A BSTRACT Objective: The aim of this systematic review was to evaluate the clinical implications of continuous glucose monitoring (CGM) among patients with diabetes mellitus using variables that include glycated hemoglobin (HbA1c), estimated A1c, glucose variability, and users’ perspectives. Materials and Methods: This study analyzed 17 articles that were identified and studied according to the research question criteria. PRISMA guidelines were used for identification and screening of the literature. The required data were searched using Medscape, PubMed, PROSPERO, Wiley Library, Scopus, Clinical Trial Registry, and Trip. Results: The articles reviewed were on the use of CGM in type 1 and type 2 diabetes mellitus, which showed significant improvement in the levels of HbA1c as compared to non-CGM. The application of CGM on acute sudden onset type of adverse drug reactions (i.e., hypoglycemia) is better than fasting blood sugar or self-monitoring of blood glucose or capillary blood glucose (random blood glucose monitoring). CGM is beneficial for use in patients with type 2 diabetes mellitus including elderly patients as it gives information regarding glucose variability as well as HbA1c levels. The health-care providers require full spectrum of patients’ CGM data to design a better therapeutic plan. However, the patients experienced inconvenience on wearing the device on the body for longer periods. The findings also stated the fact that more education and training is required for the patients to interpret their own glycemic data using CGM and modify their lifestyle accordingly. Use of CGM along with HbA1c has also been used to achieve better glycemic results and it allows the health care professional to guide patients in terms of their glucose level; whether they are hypoglycemic or hyperglycemic, however its use has some controversies that minimize its application. Conclusion: The study concluded that CGM has significant potential in the management of not only patients with type 1 diabetes mellitus but also patients with type 2 diabetes mellitus in spite of the few limitations that are being improvised in the upcoming years. However, limited literature of CGM among patients with type 2 diabetes mellitus and pregnant women reduces the practice scope.

The aims of the study were to evaluate the services of emergency medicine pharmacists in patient care and to assess the need to implement clinical pharmacy practice in emergency department. This study analyzed English language articles, which were identified and studied according to the inclusion criteria. The articles were identified from different databases from 1982 to 2020. Two hundred fifty articles were primarily searched for inclusion criteria and a preferred reporting items for systematic reviews and meta-analyses diagram was created to describe qualitative analysis. Quality assessment of the studies was done using the strengthening the reporting of observational studies in epidemiology checklist. A total of 9 studies were quality assessed and included for evidence synthesis. Four studies showed a significant reduction in readmission rate P < 0.0001 with an odds ratio (OR) of 1.6341 for the patients with the pharmacist care group. Patient's in-hospital mortality and appropriateness of medications had an OR of 3.2196 (P = 0.0353) and 0.1444 (P = 0.0001), respectively. The pooled OR (n = 1026) in 4 studies was 1.4534 (95% confidence interval = 0.2844–0.7292) in antibiotic guidelines for pharmacist interventions. In addition, evidence showed a statistically significant reduction in hospital revisits (P < 0.00001, OR = 2.05, 95% confidence interval = 1.76–2.39) with the pharmacist in the emergency department compared with no pharmacist. The meta-analysis concluded that clinical pharmacy interventions in the ambulatory setting had a positive impact on clinical outcomes related to disease management, medication optimization, ensuring patient safety, and providing quality of care. Studies identified did not evaluate the impact of pharmacists on cost-effectiveness, which is a useful direction for future study.

The aim of this clinical review was to have an in-depth knowledge of the antibiotics being used to treat lower respiratory tract infections which are most likely to occur in the pediatric population of different age groups. Methods: This study analyzed 43 articles which were studied and identified according to the research criteria. The required data has been searched using research gate, ncbi, Medscape, Mayo Clinic, WebMD. Results: The findings included different levels of effectiveness in the 5 generations of cephalosporin's as some killed certain bacteria's better than others and are relatively short acting with half-life of about 30-120 minutes when compared to penicillin. For example, first generation cephalosporin's were quite active against gram positive bacteria when compared to gram negative bacteria however, the efficacy was reduced due to resistance. It was discussed regarding second generations that they are effective against both gram negative and gram-positive bacteria and are resistant to Blactamase more than the first generations, therefore have a high anti-bacterial activity. As far as the third and fourth generations were concerned, they were able to penetrate the blood-brain barrier and were frequently designed for bacterial meningitis which were caused by susceptible pathogens. Fifth generations have a similar mechanism of action as that of the 3 rd generations and can treat resistant staphylococcus aureus and streptococcus species which are resistant to penicillin antibiotics. On the other hand, Carbapenems (penetrates bacterial cell wall of micro-organisms and inhibits cell wall synthesis) and aminoglycosides (inhibits protein synthesis by binding to bacterial ribosomes and inducing misreading of the of the genetic code) are one of the most highly efficacious as they prevent severe and high risk bacterial infections although, rare incidents of toxicity and life threatening side effects have been reported when taken aminoglycosides. Conclusion: Penicillin is the safest to treat and prevent the lower respiratory tract infections in the pediatric population as they have minor side effects such as headache, nausea compared to other antibiotics.