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Introduction. The introduction of sodium glucose cotransporter 2 inhibitors in the management of diabetes was an innovation in the treatment of this disease, considering the protective cardiovascular effect not only the ability of decreasing the plasma glucose. In Europe, this class of medication is approved for the treatment of type 2 diabetes and some of them (dapagliflozin and sotagliflozin) are also approved for use in certain patients with type 1 diabetes mellitus. These patients must have inadequate control of their blood glucose levels despite optimal insulin therapy. One of the adverse effects is diabetic ketoacidosis.
Case report. This case report presents a diabetic patient whose treatment was changed from insulin therapy to oral therapy. Within 10 days after the initiation of the new treatment her condition gradually worsened and she arrived at the emergency room with nausea, vomiting and altered general condition. She was admitted for euglycemic ketoacidosis and treated according to the protocol.
Conclusions. This case reveals the importance of continuing the insulin therapy when adding a sodium glucose cotransporter 2 inhibitor in type 1 diabetes patients.
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Macklin R. The Declaration of Helsinki: another revision. Indian J Med Ethics
Pascal Meier, Olaf Franzen and Alexandra J. Lansky
Recent innovations in interventional cardiology have dramatically expanded the therapeutic options for patients with cardiac conditions. Interventional cardiology is no longer limited to the treatment of coronary artery disease but allows also treatment of valvular disease, stroke prevention, hypertension, etc. One of the most important new treatment options is the percutaneous treatment for aortic valve stenosis (transcatheter aortic valve implantation), since aortic valve disease is a rather common problem in elderly patients, with many of them at high risk for surgery. Similarly, mitral regurgitation is often associated with comorbidities which make surgery high risk. The MitraClip is a promising percutaneous alternative to surgical valve repair or replacement. Other procedures discussed in this review are the percutaneous left atrial appendage closure as a non-pharmacologic therapy to prevent strokes, and renal denervation for resistant hypertension. This review explains the basic principles of these procedures, the most important clinical evidence, and also provides additional recent clinical data on each of these them.
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3. International Diabetes
Simona Popescu, Laura Diaconu, Bogdan Timar and Romulus Timar
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Novita Intan Arovah and Bernadeta Maria Wara Kushartanti
around the world. McKinsey’s Center for Healthcare Research and Innovation (CHRI) 2016.
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