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There is limited data comparing two gliflozins on their effect on biomarkers in diabetic patients with chronic heart failure. A prospective, multicenter, active controlled, double-arm, investigator-initiated, interventional study enrolled 250 adults with type 2 diabetes mellitus (T2DM) and comorbid congestive heart failure (CHF; left ventricular ejection fraction [LVEF] <40%; N-terminal pro-B-type natriuretic peptide [NT-proBNP] >600 pg/mL). A total of 125 patients were allocated each to a remogliflozin (R) and empagliflozin (E) group and followed up for 24 weeks. The primary endpoint was the mean percentage change from baseline in NT-proBNP level after 24 weeks. There was significant improvement from baseline in mean NT-proBNP level in both groups after 24 weeks. However, there was no significant difference between the two groups (P =.214). The mean NT-proBNP level improved from 2078.15 ± 1764.70 pg/mL at baseline to 1185.06 ± 1164.21 pg/mL at 6 months in the R-group (P ≤.001) and from 2283.98 ± 1759.15 pg/mL at baseline to 1395.33 ± 1304.18 pg/mL at 6 months in the E-group (P <.001). LVEF and LV volumes improved in both groups. The glycemic parameters (HbA1c, FPG, and PPG) demonstrated a significant reduction from baseline to week 24 in both groups. Similar improvement was seen in heart rate, blood pressure, and weight reduction over 6 months in both groups. There was no drug-related serious adverse events in any group. Remogliflozin and empagliflozin significantly improve glycemic parameters and NT-proBNP levels as the index of the therapeutic effects in T2DM patients with CHF. The positive effects are comparable in both groups. [ABSTRACT FROM AUTHOR]

The rising challenge of carbapenem-resistant Enterobacterales (CRE) infections in Indian healthcare settings calls for clear clinical guidance on the management of these infections. The Indian consensus on the management of CRE infection in critically ill patients (ICONIC-II) is a follow-up of the ICONIC-I study, which was undertaken in 2019. A modified Delphi method was used to build expert consensus on CRE management in India, involving online surveys, face-to – face expert meetings, and a literature review. A panel of 12 experts was formed to develop potential clinical consensus statements (CCSs), which were rated through two survey rounds. The CCSs were finalized in a final face-to – face discussion. The finalized CCSs were categorized as consensus, near consensus, and no consensus. The outcomes included 46 CCSs (consensus: 40; near consensus: 3; and no consensus: 3). The expert panel discussed and achieved consensus on various strategies for managing CRE infections, emphasizing the significance of existing and emerging resistance mechanisms, prompt and tailored empiric therapy, and use of combination therapies. The consensus statements based on the collective expertise of the panel can potentially assist clinicians in the management of CRE infections that lack high-level evidence. [ABSTRACT FROM AUTHOR]

Background: The safety and efficacy of fixed-dose combination (FDC) of glycopyrronium bromide 12.5 μg/formoterol fumarate 12 μg (GB/FF) twice daily as dry powder inhalers (DPIs) compared to glycopyrronium 50 μg monotherapy (GLY) once daily as DPI in subjects with moderate-to-severe chronic obstructive pulmonary disease (COPD) were evaluated. Methods: This was a phase-3, randomized, double-blind, active-controlled, parallel-group, superiority study conducted in India. COPD patients aged ≥40 to ≤65 years, current or ex-smokers with FEV1/FVC <0.70, using ICS, LAMA, or LABA for ≥1 month were included. Subjects were randomized (1:1) to GB/FF or GLY for 12 weeks. The primary efficacy endpoint was the change from baseline in peak FEV1 at the end of 12 weeks. The study is registered with the Clinical Trials Registry of India (CTRI/2017/02/007814). Results: Between March 2017 and July 2018, 331 patients were enrolled and randomized into GB/FF FDC (165 patients) and GLY monotherapy (166 patients) groups. At week 12, the difference in change from baseline in the peak FEV1 for GB/FF DPI versus GLY was 0.115 L (SE = 0.02; 95% CI = 0.061, 0.170; P < 0.0001). Trough FEV1 increased significantly in the GB/FF group compared to the GLY group with a treatment difference of 0.078 L (SE = 0.02; 95% CI = 0.015, 0.14; P = 0.01). There were no significant differences in adverse events between the groups. Conclusion: FDC of GB/FF (12.5/12 μg twice daily) as a DPI provides superior bronchodilation and lung function improvement over GLY (50 μg once daily) monotherapy. It is safe and well tolerated in symptomatic COPD patients. [ABSTRACT FROM AUTHOR]

The selection of chemotherapeutic agents in the management of metastatic renal cell carcinoma is a challenge as it has to strike a delicate balance between adverse effects and patient affordability based on the individual risk stratification. In this narrative review, authors have discussed about the various tyrosine kinase inhibitors available and the preference for axitinib as the first-line drug when used as a single agent or in combination with immunotherapeutic agents. This review article has been written based on a literature search of relevant articles conducted from September 2020 to December 2020 across PubMed and Google Scholar. [ABSTRACT FROM AUTHOR]

Background: This study presents a real-world scenario for prescription pattern, efficacy, and safety data on the current clinical use of intravenous fosfomycin in critically ill patients in Indian settings. Patients and methods: This was a retrospective cohort study conducted for a period of 10 months among critically ill patients admitted to hospital's critical care unit. The primary objective of the study was to analyze the prescription pattern of intravenous fosfomycin, and the secondary objective was to evaluate the safety profile and patient outcomes. Results: A total of 309 patients were enrolled, and they were diagnosed with bacteremia (45.3%), pneumonia (15.85%), septic shock (14.24%), and urinary tract infections (UTI) (13.91%). The average dose of fosfomycin given was 11.7 ± 4.06 gm/day. The average duration of the therapy was 4.85 ± 3.59 days with a median duration of 4 days. Fosfomycin was given at 8 hourly dosing frequency to maximum (45.6%) cases. Hypokalemia was the most observed adverse event. The overall survival was seen in 55% of patients. Conclusion: Our data suggest that UTI, infection caused by Escherichia coli, and a daily dose of >12 g were associated with better clinical outcomes. The overall survival of critically ill patients receiving fosfomycin was 55%. [ABSTRACT FROM AUTHOR]

Astaxanthin is a naturally occurring ketocarotenoid which has been found to have numerous biological functions, with its strong antioxidant property being the prominent feature. The compound has attracted a great amount of interest with respect to its potential utilization in the betterment of human health. In the recent past, astaxanthin has been extensively studied with respect to its possible effect on skin health, with positive results. Astaxanthin has also shown to have anti‐inflammatory, immune‐modulating, and DNA repair properties, which have further encouraged its usage to maintain skin health and tackle skin damage. In this review article, we highlight the pharmacokinetic profile of the antioxidant in brief and describe the findings of various recent published research articles which studied the effect of astaxanthin in improvement of skin health. We also mention the possible mechanisms which form the basis of the positive dermatological effects of astaxanthin and the potential indications of the antioxidant molecule in cosmetology and dermatology. [ABSTRACT FROM AUTHOR]

The article reports on a case of ventilator-associated pneumonia due to extensive drug resistant (XDR) Pseudomonas aeruginosa managed by polymyxin-B and doripenem combination. Topics covered include the result of the patient's computed tomography examination, treatments received by the patient for acute respiratory distress syndrome (ARDS), and the importance of adaptive resistance in bacterial growth during polymyxin treatment.

Necrotizing fasciitis (NF) is an aggressive and life-threatening infection of skin and soft tissue characterized by widespread fascial necrosis, leads to gross morbidity and mortality if left untreated. Although MRSA has become a common isolate associated with skin and soft tissue infections globally over the past few years, monomicrobial MRSA NF has been reported only in a few studies. Our case represents the development of NF followed by trivial trauma salvaged with daptomycin and amputation of the affected limb. Prompt diagnosis and surgical management with empiric MRSA cover in areas where community acquired MRSA (CA-MRSA) is endemic for suspected cases of necrotizing fasciitis can prevent the dreaded consequences. [ABSTRACT FROM AUTHOR]

Background Cough in common cold is often associated with rhinorrhoea and nasal congestion, requiring treatment with a cough suppressant, decongestant, and antihistamine. Bilastine is a non-sedating antihistamine, a preferred option over sedating antihistamines. A combination of bilastine, dextromethorphan, and phenylephrine is expected to provide non-sedating treatment for cough associated with a common cold or allergy. Methods In this open-label, randomized, active-controlled, multicentre, clinical trial, adult and adolescent subjects with acute dry cough received bilastine 6.6 mg/dextromethorphan 20 mg/phenylephrine 10 mg syrup (BDP) thrice daily or Alex ® syrup (chlorpheniramine maleate 4 mg/dextromethorphan 20 mg/phenylephrine 10 mg) for seven days. The objective of the study was to evaluate the efficacy and safety of a fixed-dose combination syrup of bilastine, dextromethorphan, and phenylephrine in cough relief in patients with cough associated with a common cold or allergy. Results Of 134 randomized subjects, 67 received BDP and the remaining 67 received Alex® syrup. The least-square mean (LSM) standard error (SE) change in cough severity from baseline on day 4 was 37.86 mm (2.012) in the BDP group (p < 0.001), with a mean difference between the two groups of -4.09 mm (95% CI: -9.68, 1.51). The confidence interval was within the non-inferiority (NI) limits of 30 mm, proving non-inferiority to Alex ® syrup (p-value for NI < 0.001). The drowsiness score was significantly lower in the BDP group on day 2 (difference -0.46, p = 0.004), day 4 (difference -0.99, p < 0.001), and day 8 (difference -0.97, p < 0.001). No serious or severe adverse event was reported, and adverse events were comparable between the two groups. Conclusion Bilastine/dextromethorphan/phenylephrine combination syrup is efficacious, safe, non-sedating, and non-inferior to Alex ® syrup in the treatment of acute dry cough due to a common cold or allergy., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Suyash Hospital Institutional Ethics Committee issued approval GPL/CT/2022/001/III. Statement from the ethics committee: We approve the trial to be conducted in its presented form at the following site: Suyash Institute of Medical Science Pvt. Ltd. The above approval is 1 of 10 ethics committee approvals taken corresponding to 10 study sites. The scanned copies of all the IRB approval letters have been sent to the editor by a member of the Cureus Support team owing to a technical issue with uploading figures to the Appendices section (as suggested) as per Request #108307. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Dr Rahul Kodgule, Wen Wu, Amol Pendse, Dr Sheldon Creado, Dr Saiprasad Patil, Dr Hanmant Barkate and Dr Monika Tandon declare(s) employment from Glenmark Pharmaceuticals Limited. The authors mentioned are employees of Glenmark Pharmaceuticals Limited. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kodgule et al.)