Expert consensus from the Arabian Gulf on selecting disease-modifying treatment for people with multiple sclerosis according to disease activity.
Authors: Alroughani R, Inshasi J, Al-Asmi A, Alqallaf A, Al Salti A, Shatila A, Boshra A, Canibano B, Deleu D, Al Sharoqi I, Al Khabouri J Abstract Recent research has expanded our understanding of the natural history and clinical course of multiple sclerosis (MS) in the Arabian Gulf region. In addition, the number of available therapies for MS has increased greatly in recent years, which complicates considerably the design of therapeutic regimens. We, an expert group of physicians practising in Arabian Gulf countries, present pragmatic consensus recommendations for the use of disease modifying therapy, according t...
Source: Postgraduate Medicine - February 25, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The effect of early oral feeding after esophagectomy on the incidence of anastomotic leakage: An updated review.
Authors: Zhang C, Zhang M, Gong L, Wu W Abstract Early oral feeding (EOF) is an important component of enhanced recovery after surgery (ERAS), but raises the concern of increased risk of anastomotic leakage (AL) in patients receiving esophagectomy. We searched PubMed, Web of Science, Scopus, Cochrane Library and Google Scholar from their inception to February 2020 for published articles that compared AL after EOF (oral feeding initiated within 3 postoperative day [POD] 3) vs. conventional feeding regimen (nil-by-mouth with enteral tube nutrition support, until oral feeding initiated since POD 4 and beyond) followin...
Source: Postgraduate Medicine - February 25, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Application of Narrow Band Imaging thoracoscopy in diagnosis of pleural diseases.
The objective of this study was to investigate the diagnostic value of NBI technology during thoracoscopy. Methods: Patients with undiagnosed pleural effusions admitted to our hospital between September 2017 and September 2019 were enrolled. During the thoracoscopy, we performed WL mode first and then NBI. Pictures of endoscopic real-time lesions were recorded under two modes, and at least 5 pieces of tissue were taken respectively on pleura lesions. Biopsy specimens were respectively taken for pathologic analysis. Diagnostic sensitivity, specificity were calculated to compare with pathologic results. Results: 100 eligible...
Source: Postgraduate Medicine - February 22, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Treatment of painful polyneuropathies of diabetic and other origins with 10 kHz SCS: A case series.
In conclusion, 10 kHz SCS treatment resulted in significant pain relief in all the patients, decreased reliance on pain medication and improved lower limb sensory function in majority of patients. PMID: 32073352 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 21, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Hospital mortality and long-term mortality among hospitalized patients with various admission serum ionized calcium levels.
Conclusion: Both hypocalcemia and hypercalcemia were associated with increased short- and long-term mortality with a U-shape relationship. PMID: 32066311 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 19, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Interventional psychiatry.
Authors: Vincent KM, Ryan M, Palmer E, Rosales JL, Lippmann S, El-Mallakh RS PMID: 32053020 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 15, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Health benefits of Lactobacillus rhamnosus GG and Bifidobacterium animalis subspecies lactis BB-12 in children.
In conclusion, we propose that LGG can be safely administered to toddlers and older children to manage the symptoms of AGE and prevent AAD. These findings should be considered for incorporation into clinical practice guidelines and should help to focus the efforts of the probiotic industry. PMID: 32059116 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 15, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Primary hyperparathyroidism associated with non-Hodgkin lymphoma: a case report and literature review.
We report a case of primary hyperparathyroidism associated with NHL. The first symptom of this patient was hypercalcemia. Hypercalcemia is the primary first clinical manifestation of primary hyperparathyroidism, while NHL may also be diagnosed by hypercalcemia. Clinically, patients with hypercalcemia as the first symptom should be alert to the coexistence of their two diseases. As primary hyperparathyroidism and NHL occur simultaneously, the relationship between the two diseases requires further study. A review of the literature regarding primary hyperparathyroidism associated with NHL was performed, focusing on clinical p...
Source: Postgraduate Medicine - February 14, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Blood volume and pain perception during finger prick capillary blood sampling: are all safety lancets equal?
Conclusions: This study suggests that although all investigated safety lancets achieve adequate performance regarding the necessary capillary blood volume to run a diagnostic of test, lancets equipped with blades differ significantly from those equipped with needles in terms of the mean obtained capillary blood volume. Further, although all devices produced relatively low levels of pain, the amount of pain caused by blade versions of safety lancets has been found to be higher than that of needle versions.ClinicalTrials.gov ID: NCT04001348. (https://clinicaltrials.gov/ct2/show/NCT04001348?term=NCT04001348&draw=2&ran...
Source: Postgraduate Medicine - February 8, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Reappraising the use of benzodiazepines in chronic pain patients.
Authors: Pergolizzi JV, LeQuang JA PMID: 32008385 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 7, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Admittances characteristics by sepsis in the Spanish internal medicine services between 2005 and 2015: mortality pattern.
Authors: Canora J, Moreno G, Marco J, San Román J, Plaza S, Zapatero A, Barba R Abstract Background: Studies in recent years suggest an increase in the incidence of sepsis but a decrease in mortality. The aim of this study is to describe the characteristics of patients discharged after a sepsis episode from Spanish internal medicine services between 2005 and 2015.Results: Since 2005, in which there were a total of 4,319 cases, sepsis hospitalizations has been consistently increasing yearly reaching a total of 25,820 cases in 2015. We observed that septic patients are older and with higher comorbidity than th...
Source: Postgraduate Medicine - January 29, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Real-world management of hyperkalemia with patiromer among United States Veterans.
Authors: Kovesdy CP, Gosmanova EO, Woods SD, Fogli JJ, Rowan CG, Hansen JL, Sauer BC Abstract Objective: Patiromer is a sodium-free, non-absorbed, potassium (K+) binder approved for the treatment of hyperkalemia (HK). Among US Veterans with HK, this retrospective, observational cohort study evaluated patiromer utilization, RAASi continuation, and K+ concentration change following patiromer initiation.Methods: Using data from the Veterans Affairs Corporate Data Warehouse, Veterans with HK (K+ ≥5.1 mmol/L) were included upon patiromer initiation (index date) during the study period (1/2016-8/2018). All patien...
Source: Postgraduate Medicine - January 25, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Synergistic interaction of hyperuricemia and hypertension on reduced eGFR: insights from a general chinese population.
Conclusions: Hyperuricemia and hypertension may have a synergistic interaction towards renal function loss in addition to their independent impacts. Our findings may provide a straightforward illustration which is easy for the public to realize the hazard of coexistent hypertension and hyperuricemia on renal injury. PMID: 31962051 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - January 23, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Prevalence of Iron Deficiency (ID) without Anemia in the General Population Presenting to Primary Care Clinics: A Cross-Sectional Study.
Authors: Abuaisha M, El Masri R, Itani H, Antoun J Abstract Objectives: There are no evidence-based recommendations to screen for iron deficiency in non-anemic patients, even though symptoms may be present. The aim of this study is to measure the prevalence of iron deficiency (ID) without anemia in the general population aged 18-50 presenting to primary care along with the incidence and time to develop anemia in the iron-deficient population.Methods: A single-center retrospective chart review of patients who presented to family medicine clinics between June 2010 and March 2018 at the American University of Beirut M...
Source: Postgraduate Medicine - January 16, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Cardiologists' and cardiovascular surgeons' attitudes toward managing endodontic infections and oral health in patients with cardiovascular diseases.
Conclusion: Although there is not yet any conclusive evidence on whether the presence of an endodontic infection may have an impact on CVDs, this study showed that most cardiac specialists attached importance to endodontic infections. PMID: 31933403 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - January 16, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The Physical Examination: A Survey of Patient Preferences and Expectations During Primary Care Visits.
Authors: Duan L, Mukherjee EM, Federman DG Abstract Background: Little is known about patient preference regarding the physical exam in non-urgent primary care settings.Objective: To determine the differences between a patient's expectations of the physical exam and the actual components of the physical examination performed during a non-urgent visit.Design: 452 surveys administered in the waiting room of a VA primary care clinic in West Haven, CT.Key Results: The response rate was 91.6% (n = 414). For 15 of 16 maneuvers on the survey, more respondents believed a reasonable provider should conduct it than received ...
Source: Postgraduate Medicine - January 15, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Prevalence of burnout syndrome in gastroenterologists and endoscopists: results of a national survey in Mexico.
Conclusion: BOS is a frequent entity in Mexican gastroenterologists and endoscopists. There are potentially modifiable factors associated with BOS. PMID: 31922437 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - January 12, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Long-term safety and efficacy of secukinumab in patients with psoriasis and major psychiatric disorders: a case series.
Authors: Esposito M, Giunta A, Del Duca E, Manfreda V, Troisi A, Bianchi L, Fargnoli MC Abstract Patients with psoriasis are at increased risk for psychiatric comorbidities, including suicidal ideation and behavior. For this reason, a careful assessment of patients, in particular for those reporting history of psychiatric symptoms is needed. We herein report a case series of 3 patients affected by major psychiatric disorders and moderate-to-severe psoriasis, successfully treated with secukinumab, an IL17A inhibitor, with a long-term psychiatric disease stability. PMID: 31916470 [PubMed - as supplied by publishe...
Source: Postgraduate Medicine - January 11, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The effect of genotype on musculoskeletal complaints in patients with familial mediterranean fever.
THE EFFECT OF GENOTYPE ON MUSCULOSKELETAL COMPLAINTS IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER. Postgrad Med. 2020 Jan 04;: Authors: Kunt SŞ, Aydın F, Çakar N, Özdel S, Yalçınkaya F, Özçakar ZB Abstract Objectives: Familial Mediterranean fever (FMF) is an autosomal recessive disease, characterized by recurrent, self limited attacks of fever with serositis. The aim of this study was to describe the frequency of musculoskeletal complaints in children with FMF and to investigate the effect of genotype on these findings.Methods: Files of patients who had been seen in o...
Source: Postgraduate Medicine - January 8, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Influence of relative wall thickness on electrocardiographic voltage measures in left ventricular hypertrophy: a novel factor contributing to poor diagnostic accuracy.
Authors: Ye N, Sun GZ, Zhou Y, Wu SJ, Sun YX Abstract Objective: To characterize the influence of relative wall thickness (RWT) on Cornell, Sokolow-Lyon and Peguero-Lo Presti voltages and elucidate its potential impacts on their diagnostic accuracy for LVH in a large general Chinese population.Methods: A total of 10,614 permanent residents aged ≥ 35 years were recruited for this study. All the participants were subjected to ECG and echocardiogram during the same visit. Multivariate linear and logistic regression analyzes were conducted to assess the influence of RWT on the voltages and their diagnostic perf...
Source: Postgraduate Medicine - January 6, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The influence of value reference point and risk preference on adherence in hypertensive patients in a low-income area of China.
Authors: Wang C, Wang P, Dong H, Zhang L, Wu T Abstract Aims: Prevention and control of hypertension can be achieved by improving patient adherence to long-term treatment regimens. Non-adherence is an obstacle to chronic disease management. We studied the impact of value reference point and risk preference on patient adherence and influencing factors from the perspective of behavioral economics so as to offer targeted recommendations to improving patient adherence in low-income areas.Methods: A representative impoverished area, Qianjiang District in Chongqing was selected as the sample district. A cross-sectional s...
Source: Postgraduate Medicine - January 6, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β2-agonist bronchodilators.
Current evidence for COPD management with dual long-acting muscarinic antagonist/long-acting β2-agonist bronchodilators. Postgrad Med. 2020 Jan 03;:1-8 Authors: Skolnik NS, Nguyen TS, Shrestha A, Ray R, Corbridge TC, Brunton SA Abstract Long-acting inhaled bronchodilator medications are recommended as initial maintenance therapy for many patients with COPD. These medications include long-acting muscarinic antagonists (LAMA) and long-acting β2-agonists (LABA). Combinations of long-acting bronchodilator agents (LAMA/LABA) and inhaled corticosteroids combined with LABA (ICS/LABA) are also used a...
Source: Postgraduate Medicine - January 6, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Utility of lidocaine as a topical analgesic and improvements in patch delivery systems.
Authors: Gudin J, Nalamachu S Abstract Interest in and use of topical analgesics has been increasing, presumably due to their potential utility for relief of acute and chronic pain. Topically applied agents with analgesic properties can target peripheral nociceptive pathways while minimizing absorption into the plasma that leads to potential systemic adverse effects.Clinical trials have found 5% lidocaine patches to be effective and well tolerated for the treatment of post-herpetic neuralgia (PHN) with a minimal risk of toxicity or drug-drug interactions. With this patch formulation, the penetration of lidocaine in...
Source: Postgraduate Medicine - January 6, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Immune Checkpoint Inhibitors and endocrine side effects, a narrative review.
Authors: Agrawal L, Bacal A, Jain S, Singh V, Emanuele N, Emanuele MA, Meah F Abstract Immune checkpoint inhibitors (ICPIs) are novel drugs in the field of oncology however carry the risk of immune related dermatologic, gastrointestinal, and endocrine side effects which can be fatal. These new innovative immunoregulatory drugs have intertwined the fields of oncology and endocrinology. CTLA-4 and PD-1 are co-inhibitory receptors on T cells that turn the T cell "off" when binding to receptors on APCs. Tumor cells can also carry receptors for CTLA- and PD-1. By rendering T cells inactive, tumor cells can eva...
Source: Postgraduate Medicine - December 27, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Pharmacological treatment of stable COPD: need for a simplified approach.
Authors: Hillas G, Papaporfyriou A, Dimakou K, Papaioannou AI Abstract Chronic obstructive pulmonary disease (COPD) is one of the most common diseases worldwide. Although different guidelines regarding therapeutic algorithms exist, the most widely adopted approach is the one suggested by the Global Initiative in Chronic Obstructive Lung Disease in which patients are stratified according to their dyspnea severity and their exacerbation history during the previous year. This combined assessment of COPD, which takes into consideration all aforementioned characteristics of COPD patients as well as the number of blood e...
Source: Postgraduate Medicine - December 20, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A nonlinear association between resting heart rate and ischemic stroke among community elderly hypertensive patients.
Conclusions: In Chinese elderly hypertensive patients, elevated resting heart rate was an independent predictor of ischemic stroke, and the optimal resting heart rate was around 70bpm. PMID: 31829063 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 13, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

New discoveries for an old drug: A review of recent olanzapine research.
CONCLUSIONS: Olanzapine remains a useful antipsychotic albeit with careful monitoring. Further research is needed to compare the different options available to mitigate olanzapine-induced weight gain and to evaluate potential synergism between pharmacological and non-pharmacological treatments. PMID: 31813311 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 10, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Gender difference in the association of serum selenium with all-cause and cardiovascular mortality.
Authors: Li J, Lo K, Shen G, Feng YQ, Huang YQ Abstract Objectives: The relationship between selenium and all-cause mortality has been inconsistent from observational studies and clinical trials. The present study aimed to reveal the relationship between serum selenium and all-cause and cardiovascular disease (CVD) mortality and the potential gender differences.Methods: All participants were recruited from the 1999-2006 National Health and Nutrition Examination Survey (NHANES). Participants with available serum selenium data were followed up until 31 December 2015. Cox proportional hazards models were performed to ...
Source: Postgraduate Medicine - December 9, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The New Kid on the Block in Physical Diagnosis? Introducing Digital Microscopy.
The objective of this paper is to familiarize physicians with the advantages of digital microscopy through numerous clinical illustrations, as: characterization and surveillance of lesions, sores, cutaneous and corneal foreign bodies, painful conditions of the nipple, hematomas retained sutures, secretions and purulent lesions.This introduction is hoped to arouse enthusiasm towards digital microscopy and encourage its adoption into routine practice. PMID: 31791177 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 4, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Update on non-pharmacological interventions in parasomnias.
Authors: Ntafouli M, Galbiati A, Gazea M, Bassetti C, Bargiotas P Abstract Parasomnias are abnormal behaviors that occur during the sleep and can be associated, in particular during adulthood, with impaired sleep quality, daytime dysfunction and occasionally with violent and harmful nocturnal behaviors. In these cases, therapies are often considered. Pharmacological treatments are invasive and often have limited efficacy. Therefore, behavioral approaches remain an important treatment option for several types of parasomnias. However, the evidence-based approaches are limited. In the current review, we highlight resu...
Source: Postgraduate Medicine - November 27, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Are postoperative pain and patient satisfaction influenced by the number of ports in VATS for malignant pleural effusion treatment?
ConclusionsBased on our study and the studies of other authors, it can be concluded that post-operative pain and satisfaction after VATS in patients with MPE are influenced by the number of ports and the one-port technique shows better results than the conventional three-port method.The research study was registered and approved by the Clinical Research and Ethics Committee at the "Prof. Dr. Stoyan Kirkovich" AD University Multi-Profile Hospital for Active Treatment Hospital, Stara Zagora. According to Protocol No. 11, Ref. No. 12471/30.10.2015, approved are the methods used by the sociological research study whi...
Source: Postgraduate Medicine - November 27, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Mycobacterium chimaera chorioretinitis as a biomarker of systemic disease activity following nosocomial acquisition during cardiopulmonary bypass.
Conclusions: Ophthalmologic examination can play a key role in diagnosis and management of systemic Mycobacterium chimaera following cardiopulmonary bypass; such examinations may yield earlier diagnosis, diminishing mortality rates. PMID: 31766930 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - November 27, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Adrenal insufficiency due to recurrent renal cell carcinoma in the left adrenal gland 3 years after right radical nephrectomy for renal cell carcinoma.
Authors: Lee MW, Lee HJ Abstract Primary adrenal insufficiency due to tumor involvement is very rare. We herein report a case of adrenal insufficiency caused by cancer metastasis to a remaining single adrenal gland in a renal cell carcinoma patient who had undergone radical nephrectomy including removal of the right adrenal gland. The patient presented with abdominal discomfort, nausea, and vomiting which had begun about 3 months earlier. A rapid adrenocorticotropic hormone (ACTH) test showed no cortisol response with upper normal level of baseline ACTH. The patient was treated with prednisolone after diagnosis of ...
Source: Postgraduate Medicine - November 23, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Pain as a determinant of health-related quality of life in patients with carpal tunnel syndrome; a case-controlled study.
Authors: Damms NA, McCallum LM, Sarrigiannis PG, Zis P Abstract Introduction Carpal tunnel syndrome (CTS) is an entrapment neuropathy accounting for up to 90% of nerve compression syndromes. It causes both positive and negative symptoms in the hands. These symptoms, especially pain, can be debilitating, which can in-turn have a negative effect on patients' quality of life (QoL). The aim of this cross-sectional case-controlled study was two-fold; to compare the QoL of patients with CTS and subjects without CTS and to determine the effect of pain on QoL in patients with CTS.Methods All patients underwent nerve conduc...
Source: Postgraduate Medicine - November 20, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study.
Conclusion: CBD could significantly reduce opioid use and improve chronic pain and sleep quality among patients who are currently using opioids for pain management.Key Message: This is a prospective, single-arm cohort study for the potential role of cannabinoids as an alternative for opioids. The results indicate that using the CBD-rich extract enabled our patients to reduce or eliminate opioids with significant improvement in their quality of life indices. PMID: 31711352 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - November 15, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Postmarketing studies program to assess the risks and benefits of long-term use of extended-release/long-acting opioids among chronic pain patients.
Conclusions: A series of 10 observational studies was or are being conducted in response to the FDA's postmarketing requirement. All studies have been feasible to conduct, although a validated algorithm for measuring abuse and addiction in databases was not successful. PMID: 31721609 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - November 15, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A description of eosinophilic esophagitis in the Southwestern state of Nevada.
Authors: Anderson J, Moonie S, Hogan MB, Labus B Abstract OBJECTIVES: Eosinophilic esophagitis (EoE) is a rare immune-mediated esophageal disorder that has been documented worldwide. Prior to this study, eosinophilic esophagitis had not been described in the Southwestern state of Nevada. Records containing positive eosinophilic esophagitis diagnosis codes were extracted from a large hospital utilization database and yielded over 2,000 records over five years (2013-2017). METHODS: Descriptive statistics were used to identify the overall population demography. Logistic regression was used to determine the factors...
Source: Postgraduate Medicine - November 3, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Type 2 diabetes mellitus and cardiovascular risk; what the pharmacotherapy can change through the epigenetics.
Authors: Andreeva-Gateva PA, Mihaleva ID, Dimova II Abstract Diabetes mellitus and cardiovascular diseases are part of the metabolic syndrome and share similar risk factors, including obesity, arterial hypertension, and dyslipidemia. Atherosclerosis and insulin resistance contribute to the development of the diseases, and subclinical inflammation is observed in both conditions. There are many proofs about the connection between epigenetic factors and different diseases, including diabetes and cardiovascular diseases. Interestingly, recent studies show that at least some anti-diabetic drugs, as well as blockers of t...
Source: Postgraduate Medicine - October 17, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Treatment of urinary tract infections in the era of antimicrobial resistance and new antimicrobial agents.
Authors: Bader MS, Loeb M, Leto D, Brooks AA Abstract Urinary tract infections (UTIs) caused by antibiotic- resistant Gram-negative bacteria are a growing concern due to limited treatment options. Knowledge of the common uropathogens in addition to local susceptibility patterns is essential in determining appropriate empiric antibiotic therapy of UTIs. The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantion, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pevmecillinam. High...
Source: Postgraduate Medicine - October 16, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Dipstick analysis of urine chemistry: benefits and limitations of dry chemistry-based assays.
Authors: Kavuru V, Vu T, Karageorge L, Choudhury D, Senger R, Robertson J Abstract Urinalysis is a commonly utilized laboratory test and analysis of urine has been studied and used since ancient times. Urine contains a wide array of metabolites that can provide information regarding the current physiologic state of the body and clinical manifestations of disease. In this review, we discuss the mechanics of the dry chemistry component of the urine dipstick such as the reaction principles underlying various assays and potential effects of collection and storage on results. Additionally, we discuss the benefits and li...
Source: Postgraduate Medicine - October 16, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The prescription opioid conundrum: 21st century solutions to a millennia-long problem.
Authors: Brennan MJ, Gudin JA Abstract Healthcare professionals are faced with a daunting task: balancing appropriate care for chronic pain with their responsibility to keep patients and others safe from treatment-related harm. Whereas opioids have historically been considered an effective tool in the analgesic armamentarium, the rise of opioid abuse has caused the pendulum to swing away from prescribing opioids to an emphasis on safety. This paradigm shift risks neglecting the very real consequences of untreated/undertreated pain. Using data from the medical literature, this review examines influences on the real ...
Source: Postgraduate Medicine - October 10, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Meningococcal vaccination: A discussion with all adolescents, whether college-bound or not.
Conclusion: Meningococcal vaccination is emphasized for college-bound adolescents, but non-college adolescents bear much of the disease burden. Low vaccine receipt preserves their risk, underscoring the need to protect all adolescents through vaccination. PMID: 31575310 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - October 4, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Within subject variability of HDL-cholesterol in HIV-infected patients.
Conclusions Within-subject variability of HDL-cholesterol was substantial among our HIV-infected patients. Smoking was inversely correlated with such variability. PMID: 31575314 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - October 4, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists as complementary agents that address multi-organ defects in type 2 diabetes.
Authors: Lajara R Abstract Type 2 diabetes (T2D) has a complex pathophysiology composed of multiple underlying defects that lead to impaired glucose homeostasis and the development of macrovascular and microvascular complications. Of the currently available glucose-lowering therapies, sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) both provide effective glycemic control and have been shown to reduce cardiovascular (CV) events in patients with T2D and a high CV risk or established CV disease. Because these agents have complementary mechanisms of action, ...
Source: Postgraduate Medicine - October 4, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Work Strain and Burnout Risk in Postgraduate Trainees in General Practice: An Overview.
In conclusion, interventions to promote physical and mental health of GP trainees are a necessity to ensure passionate GPs in the future and should therefore be integrated into any postgraduate training curriculum in General Practice. PMID: 31570072 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - October 3, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A multi-arm cluster randomized clinical trial of the use of knee kinesiography in the management of osteoarthritis patients in a primary care setting.
This study aimed at evaluating the clinical utility of adding to current medical management (CMM) by PCPs, a dynamic knee kinesiography (KneeKG) exam assessing biomechanical risk factors linked to osteoarthritis progression. Design: In this 6-month cluster randomized controlled trial, primary care clinics were randomized into three groups: 1-CMM by PCPs, 2-CMM+KneeKG, and 3-CMM+KneeKG+Education (a self-management education session and two follow-up group meetings). Primary outcomes were scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales and overall score. Results: Of the 894 patients referred from ...
Source: Postgraduate Medicine - October 3, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Gut microbiota and health.
Authors: Kc D, Sumner R, Lippmann S PMID: 31566046 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - October 1, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Meralgia Paresthetica: Finding an Effective Cure.
Authors: Sanjaya A Abstract Meralgia Paresthetica (MP) is one of the most common mononeuropathies of the lower limb. MP usually resolves on its own, even without treatment. However, many physicians are not aware of this diagnosis and may confuse patients with another nerve disease such as radiculopathies. Although no motor symptoms are associated with this condition, the sensory dysfunctions are potentially debilitating to patients. The variable course of the lateral femoral cutaneous nerve also complicates treatments. Thus, the author recommends the use of ultrasonography to help locate the nerve. Many treatments ...
Source: Postgraduate Medicine - October 1, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Measles 101.
Authors: Nathala P, Fatima S, Sumner R, Lippmann S PMID: 31554447 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 27, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Comparison of multimodal, sliding scale acute pain protocols with traditional prescribing in non-surgical patients.
Authors: Pawasauskas J, Kelley M, Gill C, Facente M Abstract OBJECTIVE: Our institution implemented six multimodal, sliding scale protocols for managing pain in non-surgical inpatients. The purpose of this study was to compare the use of these acute pain protocols with traditional prescribing in regard to pain management efficacy and safety measures. METHODS: This retrospective cohort study evaluated hospital in-patients who were prescribed one of the protocols during the first six months following implementation, admitted to the hospitalist service, and had received at least two doses of PRN analgesic medicati...
Source: Postgraduate Medicine - September 26, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research