BACKGROUND:Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are widely used in managing type 2 diabetes (T2D). A significant number of these patients choose to observe religious fasting during Ramadan. Although existing guidelines recommend caution when administering SGLT2i during Ramadan due to potential adverse effects, there is limited data on their use in this patient population. AIM:To assess the safety and effectiveness of SGLT2i in patients with T2D who fast during Ramadan. METHODS:Relevant studies involving adults with T2D who received an SGLT2i in the intervention arm and other glucose-lowering drugs in the control arm were systematically searched through electronic databases. The primary outcome was the occurrence of adverse events in the two groups; additional outcomes included changes in glycemic and anthropometric parameters during the peri-Ramadan period. RevMan Web was used to conduct meta-analysis using random-effects models. Outcomes were presented as mean differences (MDs) or risk ratios (RRs) with 95%CI. RESULTS:Twelve studies involving 3625 subjects were included. The risks of postural dizziness (RR = 6.39, 95%CI: 1.58-25.80, P = 0.009, I 2 = 44%), hypotension/postural hypotension (RR = 4.43, 95%CI: 1.35-14.55, P = 0.01, I 2 = 31%), and sodium loss (MD = -1.00 mmol/L, 95%CI: -1.34 to -0.67, P < 0.00001, I 2 = 0%) were higher in the SGLT2i group compared to the non-SGLT2i group. The SGLT-2i group achieved larger reductions in systolic (MD = -2.41 mmHg, 95%CI: -4.52 to -0.30, P = 0.02, I 2 = 46%) and diastolic blood pressure (MD = -1.71 mmHg, 95%CI: -2.70 to -0.72, P = 0.0007, I 2 = 20%), and experienced a lower risk of symptomatic hypoglycemia (RR = 0.53, 95%CI: 0.29-0.97, P = 0.04, I 2 = 69%). The two groups exhibited comparable changes in glycated hemoglobin, body weight, and renal function. The risks of other specific adverse events, including dehydration, dizziness, volume depletion, symptomatic hyperglycemia, severe hypoglycemia, and genitourinary infections, were identical in the two groups. CONCLUSION:SGLT2i may be generally safe and effectively manage T2D during Ramadan; however, the results are less robust and should be interpreted with caution. Large multicenter randomized trials are necessary to confirm their safety, especially for at-risk groups, and to improve clinical decision-making.
Obesity is a global health crisis affecting developing nations, including India. The management of obesity continues to evolve with newer drugs, metabolic and bariatric surgery and endoscopic interventions, requiring family physicians and specialists to adapt their clinical practice accordingly. There is an urgent need for a standardized algorithm to diagnose, stage, and treat obesity. The Endocrine Society of India (ESI) and the Obesity Surgeons Society of India (OSSI) appointed a steering committee to develop an evidence-based algorithm for managing patients with obesity in India. This was put to vote by 80 specialists (38 from OSSI and 42 from ESI) in a physical meeting. A proposed stage-wise algorithm based on Edmonton Obesity Staging System, Asian definition of obesity, and resources in India, received 100
We aimed to compare the improvements in pain at 1-month and in pain and functional outcomes at 1-year between the ultrasound (USG)- guided suprascapular notch (SSN) steroid injections and the USG-guided intra-articular (IA) steroid injections in the treatment of frozen shoulder. Two sequential groups were compared: the first group underwent USG-guided SSN steroid injections (SSN group, n = 29), and the second group underwent USG-guided IA steroid injections (IA group, n = 35). At 1 month, significantly greater proportion of patients had > 50
Nutrition plays a vital role in growth, development, and long-term health, particularly during adolescence, a critical phase marked by rapid physical and psychological changes. Despite increased exposure to health information, adolescents often lack structured and scientifically accurate nutrition knowledge, especially those from non-science academic backgrounds. In recent years, growing scientific evidence has highlighted the importance of gut health, gut microbiota, probiotics, prebiotics, and dietary fiber in maintaining digestive and overall well-being. However, awareness regarding these emerging concepts remains limited among younger populations. The present study aimed to assess awareness regarding gut health, probiotics, prebiotics, and dietary Fiber among junior college-going adolescent girls and to evaluate the impact of a nutrition education intervention on awareness levels. A quantitative pre-test and post-test interventional study was conducted among 100 junior college-going adolescent girls (16–18 years) in Mumbai. A self-developed, expert-validated questionnaire was used to assess awareness before and after three structured nutrition education sessions. Paired t-test analysis revealed statistically significant improvement in post-test scores across all domains (p < 0.001). The findings indicate that structured, age-appropriate nutrition education can effectively enhance gut health awareness among adolescent girls and may contribute to improved nutrition literacy in this population.
Background Severe submucosal fibrosis (SMF) is the strongest predictor of technical failure and prolonged procedure time in conventional per-oral endoscopic myotomy (POEM). Underwater POEM (uPOEM) may offer advantages in fibrotic cases, but its effectiveness remains unexplored. Methods This is a single-center, retrospective case series of consecutive patients who underwent uPOEM using near-focus magnification for achalasia with SMF between July 2024 and December 2025. Results Of 153 POEM procedures, 12 patients had SMF (median age 56 [IQR 52-63] years, symptom duration 9 [IQR 7.2-10] years). Four were treatment-naive. Eight had type I (66.7%) and four (33.3%) type II achalasia. Sigmoid esophagus (S1) was present in 3 (25%), S2 in 2 (16.7%), and straight type in 7 (58.3%). The median integrated relaxation pressure (IRP) was 30 (IQR 27-33) mmHg. uPOEM was successfully completed in all 12 patients (100%) with near-focus magnification in whom uPOEM-assisted tunneling was initiated, after exclusion of one aborted pre-tunneling case. The median procedure time was 54 (IQR 52-58) min. One patient had a mucosal breach (Type I), managed with hemoclips. The median Eckardt score decreased significantly from 7 to 0 at 3 months ( p < 0.001). Conclusions uPOEM is safe and appeared feasible in severe SMF, yielding favorable short-term outcomes. Near-focus magnification allows better identification of the submucosal layer allowing for more precise dissection.
