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Postgraduate Medicine

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https://www.readbyqxmd.com/read/28427296/predictors-of-response-to-therapy-with-omalizumab-in-patients-with-severe-allergic-asthma-a-real-life-study
#1
Maria Kallieri, Andriana I Papaioannou, Evgenia Papathanasiou, Polyxeni Ntontsi, Spyridon Papiris, Stelios Loukides
INTRODUCTION: Omalizumab is a recombinant humanized IgG1 monoclonal anti-IgE antibody, used for the treatment of severe refractory allergic asthma. However, not all patients with IgE levels within the limits of administration, respond to treatment. The aim of the present study, was to determine clinical and inflammatory characteristics that could predict response to omalizumab. METHODS: We studied retrospectively patients treated with omalizumab as per GINA guidelines in one asthma tertiary referral center...
April 21, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28425837/calprotectin-levels-in-rheumatoid-arthritis-and-their-correlation-with-disease-activity-a-meta-analysis
#2
Sang-Cheol Bae, Young Ho Lee
OBJECTIVE: We evaluated the relationship between calprotectin levels and rheumatoid arthritis (RA), and the correlation between plasma/serum calprotectin and RA activity. METHODS: We searched PUBMED, EMBASE, and Cochrane databases and performed meta-analyses comparing plasma/serum or synovial fluid calprotectin levels in RA patients and controls, and correlation coefficients between calprotectin levels and disease activity for 28 joints (DAS28) as well as C-reactive protein (CRP) in RA patients...
April 20, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28425825/reviewing-treatments-and-outcomes-in-the-evolving-landscape-of-ulcerative-colitis
#3
Marla C Dubinsky
Ulcerative colitis (UC) is a chronic inflammatory disease extending proximally from the rectum to varying lengths of the colon that is characterized by alternating cycles of relapse and remission. Therapeutic goals for patients with active UC include induction and maintenance of remission and improvement in quality of life, as well as mucosal healing, a clinical outcome recently recognized in treatment guidance as being equally important. Mucosal healing is associated with favorable long-term patient outcomes related to remission, surgery, hospitalization, and quality of life...
April 20, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28395575/safety-of-inhaled-long-acting-anti-muscarinic-agents-in-copd
#4
Nicola A Hanania, Suzanne C Lareau, Barbara P Yawn
Evidence-based guidelines recommend inhaled long-acting anti-muscarinic agents (LAMAs) as first-line maintenance therapy for symptomatic patients with COPD. Several LAMAs are now available for use either as monotherapy or in combination with other COPD medications, including long-acting β2-agonists (LABAs) or inhaled corticosteroids (ICS). The efficacy and long-term safety of these medications have been evaluated in multiple clinical trials and real-life studies. This review evaluates the evidence available on the safety of existing LAMAs alone or in combination with LABAs and ICS in patients with COPD...
April 20, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28374645/effect-of-bromocriptine-qr-therapy-on-glycemic-control-in-subjects-with-type-2-diabetes-mellitus-whose-dysglycemia-is-inadequately-controlled-on-insulin
#5
Bindu Chamarthi, Anthony Cincotta
OBJECTIVE: The concurrent use of an insulin sensitizer in type 2 diabetes mellitus (T2DM) patients with inadequate glycemic control on basal-bolus insulin may help improve glycemic control while limiting further insulin requirement. Bromocriptine-QR (B-QR), a quick release, sympatholytic, dopamine D2 receptor agonist therapy for T2DM, is a postprandial insulin sensitizer. This study evaluated the effect of B-QR on dysglycemia in T2DM subjects with suboptimal glycemic control on basal-bolus insulin plus metformin...
April 4, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28335674/an-unexpected-cause-of-transient-diarrhea
#6
Yoen Young Chuah, Yeong Yeh Lee, Tzung Jiun Tsai
Migration of percutaneous endoscopic gastrostomy (PEG) tube to colon with gastro-colonic-cutaneous fistula formation is a rare complication of the procedure. Transient episodic diarrhea following each PEG tube feeding is typical of this complication. We present a 72-year-old man with cerebrovascular disease and scoliosis who encountered episodes of transient diarrhea after each PEG tube feeding. His diarrhea was refractory to medications. Colonoscopy demonstrated a mal-positioned PEG in the transverse colon...
April 4, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28343424/biosimilar-biologic-drugs-a-new-frontier-in-medical-care
#7
Daniel M Geynisman, Guillermo De Velasco, K Lea Sewell, Ira Jacobs
Physicians in training are expected to be aware of the newest developments in patient care. Biologic therapies have changed treatment of many diseases by specifically targeting key disease mediators, but patient access to these therapies can be limited. As patents for the first biologic therapies are expiring, the development and approval of products known as biosimilars is rapidly gaining momentum. A biosimilar is a biologic product that is highly similar to a reference product (a licensed biologic product), notwithstanding minor differences in clinically inactive components...
April 3, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28322073/sglt2-inhibitor-dpp-4-inhibitor-combination-therapy-complementary-mechanisms-of-action-for-management-of-type-2-diabetes-mellitus
#8
Jayant Dey
Type 2 diabetes mellitus is a progressive disease with multiple underlying pathophysiologic defects. Monotherapy alone cannot maintain glycemic control and leads to treatment failure. Ideally, a combination of glucose-lowering agents should have complementary mechanisms of action that address multiple pathophysiologic pathways, can be used at all stages of the disease, and be generally well tolerated with no increased risk of hypoglycemia, cardiovascular events, or weight gain. The combination should also provide conveniences for patients, such as oral dosing, single-pill formulations, and once-daily administration, potentially translating to improved adherence...
April 3, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28351176/the-use-of-sodium-glucose-cotransporter-2-inhibitors-in-patients-with-type-2-diabetes-and-hypertension-a-focus-on-african-american-populations
#9
David S Kountz
Diabetes, hypertension, and severe kidney disease are all disproportionately prevalent in African Americans. Clinical trials data from type 2 diabetes (T2D) patients have demonstrated that sodium-glucose cotransporter 2 (SGLT2) inhibitors have a positive effect on cardiovascular risk factors - such as improved blood glucose control, reduced body weight, and reduced blood pressure - and also support a possible renal-protective role for SGLT2 inhibitors. The EMPA-REG OUTCOME trial revealed that empagliflozin was associated with reduced adverse cardiovascular and renal outcomes...
March 29, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28343408/safety-of-oral-direct-acting-antiviral-regimens-for-chronic-hepatitis-c-in-real-life-conditions
#10
Regina Juanbeltz, Silvia Goñi Esarte, Juan Isidro Úriz-Otano, Ana Martínez Echeverría, Inmaculada Elizalde, José Manuel Zozaya, Jesús Castilla, Ramón San Miguel
OBJECTIVES: Direct acting antivirals (DAA) are extremely effective to treat chronic hepatitis C. The aim of this study was to evaluate, by using objective variables, the safety of DAA combinations under clinical practice conditions. METHODS: A retrospective study was carried out in mono-infected patients with chronic hepatitis C treated with DAA between January and December 2015 in our centre. Discontinuations, treatment modifications, deaths and laboratory parameters were studied (liver function tests, haemoglobin, creatinine and lipid profile at baseline, weeks 4, 8 and post 12)...
March 27, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28326908/sublingual-immunotherapy-tablets-as-a-disease-modifying-add-on-treatment-option-to-pharmacotherapy-for-allergic-rhinitis-and-asthma
#11
Stephen Brunton, Harold S Nelson, David I Bernstein, Simon Lawton, Susan Lu, Hendrik Nolte
Allergic rhinitis (AR) with or without conjunctivitis (AR/C) is associated with a significant health and economic burden, and is often accompanied by asthma. Pharmacotherapies are the mainstay treatment options for AR and asthma, but guidelines also recommend allergy immunotherapy (AIT). Unlike pharmacotherapies, AIT has the ability to modify the underlying immunologic mechanisms of AR and asthma with the potential for long-term benefits after treatment is discontinued. Immunotherapy may also prevent progression of AR/C to asthma...
March 27, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28306366/serum-osmolal-gap-in-clinical-practice-usefulness-and-limitations
#12
George Liamis, Theodosios D Filippatos, Angelos Liontos, Moses S Elisaf
BACKGROUND: Although serum osmolal gap can be a useful diagnostic tool, clinicians are not familiar with its use in clinical practice. OBJECTIVES: The review presents in a series of questions-answers and under a clinical point of view the current data regarding the use of osmolal gap. DISCUSSION: The definition and the best formula used for the calculation of osmolal gap, the main causes of increased osmolal gap with or without increased anion gap metabolic acidosis, as well as the role of concurrent lactic acidosis or ketoacidosis are presented under a clinical point of view...
March 23, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28326906/a-practical-guide-to-the-sublingual-immunotherapy-tablet-adverse-event-profile-implications-for-clinical-practice
#13
David I Bernstein, Jose A Bardelas, Bodil Svanholm Fogh, Amarjot Kaur, Ziliang Li, Hendrik Nolte
OBJECTIVES: Treatment with allergy immunotherapy improves allergic rhinoconjunctivitis, but can also improve comorbidities associated with allergic rhinitis such as asthma. Sublingual immunotherapy (SLIT)-tablets are a convenient and efficacious method of allergy immunotherapy. They are self-administered after the first tablet has been provided under medical supervision. Therapy may elicit local reactions or, rarely, systemic allergic reactions. The objective of this report is to inform healthcare practitioners about the safety and tolerability profile of SLIT-tablets and use this information to provide practical guidance that may inform patients regarding potential adverse reactions and how to manage them...
March 22, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28294702/safety-and-efficacy-of-a-glucagon-like-peptide-1-receptor-agonist-added-to-basal-insulin-therapy-versus-basal-insulin-with-or-without-a-rapid-acting-insulin-in-patients-with-type-2-diabetes-results-of-a-meta-analysis
#14
Carol H Wysham, Jay Lin, Louis Kuritzky
OBJECTIVE: To consolidate the evidence from randomized controlled trials evaluating the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as add-on to basal insulin therapy in type 2 diabetes (T2D) patients. RESEARCH DESIGN AND METHODS: We searched the EMBASE® and NCBI PubMed (Medline) databases and relevant congress abstracts for randomized controlled trials evaluating the efficacy and safety of GLP-1 RAs as add-on to basal insulin compared with basal insulin with or without rapid-acting insulin (RAI) through 23 May 2016...
March 15, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28277812/considerations-on-bringing-warehoused-hcv-patients-into-active-care-following-interferon-free-direct-acting-antiviral-drug-approval
#15
Aleksandra Palak, Christine Livoti, Céline Audibert
OBJECTIVES: Until recently, lack of efficacious and tolerable hepatitis C virus (HCV) treatments prompted patient warehousing until better treatment options became available. We investigated whether the introduction of ledipasvir/sofosbuvir precipitated patient return to clinics, thereby changing HCV clinic dynamics. METHODS: Online questionnaire responses indicated the volume of HCV patients followed, the proportion of warehoused patients and those who were proactively offered new options, methods for identifying and contacting patients, and insurance authorization/reimbursement-related information...
March 9, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28276789/association-between-sedentary-behavior-and-normal-range-lactate-dehydrogenase-activity
#16
Meghan K Edwards, Samuel L Buckner, Jeremy P Loenneke, Paul D Loprinzi
OBJECTIVES: Recent research demonstrates that lactate dehydrogenase (LDH) activity within the normal range may serve as a mediator in the (positive) relationship between physical activity and cardiovascular disease risk. Emerging work supports deleterious associations between sedentary behavior and health, independent of physical activity. Thus, this study evaluated if sedentary behavior was associated with normal-range LDH activity, independent of physical activity. METHODS: Data from the 2003-2006 NHANES were used (N = 2,087 adults; 40-79 yrs)...
March 1, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28276790/new-onset-diabetes-mellitus-induced-by-statins-current-evidence
#17
Steven G Chrysant
The hydroxyl-methyl-glutaryl-coenzyme-A (HMG-CoA) reductase inhibitors of statin action are very effective and safe drugs, and they are widely used for the treatment of hyperlipidemia and the prevention of primary and secondary cardiovascular diseases (CVDs). However, recent meta-analyses of previous studies done with statins have shown that these drugs could induce new onset diabetes mellitus (NODM), especially in subjects prone to diabetes: obese, females, older age, Asian descent, and those with pre-diabetes or the metabolic syndrome...
February 24, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28116959/immunomodulatory-indications-of-azithromycin-in-respiratory-disease-a-concise-review-for-the-clinician
#18
Cassondra L Cramer, Allie Patterson, Abdulrazak Alchakaki, Ayman O Soubani
Azithromycin has a well-characterized bacteriostatic activity. However, it also has a robust immunomodulatory effect that has proven beneficial in a variety of chronic illnesses. This effect results in decreased production of pro-inflammatory cytokines in the acute phase and promotes resolution of chronic inflammation in the later phases. Specifically, azithromycin has direct activity on airway epithelial cells to maintain their function and reduce mucus secretion. These characteristics have resulted in the use of azithromycin in the management of a variety of chronic lung diseases including chronic obstructive pulmonary disease, cystic fibrosis (CF), non-CF bronchiectasis, bronchiolitis obliterans syndrome, diffuse panbronchiolitis, and asthma...
February 1, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28299959/antral-mucosal-perfusion-is-not-increased-in-gave
#19
Bezawit Tekola, Elliot Smith, James Mann, James Patrie, Christopher Moskaluk, Stephen Caldwell
OBJECTIVES: Although a common cause of intestinal blood loss, the pathophysiology of gastric antral vascular ectasia (GAVE) is not well understood. We aimed to evaluate gastric antral and body mucosal flow in GAVE patients compared to a control population using laser Doppler flowmetry. METHODS: 27 patients with GAVE and 11 control patients without GAVE were evaluated using an endoscopic LDF probe. The probe was placed in the gastric antrum and body in order to calculate standardized mucosal flow rates recorded as perfusion units (PU)...
April 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28277858/pathophysiology-of-dyspnea-in-copd
#20
REVIEW
Antonio Anzueto, Marc Miravitlles
Dyspnea refers to the sensation of breathlessness, shortness of breath, or difficulty breathing that is commonly observed in patients with respiratory and cardiac disease. In the United States alone, dyspnea is reported in up to 4 million all-cause emergency room visits annually. Dyspnea can be a symptom of several different underlying physical conditions, typically involving the lung and heart. Indeed, it is an important symptom in chronic obstructive pulmonary disease (COPD), where it is associated with limited physical activity, increased anxiety and depression, decreased health-related quality of life (HRQoL), and reduced survival...
April 2017: Postgraduate Medicine
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