Barotrauma after liquid nitrogen ingestion: a case report and literature review.
Authors: Zheng Y, Yang X, Ni X Abstract A 25-year-old man developed a gastric perforation after ingesting a homemade drink containing liquid nitrogen. Surgical repair had to be postponed to seek consultations with experts because the available practitioners in this case, including emergency physicians, surgeons, and anesthesiologists, had little experience and knowledge about the source of the patient's pneumothorax and subcutaneous emphysema. The patient ultimately underwent exploratory laparotomy with general anesthesia, considering that delaying the operation would lead to a longer duration of bacterial peritoni...
Source: Postgraduate Medicine - July 14, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A Review and Critique of Published Real-World Weight Management Program Studies.
CONCLUSIONS: Despite general acceptance that weight loss programs are capable of facilitating successful outcomes, this review revealed substantial inconsistency in the design and reporting of such programs, making it very difficult to draw conclusions about the comparative merits of different real-world weight loss strategies/components. In addition, there was a marked lack of congruence with current weight loss management guidelines, and notably few studies incorporating anti-obesity medications. There clearly is a need for greater rigor and standardization among designing and reporting RWE weight-loss studies. PMID:...
Source: Postgraduate Medicine - July 12, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Incidence of nonmedical use of OxyContin and other prescription opioid pain relievers before and after the introduction of OxyContin with abuse deterrent properties.
Conclusions This study provides evidence supporting the role of OxyContin reformulation in the reduction of onset of OxyContin nonmedical and extra-medical use. PMID: 29978755 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - July 8, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Clinical implications of the tiotropium/olodaterol inhaler for patients with chronic obstructive pulmonary disease.
Authors: Ferguson GT, Dalby RN Abstract Oral inhalation is the recommended delivery method of medications for the treatment of patients with chronic obstructive pulmonary disease (COPD). However, patients may struggle when using the various available inhaler platforms, and, as a result, may fail to achieve the benefit of the prescribed medication. Propellant-based, pressurized metered-dose inhaler and powder-based, dry powder inhaler devices are currently the most commonly prescribed delivery systems. Each of these devices has its own advantages and challenges. The Respimat® Soft Mist™ inhaler (SMI) (Boeh...
Source: Postgraduate Medicine - July 5, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Diagnostic approach to neuropsychiatric lupus erythematosus: what should we do?
Authors: Zardi EM, Giorgi C, Zardi DM Abstract Neuropsychiatric systemic lupus erythematosus is a diagnostic challenge due to the multifarious neurological and psychiatric manifestations that define it but, when suspected, diagnostic imaging can give a fundamental help. The advancements and variety of neuroimaging techniques allow us to perform more and more accurate evaluations of structure, perfusion and metabolism of the brain and to detect cerebral and spinal lesions. Moreover, vascular districts of the neck and the brain as well as the electrical brain and peripheral muscle activity may be accurately investiga...
Source: Postgraduate Medicine - June 28, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality.
CONCLUSION: Cognitive impairment and/or physical frailty are powerful prognostic factors identifying people with diabetes at high risk of mortality. PMID: 29949390 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - June 28, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Over-the-counter medication availability could augment self-management of male lower urinary tract symptoms.
Authors: Roehrborn CG, Miner MM, Sadovsky R Abstract In this review, we focus on current trends in the management of male lower urinary tract symptoms (LUTS), defined here as LUTS, namely, storage, voiding, and post-micturition symptoms presumed secondary to benign prostatic hyperplasia (BPH), and discuss possible novel approaches toward better care. According to results of a PubMed database search covering the last 10 years and using keywords pertaining to male LUTS, this condition continues to be globally undiagnosed or diagnosed late, partly because of men's hesitation to seek help for perceived embarrassin...
Source: Postgraduate Medicine - June 25, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Management of hyperuricemia and gout in obese patients undergoing bariatric surgery.
Conclusion Bariatric surgery has a high impact on hyperuricemia and gout. A perioperative approach is suggested, based on appropriate hydration, early physical resumption, urate lowering drugs and NSAIDs, or colchicine and corticosteroids if NSAIDs are ineffective or not tolerated. PMID: 29888674 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - June 12, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A case series study of hypopituitarism in older patients with and without gastrointestinal symptoms.
Authors: Li X, Yang H, Duan Z, Chang Q, Wei X, Li C, Ba Y, Du J Abstract 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) i...
Source: Postgraduate Medicine - June 7, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

New heart failure reclassification: are we left with more questions than answers?
Authors: López-Candales A, Hernández Burgos PM, Vargas PE PMID: 29846126 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - June 1, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Cardiovascular risk in chronic kidney disease - what is new in the pathogenesis and treatment?
Authors: Bazyluk A, Malyszko J, Zbroch E Abstract 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 diseas...
Source: Postgraduate Medicine - June 1, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A Randomized, Double-Blind Study of SHP465 Mixed Amphetamine Salts Extended-Release in Adults With ADHD Using a Simulated Adult Workplace Design.
Authors: Wigal T, Brams M, Frick G, Yan B, Madhoo M Abstract 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. On the final day of each 7-day treatment period, efficacy was assessed for...
Source: Postgraduate Medicine - May 30, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Knowledge and attitudes of family doctors, dermatologists and endocrinologists on sun exposure and vitamin D.
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. RESULTS: On a scale of 1-10, the mean score for recommendations to reduce sun exposure was 4.7 for dermatologists, 4.2 for endocrinologists, and 6.4 for family doctors (P
Source: Postgraduate Medicine - May 28, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Wet-wrap therapy with halometasone cream for severe adult atopic dermatitis.
Authors: Xu W, Li Y, Chen Z, Liu T, Wang S, Li L Abstract 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...
Source: Postgraduate Medicine - May 21, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Delayed intravenous immunoglobulin treatment increased the risk of coronary artery lesions in children with Kawasaki disease at different status.
CONCLUSION: Delayed IVIG treatment was an independent risk factor for the development of CALs. Children in the delayed IVIG treatment group with higher levels of CRP and ESR (CRP>79 mg/L, ESR>34 mm/h) had the greatest likelihood of developing CALs. PMID: 29745742 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - May 12, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

How blockchain technology can change medicine.
This article describes the basics of this technology and summarizes the various aspects in which BCT could change the paradigm of current medicine. The great potential of BCT, as well as its many applications in the field of health sciences, encompasses the fields of legal medicine, research, electronic medical records, medical data analysis (big data), teaching and the regulation of payment for medical services. If technological advances continue along these lines, it could bring about a revolution in medicine as we know it. PMID: 29727247 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - May 8, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Finally, after 56 years of type 1 diabetes: a regimen that works.
Authors: Bell DSH Abstract 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 utili...
Source: Postgraduate Medicine - May 3, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Angiopoietin-2 level as a tool for cardiovascular risk stratification in hypertensive type 2 diabetic subjects.
CONCLUSIONS: Further detailed studies in larger population with more attention is needed to consider Ang-2 level as a tool for CVD risk stratification in hypertensive diabetic subjects. PMID: 29707992 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - May 2, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The effect of intravenous insulin, apheresis and oral lipid-lowering agents on non-fasting hypertriglyceridemia and associated pancreatitis.
Authors: Frankova D, Olson KM, Whyms BJ, Guevara Hernandez MA, Franko J Abstract BACKGROUND: 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. OBJECTIVES: 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 severi...
Source: Postgraduate Medicine - April 29, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Evaluating the clinical value of the hypoxia burden index in patients with obstructive sleep apnea.
CONCLUSIONS: The HBI considers both hypoxia duration and severity during sleep. It may have potential value in predicting the clinical outcomes of OSA based on its correlation with ESS scores and morning blood pressure as well as its independent association with the prevalence of CVDs, whereas the AHI is not significantly associated with CVD prevalence. PMID: 29676667 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - April 22, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Educational needs in the diagnosis and management of pediatric functional constipation: a US survey of specialist and primary care clinicians.
CONCLUSIONS: CME programs focusing on applying diagnostic criteria, matching diagnostic workup to patient presentation, treatment selection, and identifying patients who may benefit from psychological evaluation may fill knowledge and practice gaps of clinicians who manage pediatric patients with functional constipation. PMID: 29667860 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - April 19, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Glycemic control of type 2 diabetes mellitus across stages of renal impairment: information for primary care providers.
Authors: Tong L, Adler S Abstract 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. Understanding the treatment considerations specific to each class of T2D...
Source: Postgraduate Medicine - April 19, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Utility of natriuretic peptides to assess and manage patients with heart failure receiving angiotensin receptor blocker/neprilysin inhibitor therapy.
Authors: Maisel AS, Daniels LB, Anand IS, McCullough PA, Chow SL Abstract 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 m...
Source: Postgraduate Medicine - March 30, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Anticipatory guidance in type 2 diabetes to improve disease management; next steps after basal insulin.
Authors: Johnson EL, Frias JP, Trujillo JM Abstract 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. Anticipatory gui...
Source: Postgraduate Medicine - March 27, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Insulin non-persistence among people with type 2 diabetes: how to get your patients to stay on insulin therapy.
Authors: Garnero TL, Davis NJ, Perez-Nieves M, Hadjiyianni I, Cao D, Ivanova JI, Peyrot M Abstract 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-p...
Source: Postgraduate Medicine - March 27, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Fixed-ratio combination therapy for type 2 diabetes: the top ten things you should know about insulin and glucagon-like peptide-1 receptor agonist combinations.
This article discusses the 'top 10' considerations that health care providers should know about these novel combination therapies as these agents begin to gain an increasing presence in clinical practice. PMID: 29521173 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - March 10, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Comorbidities and cardiovascular risk factors in an aged cohort of HIV-infected patients on antiretroviral treatment in a Spanish hospital in 2016.
CONCLUSIONS: Comorbidities and risk factors for chronic diseases are very common in HIV-infected patients aged ≥50 years and increase with age, so they should be early considered in the clinical management of these patients. It is important to encourage healthy lifestyles to prevent comorbidities and to control risk factors. Concomitant treatments with ART should be carefully monitored to prevent drug interactions, adverse effects, and patient adherence failures. PMID: 29486621 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - March 2, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Bilateral hyperkeratosis of the nipples and areolae with linear nevus: a rare case report and review of the literature.
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. The verrucous plaques were asymptomatic and could be scratched off by the patient herself. Consequently, she did not seek medical care for more than ten years. The prevalence of this condition is likely underestimated because many affected individuals are not sufficiently motivated to seek medical attention. PMID: 29486632 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - March 2, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Validity of cardiometabolic index, lipid accumulation product, and body adiposity index in predicting the risk of hypertension in Chinese population.
Authors: Wang H, Chen Y, Sun G, Jia P, Qian H, Sun Y Abstract OBJECTIVES: Adiposity, defined by higher cardiometabolic index (CMI), lipid accumulation product (LAP), and body adiposity index (BAI), has conferred increased metabolic risk. However, the incremental utility of CMI, LAP, and BAI in association with prevalent hypertension has not been well described in a population-based setting. We hypothesized that CMI, LAP, and BAI would provide important insight into hypertension risk. METHODS: Blood pressure (BP), fasting lipid profiles, and anthropometric parameters were recorded in a cross-sectional study of 1...
Source: Postgraduate Medicine - February 28, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Risk of Osteoporosis in Microscopic Colitis.
Authors: Wildt S, Munck LK, Becker S, Brockstedt H, Bonderup OK, Hitz MF Abstract OBJECTIVES: Patients with microscopic colitis (MC) have several risk factors for osteoporosis. The prevalence of osteopenia and osteoporosis in MC is unknown. The primary purpose of this study was to evaluate bone mineral status in MC. METHODS: Patients with MC and disease activity within the last 2 years were included. Bone turnover markers were analyzed and bone mineral density (BMD) was measured with Dual Energy X-ray Absorptiometry (DXA) at inclusion and after one year. Medical history, demographics, risk factors for osteoporo...
Source: Postgraduate Medicine - February 21, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Video assisted patient education improves compliance with follow up and depression scores in Inflammatory Bowel Diseases.
Authors: Kamat N, Rajan Mallayasamy S, Sharma PSVN, Kamath A, Pai CG Abstract OBJECTIVES: Patients with inflammatory bowel diseases (IBD) have to deal with a poor quality of life (QOL) and psychomorbidity resulting from an incurable illness. We aimed to study the effect of patient education on QOL, compliance, anxiety and depression in IBD. METHODS: Patients were prospectively enrolled over two years beginning July 2014 and divided into an interventional and usual care group. Both received the standard of care, but the former in addition received an 8 minute session of video-assisted education. Compliance to dr...
Source: Postgraduate Medicine - February 21, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Early insights into the characteristics and evolution of clinical parameters in a cohort of patients prescribed sacubitril/valsartan in Germany.
This study aimed to provide early insights into sacubitril/valsartan (sac/val) prescription patterns and the demographic and clinical characteristics of patients prescribed sac/val in primary care and cardiology settings in Germany. METHODS:  The study used electronic medical records from the German IMS® Disease Analyzer database. Patients with ≥1 prescription for sac/val during 1 January-31 December 2016 (n = 1643) were identified and followed up for ≤12 months from first prescription. Patients with ≥1 heart failure (HF) diagnosis during the study period, ≥1 additional HF diagnosis in the full his...
Source: Postgraduate Medicine - February 17, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Cutaneous irritancy of an ibuprofen medicated plaster in healthy volunteers.
CONCLUSIONS: The findings indicate that the both the irritancy and contact sensitization of the ibuprofen medicated plaster is acceptable. PMID: 29415606 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 10, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Gastrointestinal safety and tolerability of oral non-aspirin over-the-counter analgesics.
Authors: Moore N, Scheiman JM Abstract Over-the-counter (OTC) analgesics are routinely used worldwide for self-management of various painful conditions. Despite this, there has been little in-depth review of the safety of non-aspirin analgesics at OTC doses. This paper reviews the available literature on the gastrointestinal (GI) and hepatic safety of non-aspirin OTC analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs; ibuprofen, ketoprofen, diclofenac, and naproxen) and acetaminophen; safety in overdose is also reviewed. Each non-aspirin OTC analgesic has a distinct adverse event (AE) profile, with ...
Source: Postgraduate Medicine - February 10, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Barriers to implementation of a pelvic examination among family doctors in primary care clinics.
CONCLUSIONS: Although most family doctors believe that pelvic examinations are an important part of their work, only a small percentage actually do a pelvic examination. Among the reasons for not doing the examination are lack of knowledge, lack of experience, and work burden. PMID: 29405077 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 8, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

PCSK9 inhibitors: a non-statin cholesterol-lowering treatment option.
Authors: Pokrywka GS Abstract Elevated low-density lipoprotein cholesterol (LDL-C) plays a major role in the development of atherosclerotic cardiovascular disease. Statins are the first-line treatment to lower LDL-C in patients with hypercholesterolemia; however, some high cardiovascular risk patients may have inadequate responses to statin therapy or are intolerant to statins, and may need additional and/or alternative non-statin therapies to further reduce their LDL-C levels. Monoclonal antibodies that inhibit proprotein convertase subtilisin/kexin type 9 (PCSK9), a key regulator of circulating LDL-C levels, have...
Source: Postgraduate Medicine - February 8, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Safety and tolerability of new-generation anti-obesity medications: a narrative review.
Authors: Patel DK, Stanford FC Abstract The prevalence of obesity and associated comorbidities is rising. Despite their weight-loss efficacy, new generation anti-obesity medications are only prescribed to a minority of adults with obesity, possibly, which in part may be due to safety concerns. This review presents detailed safety profiles for orlistat, phentermine/topiramate, lorcaserin, naltrexone/bupropion and liraglutide 3.0 mg, and discusses the associated risk-benefit profiles. Two anti-obesity medications presented safety issues that warranted further discussion; phentermine/topiramate (fetal toxicity) and li...
Source: Postgraduate Medicine - February 3, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A simple risk score based on sleep quality for predicting depressive symptoms in menopausal women: a multicenter study.
CONCLUSIONS: The risk score for predicting depressive symptoms in menopausal women based on sleep is convenient. Because there is no complex assessment of multiple scales requiredIt may be a preliminary screening tool for depressive symptoms in menopausal women. PMID: 29380646 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 1, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Aggressive systolic blood pressure control in older subjects: benefits and risks.
Authors: Chrysant SG Abstract Systolic hypertension, especially isolated hypertension (ISH) is very common in older subjects aged ≥ 65 years and is a major risk factor for cardiovascular disease (CVD), strokes, heart failure (HF) and chronic kidney disease (CKD). It is also, directly and linearly related with these complications irrespective of sex, or ethnicity, but it is worse with the advancement of age. Effective control of systolic blood pressure (SBP), is associated with significant reduction in the incidence of these complications. Currently, there is a debate about the optimal SBP control in view of the ...
Source: Postgraduate Medicine - January 31, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Disease or adaptation: another look at the practice of medicine.
Authors: Soeters PB, de Leeuw PW Abstract The practice of medicine has changed considerably over the past few decades and is now focusing more and more on early intervention strategies. As a result, we tend to consider pre-symptomatic abnormalities, however small, already as a potential target for treatment. In this viewpoint, we argue that we should put more emphasis on pathophysiological thinking as many of the so-called early abnormalities may, in fact, reflect adaptive mechanisms rather than disease. This view should influence medical care and education, emphasizing the importance of knowledge of pathophysiolog...
Source: Postgraduate Medicine - January 26, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Practice Pearl: Liraglutide and Cardiovascular and Renal Events in Type 2 Diabetes.
Authors: Guthrie R Abstract Review of: Marso S, Daniels G, Brown-Frandsen K, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375: 311-322. Mann J, Orsted D, Brown-Frandsen K, et al. Liraglutide and Renal Outcomes in Type 2 Diabetes. N Engl J Med 2017; 377: 839-848. This comprehensive research project, LEADER, led to two reports, one focusing on the effect of liraglutide on cardiovascular events, and the second one reporting on the renal effects on the same study population. The study group included 9340 patients with type 2 diabetes. Patients were required to have type 2 diabet...
Source: Postgraduate Medicine - January 21, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The impact of gender on asthma in the daily clinical practice.
CONCLUSIONS: In the daily clinical practice, it is relevant to consider gender in the management of asthma. PMID: 29350578 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - January 21, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Changes in patient characteristics, glucose lowering treatment, glycemic control and complications in type 2 diabetes in general practices (Disease Analyzer, Germany: 2008-2016).
The objectives were to examine long-term changes in type 2 diabetes patient characteristics, diabetes treatment, control and complications in general practices. METHODS: All type 2 diabetes patients were identified in a representative general practice database (Disease Analyser, Germany) in three periods (01/2008-12/2008: n = 90.866, 818 practices, mean age (SD): 67.6 (12.1) years, 51% males; 01/2012-12/2012: n = 179.923, 1.158 practices, 68.3 (12.6) years, 51% males; 10/2015-09/2016: n = 201.667, 1.184 practices, 68.2 (12.9) years, 52% males). Chi-square and Wilcoxon rank-sum tests were u...
Source: Postgraduate Medicine - January 5, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Cultural primer for cardiometabolic health: health disparities, structural factors, community, pathways to improvement, and clinical applications.
Authors: Kones R, Rumana U Abstract The quest to optimize cardiometabolic health has created great interest in nonmedical health variables in the population, community-based research and coordination, and addressing social, ethnic, and cultural barriers. All of these may be of equal or even greater importance than classical health care delivery in achieving individual well-being. One dominant issue is health disparity - causes, methods of reduction, and community versus other levels of solutions. This communication summarizes some major views regarding social structures, followed by amplification and synthesis of c...
Source: Postgraduate Medicine - January 5, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Canagliflozin and cardiovascular and renal events in type 2 diabetes.
This study expands the scope of SGLT-2 inhibitor therapy to prevent cardiovascular disease in diabetic patients beyond those with preexisting cardiovascular disease studied in the previous empagliflozin study, raising the question as to whether SGLT-2 inhibitor therapy should be considered appropriate for most, if not all, type 2 diabetes patients, not only to control hyperglycemia but also to reduce cardiovascular and renal events. PMID: 29297732 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - January 5, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Switching basal insulins in type 2 diabetes: practical recommendations for health care providers.
Authors: Anderson SL, Trujillo JM, Anderson JE, Tanenberg RJ Abstract Basal insulin remains the mainstay of treatment of type 2 diabetes when diet changes and exercise in combination with oral drugs and other injectable agents are not sufficient to control hyperglycemia. Insulin therapy should be individualized, and several factors influence the choice of basal insulin; these include pharmacological properties, patient preferences, and lifestyle, as well as health insurance plan formularies. The recent availability of basal insulin formulations with longer durations of action has provided further dosing flexibility...
Source: Postgraduate Medicine - December 22, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Normalizing fibromyalgia as a chronic illness.
Authors: Clauw DJ, D'Arcy Y, Gebke K, Semel D, Pauer L, Jones KD Abstract Fibromyalgia (FM) is a complex chronic disease that affects 3-10% of the general adult population and is principally characterized by widespread pain, and is often associated with disrupted sleep, fatigue, and comorbidities, among other symptoms. There are many gaps in our knowledge of FM, such that, compared with other chronic illnesses including diabetes, rheumatoid arthritis, and asthma, it is far behind in terms of provider understanding and therapeutic approaches. The experience that healthcare professionals (HCPs) historically gained in...
Source: Postgraduate Medicine - December 20, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Sarcoidosis presenting with acute dacryoadenitis.
We report a case of the disease that presented with acute dacryoadenitis followed by acute parotitis. PMID: 29257721 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 20, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Vaginal discharge.
Authors: Fox KK, Behets FM Abstract Preview A variety of genital pathogens, many of which are sexually transmitted, cause infections of the vagina and cervix. Discharge is often a prominent and telling symptom. Which infectious agents should be suspected when the discharge is accompanied by itching? Vulvar pain? Odor? Which laboratory tests are most helpful in making a diagnosis? The authors answer these and other questions in this overview of genital infections in women. PMID: 29231096 [PubMed] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 15, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Genital ulcer disease.
Authors: Hoffman IF, Schmitz JL Abstract Preview What are the main causes of genital ulcer disease in the United States? Why is clinical diagnosis so difficult? What role will molecular diagnostics have in the future? The authors answer these questions and provide a functional approach to successful management of three common types of sexually transmitted genital ulcers. PMID: 29231097 [PubMed] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 15, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research