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Background Recent data suggest that the prevalence of heart failure has increased to approximately 23 million people globally. With increasing advancement in pharmacotherapeutics, Sodium-Glucose Cotransporter-2 inhibitors (SGLT2i) have garnered attention among clinicians to treat Heart failure with reduced ejection fraction (HFrEF) in diabetic as well as non-diabetic patients. Methods MEDLINE, Scopus, Embase and Cochrane CENTRAL database were searched using relevant keywords and MeSH terms. Studies were considered only if they were randomized in nature and had a sample size >1000 HF patients. Results Our comprehensive search strategy yielded 864 articles, of which three RCTs met the inclusion criteria with a total population of 9696. Pooled analysis revealed an association between the use of SGLT2i and decreased frequency of primary outcome irrespective of background ARNI use (HR 0.73, 95% CI [0.58–0.93], p = 0.0106; HR 0.73, 95% CI [0.66–0.81], p < 0.0001). Conclusion This meta-analysis provides substantial evidence, to safely use SGLT2i atop ARNI therapy in select HF patients to further improve outcomes.

OBJECTIVE To compare the possibility of Post-operative hemorrhage in septoplasty with and without nasal packing among the patients operated at PNS SHIFA hospital Karachi STUDY DESIGN: Comparative Study  SETTING: PNS SHIFA hospital Karachi DURATION OF STUDY: Six months, 21-04-2019 to 20-10-2019 PATIENTS AND METHODS: Ninety two patients who underwent septoplasty due to deviation of nasal septum at ENT department of PNS SHIFA were included in the analysis. Patients were randomly divided into two groups. Group one did not undergo nasal packing after the surgery and group two underwent nasal packing after the surgical procedure. Chi-square was used to see the difference in post-operative hemorrhage, headache, discomfort and septal perforation between the two groups. RESULTS Out of 92 patients included in the final analysis 61 were male and 31 were female. Pot operative bleeding was found in three patients in group one while thirteen patients in group two had bleeding after the procedure. With Pearson chi-square test, we found that post-operative bleeding, headache and discomfort was significantly more in the patients with nasal packing after the procedure of septoplasty due to deviated nasal septum. CONCLUSION Nasal packing emerged as a procedure linked with more complications rather than benefits among the patients undergoing septoplasty in our study. Not only post-operative hemorrhage but also headache and discomfort were more common among the patients with nasal packing as compared to those without nasal packing. Nasal packing after septoplasty should be discouraged without any obvious indication in the patients undergoing septoplasty.

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