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Postgraduate Medicine

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https://www.readbyqxmd.com/read/28818004/identification-and-treatment-of-augmentation-in-patients-with-restless-legs-syndrome-practical-recommendations
#1
James Geyer, Richard Bogan
Restless legs syndrome (RLS) is a chronic disorder causing clinically significant discomfort to approximately 3% of adults. Although RLS was first identified centuries ago, our understanding of this disorder, its causes, and its treatments is still evolving. In particular, our knowledge of the potential negative effects of RLS treatments, including dopaminergic augmentation, continues to expand. Augmentation, which refers to a paradoxical treatment-related increase in RLS symptoms, has been associated with all three dopamine agonists approved for the treatment of RLS - rotigotine, pramipexole, and ropinirole...
August 18, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28787218/how-to-evaluate-renal-function-in-stable-cirrhotic-patients
#2
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
https://www.readbyqxmd.com/read/28770650/osteoblast-as-a-target-of-anti-osteoporotic-treatment
#3
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
https://www.readbyqxmd.com/read/28770640/macrolide-and-fluoroquinolone-mediated-cardiac-arrhythmias-clinical-considerations-and-comprehensive-review
#4
Elyse Cornett, Matthew B Novitch, Alan D Kaye, Chris A Pann, Harish Siddaiah Bangalore, Gregory Allred, Matthew Bral, Preya K Jhita, Adam M Kaye
BACKGROUND: While there is evidence for cardiac arrhythmias associated with macrolide and fluoroquinolone antibiotics, there is still debate among health care providers as to whether this risk of arrhythmia is overstated. A joint panel of the US Food and Drug Administration suggested that macrolide and fluoroquinolone labels need much stronger warnings regarding the possible serious adverse cardiac effects associated with these antibiotics, especially since they are so widely prescribed...
August 3, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28770635/natural-history-and-treatment-of-cutaneous-and-systemic-mastocytosis
#5
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 3, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28762862/a-clinician-s-guide-to-adhd-treatment-options
#6
Gregory W Mattingly, Joshua Wilson, Anthony L Rostain
Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition of children and adolescents that often persists into adulthood. Primary care physicians are commonly the first to diagnosis ADHD and initiate a treatment plan with the patient. Guidelines recommend psychostimulant treatment as a first-line therapy in the management plan because it has a substantial impact on alleviating the core symptoms of ADHD. The recent development of a variety of methylphenidate and amphetamine formulations provides many options to meet individual patient lifestyle needs...
August 1, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28749197/cardiovascular-benefits-and-safety-of-non-insulin-medications-used-in-the-treatment-of-type-2-diabetes-mellitus
#7
Srikanth Yandrapalli, George Jolly, Adam Horblitt, Abdallah Sanaani, Wilbert S Aronow
Diabetes mellitus is a growing in exponential proportions. If the current growth trend continues, it may result in every third adult in the United States having diabetes mellitus by 2050, and every 10(th) adult worldwide. Type 2 diabetes mellitus (T2DM) confers a 2- to 3-fold increased risk of cardiovascular (CV) events compared with non-diabetic patients, and CV mortality is responsible for around 80% mortality in this population. Patients with T2DM can have other features of insulin resistance-metabolic syndrome like hypertension, lipid abnormalities, and obesity which are all associated with increased CV disease and stroke risk even in the absence of T2DM...
July 27, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28737059/authors-reply-delta-hr-bt-as-a-possible-predictor-of-severity-or-mortality-not-a-predictor-of-bacterial-infection
#8
Jun Hamano, Yasuharu Tokuda
No abstract text is available yet for this article.
July 27, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28730854/physical-activity-body-mass-index-and-waist-circumference-change-and-normal-range-glycated-hemoglobin-on-incident-diabetes-jackson-heart-study
#9
Meghan K Edwards, Ovuokerie Addoh, Eveleen Sng, Toshikazu Ikuta, Teresa Carithers, Alain G Bertoni, Paul D Loprinzi
OBJECTIVES: The purpose of this study was to 1) evaluate whether physical activity has a protective effect on incident diabetes among African Americans across combinations of body mass index (BMI) and waist circumference (WC), 2) evaluate the effect of changes on BMI and WC on incident diabetes, and 3) evaluate the effect of 'normal range' glycated hemoglobin (A1C) on incident diabetes. METHODS: Data from the prospective Jackson Heart Study were evaluated, with baseline data assessed between 2001 and 2004 and follow-up data occurring between 2009 and 2013...
July 26, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28707495/individualizing-the-selection-of-long-acting-bronchodilator-therapy-for-patients-with-copd-considerations-in-primary-care
#10
Brian W Carlin, Sandra K Schuldheisz, Imre Noth, Gerard J Criner
Chronic obstructive pulmonary disease (COPD) is a common condition encountered in primary care settings. COPD remains the third leading cause of death in the United States and carries a significant burden to both patients and the healthcare system. COPD is a chronic, progressive, irreversible lung disease associated with high morbidity and mortality. Proper assessment and diagnosis requires spirometry which is currently underutilized in primary care. Management is focused on adequate symptom control, improving quality of breathing and quality of life, and preventing exacerbations and hospitalizations...
July 24, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28695762/a-review-on-the-performance-of-osteoporosis-self-assessment-tool-for-asians-in-determining-osteoporosis-and-fracture-risk
#11
Kok-Yong Chin
The prevalence of osteoporosis in Asian countries is growing. An effective screening method will enable patients at risk for osteoporosis to receive early diagnosis and treatment, and avoid overcrowding the limited dual-energy x-ray absorptiometry (DXA) machines available in Asian countries. Many simple osteoporosis screening algorithms have been developed but they are not validated for use in Asian populations. osteoporosis self-assessment tools for Asians (OSTA), established using a multinational Asian cohort, is the first screening algorithm that caters for the Asian populations...
July 24, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28730913/delta-hr-bt-as-a-possible-predictor-of-severity-or-mortality-not-a-predictor-of-bacterial-infection
#12
Shungo Yamamoto, Yuki Kataoka
No abstract text is available yet for this article.
July 21, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28724322/predictors-of-urinary-incontinence-between-abdominal-obesity-and-non-obese-male-adults
#13
Dongmei Li, Yi Xu, Qingbin Nie, Yan Li, Gengsheng Mao
OBJECTIVES: To investigate factors that may be associated with urinary incontinence (UI) in abdominal obese and non-obese adult males. METHODS: Data were analyzed for 2671 men (≥40 years of age) who participated in the National Health and Nutrition Examination Survey (2005-2008). We define abdominal obesity as a waist circumference >102 cm. Men with Incontinence Severity Index ≥3 were defined as having UI. Logistic regression analyses were used to identify factors associated with stress and urge UI...
July 20, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28657399/combination-sglt2-inhibitor-and-glp-1-receptor-agonist-therapy-a-complementary-approach-to-the-treatment-of-type-2-diabetes
#14
Robert S Busch, Michael P Kane
Among persons with type 2 diabetes (t2d), the development of glucose intolerance involves dysfunction in several organs and tissues, including the muscle, liver, pancreas, kidney, gastrointestinal tract, adipose tissue, and brain. individuals with t2d typically have a number of comorbidities, including hypertension, hyperlipidemia, and being overweight or obese, and are, consequently, at high cardiovascular risk. guidelines recommend a comprehensive care strategy that includes treatment of diabetes-related complications and comorbidities beyond those related to hyperglycemia...
June 28, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28643575/combined-rex-bypass-shunt-with-pericardial-devascularization-alleviated-prehepatic-portal-hypertension-caused-by-cavernomatous-transformation-of-portal-vein
#15
Ruo-Yi Wang, Jun-Feng Wang, Qian Liu, Nan Ma, Wei-Xiu Chen, Jin-Liang Li
OBJECTIVE: To evaluate the effects of combined Rex-bypass shunt and pericardial devascularization on prehepatic portal hypertension secondary to cavernomatous transformation of portal vein (CTPV). METHODS: Forty-two patients aged from 3 years to 49 years (divided into 3 groups), 26 cases male and 16 female, with prehepatic vascular hepertention were treated with Rex-bypass shunt combined with pericardial devascularization. In each patient, preoperative assessment included ultrasound and computed tomographic angiography of the portal vein and blood analysis...
June 23, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28635354/the-effects-of-food-on-opioid-induced-nausea-and-vomiting-and-pharmacological-parameters-a-systematic-review
#16
Robert B Raffa, Robert Colucci, Joseph V Pergolizzi
Opioids remain the standard of care for treating moderate to severe pain resulting from surgery or injury in cases of acute pain, and are recommended for patients who have not responded to nonopioid analgesics. Effective management of pain has an impact on clinical course and often depends on achieving an acceptable balance between opioid efficacy, safety, and tolerability. Common opioid-related adverse events such as nausea and vomiting are associated with an overall lower achievement of effective pain management and patient satisfaction...
June 21, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28627954/reliability-analysis-of-cobb-measurement-in-degenerative-lumbar-scoliosis-using-endplate-versus-pedicle-as-bony-landmarks
#17
Jing Guo, Xian-Chao Deng, Qin-Jie Ling, Zhi-Xun Yin, Er-Xing He
OBJECTIVES: Degenerative changes of endplates in older patients and tilting of vertebral body in lumbosacral lordosis could make an accurate identification of endplates for the Cobb measurement difficult. Pedicles have been proposed as alternative landmarks because they are usually better visualized, and offer similar clinical validity to the endplates. The objective of this study was to investigate the reliability of the pedicle method of Cobb measurement in degenerative lumbar scoliosis and compare it with the traditional endplate method...
June 21, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28562155/challenges-of-implementing-fibromyalgia-treatment-guidelines-in-current-clinical-practice
#18
Lesley M Arnold, Daniel J Clauw
The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary...
June 19, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28562148/cross-sectional-association-of-exercise-strengthening-activities-and-cardiorespiratory-fitness-on-generalized-anxiety-panic-and-depressive-symptoms
#19
Paul D Loprinzi, Ovuokerie Addoh, Nina Wong Sarver, Ingrid Espinoza, Joshua R Mann
OBJECTIVE: Limited research has evaluated the individual and combined associations of physical activity (PA), cardiorespiratory fitness (CRF) and muscle strengthening activities (MSA) on generalized anxiety, panic and depressive symptoms. We evaluated this topic in a representative sample of young (20-39 years) adults, with considerations by sex. METHODS: Data from the 1999-2004 National Health and Nutrition Examination Survey (N = 2088) were used. Generalized anxiety, panic and depressive symptoms were assessed via self-report as well as using the Generalized Anxiety Disorder, Panic Disorder, and Depressive Disorders modules of the automated version of the World Health Organization Composite International Diagnostic Interview (CIDI-Auto 2...
June 2, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28670961/rationales-and-choices-for-the-treatment-of-patients-with-nyha-class-ii-heart-failure
#20
REVIEW
Edward M Gilbert, Weining David Xu
Heart failure (HF) in the United States represents a significant burden for patients and a tremendous strain on the healthcare system. Patients receiving a diagnosis of HF can be placed into 1 of 4 New York Heart Association (NYHA) functional classifications; the greatest proportion of patients are in the NYHA class II category, which is defined as patients having a slight limitation of physical activity but who are comfortable at rest, and for whom ordinary physical activity results in symptoms of HF. Because the severity of NYHA class II HF may be perceived as mild or unalarming by this definition, the urgency to treat this type of HF may be overlooked...
August 2017: Postgraduate Medicine
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