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Role of bisphosphonates in the management of acute Charcot foot

World Journal of Diabetes 2018年第7期9卷 115-126页

作者： harsh durgia Jayaprakash Sahoo Sadishkumar Kam-alanathan Rajan Palui Kalyani Sridharan Henith Raj Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research

Diabetes mellitus is the most common cause of Charcot neuropathy affecting foot and ankle. Acute Charcot foot(CF) presents with a red and swollen foot in co-ntrast to the painless deformed one of chronic CF. En-hanced osteoclastogenesis plays a central role in the pathogenesis of acute CF. Many studies have shown elevated levels of bone turnover markers in patients with acute CF confirming it. These findings have led cl-inicians to use anti-resorptive agents [bisphosphonates(BP), calcitonin, and denosumab] along with immobi-lization and offloading in acute CF patients. The ma-ximum evidence among all anti-resorptive agents is available for BPs, although its quality is low. Pamidronate has been shown to reduce the markers of activity of CF like raised skin temperature, pain, edema, and bone turnover markers in the majority of studies. Intravenous BPs are known to cause acute phase reactions leading to flu-like illness following their first infusion, which can be ameliorated by oral acetaminophen. Alendronate is the only oral BP used in these patients. It needs to be taken on an empty stomach with a full glass of water to avoid esophagitis. The side-effects and contraindications to BPs should be kept in mind while treating acute CF patients with them.

关键词： Charcot foot Diabetes mellitus Charcot neuroarthropathy Bisphosphonates Pamidronate

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SGLT-2 inhibitors in non-alcoholic fatty liver disease patients with type 2 diabetes mellitus: A systematic review

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World Journal of Diabetes 2019年第2期10卷 114-132页

作者： Henith Raj harsh durgia Rajan Palui Sadishkumar Kamalanathan Sandhiya Selvarajan Sitanshu Sekhar Kar Jayaprakash Sahoo Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research Puducherry 605006 India Department of Clinical Pharmacology Jawaharlal Institute of Postgraduate Medical Education and Research Puducherry 605006 India Department of Preventive and Social Medicine Jawaharlal Institute of Postgraduate Medical Education and Research Puducherry 605006 India

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is a common comorbidity with type 2 *** existing therapeutic options for NAFLD are not *** diet and exercise is the cornerstone of therapy in *** is the only drug recommended in diabetes patients with biopsy proven non-alcoholic *** frequent coexistence of NAFLD and type 2 diabetes with their combined adverse health consequences and inadequate therapeutic options makes it necessary to search for newer *** To assess the effect of sodium glucose cotransporter-2(SGLT-2)inhibitors on liver enzymes in type 2 diabetes patients with *** We searched PubMed/MEDLINE,Cochrane library,Google scholar,and *** for the relevant articles to be included in this systematic *** studies done in type 2 diabetes patients with NAFLD treated with SGLT-2 inhibitors for at least 12 wk were *** from eight studies(four randomised controlled trials and four observational studies)were extracted and a narrative synthesis was done.A total of 214 patients were treated with SGLT-2 inhibitors in these studies(94 in randomised controlled trials and 120 in observational studies).RESULTS The primary outcome measure was change in serum alanine aminotransferase *** of eight studies,seven studies showed a significant decrease in serum alanine aminotransferase *** of the studies revealed reduction in serum level of other liver enzymes like aspartate aminotransferase and gamma glutamyl *** studies that reported a change in hepatic fat exhibited a significant reduction in hepatic fat content in those treated with SGLT-2 ***,among the three studies that evaluated a change in indices of hepatic fibrosis,two studies revealed a significant improvement in liver ***,there was an improvement in obesity,insulin resistance,glycaemia,and lipid parameters in those subjects taking SGLT-2 *** st

关键词： Alanine aminotransferase Hepatic fat Hepatic fibrosis Non-alcoholic fatty liver disease Sodium-glucose cotransporter-2 inhibitor Type 2 diabetes mellitus

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