RESUMEN
Renin-angiotensin-aldosterone system (RAAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are commonly used in the management of hypertension. High blood pressure is a vital risk factor for cardiovascular disease. This study aims to establish any significant difference in using ACEIs and ARBs in managing hypertension. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct this systematic review. We searched PubMed, MEDLINE, and ScienceDirect for articles published in the last 20 years (2003 to 2023). Our search was last done on the 27th of June, 2023. Following the initial search, 8,313 articles were found on PubMed. After screening the articles selected from the databases, 10 articles examining 1,621,445 patients were selected for the final study. Three articles were identified that compared ACEI and ARB in their capacity to lower blood pressure. Six articles compared both medications' capacity to reduce cardiovascular events and mortality. Five articles were identified that compared both classes of drugs for adverse effects. This study was made to determine whether or not there is a difference between the use of ACEIs and ARBs in the treatment of hypertension. The study showed that both ACEIs and ARBs are similar in their efficacy in lowering blood pressure. However, ACEI was revealed to be superior to ARB in reducing cardiovascular events and all-cause mortality. ARB was shown to be better tolerated by patients than ACEI.
RESUMEN
The integration of artificial intelligence (AI) in healthcare has sparked interest in its potential to revolutionize medical diagnostics. This systematic review explores the application of AI and machine learning (ML) techniques in diagnosing scaphoid fractures, which account for a significant percentage of carpal bone fractures and have important implications for wrist function. Scaphoid fractures, common in young and active individuals, require an early and accurate diagnosis for effective treatment. AI has the potential to automate and improve the accuracy of scaphoid fracture detection on radiography, aiding in early diagnosis and reducing unnecessary clinical examinations. This systematic review discusses the methods used to identify relevant studies, including search criteria and quality assessment tools, and presents the results of the selected studies. The findings indicate that AI-driven methods can improve diagnostic accuracy, reducing the risk of missed fractures and complications. AI assistance can also alleviate the workload of medical professionals, improving diagnostic efficiency and reducing observer fatigue. However, challenges such as algorithm limitations and the need for continuous refinement must be addressed to ensure reliable fracture identification. This review underscores the clinical significance of AI-assisted diagnostics, especially in cases where fractures may be subtle or occult. It emphasizes the importance of integrating AI into medical education and training and calls for robust data collection and collaboration between AI developers and medical practitioners. Future research should focus on larger datasets, algorithm improvement, cost-effectiveness assessment, and international partnerships to fully harness the potential of AI in diagnosing scaphoid fractures.
RESUMEN
Niemann-Pick disease (NPD) A/B is a lysosomal storage disease (LSD), caused by an autosomal recessive disorder that causes variation in sphingomyelin phosphodiesterase-1 (SMPD1). Systemic signs are cholestatic jaundice in the neonatal period or hepatosplenomegaly in infancy. The clinical course experienced by our patient did not correspond to the classic phenotypes. The diagnosis was effectively made at four years and three months of age when different signs such as abdominal distension, hepatosplenomegaly, and chronic malnutrition were present. Given the high suspicion of metabolic storage disease, an enzyme activity study, liver and bone marrow biopsies, and molecular studies were performed. In the bone marrow biopsy, pseudo-Gaucher foam cells were observed. Additionally, the liver biopsy showed dispersed ballooned cells with deposit material and nested cells with granular material. The double enzymatic assay was ordered to determine if the cause of these findings was due to Niemann-Pick or Gaucher disease; decreased sphingomyelinase activity values were obtained (0.28 mcoml/L/h). Subsequently, the molecular genetics study reported a double alteration in the sequence that encodes the SMPD1 gene, located on chromosome 11p15.4, which confirmed NPD type A or B. The overlap and the lack of some findings made the diagnosis very difficult. Diagnosis is crucial due to the multisystem involvement that this LSD can have.