MEFV gene variants in children with Henoch-Sch önlein Purpura and association with clinical manifestations: a single center Mediterranean experience.
CONCLUSION: MEFV variants in exon 10 may affect clinical presentation of HSP in populations where FMF is common. While HSP may be an initial symptom of FMF, we speculate that physicians should be aware of FMF possibility in children with intussusception and lower hemoglobin, higher serum IgA, leukocyte and platelet count. PMID: 30513227 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 6, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Clinical workup of fatty liver for the primary care provider.
Authors: Jensen T, Wieland A, Cree-Green M, Nadeau K, Sullivan S Abstract Nonalcoholic fatty liver disease (NAFLD) is quickly emerging as a global epidemic in parallel with the rise in obesity and the Metabolic Syndrome. NAFLD, once seen simply as a passive consequence of the Metabolic Syndrome (MetS), has been found to interact with other features of MetS to exacerbate insulin resistance, diabetes, and cardiovascular disease. NAFLD is also becoming the top indication for liver transplant and an important risk factor for hepatocellular carcinoma. Treatment of this disorder is limited mainly to lifestyle modificatio...
Source: Postgraduate Medicine - November 30, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Efficacy and renal outcomes of SGLT2 inhibitors in patients with type 2 diabetes and chronic kidney disease.
CONCLUSIONS: In patients with T2DM and CKD, SGLT2 inhibitors have a decreased glucose-lowering effect compared to patients without CKD. Renal benefits among patients with CKD are similar to those without CKD and include a significant reduction in albuminuria and reduced incidence of worsening albuminuria. Given that CKD and T2DM are both associated with increased cardiovascular risk, we believe these agents should considered as preferred add-on agents in most patients with uncontrolled T2DM and eGFR>30 ml/min/1.73m2. Ongoing studies will provide additional information as to whether these agents should be added to the cu...
Source: Postgraduate Medicine - November 20, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Effect of video-assisted patient education on compliance with therapy, quality of life, psychomorbidity and cost of illness in Irritable Bowel Syndrome.
Authors: Kamat N, Rajan Mallayasamy S, Sharma P, Kamath A, Pai G Abstract Background Patient education is important in Irritable bowel syndrome (IBS), but its effects on outcomes have not been studied extensively. Methods Patients were enrolled and prospectively divided into an interventional and usual care group. Both received standard of care, but the former additionally received video-assisted patient education. Self-administered questionnaires IBS-QOL, Beck Anxiety-Depression Inventory II (BAI, BDI) and Hospital Anxiety and Depression Scale (HADS) were administered at baseline, 3 and 6 months. Compliance was de...
Source: Postgraduate Medicine - November 19, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Bacterial vaginosis: a primer for clinicians.
Authors: Reiter S, Kellogg Spadt S Abstract Bacterial vaginosis (BV) affects approximately one third of women in the United States. While often asymptomatic, BV infection may be accompanied by serious health consequences, such as preterm birth and pelvic inflammatory disease, and may facilitate acquisition of sexually transmitted infections. Identifying appropriate patients for screening, such as pregnant women, women planning pregnancy, and women with multiple and/or new sexual partners, is imperative for treatment. Diagnosis of BV has traditionally depended on the presence of vaginal discharge and odor, elevated ...
Source: Postgraduate Medicine - November 16, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

First-generation versus second-generation drug-eluting stents in patients with chronic kidney disease: a systematic review and meta-analysis.
Conclusions: In CKD patients, the use of second-generation DES was associated with lower risk of long-term all-cause mortality, in stent restenosis and stent thrombosis as compared with first-generation DES. No differences were found regarding repeat revascularization, MI, and MACE. PMID: 30422052 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - November 15, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Untreated depression and non-medical use of prescription pain relievers: findings from the National Survey on Drug Use and Health 2008-2014.
We examined past year rates of NMUPPRs and major depressive episode (MDE), using data between 2008 and 2014 from the National Survey on Drug Use and Health for both youths (12-17 yrs.) and adults (18 or older). Prevalence estimates with 95% confidence intervals (CIs) were computed. Stratified analyses and generalized linear models were run to examine the association between NMUPPRs and MDE, controlling for treatments received for mental health and/or substance misuse. In order to explore whether MDE effect might change by treatment received, a model with an interaction term including MDE and treatment was fit. Results Amon...
Source: Postgraduate Medicine - November 13, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Venous thromboembolism prevention through the use of novel Factor Xa inhibitors.
Authors: Al-Hillan A, Bajwa RS, Cheema A, Ezeume A, Gor S, Mahida H, Kountz DS Abstract The risk of a venous thromboembolic event is not limited to the pre-hospital, hospital, or immediate post-hospital period. Because of challenges with data collection, the risk of VTE up to 3 months post-hospitalization for patients with acute and serious medical problems in the setting of chronic disease and/or risk factors for venous thromboembolism (VTE) is probably under reported. The growing acceptance and indications of direct oral anticoagulants (DOACs) now includes an indication for VTE prevention for one of the Factor Xa...
Source: Postgraduate Medicine - November 6, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Development of the Painful Periods Screening Tool for endometriosis.
CONCLUSION: The PPST assesses the most important endometriosis-related symptoms and may help facilitate discussions between patients and physicians, promoting earlier diagnosis and treatment of endometriosis. PMID: 30334456 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - October 20, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Taurine and aneurysmal subarachnoid hemorrhage prognosis.
Authors: Pérez-Neri I, Diéguez-Campa CE Abstract Despite its beneficial effects for the cardiovascular system, taurine remains a controversial substance. Taurine increases cardiac muscle strength and prevents arrhythmias, but its benefits go beyond this. Determining taurine levels may become an issue of life or death. In aneurysmal subarachnoid hemorrhage, taurine may be a warning signal informing of the risk of death in a patient. High plasma taurine levels may identify those patients at a high risk for death or a vegetative state at discharge from the hospital; thus, taurine may be a vital marker fo...
Source: Postgraduate Medicine - October 17, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Re-examining insulin compared to non-insulin therapies for type 2 diabetes: when in the disease trajectory is insulin preferable?
In conclusion, long-term insulin use appears neutral if not potentially harmful with respect to insulin resistance and cardiovascular outcomes. While this review has limitations and should be dealt cautiously, it raises questions regarding the benefit of insulin in patients with type 2 diabetes with features of insulin resistance. Further research is needed to confirm these findings. PMID: 30301398 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - October 13, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Porphyrias and photosensitivity: pathophysiology for the clinician.
Authors: Kakoullis L, Louppides S, Papachristodoulou E, Panos G Abstract Porphyrias are disorders caused by defects in the biosynthetic pathway of heme. Their manifestations can be divided into three distinct syndromes, each attributable to the accumulation of three distinct classes of molecules. The acute neurovisceral syndrome is caused by the accumulation of the neurotoxic porphyrin precursors, delta aminolevulinic acid and porphobilinogen; the syndrome of immediate painful photosensitivity is caused by the lipid-soluble protoporphyrin IX and, the syndrome of delayed blistering photosensitivity, caused by the wa...
Source: Postgraduate Medicine - October 10, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Massive hemorrhage from a unique old cesarean scar ectopic pregnancy with negative urine and serum β-HCG: a rare case report.
Massive hemorrhage from a unique old cesarean scar ectopic pregnancy with negative urine and serum β-HCG: a rare case report. Postgrad Med. 2018 Oct 09;:1-4 Authors: Yang X, Wei XQ, Feng D, He W, Chen Y, Hua P Abstract Human chorionic gonadotropin (HCG) is an important indicator for the diagnosis of pregnancy. The authors report a unique case of cesarean scar ectopic pregnancy (CSEP) with negative urine and serum HCG levels, which was initially misdiagnosed as an intrauterine tumor despite the use of transvaginal ultrasound. Dilation and curettage was performed, which caused massive vaginal bleedi...
Source: Postgraduate Medicine - October 10, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Vaginal bleeding/spotting with conjugated estrogens/bazedoxifene, conjugated estrogens/medroxyprogesterone acetate, and placebo.
Authors: Kagan R, Abreu P, Andrews E Abstract OBJECTIVE: In the 1-year phase 3 Selective estrogens, Menopause, And Response to Therapy-5 trial, cumulative amenorrhea rates with conjugated estrogens/bazedoxifene (CE/BZA) were similar to placebo and higher than with conjugated estrogens/medroxyprogesterone acetate (CE/MPA). This post hoc analysis reports bleeding/spotting rates in 4-week intervals (cycles) and 3-month intervals (quarters) with these therapies and the percentage of cases attributable to spotting only. METHODS: Generally healthy postmenopausal women with menopausal symptoms recorded vaginal bleedin...
Source: Postgraduate Medicine - October 4, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Beyond the New Blood Pressure Guidelines: The Beat Goes On.
Authors: López-Candales A PMID: 30244624 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 26, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Preterm and term preeclampsia: differences in biochemical parameter and pregnancy outcomes.
Conclusion Our study found that preterm PE significantly correlated with higher incidence of PEs, neonatal morbidities, also higher liver and kidney function compared to term PE. These results may be helpful for obstetricians to make accurate quantification of risk regarding every result of antenatal check-up, and perform close follow up if any abnormalities were found on blood pressure, ultrasound, or blood tests. PMID: 30246594 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 26, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

An alternative approach to solving the opioid epidemic: is there a role for non-pharmacologic analgesic therapies?
Authors: White PF PMID: 30232921 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 22, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Emotional Intelligence and Leadership Traits among Family Physicians.
CONCLUSION: Emotional intelligence and leadership traits play crucial roles in increasing physicians' personal and professional development. This may also increase physicians' caregiving competencies and thus the quality of health services, as well as potentially decreasing physicians' burnout and health-related costs. PMID: 30173626 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 4, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Topical therapies for knee osteoarthritis.
CONCLUSIONS: Although some controversy exists on the role of topical NSAIDs, current management guidelines advise topical NSAIDs as an option and even first-line therapy for knee OA treatment, particularly among elderly patients. Topical NSAIDs may be contemplated as similar options to oral NSAIDs and are associated with fewer gastrointestinal complications when compared with oral NSAIDs. Caution should be taken with the use of both topical and oral NSAIDs, including close adherence to dosing regimens and monitoring, especially for patients with previous complications of NSAIDs. The role of other topical therapies needs fu...
Source: Postgraduate Medicine - August 31, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

High prevalence of the risk factors for QT interval prolongation and associated drug-drug interactions in coronary care units.
Authors: Khan Q, Ismail M, Haider I Abstract OBJECTIVES: Patients admitted in coronary care units are susceptible to QT interval prolongation due to numerous risk factors. The purpose of this study was to identify the prevalence of risk factors for QT interval prolongation; QT prolonging medications; drug-drug interactions; their predictors; and torsades de pointes risks of drugs. METHODS: After obtaining approval, this cross-sectional study was carried out during one-year period in coronary care units of two major tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan. The Arizona Center for Education and Res...
Source: Postgraduate Medicine - August 28, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

PAINWeek Abstract Book 2018.
Authors: PMID: 30136618 [PubMed - in process] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 24, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Progression to chronic kidney disease in patients undergoing nephrectomy for small renal masses: a price to pay for a therapeutic success?
Authors: Charytoniuk T, Małyszko M, Bączek J, Fiedorczyk P, Siedlaczek K, Małyszko J Abstract Nephrectomy, which constitutes a gold-standard procedure for the treatment of renal-cell carcinoma (RCC), has been widely discussed in the past decade as a significant risk factor of the development of chronic kidney disease (CKD). RCC is the third most common genitourinary cancer in the United States, with an estimated more than 65,000 new cases and 14,970 deaths. The aim of this review was to precisely and comprehensively summarize the status of current knowledge in chronic kidney disease risk factors after nephrectom...
Source: Postgraduate Medicine - August 15, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The impact of residential medication management reviews (RMMRs) on medication regimen complexity.
CONCLUSION: Our study revealed high acceptance of pharmacists' recommendations by GPs. This suggests that RMMRs are useful for identifying and resolving drug-related issues among residents of ACFs. However, our study failed to show a significant effect of RMMRs in reducing the medication regimen complexity, as measured by the MRCI. Further studies are needed to establish the association of medication regimen complexity and clinical outcomes in residents of ACFs. PMID: 30091394 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 11, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Typhlitis as a complication of influenza in a patient with advanced HIV infection.
Authors: Roca B, Fernandez P, Roca M Abstract The authors report the case of an HIV-infected patient who presented with typhlitis as a complication of typical influenza. To the best of their knowledge, this is the first case reported in the literature with such an association of clinical conditions. PMID: 30092166 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 11, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Risk factors for latent tuberculosis infection in children in South Korea.
CONCLUSION: These results indicate that children born in high TB burden foreign countries should be considered a high-risk group for LTBI in South Korea; the inclusion of these children in LTBI screening should be considered. PMID: 30095331 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 11, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Fecal markers in the management of inflammatory bowel disease.
The objective of this review is to introduce the clinical applications of fecal markers in the diagnosis, monitoring and prediction of outcomes of inflammatory bowel disease. PMID: 30063872 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 4, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Clinical manifestations of granulomatosis with polyangiitis: key considerations and major features.
CONCLUSION: Major advances in the understanding and treatment of GPA over recent decades have contributed to the notable decline in morbidity and mortality of patients. The ultimate goal is an improved prognosis through outcome measures which assesses the disease control with minimal adverse effects of intensive immunosuppressive regimens, an integral part of the clinical approach to improve the quality of life of GPA patients. PMID: 30071173 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 4, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Cost-Effectiveness of pharmaceutical care on patients undergoing maintenance hemodialysis - A multicenter randomized controlled study.
CONCLUSIONS: It depends upon the policymakers and regulators to take the decision, if they believe that the extra cost is worth the extra QALY. PMID: 30047816 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - July 28, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Combining prescription monitoring, benchmarking and educational interventions to reduce benzodiazepine prescriptions among internal medicine in-patients; a multicenter before and after study in a network of Swiss Public Hospitals.
Authors: Del Giorno R, Greco A, Zasa A, Clivio L, Pironi M, Ceschi A, Gabutti L Abstract Objectives Reducing the inappropriate benzodiazepine (BZD) prescriptions represents a challenge for healthcare systems worldwide. The Choosing Wisely Campaign recommends against the use of BZD in the elderly as the first choice for insomnia, agitation or delirium. We aimed to determine whether a transparent monitoring-benchmarking together with educational interventions, on top of the internal publication of a targeted recommendation, could be effective in curbing BZD prescriptions. Methods Multicenter Before and After Study in...
Source: Postgraduate Medicine - July 27, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Abuse of immediate-release opioids and current approaches to reduce misuse, abuse, and diversion.
Authors: Nalamachu SR, Shah B Abstract Deaths from opioid overdoses have increased dramatically over the past few years. Given that immediate-release (IR) opioids account for most of the US market share, and that abusers generally prefer IR opioids over extended-release (ER) opioids, it is not surprising that rates of abuse are higher for IR than ER opioids. IR opioids are widely prescribed, often without consideration for risks of abuse, misuse, and diversion. Prescription opioid abuse and misuse often begins through oral administration and progresses into non-oral routes (e.g. snorting, injecting) as abusers gain...
Source: Postgraduate Medicine - July 21, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Nasal plasmacytoma: a rare cause of persistent epistaxis.
We present a case of recurrent epistaxis for 6 months and extensive work up revealed EP of the right nasal cavity. Primary care physicians and otolaryngologists should be aware of this very rare but a plausible cause of epistaxis and keep EP in the differential diagnosis of recurrent epistaxis. PMID: 30016897 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - July 19, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

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