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Sodium-Glucose Cotransporter-2 Inhibitors: Who, When & How? Guidance for Use from a Multidisciplinary Practical Approach

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International Journal of Clinical Medicine 2024年第9期15卷 413-435页

作者： Khalifa Abdullah Magdy ElSharkawy Emad R. Issak Ahmed Shawky ElSerafy Samah Idris Ahmed Bendary haytham reda badr May Shehata Ashraf reda Internal Medicine Department Diabetes & Metabolism Unit Faculty of Medicine Alexandria University Alexandria Egypt Nephrology Department Faculty of Medicine Ain Shams University Cairo Egypt Internal Medicine Department Faculty of Medicine Ain Shams University Cairo Egypt Cardiology Department Faculty of Medicine Ain Shams University Cairo Egypt Internal Medicine and Nephrology Department Faculty of Medicine Alexandria University Alexandria Egypt Cardiology Department Faculty of Medicine Benha University Benha Egypt Internal Medicine Department Diabetes and Endocrinology Unit Faculty of Medicine Menoufia University Menoufia Egypt Product Manager Al-Esraa Pharma Cairo Egypt Cardiology Department Faculty of Medicine Menoufia University Menoufia Egypt

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) have transformed diabetes management by targeting renal glucose reabsorption. Designed initially as antidiabetic agents, their ability to lower blood glucose levels independently of insulin is well-documented. Beyond glycemic control, emerging research has unveiled their profound cardiorenal benefits. By inhibiting SGLT-2 protein, these drugs enhance glucose excretion in urine, reducing blood glucose levels. This mechanism has translated into significant cardiovascular and renal protection, establishing SGLT-2 inhibitors as pivotal in managing not only diabetes but also cardiovascular and renal diseases. Recent studies have illuminated the broader therapeutic potential of SGLT-2 inhibitors beyond diabetes. Evidence indicates their efficacy in managing heart failure, chronic kidney disease (CKD), and cardiovascular complications in individuals with or without diabetes. This expanded therapeutic landscape has catalyzed a paradigm shift in SGLT-2 inhibitor use, positioning them as key agents in the cardiorenal metabolic continuum. Moreover, their role in the secondary prevention of cardiovascular events and slowing CKD progression in T2DM patients has garnered considerable attention. This consensus-based review aims to offer practical guidance in an algorithmic approach to primary care healthcare professionals to optimize SGLT-2 inhibitors utilization and maximize their benefits. The review seeks to empower clinicians to effectively manage patients who may benefit from SGLT-2 inhibitor therapy by addressing common initiation barriers and optimizing treatment strategies. Additionally, it aims to raise awareness among primary care physicians regarding the multifaceted benefits of these medications and overcome clinical inertia in their adoption into routine clinical practice.

关键词： Sodium-Glucose Cotransporter-2 Inhibitors Cardiorenal Benefits Therapeutic Potential Cardiovascular Protection Primary Care Optimization

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Pediatric Continuous Brachial Plexus Catheter for a Case of Complex Regional Pain Syndrome (CRPS)

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Open Journal of Anesthesiology 2015年第1期5卷 1-6页

作者： reda Tolba Rhamee badr Maged Guirguis Loran Mounir Soliman Anesthesiology and Pain Management Department Ochsner Health System New Orleans USA Tulane University School of Medicine New Orleans USA Anesthesiology Institute Cleveland Clinic Foundation Cleveland USA

Introduction: Complex regional pain syndrome (CRPS) is a disorder characterized by pain as well as a myriad of sensory, autonomic, and motor disturbances. We are reporting a case of child diagnosed with CRPS and successfully treated with supraclavicular brachial plexus catheter infusion of local anesthetic. Case Report: An eight-year-old male underwent a left thoracotomy, repair of esophageal vascular ring, and translocation of the left subclavian to the left carotid artery. Post-operative course was relevant for severe intractable left shoulder and left arm pain associated with allodynia and hyperalgesia. A supraclavicular catheter was inserted, and an infusion of ropivacaine 0.2% was started. The child was sent for physical therapy as he gradually regained all functions of his left arm and resumed his regular activities. Conclusion: Continuous supraclavicular brachial plexus catheter infusion of local anesthetic is a valuable method of reducing pain in severe cases of upper extremity pediatric CRPS and may be safer and more effective than other invasive measures such as sympathetic blocks and epidural catheterization. Further research surrounding the diagnosis and treatment of pediatric CRPS is needed to allow early diagnosis and treatment and to improve outcome.

关键词： Complex Regional Pain Syndrome (CRPS) Supraclavicular Brachial Plexus Catheter Pediatric

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