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Postgraduate Medicine

Claudio Tana, Luca Busetto, Angelo di Vincenzo, Fabrizio Ricci, Andrea Ticinesi, Fulvio Lauretani, Antonio Nouvenne, Maria Adele Giamberardino, Francesco Cipollone, Roberto Vettor, Tiziana Meschi
Background Hyperuricemia and gout represent important issues in the obese patients. Considering the epidemic trend of overweight and obesity in developed countries, the impact of these conditions is likely to increase. At present, bariatric surgery represents the most effective treatment for the management of severe obesity for reducing weight and the impact of associated comorbidities, but its effects on hyperuricemia and gout have not been fully elucidated. Methods In this narrative review, we discuss the current knowledge about hyperuricemia and gout in obese patients undergoing bariatric surgery...
June 9, 2018: Postgraduate Medicine
Xiaowei Li, Hang Yang, Zhijun Duan, Qingyong Chang, Xiaoting Wei, Changjin Li, Ying Ba, Jianling Du
OBJECTIVES: Some older individuals who present with gastrointestinal symptoms as their chief complaint were ultimately diagnosed with hypopituitarism instead of gastrointestinal diseases. The aim of this study was to find the characteristics of biochemical indicators in these patients so as to reduce early misdiagnosis. METHODS: We conducted a retrospective review of 45 patients with hypopituitarism who were at least 60 years of age. Two groups were included: group of hypopituitarism patients with gastrointestinal symptoms (Group G) included 23 patients with gastrointestinal symptoms and group of hypopituitarism patients without gastrointestinal symptoms (Group N) included 22 patients without these symptoms...
June 4, 2018: Postgraduate Medicine
Angelika Bazyluk, J Malyszko, Edyta Zbroch
The prevalence of chronic kidney disease has increased markedly over past decades due to the aging of the worldwide population. Despite the progress in the prevention and treatment, the cardiovascular morbidity and mortality remains high among patients with chronic kidney disease. Although chronic kidney disease is a progressive and irreversible condition, it is possible to slow decreasing kidney function, as well as the development and progression of associated with kidney disease comorbidities. Diabetes mellitus (DM) has become major cause of chronic kidney disease worldwide...
May 30, 2018: Postgraduate Medicine
Angel López-Candales, Paula M Hernández Burgos, Pedro E Vargas
No abstract text is available yet for this article.
May 30, 2018: Postgraduate Medicine
Timothy Wigal, Matthew Brams, Glen Frick, Brian Yan, Manisha Madhoo
OBJECTIVES: Evaluate the efficacy, duration of effect, and tolerability of SHP465 mixed amphetamine salts (MAS) extended-release versus placebo and immediate-release MAS (MAS IR) in adults with attention-deficit/hyperactivity disorder (ADHD). METHODS: Adults with ADHD Rating Scale, Version IV (ADHD-RS-IV) scores ≥24 were randomized to SHP465 MAS (50 or 75 mg), placebo, or 25 mg MAS IR in a double-blind, 3-period, crossover study using a simulated adult workplace environment...
May 29, 2018: Postgraduate Medicine
Arif Abu-Abed, Said Azbarga, Roni Peleg
OBJECTIVES: Vitamin D is an important component of bone metabolism. Skin cells synthesize vitamin D when exposed to the sun. However, prolonged sun exposure damages the skin and increases the risk for skin cancer. The objective is to evaluate and compare the attitudes and recommendations of family doctors, dermatologists, and endocrinologists on exposure to the sun and vitamin D. METHODS: In a cross-sectional study, a questionnaire was completed by personal interview in a study population of 78 family doctors, 21 dermatologists, and 22 endocrinologists...
May 24, 2018: Postgraduate Medicine
Wei Xu, Yan Li, Zeyu Chen, Teng Liu, Shan Wang, Linfeng Li
BACKGROUND: Currently there is no cure for severe atopic dermatitis (AD). Wet-wrap therapy (WWT) has also been used to treat pediatric AD and shown a satisfactory effectiveness, but clinical evidence supporting the use of WWT on severe adult AD is still insufficient. METHODS: Twelve patients (8 men and 4 women) with severe AD (SCORing Atopic Dermatitis [SCORAD] score≥50) treated between January 2015 and September 2017 in our hospital were included. The patients underwent WWT (daily dose: 15g halometasone cream+100g Vaseline ointment) twice daily for 2 hours/session for 7 days...
May 16, 2018: Postgraduate Medicine
David S H Bell
Prior to the availability of degludec and regular human insulin inhalation powder in the type 1 diabetic patient glycemic control with subcutaneous insulin injections was difficult to obtain due to nocturnal, pre-prandial and often severe hypoglycemia as well as post-prandial hyperglycemia and hypoglycemia due to 'stacking' of insulin. A 62-year-old female with type 1 diabetes for 56 years who could not be controlled with continuous subcutaneous insulin aspart infusion obtained glycemic control without significant hypoglycemia or increased post-prandial glycemic excursions utilizing degludec insulin for basal needs and technosphere before meals and between meals if needed...
May 14, 2018: Postgraduate Medicine
Daniela Frankova, Kristin Melissa Olson, Brian Joseph Whyms, Maria Alejandra Guevara Hernandez, Jan Franko
OBJECTIVES: There is evidence that increasing severity of hypertriglyceridemia increases the risk of acute pancreatitis. There is a debate about superiority of treatment methods and previous works have specifically called for direct comparison between IV insulin and apheresis techniques. Identify patient characteristics predictive of lipid-lowering therapy selection in a large community hospital for treatment of hypertriglyceridemia; evaluate for a concentration-dependent relationship between hypertriglyceridemia severity and risk of acute pancreatitis; assess for differences in clinical outcomes between patients treated with IV insulin versus apheresis...
May 4, 2018: Postgraduate Medicine
Khalid Siddiqui, Salini Scaria Joy, Shaik Sarfaraz Nawaz, Mohammad T Al Otaibi, Khalid Al-Rubeaan
OBJECTIVES: This observational cross-sectional study aimed to investigate the relationship between serum Angiopoietin-2 (Ang-2) levels and cardiovascular (CVD) risk factors in drug controlled hypertensive diabetic subjects without cardiovascular complications. METHODS: All subjects were evaluated for fasting blood glucose (FBG), HbA1c, liver enzymes, lipid profile and serum Ang-2. RESULTS: Mean serum Ang-2 level was significantly higher in hypertensive diabetic subjects...
April 30, 2018: Postgraduate Medicine
Theresa L Garnero, Nichola J Davis, Magaly Perez-Nieves, Irene Hadjiyianni, Dachuang Cao, Jasmina I Ivanova, Mark Peyrot
Continuing use of medication is key to effective treatment and positive health outcomes, particularly in chronic conditions such as diabetes. However, in primary care, non-persistence (i.e. discontinuing or interrupting treatment) with insulin therapy is a common problem among patients with type 2 diabetes. To help primary care physicians manage patients who are non-persistent or likely not to be persistent, this review aimed to provide an overview of modifiable and non-modifiable factors associated with insulin non-persistence as well as practical strategies to address them...
April 6, 2018: Postgraduate Medicine
Gladstone C McDowell, Joseph Winchell
OBJECTIVES: The majority of patients seeking medical care for chronic pain consult a primary care physician (PCP). Because systemic opioids are commonly prescribed to patients with chronic pain, PCPs are attempting to balance the competing priorities of providing adequate pain relief while reducing risks for opioid misuse and overdose. It is important for PCPs to be aware of pain management strategies other than systemic opioid dose escalation when patients with chronic pain fail to respond to conservative therapies and to initiate a multimodal treatment plan...
March 28, 2018: Postgraduate Medicine
Eric L Johnson, Juan P Frias, Jennifer M Trujillo
The alarming rise in the number of people living with type 2 diabetes (T2D) presents primary care physicians with increasing challenges associated with long-term chronic disease care. Studies have shown that the majority of patients are not achieving or maintaining glycemic goals, putting them at risk of a wide range of diabetes-related complications. Disease- and self-management programs have been shown to help patients improve their glycemic control, and are likely to be of particular benefit for patients with diabetes dealing with these issues...
March 23, 2018: Postgraduate Medicine
Huixian Qiu, Yuee He, Xing Rong, Yue Ren, Lulu Pan, Maoping Chu, Rongzhou Wu, Hongying Shi
OBJECTIVE: Kawasaki disease (KD) is a systemic vasculitis with serious complications, especially the development of coronary artery lesions (CALs). The aim of this study was to identify the risk for the development of CALs with IVIG treatment of KD >10 days after illness onset in patients with different KD status, and explore potential moderators of the association between delayed treatment and CALs. METHODS: We performed a retrospective review of the medical records of KD patients...
May 2018: Postgraduate Medicine
Juan M Roman-Belmonte, Hortensia De la Corte-Rodriguez, E Carlos Rodriguez-Merchan
Although the best-known use of blockchain technology (BCT) is in the field of economics and cryptocurrencies in general, its usefulness is extending to other fields, including the biomedical field. The purpose of this article is to clarify the role that BCT can play in the field of medicine. We have performed a narrative review of the literature on BCT in general and on medicine in particular. The great advantage of BCT in the health arena is that it allows development of a stable and secure data set with which users can interact through transactions of various types...
May 10, 2018: Postgraduate Medicine
Fengwei Chen, Kun Chen, Cheng Zhang, Xue Chen, Junjun Huang, Peng Jia, Jing Ma, Jue Zhang, Jing Fang, Guangfa Wang
PURPOSE: We aimed to develop a novel index, the hypoxia burden index (HBI), that reflects the degree and duration of oxygen desaturation, and to determine whether this index is better than the apnea hypopnea-index (AHI) for evaluating obstructive sleep apnea (OSA) and cardiovascular diseases morbidities. METHODS: We retrospectively analyzed 459 adult subjects who underwent overnight polysomnography (PSG) in this study. The HBI was calculated by dividing the total desaturation area of SpO2 below 90% by the TST measured in seconds...
May 2018: Postgraduate Medicine
Lili Tong, Sharon Adler
Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and elevates individuals' risk for cardiovascular disease, the leading cause of morbidity and mortality in T2DM. Achieving and maintaining tight glycemic control is key to preventing development or progression of CKD; however, improving glycemic control may be limited by effects of renal impairment on the efficacy and safety of T2DM treatments, necessitating dosing adjustments and careful evaluation of contraindications...
May 2018: Postgraduate Medicine
Justin Barnes, Brandon Coleman, Sharon Hwang, Aleksandra Stolic, Athos Bousvaros, Samuel Nurko, Gregory D Salinas
OBJECTIVES: The goal of this study was to identify opportunities among gastroenterologists and gastroenterology nurse practitioners (NPs)/physician assistants (PAs) for continuing medical education (CME) related to functional constipation. METHODS: An online, case-vignette survey was designed to identify and quantify practice patterns of pediatric gastroenterology clinicians. Case vignettes are a validated method for assessing clinician practice patterns. The survey consisted of three patient cases: a 3-year-old female with a 6-month history of constipation; a 6-year-old male with a 1-year history of constipation refractory to treatment and a sacral dimple with nearby tuft of hair; and a 16-year-old male with a 10-year history of constipation, and a sullen, depressed mood...
May 2018: Postgraduate Medicine
Alan S Maisel, Lori B Daniels, Inder S Anand, Peter A McCullough, Sheryl L Chow
Levels of natriuretic peptides (NPs), such as B-type NP (BNP) and the N-terminal fragment of its prohormone (NT-proBNP), are well-established biomarkers for patients with heart failure (HF). Although these biomarkers have consistently demonstrated their value in the diagnosis and prognostication of HF, their ability to help clinicians in making treatment decisions remains debated. Moreover, some new HF drugs can affect concentrations of NPs, such as the prevention of BNP degradation by angiotensin receptor/neprilysin inhibitors (ARNIs), and may present a challenge in the interpretation of levels of BNP...
April 2018: Postgraduate Medicine
Mei-Fang Wang, Li Wang, Lin-Feng Li
Hyperkeratosis of the nipple and areola is an uncommon dermatosis without well-defined etiology, which occurs mostly in young women and may only be a cosmetic problem. In 1938, Levy-Frankel classified this disease into three variants; type I involves hyperkeratosis with an epidermal nevus, and has rarely been reported. We report a case of a 23-year-old woman with long-term bilateral pigmentation and thickening of the nipples and areolae, accompanied with dark brown, flat lesions with a linear distribution on her left forearm...
April 2018: Postgraduate Medicine
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