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Objective and background: Tumor lysis syndrome (TLS) is a life-threatening emergency and demands emergency care of effective outcome with minimal or no side effects. The Hypouricemic agents, including Rasburicase, Allopurinol and Febuxostate used for the management of TLS. This study was designed to evaluate the Role of Hypouricemic agents by analyzing TLS development rate, control of uric acid, and Creatinine levels. Methods: An extensive electronic data search was conducted by using all leading scientific databases. Twenty-six studies were selected to conduct this study, as per the inclusion criteria. Results: The Odd ratio of TLS development rate was 4.06, 1.24, and 1.49 by Rusbricase, Allopurinol & Febuxostate administration respectively. 95% confidence interval was reported by selected studies against TLS development rate, Uric acid, and Creatinine levels by administrating Rusbricase, Allopurinol & Febuxostate. Conclusion: All Hypouricemic agents, including Rasburicase, Allopurinol and Febuxostate, are effective to manage Tumor lysis Syndrome. However, a suitable and most effective intervention dose needs to identify with better efficacy and minimal side effects both in Adults and Children.

Diabetic Peripheral Neuropathy (DPN) and restless leg syndrome are common among patients with diabetes and might complicate each other's deleterious consequences. The study assessed the rates of peripheral neuropathy and restless leg syndrome in diabetes mellitus. This study is a case-control carried out in king Fahad specialist hospital and primary healthcare centers in Tabuk city, Saudi Arabia during the period from September to December 2020, 132 diabetic patients were selected as cases, and 132 as controls. A structured, self-administered questionnaire based on the International Restless Leg Syndrome Study Group consensus criteria and Michigan peripheral neuropathy assessment questionnaire were used to obtain information from the participants. Moreover, the Statistical Package for Social Sciences (SPSS) software was used for data analysis. Out of 264 participants with a mean age (46 ± 14 years), males' dominance was obvious (73.5% and 75.0% in patients and the control group, respectively). Peripheral neuropathy was evident in 18.2% of patients and 2.3% of the control group, P-value < 0.001). Ninety-one of the participants in both of the study groups had restless leg syndrome, out of which 53.9% were from the diabetes mellitus group. No significant association was found between having restless leg syndrome with neither peripheral neuropathy nor diabetes mellitus, p values: 0.524, and 0.822, respectively. Peripheral neuropathy and restless leg syndrome were common among patients with diabetes, however, no significant association was found between restless leg syndrome with neither diabetes nor peripheral neuropathy; So, raising the awareness of the public and clinicians is highly needed.

Vasospastic angina is caused by transient coronary spasms unrelated to exertion, which may even occur at rest (classically at night) and promptly responds to short acting nitrates. It is thought to be caused by inherent generalised hyper reactivity of the smooth muscle cells of epicardial vessels to various stimuli. Being comparatively less studied, the risk factors for VSA vary considerably from obstructive or atherosclerotic cardiac disease. However, coronary vasospasm can occur in non stenosed arteries, atherosclerotic arteries as well as sub critically stenosed arteries which can result in significant overlap between the risk factors and underlying pathophysiology. 1-14% of AMI can be caused by non-obstructive, or ‘functional’ coronary artery disorders like vasospastic angina but VSA continues to be underdiagnosed and less well understood than obstructive coronary artery disorders. This prompted us to study the existing literature for modifiable risk factors of coronary artery vasospasm so that an emphasis can be made on proper lifestyle modifications and avoidance of vasospastic agents in susceptible individuals. Smoking proved to be the most important risk factor whereas recreational drugs and drugs used for treatment of certain medical disorders have also been shown to associate with coronary vasospasm. Medical personnel, therefore, need to be more vigilant in history taking as well as investigating cardiac chest pain in which traditional investigations end up being normal so that an early diagnosis of vasospastic angina can be made and appropriate steps taken to improve the quality of life of patients.

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