SGLT2 inhibitors in patients with type 2 diabetes and renal disease: overview of current evidence.
Authors: Davidson JA Abstract Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and is associated with poor clinical outcomes, including an increased risk of all-cause and cardiovascular mortality, as well as adverse economic and social effects. Slowing the development and progression of CKD remains an unmet clinical need in patients with T2DM. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are widely used for the management of T2DM and have effects beyond glucose lowering that include cardiovascular benefits and potential renoprotective effects. Although the glucose-low...
Source: Postgraduate Medicine - April 3, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Hyperchloremic metabolic acidosis in the kidney transplant patient.
In conclusion: Hyperchloremic metabolic acidosis of renal origin is a relatively frequent complication in kidney transplantation patients, which can be harmful, and should be adequately treated in order to avoid its renal and systemic adverse effects. PMID: 30924703 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - March 31, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Inflammatory profile in optimally treated patients with adult versus early onset asthma.
CONCLUSION: Adult onset asthma was characterized by less sputum eosinophilia, a nonatopic profile and a higher BMI compared to early onset asthma. The presence of blood eosinophilia and increased FeNO in patients with severe asthma was comparable in the two groups. PMID: 30920326 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - March 30, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Pulmonary lymphangitis carcinomatosis: systematic review and meta-analysis of case reports, 1970-2018.
CONCLUSIONS: In the presence of progressive dyspnea, cough, and lesions comparable to interstitial lung disease, diagnosis of PLC should be considered. Pulmonary lymphangitis carcinomatosis can be the first manifestation of primary occult neoplasm and may occur at any age. Adenocarcinoma, especially primary lung, breast, and gastric cancers is the most common cancer coexisting with PLC. PMID: 30900501 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - March 24, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A proposed definition of remission from chronic pain, based on retrospective evaluation of 24-month outcomes with spinal cord stimulation.
The objective of this paper is to propose a definition for remission for use as an outcome to evaluate the long-term efficacy of therapies for chronic pain. METHODS: Data from a randomized clinical trial (NCT01609972) testing the efficacy of spinal cord stimulation in low back and leg pain subjects was used to evaluate the association between pain and functional outcomes and identify the cut-off value to predict remission. Available data over 24-month assessment period included visual analog score (VAS), disability (Oswestry Disability Index [ODI]), patient and clinician global impression of change (PGIC and CGIC), and...
Source: Postgraduate Medicine - March 24, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Estimate of reduced glomerular filtration rate by triglyceride-glucose index: insights from a general Chinese population.
Authors: Shi W, Liu S, Jing L, Tian Y, Xing L Abstract OBJECTIVES: Recent studies have identified triglyceride-glucose index (TyG) as a surrogate of insulin resistance. Since insulin resistance correlates with renal damage, our study aims to investigate the impact of TyG on the risk of reduced eGFR and explore its value to improve the risk stratification and prevention of reduced eGFR. METHODS: This cross-sectional study included 6466 participants (mean age:59.57 years, 60.2% females) from rural areas of northeast China between September 2017 to May 2018. TyG was calculated as ln[fasting triglyceride (mg/dL)&ti...
Source: Postgraduate Medicine - March 21, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Pulmonary complications of influenza infection: a targeted narrative review.
Authors: Daoud A, Laktineh A, Macrander C, Mushtaq A, Soubani AO Abstract Severe influenza infection represents a leading cause of global morbidity and mortality. Several clinical syndromes that involve a number of organs may be associated with Influenza infection. However, lower respiratory complications remain the most common and serious sequel of influenza infection. These include influenza pneumonia, superinfection with bacteria and fungi, exacerbation of underlying lung disease and ARDS. This review analyzes the available literature on the epidemiology and clinical considerations of these conditions. It also p...
Source: Postgraduate Medicine - March 10, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Heart failure readmissions: a losing battle or an opportunity for improvement?
Authors: Marrero-Rivera GE, Vargas P, López-Candales A Abstract Despite great strides in diagnosis and management of heart failure (HF), this chronic illness continues to be a worldwide epidemic with approximately 23 million people afflicted across the globe. In the US, over 6.5 million carry a HF diagnosis with almost 90% of all HF deaths occurring in patients over the age of 70. Since one in five Americans are expected to be older than 65 years by 2050, almost 1,000,000 new HF cases are expected to be diagnosed every year. The staggering nature of these numbers only pales in comparison to current dismal HF...
Source: Postgraduate Medicine - March 9, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Correlation between hypocalcemia and acute exacerbation of chronic obstructive pulmonary disease in the elderly.
This study was performed to analyze total serum calcium levels in elderly patients with AECOPD and identify the correlation between hypocalcemia and AECOPD. METHODS: 153 elderly patients with AECOPD served as the observation group, and 115 healthy elderly people undergoing physical examinations served as the control group. Differences in the corrected serum calcium, albumin (ALB), and neutrophil/lymphocyte ratio (NLR) were analyzed between the observation and control groups before and after treatment. The incidence of hypocalcemia was compared among patients at different ages and with different pulmonary function class...
Source: Postgraduate Medicine - February 28, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

High Frequency Spinal Cord Stimulation at 10 kHz for Widespread Pain: A Retrospective Survey of Outcomes from Combined Cervical and Thoracic Electrode Placements.
CONCLUSIONS: HF10-SCS at 10 kHz provides long term widespread pain relief when leads are staggered across the cervical and thoracic spine. The improved return to work outcomes and opiate reductions suggest that cost effectiveness as well as clinical effectiveness may be achieved with this treatment approach. PMID: 30807247 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 28, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The prognostic impact of TP53 comutation in EGFR mutant lung cancer patients: a systematic review and meta-analysis.
Authors: Zhang R, Tian P, Chen B, Wang T, Li W Abstract Background The prognostic value of TP53 commutation in epidermal growth factor receptor (EGFR) mutant lung cancer is controversial and we therefore conducted this systematic review and meta-analysis. Methods A systematic search was carried out in Pubmed, Web of Science, the Cochrane Library, Medline and Embase up to 19 April 2018. The pooled hazard ratio (HR) of overall survival (OS) and progression free survival (PFS), the relative risk (RR) of objective response rate (ORR) were calculated. Results Overall, a total of eight studies comprising 2979 patients we...
Source: Postgraduate Medicine - February 27, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Real-world misuse, abuse, and dependence of abuse deterrent versus non-abuse-deterrent extended-release morphine in Medicaid non-cancer patients.
CONCLUSION: Misuse, abuse, and dependence events were numerically lower in patients receiving ER-MSN compared with those receiving ERM products. PMID: 30794760 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 24, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

SGLT2 inhibitors and cardioprotection: a matter of debate and multiple hypotheses.
Authors: Filippatos TD, Liontos A, Papakitsou I, Elisaf MS Abstract Sodium-glucose co-transporter 2 (SGLT2) inhibitors inhibit glucose re-absorption in the proximal renal tubules. Two trials have shown significant reductions of cardiovascular (CV) events with empagliflozin and canagliflozin, which could not be attributed solely to their antidiabetic effects. Aim of the review is the critical presentation of suggested mechanisms/hypotheses for the SGLT2 inhibitors-cardioprotection. The search of the literature revealed many possible cardioprotective mechanisms, because SGLT2 inhibitors i) increase natriuresis and ac...
Source: Postgraduate Medicine - February 14, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Management of hypoglycemia in older adults with type 2 diabetes.
This article highlights the issues faced by older people with T2D, the risk factors for hypoglycemia in this population, and the challenges faced by health care providers regarding glycemic management in this patient group. PMID: 30724638 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 8, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Apremilast efficacy and safety in a psoriatic arthritis patient affected by HIV and HBV virus infections.
We report the case of a patient with psoriatic arthritis and concomitant HIV and HBV infection successfully treated with apremilast. PMID: 30700196 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - February 1, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management.
Authors: Clauw DJ, Essex MN, Pitman V, Jones KD Abstract Chronic pain is a common public health problem that has a detrimental impact on patient health, quality of life (QoL), and function, and poses a substantial socioeconomic burden. Evidence supports redefinition of chronic pain as a distinct disease entity, not simply a symptom of injury or illness. Chronic pain conditions are characterized by three types of pain pathophysiology - i.e., nociceptive, neuropathic, and centralized pain/central sensitization -influenced by a cluster of coexisting psychosocial factors. Negative risk/vulnerability factors, e.g., mood...
Source: Postgraduate Medicine - February 1, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Pharmacokinetic and pharmacodynamic differences of new generation, longer-acting basal insulins: potential implications for clinical practice in type 2 diabetes.
Authors: Hompesch M, Patel DK, LaSalle JR, Bolli GB Abstract The treatment of type 2 diabetes (T2D) is often complicated by factors such as patient co-morbidities, complex drug-drug interactions, and management of adverse events. In addition, some of these factors are highly dependent on the nature of the treatment regimen and the molecular and physical properties of the drugs being used to treat patients with this disease. This calls for a better understanding of how the properties of individual drugs affect the overall outcome for patients with diabetes. Clinical pharmacology studies to assess the pharmacokinetic...
Source: Postgraduate Medicine - January 31, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A proposed anti-maladaptive aggression agent classification: improving our approach to treating impulsive aggression.
Authors: Robb AS, Schwabe S, Ceresoli-Borroni G, Nasser A, Yu C, Marcus R, Candler SA, Findling RL Abstract Proper drug categorization enables clinicians to readily identify the agents most appropriate for patients in need. Currently, patients with maladaptive aggression do not all always fall into a single existing diagnostic or treatment category. Such is the case for those with impulsive aggression (IA). IA is an associated feature of numerous neuropsychiatric disorders, and can be described as eruptive, aggressive behavior or a "short fuse". Although agents from a broad spectrum of drug classes have b...
Source: Postgraduate Medicine - January 28, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A randomized, double-blind, 3-way crossover, analog classroom study of SHP465 mixed amphetamine salts extended-release in adolescents with ADHD.
Authors: Wigal S, Lopez F, Frick G, Yan B, Robertson B, Madhoo M Abstract OBJECTIVES: To evaluate the duration of efficacy, safety, and tolerability of SHP465 mixed amphetamine salts (MAS) extended-release versus placebo and immediate-release MAS (MAS IR) in adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS: This phase 2, randomized, 3-period, 3-treatment crossover study compared SHP465 MAS (25/50 mg) with placebo and MAS IR (12.5 mg) in 13-17-year-old adolescents with ADHD having ADHD Rating Scale, Version IV (ADHD-RS-IV) total scores ≥24. A laboratory classroom served as a controlle...
Source: Postgraduate Medicine - January 28, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Early and late relapses of cutaneous melanoma patients.
CONCLUSION: The current study has detected potential risk factors for relapse of patients who developed ER and LR. These indicators may be useful for rational follow-up programs of the patients. PMID: 30644788 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - January 17, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

High burden and low awareness of toxoplasmosis in the United States.
Authors: Ben-Harari RR, Connolly MP Abstract Toxoplasmosis, a disease with diverse clinical manifestations, caused by infection with the Apicomplexan parasite, Toxoplasma gondii (T. gondii), is a major source of morbidity and mortality in the United States. Although toxoplasmosis prevalence and mortality have declined over the past two decades, the CDC considers this disease a neglected parasitic infection requiring public health action. Here, we overview the literature to bring attention to the prevalence of the disease in the United States, and high economic burden associated with the disease. The conclusions to ...
Source: Postgraduate Medicine - January 15, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Cardio-oncology: in search of the right balance.
Authors: López-Candales A PMID: 30632433 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - January 12, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Multifocal gastrointestinal varices: a rare manifestation of immunoglobulin G4-related disease.
Authors: Lin TC, Chang WL Abstract Multifocal gastrointestinal varices are uncommon and often associated with liver cirrhosis. They consist of varices at the gastroesophageal region and the other sites (i.e., ectopic varices) simultaneously. The etiology includes venous system anomalies or thrombosis (congenital or acquired), vascular injury (iatrogenic or traumatic), or portal hypertension (either intrahepatic or extrahepatic). The clinical manifestations vary from asymptomatic lesions to life-threatening variceal hemorrhage. The identification of bleeding foci, as well as the etiology of varices, can be challengi...
Source: Postgraduate Medicine - January 12, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The single use of body mass index for the obesity paradox is misleading and should be used in conjunction with other obesity indices.
Authors: Chrysant SG, Chrysant GS Abstract Overweight and obesity in children and adults have significantly risen in the US and worldwide due to biological, environmental, and cultural drivers and account for about 2.1 billion people. In addition, obesity, even metabolically healthy, is a major risk factor for the metabolic syndrome, diabetes mellitus, dyslipidemia, and hypertension, all significant causes of cardiovascular disease (CVD), coronary heart disease (CHD) heart failure (HF) and stroke. However, despite these causative effects, overweight and obesity frequently, confer a protection in patients with estab...
Source: Postgraduate Medicine - January 12, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Impact of treatment modality on clinical outcome in metastatic colorectal cancer patients stratified by metastatic sites.
Authors: Lai HW, Wei JC, Hung HC, Lin CC Abstract OBJECTIVES: To investigate the impact of location of metastases, and therapeutic modality on clinical outcomes in patients with metastatic colorectal cancer (CRC). METHODS: Data for metastatic CRC patients were sourced from the Surveillance, Epidemiology, and End Results (SEER) database (SEER ID: 15309-Nov2017). Patients were classified as follows: Group 1 patients had only liver metastasis; Group 2 patients had liver and lung metastasis; Group 3 patients had more than 2 metastasis sites. Patients were treated with surgery alone, radiation alone, or surgery plus...
Source: Postgraduate Medicine - January 12, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Treating patients with pain: how to make it less painful.
Authors: Federman DG PMID: 30587057 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 29, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Babesiosis as a cause of acute respiratory distress syndrome: a series of eight cases.
CONCLUSION: Among 22 critically ill adult patients with B. microti infection, ARDS developed in eight (35.4%), and three (37.5%) expired without resolution of the ARDS. ARDS often followed the initiation of anti-babesia drug therapy, raising the question of whether the death of the parasite per se contributed to its development. However, this observation was confounded by the longer duration of symptoms preceding initiation of drug therapy. PMID: 30585748 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 28, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

One-stage posterior approach for treating multilevel noncontiguous thoracic and lumbar spinal tuberculosis.
CONCLUSIONS: The study demonstrated that a one-stage posterior debridement and decompression, combined with an intervertebral fusion and posterior instrumentation, was effective for treating MNST. PMID: 30585750 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 28, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Symptomatic treatment of dengue: Should the NSAID contraindication be reconsidered?
Authors: Kellstein D, Fernandes L Abstract Consensus guidelines for treatment of dengue fever from the World Health Organization and US Centers for Disease Control recommend acetaminophen to manage pain and fever but contraindicate nonsteroidal anti-inflammatory agents (NSAIDs) because of potentially increased bleeding risk, with thrombocytopenia as a complication. Neither acetaminophen nor ibuprofen (the NSAID with lowest bleeding risk) have been evaluated for dengue treatment in randomized, controlled clinical trials. Epidemiologic and cohort studies and case series describing NSAID use in dengue generally point ...
Source: Postgraduate Medicine - December 25, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Circulating levels of prolactin are elevated in patients with rheumatoid arthritis: a meta-analysis.
Authors: Wu Q, Dan YL, Zhao CN, Mao YM, Liu LN, Li XM, Wang DG, Pan HF Abstract BACKGROUND: Prolactin (PRL), an inflammatory hormone with cytokine properties, has long been proposed to play a crucial role in the pathogenesis of autoimmune disorders, including rheumatoid arthritis (RA). However, the circulating levels of PRL in RA were discordant among published studies. METHODS: PubMed, Embase, and The Cochrane Library database were systematically searched from inception up to 30 June 2018. The available studies were obtained from the initial search in accordance with the rigorous inclusion and exclusion criter...
Source: Postgraduate Medicine - December 22, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Clinical analysis of false-negative fine needle aspiration cytology of head and neck cancers.
CONCLUSIONS: We have assessed the quality of preoperative FNA cytology in head and neck tumors. To avoid misdiagnosis by FNA, it is important that the target tumor is punctured accurately. If the specimen obtained is too small, FNA should be repeated. PMID: 30557076 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - December 19, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Early age at menarche is associated with insulin resistance: a systemic review and meta-analysis.
Authors: Zhang Z, Hu X, Yang C, Chen X Abstract Objectives We aimed to conduct a systemic review and meta-analysis of the relevant studies to further investigate the association between age at menarche and insulin resistance. Methods PubMed, EMBASE and Web of Science (SCI) databases were systemically searched until December, 2017. Observational studies comparing the incidences of insulin resistance in patients with early, average and late menarchal ages were identified. Weighted mean difference (WMD) for HOMA-IR scores and fasting serum insulin levels in early vs late, early vs average and average vs late compariso...
Source: Postgraduate Medicine - December 19, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

MEFV gene variants in children with Henoch-Sch ├Ânlein 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 ╬▓-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 5, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research