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Linagliptin is a convenient and effective drug approved for glycemic management in type 2 diabetes mellitus (T2DM). However, the effectiveness and safety evidence of linagliptin remains unclear with the increasing prevalence of T2DM in elderly patients.

For evaluating the effectiveness and safety of linagliptin within T2DM cases who aged ≥60 years.

The researchers pooled 4903 cases aged ≥60 years with T2DM from 5 published randomized clinical trials obtained from multiple databases. The safety was evaluated by the incidence and severity of adverse events (AEs) which mainly focused on hypoglycaemia. The major effectiveness end point was the change of glycated haemoglobin (HbA1c). Then the researchers made the qualitative and quantitative assessments of the investigation.

The level of HbA1c and FPG was significantly reduced by linagliptin (WMD=-0.63%, 95% CI -0.81, -0.44; p<0.00001; Z=6.70) and (WMD=-15.58 mg/dL, 95% CI -22.34, -8.82; p<0.00001; Z=4.52) relative to that in the placebo cohort. The incidences of overall (OR=1.01, 95% CI 0.82, 1.25; p=0.91) and severe negative events (OR=0.88, 95% CI 0.61, 1.25; p=0.46) were not significant increased in linagliptin cohorts compared to the placebo cohorts. There is insignificant difference in hypoglycaemia between linagliptin and placebo cohorts for the 24 weeks' study(OR=1.12, 95% CI 0.85, 1.48; p=0.41). Severe hypoglycemia had slightly descended incidence, whereas insignificant difference was shown in the linagliptin cohorts in contrast to placebo cohorts (OR=0.95, 95 % CI 0.68, 1.32, p=0.76).

Linagliptin is an effective drug with excellent safety for elderly T2DM.

Linagliptin is an effective drug with excellent safety for elderly T2DM.

In cancer patients with diabetes, anticancer drugs (ADs) may negatively affect the course of diabetes vascular complications. The short-term effects of ADs on type 2 diabetes (T2D) retinopathy are poorly known. This study evaluated the short-term effects of different classes of ADs on diabetic retinopathy (DR) and clinical risk factors for retinal worsening (RW) in cancer patients affected by T2D.

Retrospective single-centre study evaluating 168 patients with T2D and cancer. The diagnosis of T2D preceded those of cancer in all patients. We evaluated the retinal short-term effects within the six months after the first-line ADs treatment.

After ADs, 6% of patients had a short-term RW. BMI is positively associated with the risk of RW (OR 1.45, 95% confidence interval (CI) 1.1-1.9, p<0.005). Patients treated with alkylating agents and topoisomerase inhibitors have an increased risk of RW (p=0.049 and p=0.057, respectively) and a significantly higher HDL level (p<0.01).

To our knowledge, this study is the first investigating the short-term impact of ADs on DR of T2D patients. Moreover, we provide information arose from a real-world setting. As confirmed by other studies, these findings could help to identify patients at risk for shortterm RW, who should be promptly referred to the ophthalmologist for the prevention of visual impairment.

To our knowledge, this study is the first investigating the short-term impact of ADs on DR of T2D patients. Moreover, we provide information arose from a real-world setting. As confirmed by other studies, these findings could help to identify patients at risk for shortterm RW, who should be promptly referred to the ophthalmologist for the prevention of visual impairment.

Diabetic Nephropathy (DN), a microvascular complication associated with long-standing diabetes, is a major cause of the end-stage renal disease (ESRD). Our in-silico analysis indicates several enrichment analyses involved in glucose metabolism to be affected by GDF15 transcription factors.

In-silico analysis was used to identify GDF15 and Insulin related protein-protein interaction (PPI) network and a common set of GDF15 regulating transcription factors by various databases. Common targeting miRNA of GDF15 regulating transcription factors were investigated in miRNet and TargetScan. Further, healthy controls (n=30) and patients with pre-Type-2 Diabetes mellitus (Pre-diabetes) (n=30), T2DM (n=30) and DN (n=30) were included for analysis of routine biochemical tests, serum GDF15 levels by ELISA and to evaluate the Fold change expression (FCE) of circulating hsa-miR-21 by RT-PCR.

MicroRNA-21 was found to directly target GDF15 downregulating transcription factors KLF4, TP53, and CEBPB. A significant difference in the levels of serum GDF15 was observed in Pre-diabetes (708.56 ±76.37), T2DM (1528.87 ±140.75) and DN patients (10-fold higher; 5507.90 ±503.88) when compared to healthy controls (567.36 ±69.99). The FCE of circulating hsa-miR-21 was 6.19 (Pre-diabetes), 8.22 (T2DM), 9.19 (DN), folds higher in cases as compared to controls, reflecting an increasing trend and several folds higher levels of hsa-miR-21 in patients.

We suggest the potential of serum GDF15 and circulating-hsa-miR-21 to serve as clinically important biomarkers and therapeutic targets for controlling advancement of diabetes to DN.

We suggest the potential of serum GDF15 and circulating-hsa-miR-21 to serve as clinically important biomarkers and therapeutic targets for controlling advancement of diabetes to DN.

To describe the approach to the patients with suspected sepsis in the Spanish emergency department hospitals (ED) and analyze whether there are differences according to the size of the hospital and the number of visits to the emergency room.

Structured survey of those responsible for the 282 public EDs that serve adults 24 hours a day, 365 days a year. It was asked about assistance and management in the emergency room in the care of patients with suspected sepsis. The results are compared according to hospital size (large ≥ 500 beds vs medium-small <500) and influx to the emergency room (discharge ≥ 200 visits / day vs medium-low <200).

A total of 250 Spanish EDs responded (89%). Sepsis protocols are available in 163 (65%) EDs median weekly sepsis treated ranged from 0-5 per week in 39 (71%) ED, 6-10 per week in 10 (18%), 11-15 per week in 4 (7%), and more than 15 activations per week in 3 centers (3.6%). The criteria used for sepsis diagnosis were the qSOFA/SOFA in 105 (63.6%) of the hospitals, SIRS in 6 (3.6%), while in 49 (29.7%) they used both criteria simultaneously. In 79 centers, the sepsis diagnosis was computerized, and in 56 there were tools to help decision-making. 48% (79 of 163) of the EDs had data on bundles compliance. In 61% (99 of 163) of EDs there was training in sepsis and in 56% (55 of 99) it was periodic. Considering the size of the hospital, large hospitals participated more frequently as recipients of patients with sepsis and had an infectious, sepsis and short-stay unit, a microbiologist and infectious disease specialist on duty.

Most EDs have sepsis protocols, but there is room for improvement. The computerization and development of alerts for diagnosis and treatment still have a long way to go in EDs.

Most EDs have sepsis protocols, but there is room for improvement. The computerization and development of alerts for diagnosis and treatment still have a long way to go in EDs.

To analyze whether current medical residency training programs in Spain foster the acquisition of knowledge and skills that enable specialists to provide emergency and urgent medical care.

We studied documents related to the content of residency programs for the following 4 specialties in effect in June 2021 internal medicine, intensive care medicine, anesthesiology and critical care, and family and community medicine. Program descriptions were obtained from the website of the Spanish Ministry of Health and the professional associations for each specialty. The associations' unofficial drafts and proposed updates were also studied. For emergency and urgent medicine, we studied drafts and updates of proposals presented to the Ministry of Health by the Spanish Society of Emergency Medicine (SEMES) in 2010 and an updated version presented in 2021. The proposals were drafted by the SEMES committee to promote specialization in emergency medicine.

Existing residency programs treat the management of urgent evenmergency and urgent care resource coordination centers are also included.

Currently available residency training in Spain does not provide appropriate preparation for practicing emergency medicine. Emergency medicine has its own body of theory and settings for practice that differ from those of other specialties. Therefore, at present there is a training gap in Spain that should be filled by creating a specialization in emergency medicine.

Currently available residency training in Spain does not provide appropriate preparation for practicing emergency medicine. Emergency medicine has its own body of theory and settings for practice that differ from those of other specialties. Therefore, at present there is a training gap in Spain that should be filled by creating a specialization in emergency medicine.

Emergency services' main purpose is to save lives, but that worthy mission cannot always be accomplished. When caring for patients toward the end of life, we have an ethical obligation to talk with them and their relatives to obtain consensus on treatment and possibly limit it or adjust management in accordance with the patient's condition. Emergency department protocols are necessary for optimizing care to provide the greatest possible comfort and control of symptoms in patients at the end of life to prevent unnecessary suffering and preserve dignity. This article sets out recommendations - including the principles and ethical standards that underlie them - so that emergency services can develop end-of-life care protocols for use in their own settings.

Emergency services' main purpose is to save lives, but that worthy mission cannot always be accomplished. When caring for patients toward the end of life, we have an ethical obligation to talk with them and their relatives to obtain consensus on treatment and possibly limit it or adjust management in accordance with the patient's condition. Emergency department protocols are necessary for optimizing care to provide the greatest possible comfort and control of symptoms in patients at the end of life to prevent unnecessary suffering and preserve dignity. This article sets out recommendations - including the principles and ethical standards that underlie them - so that emergency services can develop end-of-life care protocols for use in their own settings.

To analyze the frequencies of 3 types of hospital revisits by patients after treatment for COVID-19 in the emergency department.

Retrospective observational study of consecutive patients who came to the emergency department in March and April 2020 and were discharged alive with a diagnosis of COVID-19. ISX-9 research buy Baseline and acute episode data were collected and the patients were followed for 1 year. We analyzed variables associated with revisits for any reason, revisits related to COVID-19, and early COVID-19-related revisits (within 30 days).

A total of 1352 patients with a mean age of 62.1 years (52.9% male) were studied. A total of 553 revisits were made by 342 patients (25.3%) for any reason; 132 (9.8%) revisited in relation to COVID-19 at least once. Of those, 103 (7.6%) revisited within 30 days (early) and 29 (2.2%) came later. COVID-19-related revisits were associated with thrombotic events (odds ratio [OR], 7.58; 95% CI, 1.75-32.81) and pulmonary fibrosis (OR, 4.95; 95% CI, 1.27-19.24); early revisits were inversely associated with follow-up management by a contracted health care support service (OR, 0.