaux sociaux avant l'épidémie (3,0 ± 32,46) et le temps passé sur les réseaux sociaux après l'épidémie (6,0 ± 3,52) en une seule journée (p = 0,000). Conclusions: Notre recherche a révélé qu'en raison du verrouillage imposé par le gouvernement en réponse au COVID-19, les habitudes de sommeil des étudiants étaient les plus affectées. Nos résultats montrent que l'augmentation de l'utilisation des applications de médias sociaux a conduit à une augmentation généralisée de la durée du sommeil, à une aggravation des habitudes de sommeil (personnes qui dorment beaucoup plus tard que d'habitude) et à une sensation générale de fatigue. Un manque général de souvenir du jour de la semaine, ainsi qu'un changement dans l'écoulement perçu du temps, étaient également notables. Tous ces résultats indiquent le déclin de la santé mentale des étudiants en raison du verrouillage. La promotion de meilleures habitudes de sommeil, la minimisation de l'utilisation des médias numériques et l'encouragement des étudiants à adopter plus de passe-temps pourraient collectivement améliorer la santé et l'humeur des étudiants en quarantaine.

Association of Atrial Fibrillation With Patient Characteristics in Postoperative Coronary Artery Bypass Grafting Surgery.

Introduction Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is correlated with poor patient outcomes. The study evaluated the association of patients' clinical and sociodemographic characteristics with the incidence of atrial fibrillation, postoperatively.  Methodology A longitudinal study was performed in the cardiology department of a tertiary care unit, Sindh, Pakistan between October 2019 and November 2020. All patients who underwent CABG surgery irrespective of gender aged 30 to 75 years were included in the study. Patients with a history of atrial fibrillation or severe left ventricular dysfunction were excluded from the study. The incidence of atrial fibrillation was determined by observing an irregular pattern on electrocardiography (ECG) with no definite P-wave and irregular R-R interval. The patients were monitored for seven postoperative days. The final outcome was measured on the seventh postoperative day.  Results A total of 247 patients with a mean age of 63.43 ± 9.72 were enrolled in the study. Out of the 247 patients, 9.7% developed new-onset atrial fibrillation, postoperatively. Age above 65 years was associated with the occurrence of AF but it was not statistically significant (p>0.05). Similarly, patients who developed AF were more likely to have a left ventricle ejection fraction (LVEF) of less than 35% than those without AF (66.67% vs 43.95%; p=0.033).  Conclusion A high rate of AF was observed in the study. Older age and impaired ventricular function were significantly associated with atrial fibrillation. It is recommended that hospitals should devise guidelines and protocols for the prevention and management of atrial fibrillation in patients undergoing cardiothoracic surgeries in order to minimize patient mortality and improve patient outcomes.

Right Unilateral Versus Bilateral Electroconvulsive Therapy in Patients With Clinical Depression.

Introduction Electroconvulsive therapy (ECT) is a functional treatment for a significant mental illness that involves a momentary application of electrical stimulation to induce generalized seizures. The use of right unilateral (RUL) and bilateral (BL) ECT has been controversial. Thus, the study aimed at comparing the effectiveness of RUL ECT and BL ECT in treating depression. Methodology A longitudinal study was conducted between September 2016 and January 2021 at a tertiary care hospital in Sindh, Pakistan. All patients over the age of 18 with clinically diagnosed depression in the last month were included in the study. Baseline depression scores and post-treatment scores were determined using Hamilton Depression Rating Scale (HDRS). All patients were assigned to each treatment group. Group A was administered right unilateral electroconvulsive therapy, while group B was administered bilateral electroconvulsive therapy. Adverse effects were documented right after treatment, at four hours, and then one day after therapy. Depression severity was determined after each ECT session using the HDRS scale. Electroconvulsive therapy was discontinued when an HDRS score of 10 was achieved.  Results  The mean HDRS score at baseline in the bilateral ECT group was 24.99 ± 3.938, which lowered to 17.56 ± 2.65 by the 3rd session, 12.45 ± 3.76 by the 6th session, and to 11.86 ± 2.3 by the end of treatment (p<0.0001). Similarly, the right unilateral ECT was equally effective in improving the depressive symptoms (p<0.0001). There was no significant difference between the efficacy of bilateral and unilateral placements of electrodes in electroconvulsive therapy (p=0.116).