Clinical Update Research Articles

The Uterus as an Influencing Factor for Late Embryo/Early Fetal Loss—A Clinical Update

Simple SummaryPregnancy loss following a positive pregnancy diagnosis in the absence of infectious disease of the reproductive system is a main factor limiting reproductive efficiency in high producing dairy cows. We describe here some circumstances such as the age of the dam, retained placenta and uterine size in which the uterus may be associated with pregnancy loss.Here we revise circumstances of non-infectious causes in which the uterus may be associated with pregnancy loss during the late embryo/early fetal period (following a positive pregnancy diagnosis in lactating dairy cows). As the uterine size increases with parity and pregnant heifers with no detrimental effects of a previous parturition, a primigravid uterus is proposed as a reference for identifying risk factors that negatively influence pregnancy in lactating cows. Cows suffering placenta retention or with a large uterus at insemination were selected as topics for this revision. Retained placenta, that occurs around parturition, has a long-lasting influence on subsequent pregnancy loss. Although retained placenta is a particularly predisposing factor for uterine infection, farm conditions along with cow factors of non-infectious cause and their interactions have been identified as main factors favoring this disorder. A large uterus (cervix and uterine horns lying outside the pelvic cavity) with no detectable abnormalities has been associated with low fertility and with a greater incidence of pregnancy loss. A large reproductive tract may well derive from an inadequate uterine involution. Therefore, peripartum management and strategies to reduce the incidence of uterine disorders should reduce their associated financial losses in the herds.

Systemic Mastocytosis and Other Entities Involving Mast Cells: A Practical Review and Update.

Simple SummaryIn this article, we outline recent updates in systemic mastocytosis (SM) classification, including the bone marrow mastocytosis subtype; and discuss the mast cell leukemia subtype (acute or chronic), the rare variant of SM known as well-differentiated SM (morphologic variant), and other diseases involving mast cells (i.e., myelomastocytic leukemia and mast cell activation syndrome) that may be diagnostically challenging. We also provide a concise clinical update of new adjusted risk stratification models and overview new treatments that were approved for advanced SM (midostaurin, avapritinib).Evidence in the recent literature suggests that the presentation spectrum of mast cell neoplasms is broad. In this article, we elaborate on recent data pertaining to minor diagnostic criteria of systemic mastocytosis (SM), including sensitive testing methods for detection of activating mutations in the KIT gene or its variants, and adjusted serum tryptase levels in cases with hereditary α-tryptasemia. We also summarize entities that require differential diagnosis, such as the recently reclassified SM subtype named bone marrow mastocytosis, mast cell leukemia (an SM subtype that can be acute or chronic); the rare morphological variant of all SM subtypes known as well-differentiated systemic mastocytosis; the extremely rare myelomastocytic leukemia and its differentiating features from mast cell leukemia; and mast cell activation syndrome. In addition, we provide a concise clinical update of the latest adjusted risk stratification model incorporating genomic data to define prognosis in SM and new treatments that were approved for advanced SM (midostaurin, avapritinib).

Remote management of musculoskeletal pain : Apragmatic approach to the implementation of video and phone consultations in musculoskeletal practice. German version

EinleitungTelefon- oder Videosprechstunden gewinnen in der Therapie von muskuloskeletalem Schmerz über verschiedene Versorgungsbereiche hinweg an Bedeutung. Die verfügbaren technischen Optionen sind für die BehandlerInnen jedoch in ihrer Fülle schwer zu überblicken, und die Anpassung der klinischen Abläufe ist mit vielfältigen Herausforderungen verbunden. Darüber hinaus sind einige spezifische Aspekte hinsichtlich der regulatorischen Rahmenbedingungen sowie der PatientInnenversorgung zu berücksichtigen. Problematisch ist der Mangel an hochwertigen Peer-Review-Publikationen als Orientierungshilfe für die Planung und praktische Implementierung von Fernsprechstunden.ZielsetzungDieser Artikel soll praktische Orientierung bei der Planung und Implementierung von Fernsprechstunden für Management und Therapie von PatientInnen mit muskuloskeletalem Schmerz geben.MethodenDie Empfehlungen stützen sich auf eine kurze Übersicht der einschlägigen Studien zu Telefon- und Videosprechstunden in der Behandlung von Menschen mit Schmerzen des Bewegungsapparats. Empfehlungen werden aus Literatur, relevanten Leitlinien und praktischen Erfahrungen abgeleitet.ErgebnisseDie technische Machbarkeit von Fernsprechstunden bei muskuloskeletalen Beschwerden ist gut und die PatientInnenzufriedenheit hoch. Hinsichtlich einer Verbesserung von Schmerz und Funktionsfähigkeit gibt es zunehmend Belege für eine Wirksamkeit unter gewissen Bedingungen im Vergleich zu persönlichen Sprechstunden. Im vorliegenden Beitrag werden praktische Aspekte, wie die Wahl der Hard- und Software, detailliert behandelt. Auch auf den rechtlichen und regulatorischen Rahmen wird kurz eingegangen. Ein Fokus liegt auf der Anpassung klinischer Abläufe und der Kommunikation.SchlussfolgerungDer Beitrag fasst die Datenlage zum optimalen Vorgehen in einem praktisch anwendbaren Format zusammen, sodass TherapeutInnen, die mit SchmerzpatientInnen arbeiten, dieses Wissen direkt auf ihre persönliche klinische Umgebung und die Bedürfnisse ihrer PatientInnen anwenden können.

Diagnostics of BAP1-Tumor Predisposition Syndrome by a Multitesting Approach: A Ten-Year-Long Experience.

Germline mutations in the tumor suppressor gene BRCA1-associated protein-1 (BAP1) lead to BAP1 tumor predisposition syndrome (BAP1-TPDS), characterized by high susceptibility to several tumor types, chiefly melanoma, mesothelioma, renal cell carcinoma, and basal cell carcinoma. Here, we present the results of our ten-year experience in the molecular diagnosis of BAP1-TPDS, along with a clinical update and cascade genetic testing of previously reported BAP1-TPDS patients and their relatives. Specifically, we sequenced germline DNA samples from 101 individuals with suspected BAP1-TPDS and validated pathogenic variants (PVs) by assessing BAP1 somatic loss in matching tumor specimens. Overall, we identified seven patients (7/101, 6.9%) carrying six different germline BAP1 PVs, including one novel variant. Consistently, cascade testing revealed a total of seven BAP1 PV carriers. In addition, we explored the mutational burden of BAP1-TPDS tumors by targeted next-generation sequencing. Lastly, we found that certain tumors present in PV carriers retain a wild-type BAP1 allele, suggesting a sporadic origin of these tumors or a functional role of heterozygous BAP1 in neoplastic development. Altogether, our findings have important clinical implications for therapeutic response of BAP1-TPDS patients.

Long-Term Benefits of Tagraxofusp for Patients With Blastic Plasmacytoid Dendritic Cell Neoplasm.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive myeloid malignancy. We report long-term results, including data from the continued access phase, of the largest prospective BPDCN trial evaluating the CD123-targeted therapy tagraxofusp (TAG) in adults with treatment-naive and relapsed/refractory BPDCN. The primary outcome was complete response (CR) + clinical CR (CRc: CR with residual skin abnormality not indicative of active disease). Eighty-four (65 treatment-naive and 19 relapsed/refractory) of 89 patients received TAG 12 μg/kg once daily; the median follow-up was 34.0 months. For treatment-naive patients, the overall response rate was 75%; 57% achieved CR + CRc. The median time to remission was 39 (range, 14-131) days, and the median CR + CRc duration was 24.9 (95% CI, 3.8 to not reached) months. Nineteen patients (51%) with CR + CRc were bridged to stem-cell transplant, with a median CR + CRc duration of 22.2 (range, 1.5-57.4) months. Most common adverse events were increased alanine (64%) or aspartate (60%) aminotransferase and hypoalbuminemia (51%); most occurred in cycle 1 and were transient. Capillary leak syndrome occurred in 21% of patients (grade ≥ 3: 7%). In first-line patients with BPDCN, TAG monotherapy resulted in high and durable responses, allowing many to bridge to stem-cell transplant. TAG was generally well-tolerated with a predictable and manageable safety profile.

Clinical Updates on Screening and Diagnosis Criteria for Gestational Diabetes Mellitus Patients, as well as Therapeutic Management

The most prevalent metabolic and endocrine perinatal issue is gestational diabetes mellitus (GDM), which is an increasing health problem worldwide. It is a controversial entity, with conflicting guidelines and treatment protocols. In the United States, most doctors utilise a two-step strategy, first with a 50-g non fasting oral glucose challenge test at 24 to 28 weeks and then a 100-g fasting test for women who have a positive screening result. Alternatively, Clinicians take a one step Diabetes in Pregnancy Study Group India (DIPSI) method and perform simply a 75-g two hour fasting oral glucose tolerance test. The DIPSI approach of antenatal GDM screening has been demonstrated to be straightforward, cost effective, easy to use, patient friendly, and convenient. When comparing the findings to the gold standard of the International Association of Diabetes and Pregnancy Study Group (IADPSG), DIPSI shows high specificity and acceptable sensitivity. To maintain euglycemia, glucose monitoring, dietary changes, exercise, and, if necessary, medicines are used. Although insulin therapy is the most common treatment, glyburide and metformin may become more popular. Prenatal testing with nonstress tests and amniotic fluid indices, commencing in the third trimester, is commonly used to assess foetal well-being in women undergoing medication. The delivery technique and time are contentious. Women who have gestational diabetes are at a significant risk of developing type 2 diabetes later in life. As a result, along with routine diabetes screening, lifestyle adjustment should be recommended.

S181: MODAKAFUSP ALFA (TAK-573): UPDATED CLINICAL, PHARMACOKINETIC (PK), AND IMMUNOGENICITY RESULTS FROM A PHASE 1/2 STUDY IN PATIENTS (PTS) WITH RELAPSED/REFRACTORY MULTIPLE MYELOMA (RRMM)

Background: Modakafusp alfa (TAK-573) is a first-in-class immunocytokine designed to deliver attenuated interferon alpha-2b to CD38+ cells. In this phase 1/2 study (NCT03215030), the maximum tolerated dose of modakafusp alfa was defined as 3 mg/kg every 4 weeks (Q4W); preliminary data from 29 pts treated at 1.5 mg/kg Q4W (5 in dose escalation, 24 in dose expansion) showed single-agent, anti-myeloma activity with an overall response rate (ORR) of 38% after a median follow-up of 4.2 months (mos) (Vogl ASH 2021, #898). Aims: We present a clinical update on the efficacy and safety of modakafusp alfa 1.5 mg/kg Q4W after a median follow-up of 4.5 mos. We also present PK, immunogenicity, and dose-exposure-response data from the overall study. Methods: Eligible pts had received ≥3 prior lines of treatment. Pts received modakafusp alfa as a 1–4-hour IV infusion at 10 dose levels from 0.001–6 mg/kg at weekly (cycles 1–2 only; 0.001–0.75 mg/kg), every-2-week (0.2–0.3 mg/kg), every-3-week (Q3W; 0.4–0.75 mg/kg), or Q4W (0.75–6 mg/kg) dosing intervals; an expansion cohort was opened at 1.5 mg/kg Q4W after anti-myeloma activity was observed in 3/5 pts in the escalation cohort at that dose. Serum samples prepared from blood were used for PK and anti-modakafusp alfa antibody (ADA) assessments. Modakafusp alfa concentrations were determined via a validated enzyme-linked immunosorbent assay; ADA were detected using a validated bridging electrochemiluminescence assay. Results: As of Oct 2021, 30 pts had received modakafusp alfa 1.5 mg/kg Q4W. The median number of prior lines was 7 (range 3–16); 90% of pts were refractory to an anti-CD38 monoclonal antibody (mAb), while 37% were exposed to an anti-B-cell maturation agent (BCMA). Grade (G) 3–4 treatment-emergent adverse events (TEAEs) were reported in 25 pts (83%); the most frequent G3–4 TEAEs were neutropenia in 19 (63%), thrombocytopenia in 13 (43%), leukopenia in 12 (40%), anemia in 9 (30%), and decreased lymphocyte count in 9 (30%) pts. As reported previously, 1 pt in the 1.5 mg/kg Q4W cohort had a G3 bleeding event, while 3 pts had G3 infections. Among all pts, the ORR was 40% (complete response, 7%; very good partial response, 20%; partial response, 13%); among anti-CD38 mAb-refractory and anti BMCA-exposed pts, the ORR was 37% and 27%, respectively. Median progression-free survival was 6 mos and median duration of response had not been reached (Kaplan-Meier estimate, 91% at 6 mos). Based on pooled available data for the Q3W and Q4W cohorts (all doses) within the escalation and expansion phases, there was a strong trend for a dose-exposure-response relationship for ORR, with the apparent inflection point at 1.5 mg/kg Q4W dosing. No apparent relationship between dose-exposure-response and G3/4 thrombocytopenia or neutropenia was observed across all doses, whereas a correlation between dose-exposure-response and incidence of infusion-related reactions across the 0.4–6 mg/kg Q3W and Q4W dosing cohorts was found. There was an apparent non-linear (more than dose proportional) increase in exposure in the dose range of 0.1–3 mg/kg with a geometric mean terminal half-life of 13 hours in serum for modakafusp alfa 1.5 mg/kg. Based on the available data, 14% and 60% of pts were ADA positive at baseline and post-treatment, respectively. Summary/Conclusion: Modakafusp alfa has a novel mechanism of action and has shown encouraging activity with a manageable safety profile in pts with RRMM. Characterization of the potential clinical impact of immunogenicity is ongoing. The optimal dose for single-agent modakafusp alfa will be further investigated in a phase 2 study.

Joint Final Report of EORTC 26951 and RTOG 9402: Phase III Trials With Procarbazine, Lomustine, and Vincristine Chemotherapy for Anaplastic Oligodendroglial Tumors.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the basis of the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Anaplastic oligodendroglial tumors (AOTs) are chemotherapy-sensitive brain tumors. We report the final very long-term survival results from European Organization for the Research and Treatment of Cancer 26951 and Radiation Therapy Oncology Group 9402 phase III trials initiated in 1990s, which both studied radiotherapy with/without neo/adjuvant procarbazine, lomustine, and vincristine (PCV) for newly diagnosed anaplastic oligodendroglial tumors. The median follow-up duration in both was 18-19 years. For European Organization for the Research and Treatment of Cancer 26951, median, 14-year, and probable 20-year overall survival rates without versus with PCV were 2.6 years, 13.4%, and 10.1% versus 3.5 years, 25.1%, and 16.8% (N = 368 overall; hazard ratio [HR] 0.78; 95% CI, 0.63 to 0.98; P = .033), with 1p19q codeletion 9.3 years, 26.2%, and 13.6% versus 14.2 years, 51.0%, and 37.1% (n = 80; HR 0.60; 95% CI, 0.35 to 1.03; P = .063), respectively. For Radiation Therapy Oncology Group 9402, analogous results were 4.8 years, 16.5%, and 11.2% versus 4.8 years, 29.1%, and 24.6% (N = 289 overall; HR 0.79; 95% CI, 0.61 to 1.03; P = .08), with codeletion 7.3 years, 25.0%, and 14.9% versus 13.2 years, 46.1%, and 37% (n = 125; HR 0.61; 95% CI, 0.40 to 0.94; P = .02), respectively. With that, the studies show similar long-term survival even without tumor recurrence in a significant proportion of patients after first-line treatment with radiotherapy/PCV.

1049 IMPROVING TELEPHONE COMMUNICATION WITH FAMILIES ON A BUSY MEDICAL WARD DURING THE PANDEMIC

Abstract During the pandemic it became critical to reduce visiting to only very specific situations. This resulted in an increase of complaints where a lack of communication from the ward had been recognised as a theme, in spite of the fact that many doctors spent a great deal of time providing updates over the phone to patient’s families. It was noted there were a number of inefficiencies with respect to communicating with families; some families were being contacted repeatedly whereas others were struggling to get in touch. Chronic staffing shortages were also a barrier to effective and timely communication. Qualitative data collected via an online survey demonstrated that junior doctors valued the importance of communicating with families, particularly to provide clinical updates or obtain collateral histories, but found that the extra burden created by the pandemic resulted in far less time to do this efficiently and often resulted in time management difficulties. We introduced a strategy, by way of a magnetic communication board, that provided a flexible, at-a-glance method of ensuring all families had received regular updates from the medical team and collateral histories had been obtained for all relevant patients. We collected weekly data regarding the number of interactions between the medical team and patient relatives’ as a percentage of the total number of bed spaces. An overall improvement was noted: 67% pre-intervention to 76% post, with a maximum of 88% during one particularly successful week. We also were able to demonstrate an increase in ReSPECT form completion (from 40% to 65%). The introduction of an organisational tool such as our communication board resulted in improved patient and relatives’ satisfaction; and an improvement in team performance and overall time management. We are now aiming to build on this and roll it out during the next wave of the pandemic.

A Trapped Colon

A Trapped Colon

Immune checkpoint inhibitors for solid organ transplant recipients: clinical updates.

Transplant care continues to advance with increasing clinical experience and improvements in immunosuppressive therapy. As the population ages and long-term survival improves, transplant patient care has become more complex due to comorbidities, frailty, and the increased prevalence of cancer posttransplantation. Immune checkpoint inhibitors (ICIs) have become a standard treatment option for many cancers in non-transplant patients, but the use of ICIs in transplant patients is challenging due to the possibility of disrupting immune tolerance. However, over the past few years, ICIs have gradually started to be used in transplant patients as well. In this study, we review the current use of ICIs after all solid organ transplantation procedures (kidney, liver, heart, and lung). Increasing data suggest that the type and number of immunosuppressants may affect the risk of rejection after immunotherapy. Immunotherapy for cancer in transplant patients may be a feasible option for selected patients; however, prospective trials in specific organ transplant recipients are needed.

Clinical Update in Women's Heart Disease.

The goal in selecting these recent articles was to help identify literature that may change the clinical practice of women's health for practitioners in the primary care setting. Articles were identified by reviewing high-impact medical and women's health journals, national guidelines, ACP JournalWise, and NEJM Journal Watch. In this clinical update, we selected recent publications relevant to the prevention, risk assessment, and diagnosis of cardiovascular disease (CVD) in women. Breastfeeding now has data suggesting a robust reduction in subsequent CVD, and migraine with aura and severe and early- and late-onset hot flashes can now be considered risk factors for CVD. The decision to initiate menopausal hormone therapy is influenced by estimation of underlying vascular risk, and new data suggest that CVD risk scores are more accurate in predicting CVD risk than the traditionally used age and years since menopause and should be incorporated into counseling. Finally, new data support the growing belief that breast arterial calcification on mammography is a promising noninvasive marker that can enhance CVD risk prediction in women.

Lower Gastrointestinal Tract Disorders: Clinical Updates in Women's Health Care Primary and Preventive Care Review.

Lower gastrointestinal (GI) diseases and associated symptoms account for a large number of health care visits each year. Many women visit their obstetrician-gynecologists more often than their primary care physicians or use them as primary health care providers. Many gynecologic and lower GI disorders share symptoms, such as lower abdominal or pelvic pain and bloating. Some diseases are more common in women compared with men, such as irritable bowel syndrome (IBS), or warrant special consideration in women, for example, for inflammatory bowel disease (IBD). This monograph outlines the major diseases that affect the lower GI tract and reviews epidemiology, pathology, presentation, and treatment of these diseases. Concerns specific to women are addressed, including reproductive issues, changes in GI physiology during pregnancy, and management of lower GI disease during pregnancy.

In Through the Out Door: Editas' CEOs Grasp Opportunities Amidst Challenges

In Through the Out Door: Editas' CEOs Grasp Opportunities Amidst Challenges

Evaluating the impact of education on clinician integration of guidelines, real-world data, and patient perspectives on gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

e23005 Background: Targeted therapies for somatostatin receptor-positive NETs have seen significant developments in recent years. Approved and investigational somatostatin analogs for GEP-NETs are changing the treatment landscape for these cancers allowing for better management of difficult-to-treat heterogeneous tumors. To improve competence in applying these advances and to consider patient perspectives in treatment selection, an educational initiative was designed in collaboration with the Healing NET Foundation. Methods: A 1-hour CME activity was broadcast live-online in October 2021 and remains on-demand through October 2022 at OMedLive.com. The first module of the CME activity focused on real-world and quality-of-life data, and consensus guidelines related to somatostatin analogs (SSA) and peptide receptor radiotherapies (PRRT). The second module of the CME activity highlighted patient perspectives based on interviews of real patient with SSA and PRRT experience. This second section was distributed via social media through the Healing NET Foundation. Knowledge and competence questions were administered pre-, immediate post-, and 2 mos. post-activity. McNemar tests compared paired responses (pre/post & pre/2 mos) with Cohen’s d for effect size. Results: As of 01/28/22, 238 clinicians have participated in the activity, 80% of whom are physicians, advanced practitioners (NP/PA), and nurses. Through social distribution, the patient perspectives were viewed by 300 patients/caregivers. Across the four CME test questions low baseline knowledge/competence was observed when selecting treatment with SSA based on reported progression-free survival and time to deterioration of quality of life from clinical trial data. Clinical considerations based on patient perspectives and prophylactic regimens with PRRT also revealed low baseline knowledge/competence. Statistically significant improvements were seen for pre/post paired responses across all four CME questions with gains ranging from 25% to 53%. The greatest challenge managing a patient with GEP-NET, was identified as adherence to treatment schedules. At 2-mos. follow-up, 90% and 95% reported improved behavioral impact on both clinical practice and patient experience/outcomes, respectively. Qualitative data including clinician write-in examples of behavioral impact and patient perspectives from the interviews will be shared. Conclusions: Assessments reveal a positive impact of live-online education on clinical practice when sharing patient perspectives in context of clinical updates. Open-ended responses to behavioral impact questions illustrated clear improvements in clinician-reported patient experience and outcomes, clinical practice management, and knowledge of SSA and PRRT for patients with GEP-NETs.

Pregnancy and Metabolic-associated Fatty Liver Disease: A Clinical Update.

The intricate relationship between metabolic-associated fatty liver disease (MAFLD) and maternal complications has rapidly become a significant health threat in pregnant women. The presence of MAFLD in pregnancy increases the maternal risk of metabolic complications and comorbidities for both mother and baby. The preexistence or development of MAFLD in pregnancy is a complex multifactorial disorder that can lead to further complications for mother and baby. Therefore, as pregnant women are severely underrepresented in clinical research, there is a great need for a fair inclusion of this group in clinical trials. This review aims to explore the effects of MAFLD during pregnancy in the context of maternal complications and outcomes and explore the effects of pregnancy on the development and progression of MAFLD within the context of maternal obesity, altered metabolic profiles, gestational diabetes and altered hormonal profiles. We also addressed potential implications for the presence of MAFLD during pregnancy and its management in the clinical setting.

Interactions Between Statins, Exercise, and Health: A Clinical Update

Interactions Between Statins, Exercise, and Health: A Clinical Update

An Introduction to Tirzepatide.

Clinical Pharmacology Update| July 01 2022 An Introduction to Tirzepatide Taylor Bertsch Taylor Bertsch Search for other works by this author on: This Site PubMed Google Scholar Corresponding author: Taylor Bertsch, tbertsch@wsu.edu Clin Diabetes 2022;40(3):371–372 https://doi.org/10.2337/cd22-0038 PubMed: 35983423 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Citation Taylor Bertsch; An Introduction to Tirzepatide. Clin Diabetes 1 July 2022; 40 (3): 371–372. https://doi.org/10.2337/cd22-0038 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Diabetes Search Advanced Search Roughly one in 10 Americans have diabetes, and 90–95% of those have type 2 diabetes (1). Uncontrolled diabetes can lead to serious complications, including heart disease, vision impairment, and kidney damage (1). Tirzepatide, a once-weekly injectable medication in late-stage development, has shown promise in its ability to treat type 2 diabetes (2–5). Tirzepatide has not yet been approved by the U.S. Food and Drug Administration (FDA). If approved it is expected to have an indication for the treatment of type 2 diabetes. Tirzepatide is an injectable dual glucagon-like peptide 1 (GLP-1) receptor and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist (6). GIP is considered the dominant insulinotropic hormone when compared with GLP-1 and has demonstrated a stronger role in postprandial insulin secretion (7). Impressive A1C reductions to ≤5.7% (discussed below) are unique and highlight the potential clinical efficacy of... You do not currently have access to this content.

A clinical update on the molecular pathogenesis of gestational diabetes mellitus and its consequences

Gestational diabetes mellitus (GDM) is becoming more common all over the world, mainly to an increase in maternal obesity. There have been a number of approaches to screening for and diagnosing GDM described, however there is no consensus on which methods are the most effective. For the mother, developing fetus, and children born to mothers with GDM, GDM poses severe short and long-term health hazards. Macrosomia, shoulder dystocia, delivery trauma, and hypoglycemia in the immediate postpartum period are all short-term dangers for the fetus. Increased rates of childhood and adulthood obesity, as well as a higher cardio metabolic risk, are long-term hazards for offspring born to women with GDM. More investigations on the aetiology and underlying mechanisms of gestational diabetes and its complications on the long-term health of offspring are needed to offer a foundation for creating effective therapies during this important period with the goal of promoting lifelong health and well-being.

Outcome of Temporalis Myofascial Flap as an Interpositional Material in Temporomandibular Joint Ankylosis

Temporomandibular joint ankylosis is a common problem in Bangladesh due to trauma and infection. Diverse interpositional materials have been proposed in this regard with especial advantages and limitation. Interpositional arthroplasty is the best solution. The aim of this review article is to provide a useful clinical update about interpositional arthroplasty in temporomandibular joint ankylosis, its advantages and limitations. For this purpose eighteen articles were selected through searching internet, reviewed and are summarized here. Dental surgeons need proper training for proper diagnosis and adequate treatment. Research in this field will be helpful for both patients and doctors. Temporomandibular joint ankylosis, treatment objectives of TMJ ankylosis and update of temporalis myofascial flap as an interpositional material are described here. J Enam Med Col 2020; 10(3): 186-189