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Postgraduate Medicine

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https://www.readbyqxmd.com/read/28326908/sublingual-immunotherapy-tablets-as-a-disease-modifying-add-on-treatment-option-to-pharmacotherapy-for-allergic-rhinitis-and-asthma
#1
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 22, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28326906/a-practical-guide-to-the-sublingual-immunotherapy-tablet-adverse-event-profile-implications-for-clinical-practice
#2
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/28322073/sglt2-inhibitor-dpp-4-inhibitor-combination-therapy-complementary-mechanisms-of-action-for-management-of-type-2-diabetes-mellitus
#3
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...
March 21, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28306366/serum-osmolal-gap-in-clinical-practice-usefulness-and-limitations
#4
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 17, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28277858/pathophysiology-of-dyspnea-in-copd
#5
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...
March 17, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28299959/antral-mucosal-perfusion-is-not-increased-in-gave
#6
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)...
March 16, 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
#7
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
#8
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/28271921/parent-based-diagnosis-of-adhd-is-as-accurate-as-a-teacher-based-diagnosis-of-adhd
#9
Adam Bied, Joseph Biederman, Stephen Faraone
OBJECTIVE: To review the literature evaluating the psychometric properties of parent and teacher informants relative to a gold-standard ADHD diagnosis in pediatric populations. METHOD: We included studies that included both a parent and teacher informant, a gold-standard diagnosis, and diagnostic accuracy metrics. Potential confounds were evaluated. We also assessed the 'OR' and the 'AND' rules for combining informant reports. RESULTS: Eight articles met inclusion criteria...
March 8, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28276788/chronic-pain-management-in-medical-education-a-disastrous-omission
#10
John D Loeser, Michael E Schatman
No abstract text is available yet for this article.
March 6, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28276789/association-between-sedentary-behavior-and-normal-range-lactate-dehydrogenase-activity
#11
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
#12
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/28276791/licorice-induced-hypertension-a-case-of-pseudohyperaldosteronism-due-to-jelly-bean-ingestion
#13
Christopher A Foster, Kristen S Church, Megha Poddar, Stan H M Van Uum, Tamara Spaic
Hypertension is one of the most common problems encountered in the primary care setting. Numerous secondary causes of hypertension exist and are potentially reversible. The ability to screen for such causes and manage them effectively may spare patients from prolonged medical therapy and hypertensive complications. Licorice can cause hypertension and hypokalemia due its effects on cortisol metabolism. We report a case of jelly bean ingestion that highlights the presentation, pathophysiology and management of licorice-induced hypertension...
February 15, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28116959/immunomodulatory-indications-of-azithromycin-in-respiratory-disease-a-concise-review-for-the-clinician
#14
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/28135876/analysis-of-the-association-between-mycobacterium-tuberculosis-infection-and-immunoglobulin-a-nephropathy-by-early-secreted-antigenic-target-6-detection-in-renal-biopsies-a-prospective-study
#15
Sun Li, Teng Siyuan, Feng Jiangmin, Wang Hailong, Yao Li, Ma Jianfei, Wang Lining
OBJECTIVES: Immunoglobulin A nephropathy (IgAN) is the most frequent cause of primary renal disease, and clarifying the pathogenesis of IgAN is of great importance for its diagnosis and treatment. It is well known that Mycobacterium tuberculosis (MTB) can infect the urinary tract and result in the typical symptoms of cystitis. However, MTB can also affect the kidney more insidiously. Patients may present with glomerular disease, and sometimes with advanced renal failure. This study was to investigate the association between MTB infection and IgA nephropathy (IgAN), and the early diagnosis of MTB-mediated IgAN by means of early secreted antigenic target 6 (ESAT-6) detection in renal biopsies...
January 30, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28135875/contemporary-management-of-pericardial-effusion-practical-aspects-for-clinical-practice
#16
Massimo Imazio, Luca Gaido, Alberto Battaglia, Fiorenzo Gaita
A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration...
January 30, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28132583/the-evolving-role-of-oral-hormonal-therapies-and-review-of-conjugated-estrogens-bazedoxifene-for-the-management-of-menopausal-symptoms
#17
Sharon J Parish, John A Gillespie
This review describes the evolving role of oral hormone therapy (HT) for treating menopausal symptoms and preventing osteoporosis, focusing on conjugated estrogens/bazedoxifene (CE/BZA). Estrogens alleviate hot flushes and prevent bone loss associated with menopause. In nonhysterectomized women, a progestin should be added to estrogens to reduce the risk of endometrial cancer. Use of HT declined since the Women's Health Initiative (WHI) studies showed that HT does not prevent coronary heart disease (CHD) and that conjugated estrogens/medroxyprogesterone acetate increased the risk of invasive breast cancer after nearly 5 years of use...
January 30, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28128678/permanent-atrial-fibrillation-impairs-the-function-of-circulating-endothelial-progenitor-cells
#18
Qiang Tan, Shuangyue Zhang, Ximing Qi, Xiaoyi Zou, Qiang Sun
OBJECTIVE: to determine whether functions of endothelial progenitor cells (EPCs) were impaired in patients with permanent atrial fibrillation (AF). METHODS: 35 patients with permanent AF (AF group) and 35 age and sex matched controls (control group) were collected. The numbers of circulating CD34(+)/KDR(+) cells were determined with flow cytometry in the two groups. Cell proliferation, tube formation, nitric oxygen (NO) and vascular endothelial growth factor (VEGF) were assayed...
January 27, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28122468/kshv-associated-extracavitary-primary-effusion-lymphoma-in-an-hiv-seronegative-patient-a-case-report-and-review-of-the-literature
#19
Uroosa Ibrahim, Amina Saqib, Farhan Mohammad, Juan Ding, Shafinaz Hussein, Jean Paul Atallah
Primary effusion lymphoma (PEL) is a rare type of non-Hodgkin's lymphoma presenting as a lymphomatous effusion and absence of a solid tumor mass. Extracavitary PEL (EC-PEL) is a subtype of PEL with the absence of an effusion but presence of solid tumor. PEL and EC-PEL share the same histopathologic and immunophenotypic features. Kaposi sarcoma-associated herpesvirus (KSHV) positivity is seen universally in these malignancies and is a requisite for diagnosis. Most cases are seen to occur in HIV positive individuals...
January 26, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28120634/increased-plasma-serum-levels-of-prolactin-in-multiple-sclerosis-a-meta-analysis
#20
Wei Wei, Lei Liu, Zhong-Le Cheng, Bo Hu
OBJECTIVES: Prolactin (PRL) is a polypeptide hormone that is known to stimulate humoral and cell mediated immune responses. PRL levels have been investigated in several autoimmune diseases including multiple sclerosis (MS); however, these have yielded different and inconsistent results. This study aims to perform a more precise evaluation on the plasma/serum PRL levels in MS patients, and to explore the available influential factors. METHODS: Research related to plasma/serum PRL levels in MS patients and healthy controls were gathered using PubMed, EMBASE and The Cochrane Library database (until Mar 31 2016)...
January 25, 2017: Postgraduate Medicine
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