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Postgraduate Medicine

Rabia Miray Kisla Ekinci, Sibel Balci, Atil Bisgin, Bahriye Atmis, Dilek Dogruel, Derya Ufuk Altintas, Mustafa Yilmaz
OBJECTIVES: Henoch Schönlein Purpura (HSP) is characterized by non-thrombocytopenic palpable purpura, abdominal pain and arthralgia/arthritis. We aimed to describe the clinical presentations of children with HSP in a single center and compare the prevalence of each manifestations between patients with MEFV variants, particularly in exon 10 and those without. METHODS: This cohort retrospectively included 144 HSP (59 females, 85 males) patients without FMF symptoms and followed for at least 6 months...
December 4, 2018: Postgraduate Medicine
Thomas Jensen, Amanda Wieland, Melanie Cree-Green, Kristen Nadeau, Shelby Sullivan
Nonalcoholic fatty liver disease (NAFLD) is quickly emerging as a global epidemic in parallel with the rise in obesity and the Metabolic Syndrome. NAFLD, once seen simply as a passive consequence of the Metabolic Syndrome (MetS), has been found to interact with other features of MetS to exacerbate insulin resistance, diabetes, and cardiovascular disease. NAFLD is also becoming the top indication for liver transplant and an important risk factor for hepatocellular carcinoma. Treatment of this disorder is limited mainly to lifestyle modifications to promote weight loss along with consideration for off-label use of certain medications, but recent progression in clinical trials means more effective treatments are on the horizon...
November 29, 2018: Postgraduate Medicine
Michael S Kelly, Jelena Lewis, Ashley M Huntsberry, Lauren Dea, Ivan Portillo
OBJECTIVE: To review glucose-lowering efficacy and changes in renal function associated with sodium-glucose co-transporter 2 (SGLT2) inhibitors among patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). DATA SOURCES: A literature search of MEDLINE and Cochrane databases was performed from 2000 to August 2018 using search terms: SGLT2 inhibitors, sodium glucose co-transporter 2, canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, and chronic kidney disease...
November 17, 2018: Postgraduate Medicine
Nagesh Kamat, Surulivel Rajan Mallayasamy, Psvn Sharma, Asha Kamath, Ganesh Pai
Background Patient education is important in Irritable bowel syndrome (IBS), but its effects on outcomes have not been studied extensively. Methods Patients were enrolled and prospectively divided into an interventional and usual care group. Both received standard of care, but the former additionally received video-assisted patient education. Self-administered questionnaires IBS-QOL, Beck Anxiety-Depression Inventory II (BAI, BDI) and Hospital Anxiety and Depression Scale (HADS) were administered at baseline, 3 and 6 months...
November 16, 2018: Postgraduate Medicine
Suzanne Reiter, Susan Kellogg Spadt
Bacterial vaginosis (BV) affects approximately one third of women in the United States. While often asymptomatic, BV infection may be accompanied by serious health consequences, such as preterm birth and pelvic inflammatory disease, and may facilitate acquisition of sexually transmitted infections. Identifying appropriate patients for screening, such as pregnant women, women planning pregnancy, and women with multiple and/or new sexual partners, is imperative for treatment. Diagnosis of BV has traditionally depended on the presence of vaginal discharge and odor, elevated pH, and clue cells as determined by microscopy, but newer diagnostic modalities that utilize molecular techniques allow for more convenient and accurate testing for BV...
November 14, 2018: Postgraduate Medicine
Wei-Dong Gao, Min Ma, Gao-Xing Zhang, Xue-Fang Zhang, Gang Sun
Background:Chronic kidney disease (CKD) patients are associated with very high rate of adverse cardiovascular outcomes after drug-eluting stents (DES) implantation. The clinical outcomes of second-generation DES versus first-generation DES in CKD patients remain controversial. Objective: The aim of the current study was to perform a systematic review and meta-analysis to assess the safety and efficacy of second-generation DES versus first-generation DES in CKD patients. Methods:A systematical search of databases of PubMed, EMBASE, and Cochrane Library was conducted for eligible studies comparing the clinical outcomes of first-generation DES versus second-generation DES...
November 13, 2018: Postgraduate Medicine
Giuseppe Carrà, Francesco Bartoli, Marc Galanter, Cristina Crocamo
OBJECTIVES: Despite growing concerns for non-medical use of prescription pain relievers (NMUPPRs), little is known about the role of comorbid, untreated depressive disorders. METHODS: We examined past year rates of NMUPPRs and major depressive episode (MDE), using data between 2008 and 2014 from the National Survey on Drug Use and Health for both youths (12-17 years) and adults (18 or older). Prevalence estimates with 95% confidence intervals were computed. Stratified analyses and generalized linear models were run to examine the association between NMUPPRs and MDE, controlling for treatments received for mental health and/or substance misuse...
November 12, 2018: Postgraduate Medicine
A Al-Hillan, R S Bajwa, A Cheema, A Ezeume, S Gor, H Mahida, D S Kountz
The risk of a venous thromboembolic event is not limited to the pre-hospital, hospital, or immediate post-hospital period. Because of challenges with data collection, the risk of venous thromboembolism (VTE) up to 3 months post-hospitalization for patients with acute and serious medical problems in the setting of chronic disease and/or risk factors for VTE is probably under reported. The growing acceptance and indications of direct oral anticoagulants (DOACs) now includes an indication for VTE prevention for one of the Factor Xa agents...
November 3, 2018: Postgraduate Medicine
Dana B DiBenedetti, Ahmed M Soliman, Claire Ervin, Emily Evans, Charles C Coddington, Sanjay K Agarwal, Eric S Surrey, Hugh S Taylor
OBJECTIVES: Diagnostic delay is common in endometriosis. There is an unmet need for a symptom-based, patient-completed screening tool to facilitate discussions between patients and physicians about potential endometriosis symptoms. The objective of this study was to develop and assess the patient-completed Painful Periods Screening Tool (PPST) to assess the presence of potential endometriosis symptoms. METHODS: To develop and refine the PPST, a cross-sectional qualitative study was conducted with women with endometriosis and healthy controls...
October 18, 2018: Postgraduate Medicine
Iván Pérez-Neri, Carlos Eduardo Diéguez-Campa
Despite its beneficial effects for the cardiovascular system, taurine remains a controversial substance. Taurine increases cardiac muscle strength and prevents arrhythmias, but its benefits go beyond this. Determining taurine levels may become an issue of life or death. In aneurysmal subarachnoid hemorrhage, taurine may be a warning signal informing of the risk of death in a patient. High plasma taurine levels may identify those patients at a high risk for death or a vegetative state at discharge from the hospital; thus, taurine may be a vital marker for the prognosis of this disorder...
October 15, 2018: 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
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
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
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...
November 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...
November 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
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
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