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Postgraduate Medicine

Sebastian Filippas-Ntekouan, Theodosios D Filippatos, Moses S Elisaf
Sodium-glucose linked transporter type 2 (SGLT2) inhibitors are a relatively new class of anti-diabetic drugs with positive cardiovascular and kidney effects. The aim of this review is to present the safety issues associated with SGLT2 inhibitors. Urogenital infections are the most frequently encountered adverse events, although tend to be mild to moderate and are easily manageable with standard treatment. Although no increased acute kidney injury risk was evident in the major trials, the mechanism of action of these drugs requires caution when they are administered in patients with extracellular volume depletion or with drugs affecting renal hemodynamics...
October 17, 2017: Postgraduate Medicine
Lesley M Arnold, Bill H McCarberg, Andrew G Clair, Ed Whalen, Neal Thomas, Anamaria Jorga, Lynne Pauer, Richard Vissing, Peter W Park
OBJECTIVES: The pregabalin dose-response for pain, Patient Global Impression of Change (PGIC), and sleep quality measures in painful diabetic peripheral neuropathy (pDPN), postherpetic neuralgia (PHN), and fibromyalgia (FM) is relevant for physicians treating these patients. This analysis aimed to demonstrate the dose-response of pregabalin for each indication and describe the onset (incidence), onset/continuation (prevalence), and resolution of adverse events (AEs) occurring during treatment...
October 16, 2017: Postgraduate Medicine
Tamer Yacoub
Worldwide, many people with type 2 diabetes are not at recommended glycemic targets and remain at increased risk of microvascular and macrovascular complications. Reaching recommended glycemic targets requires normalizing both fasting and postprandial glucose (PPG). For some patients, this will require addition of a prandial insulin delivered by injection to control PPG excursions. Evidence from epidemiological studies suggests an association between postprandial hyperglycemia and cardiovascular disease, and thus, expert guidelines recommend that treatment for elevated PPG not be delayed...
October 14, 2017: Postgraduate Medicine
Louis Jacob, Karel Kostev
OBJECTIVES: The goal of the present study was to analyze the prevalence of pain medication prescriptions in general practices in France, Germany, and the UK. METHODS: This study included all patients aged ≥18 years followed in 2016 in general practitioner practices in France, Germany and the UK. The primary outcome was the prevalence of patients receiving prescriptions for pain medications in France, Germany, and the UK in 2016. The following drugs were included in the analysis: anti-inflammatory and antirheumatic products, non-steroids and analgesics including opioids, antimigraine preparations, and other analgesics and antipyretics...
October 12, 2017: Postgraduate Medicine
Xiaoya Zhang, Zhanying Wei, Jinwei He, Chun Wang, Zhenlin Zhang
OBJECTIVES: Defects in the chloride channel 7 (CLCN7) gene lead to autosomal dominant osteopetrosis type II (ADOII, OPTA2 MIM 166600) and autosomal recessive osteopetrosis, autosomal recessive 4 (ARO, OPTB4 MIM 611490). The objective of the present study was to expand the mutational spectrum and analyze the correlation between mutational sites and clinical phenotypes. METHODS: Seven affected individuals from unrelated Chinese families were clinically examined. X-ray examination and biochemical markers were evaluated...
October 11, 2017: Postgraduate Medicine
John R Nelson, Wayne S True, Viet Le, R Preston Mason
Residual cardiovascular (CV) risk persists even in statin-treated patients with optimized low-density lipoprotein cholesterol (LDL-C) levels. Other pathways beyond cholesterol contribute to CV risk and the key to reducing residual risk may be addressing non-cholesterol risk factors through pleiotropic mechanisms. The purpose of this review is to examine the literature relating to the potential role of the omega-3 fatty acid eicosapentaenoic acid (EPA) in reducing residual CV risk. The literature shows that EPA can robustly lower plasma triglyceride (TG) levels without raising LDL-C levels and documents EPA to have a broad range of beneficial effects on the atherosclerotic pathway, including those on lipids, lipoproteins, inflammation, oxidation, phospholipid membranes, and the atherosclerotic plaque itself...
October 9, 2017: Postgraduate Medicine
Jorge E Lascano, Michael A Campos
OBJECTIVE: Alpha-1 antitrypsin deficiency (AATD) is an underrecognized genetic disorder that can cause chronic obstructive pulmonary disease (COPD) and liver cirrhosis, two clinical conditions commonly seen by primary care physicians. AATD is estimated to affect 1/4000-1/5000 people in the United States and 1-2% of all COPD cases. METHODS: PubMed was searched for relevant articles using AAT/AATD-related terms. RESULTS: Unfortunately, <10% of symptomatic individuals have been properly diagnosed primarily due to the underdiagnosis of COPD and the lack of awareness of AATD as a possible underlying cause...
October 5, 2017: Postgraduate Medicine
Da Jung Jung, Jun Young Do, Kyu Hyang Cho, A Young Kim, Seok Hui Kang
OBJECTIVE: The aim of the present study was to evaluate the clinical association between triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio and hearing impairment in a Korean population. PATIENTS AND METHODS: This was a cross-sectional study (n = 18,004). Participants were divided into 4 quartiles based on their TG/HDL-C ratio: first quartile (1Q), second quartile (2Q), third quartile (3Q), and fourth quartile (4Q). The threshold values at 0...
September 26, 2017: Postgraduate Medicine
Irl B Hirsch
Decreasing glycated hemoglobin (A1C) is the primary goal of current diabetes management due to intervention studies in type 1 and type 2 diabetes associating levels <7.0% (53 mmol/mol) with lower complication risk. Strategic self-monitoring of blood glucose (SMBG) is also recommended to achieve greater time in range, with fewer extremes of hypo- or hyperglycemia. Unlike A1C, SMBG can distinguish among fasting, prandial, and postprandial hyperglycemia; uncover glycemic variability, including potentially dangerous hypoglycemia; and provide feedback to patients about the effects of behavior and medication on glycemic control...
September 25, 2017: Postgraduate Medicine
Lucinda A Harris, Noemi Baffy
Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and health care costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, autonomic nervous system dysfunction, and changes in the gut microbiota...
September 22, 2017: Postgraduate Medicine
Man Hung, Jerry Bounsanga, Maren Wright Voss
BACKGROUND: Critically analyzing research is a key skill in evidence-based practice and requires knowledge of research methods, results interpretation, and applications, all of which rely on a foundation based in statistics. Evidence-based practice makes high demands on trained medical professionals to interpret an ever-expanding array of research evidence. OBJECTIVE: As clinical training emphasizes medical care rather than statistics, it is useful to review the basics of statistical methods and what they mean for interpreting clinical studies...
September 22, 2017: Postgraduate Medicine
Cezary Wójcik
Primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) has become recently more complex than ever, leaving the clinicians perplexed with outdated guidelines and emerging evidence about new LDL-C lowering therapies. 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines have focused on high intensity statin therapy for specific groups of patients, while abandoning long established LDL-C goals, a strategy which no longer seems valid. PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors have emerged as the add-on therapy on top of statins and/or ezetimibe for the treatment of hypercholesterolemia and ASCVD prevention...
September 7, 2017: Postgraduate Medicine
Haoyu Wang, Yintao Chen, Xiaofan Guo, Ye Chang, Yingxian Sun
OBJECTIVES: Cardiometabolic index (CMI) has been recognized as a novel and practical marker for the assessment of cardiometabolic risk as it is independently related to diabetes and atherosclerotic progression. This study tested the hypothesis that CMI represents a risk of ischemic stroke in a general population of rural China. METHODS: From July 2012 to August 2013, we examined data from a large cross-sectional study of 11,345 participants (mean age 53.8 years; 60...
September 7, 2017: Postgraduate Medicine
Shanshan Huang, Xirun Liu, Hui Li, Wangdong Xu, Hong Jia
OBJECTIVES: Since the association between serum uric acid (SUA) and metabolic syndrome (MetS) has been reported extensively, it remains unclear whether SUA is associated with MetS and its components in a Chinese Yi population. METHODS: This study recruited 1,903 people (912 men, 991 women) older than 18 years old from the Liangshan region in Sichuan province. Anthropometric measurements and biochemical indexes were measured by a standard protocol. SUA levels were divided into four quartiles by sex...
August 31, 2017: Postgraduate Medicine
Britta K Sundquist, Brady J Bowen, Uwa Otabor, Jocelyn Celestin, Paul C Sorum
OBJECTIVES: To promote penicillin allergy testing in an outpatient setting in patients labeled as penicillin allergic, to determine the number of those who are truly allergic, evaluate patient satisfaction with the testing, and educate both patients and clinicians about testing. METHODS: Patients with a history of penicillin allergy listed in their EHR were screened and recruited by their primary care office and referred for penicillin allergy testing. The results of allergy testing and patient satisfaction after testing were the main outcomes...
August 24, 2017: Postgraduate Medicine
Gao Jing-Xia, Zhao Yu-Liang, Liu Jin-Feng, Liu Shu-Zhen, Liao Guo-Yang, Li Qi
OBJECTIVE: This study evaluated the effectiveness and safety of the egg-based, trivalent, inactivated split influenza vaccine produced by the Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College, China. METHODS: From March 2012 through May 2012, we enrolled a total of 1390 healthy volunteers between the ages of 3 and 80 years in a randomized clinical trial at the Hebei Disease Control Center Vaccine Clinical Evaluation Center...
August 21, 2017: Postgraduate Medicine
Michelle Le, Barbara Miedzybrodzki, Tim Olynych, Hugo Chapdelaine, Moshe Ben-Shoshan
INTRODUCTION: Mastocytosis, a heterogeneous group of disorders, is characterized by an abnormal increase in the number of mast cells that is limited to the skin (cutaneous mastocytosis), involving extracutaneous tissues (systemic mastocytosis), or presenting as solid tumours (mastocytoma and mast cell sarcoma). Recent studies estimate that 1 in 10,000 people are diagnosed with mastocytosis. Although prompt diagnosis and appropriate management are crucial, little is known about the natural history and currently there are no established management guidelines...
August 21, 2017: Postgraduate Medicine
Florencia I Aiello, Magdalena Bajo, Fernanda Marti, Carlos G Musso
Chronic kidney disease (CKD) is a disorder frequently suffered by cirrhotic patients, and therefore it is crucial to perform an accurate renal assessment in this population. This assessment should be based on the integral evaluation of the clinical exam, glomerular filtration rate (GFR), serum electrolytes, hemoglobin, and parathyroid hormone values, as well as renal imaging. GFR assessment can be performed by different methods, such as serum creatinine, serum cystatin C, GFR equations (based on creatinine, cystatin or both), endogenous and exogenous markers clearance, and renal functional imaging...
August 8, 2017: Postgraduate Medicine
Addolorata Corrado, Eliana Rita Sanpaolo, Silvana Di Bello, Francesco Paolo Cantatore
Osteoblasts are mesenchymal cells that play a key role in maintaining bone homeostasis; they are responsible for the production of extracellular matrix proteins, regulation of matrix mineralization, control of bone remodeling and regulate osteoclast differentiation. Osteoblasts have an essential role in the pathogenesis of many bone diseases, particularly osteoporosis. For many decades, the main current available treatments for osteoporosis have been represented by anti-resorptive drugs, such as bisphosphonates, which act mainly by inhibiting osteoclasts maturation, proliferation and activity; nevertheless, in recent years much attention has been paid on anabolic aspects of osteoporosis treatment...
August 3, 2017: Postgraduate Medicine
Shungo Yamamoto, Yuki Kataoka
No abstract text is available yet for this article.
July 28, 2017: Postgraduate Medicine
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