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Postgraduate Medicine

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https://www.readbyqxmd.com/read/28506100/diagnostic-performance-of-ctla-4-carcinoembryonic-antigen-and-cyfra-21-1-for-malignant-pleural-effusion
#1
Mei Chen, Shenglong Xie, Chun Wan, Ni Zeng, Yanqiu Wu, Jiangyue Qin, Yongchun Shen, Fuqiang Wen
OBJECTIVES: The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. As a negative regulator of T-cell activation, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has been associated with many malignant diseases. However, there is limited data about the relationship between CTLA-4 and MPE. The present study aims to investigate whether CTLA-4 levels may correlate with presence of MPE and to assess its potential diagnostic accuracy relative to that of the established markers carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1)...
May 16, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28475455/higher-concentration-insulins-an-overview-of-clinical-considerations
#2
Timothy S Reid, Fryn Schafer, Cynthia Brusko
Three higher concentration insulin products (insulin lispro 200 units/mL, insulin degludec 200 units/mL, and insulin glargine 300 units/mL) received US Food and Drug Administration (FDA) approval in 2015. Although human regular insulin 500 units/mL (U-500) was approved in 1997, a pen and dedicated U-500 syringe became available in 2016. These products offer more treatment options for the increasing numbers of patients requiring insulin to achieve and maintain glycemic targets. Higher concentration insulins have some unique safety and efficacy considerations...
May 12, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28486857/liver-to-abdominal-area-ratio-for-predicting-the-in-hospital-mortality-in-advanced-liver-cirrhosis
#3
Fan Gao, Ran Wang, Han Deng, Feifei Hou, Fernando Gomes Romeiro, Xingshun Qi
OBJECTIVES: To identify the value of liver-to-abdominal area ratio (LAAR) score for predicting the in-hospital mortality in advanced cirrhotic patients. METHODS: All cirrhotic patients with Child-Pugh class B or C who were admitted between July 2012 and June 2014 and underwent abdominal-pelvic CT scans were considered in this retrospective observational study. The association of LAAR with in-hospital death was calculated. Receiver operating characteristic curve analysis was performed...
May 9, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28480795/assessment-of-medication-adherence-among-type-2-diabetic-patients-in-quetta-city-pakistan
#4
Qaiser Iqbal, Sajid Bashir, Javeid Iqbal, Shehla Iftikhar, Brian Godman
OBJECTIVES: Type 2 diabetes (T2DM) is a growing burden among all countries including Pakistan, with medication adherence very important. However, little is known about medication adherence in Pakistan and potential predictors among T2DM patients to provide future guidance. This needs to be addressed. Consequently, the present study sought to assess medication adherence among type 2 diabetic patients in Quetta city, Pakistan. METHODS: Questionnaire based, descriptive study among 300 Pakistani patients attending public and private hospitals aged 18 years and above, having a confirmed diagnosis of T2DM, without additional co-morbidities were targeted...
May 8, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28447515/combination-of-subxiphoid-and-intercostal-uniportal-video-assisted-thoracoscopic-surgery-for-bilateral-lung-lesions-report-of-two-cases-and-review-of-the-literature
#5
Linlin Wang, Lihui Ge, Xueying Yang
Uniportal video-assisted thoracic surgery (VATS) is carried out to reduce postoperative pain after treatment of thoracic diseases. Here, we report a novel method that combines a subxiphoid and intercostal uniportal VATS approach that can be used to treat bilateral pulmonary lesions simultaneously. The first case is a 50-year-old female with bilateral pulmonary lesions who received left lower lobectomy associated with right middle lobe wedge resection synchronously; the other case is a 14-year-old male who was admitted for resection of bilateral lung metastases as a result of previous osteosarcoma...
May 5, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28425825/reviewing-treatments-and-outcomes-in-the-evolving-landscape-of-ulcerative-colitis
#6
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...
May 2, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28427296/predictors-of-response-to-therapy-with-omalizumab-in-patients-with-severe-allergic-asthma-a-real-life-study
#7
Maria Kallieri, Andriana I Papaioannou, Evgenia Papathanasiou, Polyxeni Ntontsi, Spyridon Papiris, Stelios Loukides
OBJECTIVES: 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 28, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28447542/assessing-outcomes-of-educational-videos-in-group-visits-for-patients-with-chronic-pain-at-an-academic-primary-care-clinic
#8
Carrie Vogler, Stacy Sattovia, Laura Y Salazar, Tiffany I Leung, Albert Botchway
OBJECTIVES: This study evaluates the impact of pain education group visits on patients with chronic non-cancer pain (CNCP). The primary outcome of the study was to evaluate patients' functional status and secondary outcomes included knowledge, behavior, and satisfaction, before and after participation in the pain education group visits. METHODS: Locally produced patient educational videos on chronic non-cancer pain were delivered during patient group visits led by a healthcare provider...
April 27, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28440714/hypereosinophilic-syndrome-endomyocardial-biopsy-versus-echocardiography-to-diagnose-cardiac-involvement
#9
Joseph H Butterfield, Garvan C Kane, Catherine R Weiler
OBJECTIVE: To compare echocardiograms and endomyocardial biopsies to diagnose cardiac involvement in hypereosinophilic syndrome. METHODS: We examined the agreement between echocardiography and endomyocardial biopsies to detect cardiac involvement in hypereosinophilic syndrome by reviewing cases identified as hypereosinophilia or hypereosinophilic syndrome in Mayo Clinic databases from January 1978 through June 2009. Single-organ cases of eosinophilia such as eosinophilic fasciitis and eosinophilic gastroenteritis were excluded...
April 25, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28425837/calprotectin-levels-in-rheumatoid-arthritis-and-their-correlation-with-disease-activity-a-meta-analysis
#10
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 24, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28395575/safety-of-inhaled-long-acting-anti-muscarinic-agents-in-copd
#11
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
#12
Bindu Chamarthi, Anthony H 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 12, 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
#13
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...
April 10, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28343408/safety-of-oral-direct-acting-antiviral-regimens-for-chronic-hepatitis-c-in-real-life-conditions
#14
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, hemoglobin, creatinine and lipid profile at baseline, weeks 4, 8 and post 12)...
April 10, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28335674/an-unexpected-cause-of-transient-diarrhea
#15
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
#16
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
#17
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/28326908/sublingual-immunotherapy-tablets-as-a-disease-modifying-add-on-treatment-option-to-pharmacotherapy-for-allergic-rhinitis-and-asthma
#18
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
#19
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
#20
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
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