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Postgraduate Medicine

Basem M Mishriky, Doyle M Cummings, Robert Tanenberg, Walter J Pories
In patients with type 2 diabetes secondary to excess nutrients and energy balance, relative - not absolute - insulin deficiency plays a key role in disease development and progression. Although patients with type 2 diabetes who have features of insulin resistance would usually have hyperinsulinemia, insulin therapy remains recommended by guidelines particularly when patients fail to achieve glycemic goals. This approach does not prevent complications particularly macrovascular complications. This raises a controversial question regarding the benefit of using exogenous insulin for glycemic control in patients with type 2 diabetes who have features of insulin resistance...
October 10, 2018: Postgraduate Medicine
Xiao Yang, Xiao-Qing Wei, Dan Feng, Wei He, Yuan Chen, Ping Hua
Human chorionic gonadotropin (HCG) is an important indicator for the diagnosis of pregnancy. The authors report a unique case of cesarean scar ectopic pregnancy (CSEP) with negative urine and serum HCG levels, which was initially misdiagnosed as an intrauterine tumor despite the use of transvaginal ultrasound. Dilation and curettage was performed, which caused massive vaginal bleeding. Diagnostic hysteroscopy after uterine artery embolization and pathological examination of the surgical specimen confirmed the diagnosis of old CSEP...
October 9, 2018: Postgraduate Medicine
Loukas Kakoullis, Stylianos Louppides, Eleni Papachristodoulou, George Panos
Porphyrias are disorders caused by defects in the biosynthetic pathway of heme. Their manifestations can be divided into three distinct syndromes, each attributable to the accumulation of three distinct classes of molecules. The acute neurovisceral syndrome is caused by the accumulation of the neurotoxic porphyrin precursors, delta aminolevulinic acid and porphobilinogen; the syndrome of immediate painful photosensitivity is caused by the lipid-soluble protoporphyrin IX and, the syndrome of delayed blistering photosensitivity, caused by the water-soluble porphyrins, uroporphyrin and coproporphyrin...
October 8, 2018: Postgraduate Medicine
Risa Kagan, Paula Abreu, Emma Andrews
OBJECTIVE: In the 1-year phase 3 Selective estrogens, Menopause, And Response to Therapy-5 trial, cumulative amenorrhea rates with conjugated estrogens/bazedoxifene (CE/BZA) were similar to placebo and higher than with conjugated estrogens/medroxyprogesterone acetate (CE/MPA). This post hoc analysis reports bleeding/spotting rates in 4-week intervals (cycles) and 3-month intervals (quarters) with these therapies and the percentage of cases attributable to spotting only. METHODS: Generally healthy postmenopausal women with menopausal symptoms recorded vaginal bleeding/spotting in daily diaries while receiving CE 0...
October 3, 2018: Postgraduate Medicine
Ivana Chandra, Lizhou Sun
OBJECTIVE: To analyze the similarities and differences in the clinical parameters, laboratory biomarkers, and pregnancy outcomes between preterm and term preeclampsia (PE). METHODS: Data on 185 women diagnosed with PE were collected from a Jiangsu Province Hospital from January 2017 to December 2017 and analyzed. 74 (40%) patients were diagnosed with preterm PE, of which 70 (94.6%) patients with PE with severe features (PEs) and the rest with PE. 111 (60%) patients were diagnosed with term PE, of which 54 (48...
September 22, 2018: Postgraduate Medicine
Angel López-Candales
The scope of hypertension (HTN) even for those involved in the field is staggering with numbers close to 60 million Americans and more than 1 billion individuals across the globe. It is the most common reason to seek medical attention and according to the World Health Organization, the number one cause of mortality in the world. Yet, we still don't know what is normal or abnormal. Even though the most recent 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults has created quite a commotion, new questions could be raised...
September 22, 2018: Postgraduate Medicine
Paul F White
No abstract text is available yet for this article.
September 20, 2018: Postgraduate Medicine
Qasim Khan, Mohammad Ismail, Iqbal Haider
OBJECTIVES: Patients admitted in coronary care units are susceptible to QT interval prolongation due to numerous risk factors. The purpose of this study was to identify the prevalence of risk factors for QT interval prolongation; QT prolonging medications; drug-drug interactions; their predictors; and torsades de pointes risks of drugs. METHODS: After obtaining approval, this cross-sectional study was carried out during one-year period in coronary care units of two major tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan...
September 5, 2018: Postgraduate Medicine
Srinivas R Nalamachu, Binit Shah
Deaths from opioid overdoses have increased dramatically over the past few years. Given that immediate-release (IR) opioids account for most of the U.S. market share, and that abusers generally prefer IR opioids over extended-release (ER) opioids, it is not surprising that rates of abuse are higher for IR than ER opioids. IR opioids are widely prescribed, often without consideration for risks of abuse, misuse, and diversion. Prescription opioid abuse and misuse often begins through oral administration and progresses into non-oral routes (e...
July 26, 2018: Postgraduate Medicine
Ozlem Coskun, Ilkay Ulutas, Isıl Irem Budakoglu, Mehmet Ugurlu, Yusuf Ustu
OBJECTIVES: High emotional intelligence and leadership traits are essential for physicians in managing their responsibilities and thus building successful interactions with patients. This study explored the relationship between emotional intelligence and leadership traits among family physicians. METHODS: Participants (2975 men, 972 women, mean = 42.0 ages, SD = 7.47) were family physicians working at family health-care centers across the seven geographical regions of Turkey who were contacted by e-mail...
September 2018: Postgraduate Medicine
E C Rodriguez-Merchan
BACKGROUND: Symptomatic knee osteoarthritis (OA) involves millions of adults around the world. PURPOSE: To analyze the effectiveness and tolerability of topical therapies and their contemporary placement in knee OA management criteria. METHODS: A Cochrane Library and PubMed (MEDLINE) search related to the role of topical therapies in knee OA was carried out. RESULTS: Many types of local therapy have been reported, including nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac and ketoprofen; capsaicin, cream containing glucosamine sulfate, chondroitin sulfate, and camphor; nimesulide; civamide cream 0...
September 2018: Postgraduate Medicine
Tomasz Charytoniuk, Maciej Małyszko, Jan Bączek, Piotr Fiedorczuk, Karolina Siedlaczek, Jolanta Małyszko
Nephrectomy, which constitutes a gold-standard procedure for the treatment of renal-cell carcinoma (RCC), has been widely discussed in the past decade as a significant risk factor of the development of chronic kidney disease (CKD). RCC is the third most common genitourinary cancer in the United States, with an estimated more than 65,000 new cases and 14,970 deaths. The aim of this review was to precisely and comprehensively summarize the status of current knowledge in CKD risk factors after nephrectomy, the advantages of minimally invasive vs...
September 2018: Postgraduate Medicine
Minji Son, Yoon Seon Park, Min Ho Jung, Jin Han Kang, Ui Yoon Choi
OBJECTIVES: In South Korea, latent tuberculosis infection (LTBI) screening is a critical strategy associated with efforts to reduce the incidence of tuberculosis (TB). Currently, only children with a known history of TB contact are considered as pediatric high-risk groups for LTBI, and consequently, LTBI screening is only provided to these children. However, to reduce the incidence of TB, the high-risk groups that undergo LTBI screening should be expanded. This study aimed to assess the risk factors for LTBI among children living in South Korea with no known history of TB contact for the identification of additional high-risk groups...
September 2018: Postgraduate Medicine
Bernardino Roca, Pilar Fernandez, Manuel Roca
The authors report the case of an HIV-infected patient who presented with typhlitis as a complication of typical influenza. To the best of their knowledge, this is the first case reported in the literature with such an association of clinical conditions.
September 2018: Postgraduate Medicine
Bogna Grygiel-Górniak, Nattakarn Limphaibool, Katarzyna Perkowska, Mariusz Puszczewicz
BACKGROUND: Granulomatosis with polyangiitis (GPA) presents a wide spectrum of manifestations from the common respiratory symptoms to infrequent neurological and cardiac complications. The challenge in diagnosis and management makes the rapidly progressive disorder one of the most challenging dilemmas in clinical medicine. METHOD: An extensive electronic literature search was done using multiple databases (e.g. PubMed) from January 2007 to August 2017 to gather information on the etiopathogenesis, clinical presentation, and current treatment management plan of GPA...
September 2018: Postgraduate Medicine
Cong Dai, Min Jiang, Ming-Jun Sun
Inflammatory bowel disease (IBD) is characterized by periods of symptomatic remission and relapse. Diagnosis and assessment of IBD are based on clinical evaluation, serum parameters, radiology, and endoscopy. Fecal markers have emerged as new diagnostic tools to detect and monitor intestinal inflammation. Fecal calprotectin (FC) and lactoferrin (FL) were identified decades ago as potentially revolutionary markers for IBD. Following these discoveries numerous additional markers, including S100A12, M2-PK, metalloproteinases, hemoglobin, myeloperoxidase, lysozyme, polymorphonuclear elastase, neopterin, and nitric oxide, have also been suggested as novel markers of IBD...
September 2018: Postgraduate Medicine
Uday Venkat Mateti, Anantha Naik Nagappa, Ravindra Prabhu Attur, Shankar Prasad Nagaraju, Dharshan Rangaswamy
OBJECTIVES: The aim of the study is to assess the cost-effectiveness of pharmaceutical care versus usual care on the treatment costs in patients undergoing maintenance hemodialysis (HD) in the outpatient HD centers of academic, government, and corporate hospitals. METHODS: An open-labeled randomized controlled study was registered under clinical trial registry of India (Ref. no. CTRI/2014/004900). The study was conducted for a period of 12-month follow-up in patients undergoing maintenance HD...
September 2018: Postgraduate Medicine
Rosaria Del Giorno, Angela Greco, Anna Zasa, Luca Clivio, Michela Pironi, Alessandro Ceschi, Luca Gabutti
OBJECTIVES: Reducing the inappropriate benzodiazepine (BZD) prescriptions represents a challenge for health care systems worldwide. The 'Choosing Wisely' campaign recommends against the use of BZD in the elderly as the first choice for insomnia, agitation, or delirium. We aimed to determine whether a transparent monitoring-benchmarking together with educational interventions, on top of the internal publication of a targeted recommendation, could be effective in curbing BZD prescriptions...
September 2018: Postgraduate Medicine
(no author information available yet)
No abstract text is available yet for this article.
August 2018: Postgraduate Medicine
Mahsa Pouranayatihosseinabad, Tabish Syed Zaidi, Gregory Peterson, Prasad S Nishtala, Paul Hannan, Ronald Castelino
OBJECTIVES: The primary objective of this study was to investigate the impact of RMMRs on medication regimen complexity, as assessed by a validated measure. METHODS: Retrospective analysis of RMMRs pertaining to 285 aged care residents aged ≥ 65 years in Sydney, Australia. Medication regimen complexity was measured using the Medication Regimen Complexity Index (MRCI) at baseline, after pharmacists' recommendations (assuming that all of the pharmacists' recommendations were accepted by the General Practitioner (GP)), and after the actual uptake of pharmacists' recommendations by the GP...
August 2018: Postgraduate Medicine
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