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Postgraduate Medicine

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https://www.readbyqxmd.com/read/28707495/individualizing-the-selection-of-long-acting-bronchodilator-therapy-for-patients-with-copd-considerations-in-primary-care
#1
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 14, 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
#2
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 11, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28670961/rationales-and-choices-for-the-treatment-of-patients-with-nyha-class-ii-heart-failure
#3
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...
July 3, 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
#4
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
#5
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/28633585/lipoprotein-a-activated-immunity-insulin-resistance-and-new-onset-diabetes
#6
Ayşem Kaya, Altan Onat, Hüsniye Yüksel, Günay Can, Murat Yüksel, Evin Ademoğlu
OBJECTIVES: Some evidence suggests that serum lipoprotein[Lp](a) may be inversely linked to type-2 diabetes. We aimed to determine in nondiabetic people the relationship of serum [Lp](a) with insulin resistance and new-onset diabetes (NOD). MATERIALS AND METHODS: Population-based middle-aged adults (n = 1685) were categorized by fasting glucose and stratified to gender, having excluded prevalent diabetic subjects. NOD (n = 90) occurred over a median 5 years' follow-up...
June 22, 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
#7
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
#8
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/28628338/community-acquired-tsukamurella-pneumonia-in-a-young-immunocompetent-adult-a-case-misdiagnosed-as-pulmonary-tuberculosis-and-literature-review
#9
LiKun Yang, Yan Cao, Zijun Dan, Zhongyuan Wang, Xinjing Wang
This report describes a case of Tsukamurella pneumonia in a 24-year-old immunocompetent woman. The patient was diagnosed as having pulmonary tuberculosis and was treated for nearly 9 months. The correct diagnosis was suspected only when the results of mycobacteria nucleic acid amplification tests on cultural colonies were negative. Tsukamurella was identified from the patient's sputum and bronchoalveolar lavage fluid by using 16S rRNA sequence analysis. Here, the clinical presentation, diagnosis, and treatment strategies of Tsukamurella pneumonia are discussed, along with a literature review...
June 19, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28562155/challenges-of-implementing-fibromyalgia-treatment-guidelines-in-current-clinical-practice
#10
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/28582631/chronic-kidney-disease-as-a-risk-factor-for-vestibular-dysfunction
#11
Da Jung Jung, Kyu-Yup Lee, Jun Young Do, Seok Hui Kang
OBJECTIVES: The aim of this study was to determine whether chronic kidney disease (CKD) is associated with vestibular dysfunction in a general population. METHODS: Of the total participants, 7,799 of participants were included in this study. The data collected from the participants during the health examination included an estimated glomerular filtration rate (eGFR) and balancing test results. Mild CKD was defined as an eGFR of 60-90 mL/min/1.73 m2 or an eGFR ≥ 90 mL/min/1...
June 9, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28532204/management-of-allergic-rhinitis-in-the-era-of-effective-over-the-counter-treatments
#12
Warner W Carr, Barbara P Yawn
Allergic rhinitis (AR) may be regarded as a trivial issue unworthy of the doctor's time, and with the availability of many different over-the-counter (OTC) treatments, up to two thirds of patients self-manage AR before seeking medical care. Yet, AR can have a significant impact on health-related quality of life and is associated with a greater detriment to work productivity than other chronic diseases such as diabetes and hypertension. For many patients, the impact on quality of life is greater than suggested by reported symptoms and should also be a focus of treatment...
June 9, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28562187/a-rare-incidentaloma-found-on-low-dose-ct-screening-for-lung-cancer-scanner-beware
#13
Daniel G Federman, Rebecca J Baldassarri, Hilary C Cain
Screening for lung cancer with low-dose computed tomography (LDCT) has been shown to reduce mortality and has been recommended by the U.S. Preventive Services Task Force for adults 55 to 80 years of age with a 30 pack-year smoking history who are either current smokers or those that quit within 15 years. However, the overwhelming majority of abnormalities detected are not from malignancy. We report a case of pulmonary Langerhans' cell histiocytosis, here-to-fore thought of as extremely uncommon, and make readers aware that this may be increasingly found as LDCT is more widely adopted...
June 5, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28540752/herpes-zoster-typical-and-atypical-presentations
#14
Roy Rafael Dayan, Roni Peleg
Varicella- zoster virus infection is an intriguing medical entity that involves many medical specialties including infectious diseases, immunology, dermatology, and neurology. It can affect patients from early childhood to old age. Its treatment requires expertise in pain management and psychological support. While varicella is caused by acute viremia, herpes zoster occurs after the dormant viral infection, involving the cranial nerve or sensory root ganglia, is re-activated and spreads orthodromically from the ganglion, via the sensory nerve root, to the innervated target tissue (skin, cornea, auditory canal, etc...
June 5, 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
#15
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/28540770/transdermal-estrogens-in-the-changing-landscape-of-hormone-replacement-therapy
#16
Keli L Beck, Michelle C Anderson, Julienne K Kirk
Views and clinical practice on hormone replacement therapy (HRT) for postmenopausal women have varied widely over the last several decades. The 1990s showed a dramatic decline in prescribing and only recently are prescription rates increasing again. Use of HRT is first line for women suffering from the symptoms of menopause. For a certain population of postmenopausal women, HRT is recommended for prevention of fracture. More consideration is being given to patient risk factors, side effects, and formulations available...
May 31, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28480795/assessment-of-medication-adherence-among-type-2-diabetic-patients-in-quetta-city-pakistan
#17
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 to improve care. 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 24, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28506100/diagnostic-performance-of-ctla-4-carcinoembryonic-antigen-and-cyfra-21-1-for-malignant-pleural-effusion
#18
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 19, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28486857/liver-to-abdominal-area-ratio-for-predicting-the-in-hospital-mortality-in-advanced-liver-cirrhosis
#19
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 abdominopelvic 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 19, 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
#20
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
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