Clinical characteristics of platelets and its possible gender dimorphism in patients with nonalcoholic fatty liver disease (NAFLD).
CONCLUSION: The PC showed marked sex-based differences in NAFLD patients and is affected by age and BMI. Regular changes of platelet parameters could be found in patients with varying degrees of NAFLD. These changes might be helpful in assessing the severity of NAFLD. PMID: 32921191 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 16, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Multisystem effects of COVID-19: A concise review for practitioners.
Authors: White-Dzuro G, Gibson LE, Zazzeron L, White-Dzuro C, Sullivan Z, Diiorio DA, Low SA, Chang MG, Bittner EA Abstract While COVID-19 has primarily been characterized by the respiratory impact of viral pneumonia, it affects every organ system and carries a high consequent risk of death in critically ill patients. Higher sequential organ failure assessment (SOFA) scores have been associated with increased mortality in patients critically ill patients with COVID-19. It is important that clinicians managing critically ill COVID-19 patients be aware of the multisystem impact of the disease so that care can be focu...
Source: Postgraduate Medicine - September 16, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Men and COVID-19: the aftermath.
Authors: White A Abstract The global pandemic as a result of the SARS-CoV2 virus has seen over 16m people infected and over 650,000 deaths, with men at double the risk of both developing the severe form of the disease and mortality. There are both biological (sex) and socio-cultural (gender) factors, compounded by socio-economic factors and ethnicity, that impact on the aftermath of what has occurred over the short time that this novel coronavirus has been circulating the world. The potential life-long morbidity as a result of the infection and as a consequence of highly invasive critical care treatment needs to be...
Source: Postgraduate Medicine - September 16, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Estimate of prevalent hyperuricemia by systemic inflammation response index: results from a rural Chinese population.
CONCLUSIONS: Our present study suggests a linear and robust relationship between SIRI and prevalent hyperuricemia, which implicates the value of SIRI to optimize the risk stratification and prevention of hyperuricemia. PMID: 32921215 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 16, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Does arterial stiffness affect orthostatic hypotension among high-altitude Tibetans?
This study aimed to investigate the association between arterial stiffness and orthostatic hypotension (OH) and orthostatic blood pressure (BP) changes among Tibetans living at high altitude. METHODS: A total of 630 high-altitude Tibetans were included (56.53±10.16 years; 246 men). Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV). OH was defined as a decrease in systolic BP (SBP)>20 mmHg or a decrease in diastolic BP (DBP)>10 mmHg after 1 min or 3 min of moving from supine to standing position. RESULTS: T: he prevalence of OH in this population was 6.3%. Compared with subje...
Source: Postgraduate Medicine - September 16, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Prognostic value of the combined variability of mean platelet volume and neutrophil percentage for short-term clinical outcomes of sepsis patients.
Authors: Gao L, Shi Q, Li H, Guo Q, Yan J, Zhou L Abstract INTRODUCTION: In this single center retrospective cohort study, 784 patients with sepsis were enrolled and followed up for at least 30 days. The selected endpoint was an all-cause mortality event. METHOD: The relationship between MPV-CV + NEU%-CV and all-cause mortality (in-hospital and 30-day) was analyzed by categorizing the patients into four groups according to MPV-CV and NEU%-CV values. For in-hospital mortality, a significantly higher risk of mortality was observed in patients with an MPV-CV ≥ 15.00% + NEU%-CV ≥ 16.00% than in patients of the other groups (P
Source: Postgraduate Medicine - September 13, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Penile sparing techniques for penile cancer.
Authors: Ferguson J, Fang A Abstract Penile cancers are rare malignancies. Traditional surgical options, including partial and total penectomy, can dramatically affect a patient's quality of life and mental health. In select patients, penile sparing techniques (PST) have the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual function, and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of the various PST currently available for men seeking an organ-preserving option for their penile cancer. PMID: 32907436...
Source: Postgraduate Medicine - September 12, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Tiotropium in asthma - perspectives for the primary care physician.
Authors: Kaplan A, Chang KL Abstract Asthma is a heterogeneous disease characterized by airway inflammation resulting from complex interactions between multiple host as well as environmental factors. As a chronic respiratory condition, asthma exerts a significant impact on patients and the healthcare system. Per the Global Initiative for Asthma (GINA), inhaled corticosteroids (ICS) with/without long-acting beta2-agonists (LABAs) should be used as the preferred controllers for the management of asthma. Despite a range of therapeutic options, many patients with asthma remain uncontrolled, resulting in an increased ri...
Source: Postgraduate Medicine - September 10, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Introducing a novel therapy for type 2 diabetes to primary care.
Authors: Brunton SA PMID: 32897147 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 10, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Advances in the Diagnostic Options for Prostate Cancer.
Authors: French WW, Wallen EM Abstract Over the past decade, despite the controversies surrounding prostate cancer screening, significant refinements have improved its application. PSA screening, although it has been questioned, appears to confer a mortality benefit and remains the most effective way to identify the possible presence of prostate cancer. Methods to improve the specificity of PSA screening and limit overdiagnosis of indolent cancers, including risk stratified screening regimens, are currently being utilized. Certain imaging modalities, such as multiparametric MRI, have proven to be excellent adjuncts...
Source: Postgraduate Medicine - September 10, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Experiences of breastfeeding among women residents in Alberta: a cross-sectional survey.
Conclusions: Women residents face barriers to breastfeeding at work which require systems-level intervention. Residents from surgical programs may be the most vulnerable to these barriers. Program directors, residency wellness committees, and hospital administrators should prioritize addressing these barriers for women residents returning to work after maternity leave. Examples of interventions that may address these barriers include policies, designation of lactation spaces, and flexible return-to-work schedules. PMID: 32875929 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 5, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Pain and Postgraduate Medicine.
Authors: Varrassi G PMID: 32869711 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - September 3, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Association between lateral epicondylitis and the risk of herpes zoster development.
CONCLUSION: Women with LE had a higher risk of HZ development. HZ vaccination may be needed for the female patients with LE. PMID: 32853042 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 29, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Clinical review of the efficacy and safety of oral semaglutide in patients with type 2 diabetes considered for injectable GLP-1 receptor agonist therapy or currently on insulin therapy.
This article summarizes data from two clinical studies with the first oral GLP-1RA, oral semaglutide, in situations where injectable therapy is often considered, and provides guidance on use in primary care. PIONEER 4 compared oral semaglutide 14 mg with an injectable GLP-1RA, liraglutide 1.8 mg, or placebo in patients uncontrolled on oral glucose-lowering therapies. PIONEER 8 compared oral semaglutide with placebo in patients with T2D already on insulin therapy. Treatment with oral semaglutide gave similar reductions in glycated hemoglobin (HbA1c) compared with liraglutide at 26 weeks, and significantly greater reductions...
Source: Postgraduate Medicine - August 21, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Clinical review of the efficacy and safety of oral semaglutide in patients with type 2 diabetes compared with other oral antihyperglycemic agents and placebo.
Authors: Lavernia F, Blonde L Abstract Oral semaglutide is a tablet formulation of a glucagon-like peptide-1 receptor agonist (GLP-1RA), recently approved in the USA and other countries. This paper reviews data from clinical trials (PIONEER 1, 2, 3, and 7) comparing oral semaglutide (once-daily doses of 3, 7, or 14 mg) with either once-daily placebo, empagliflozin 25 mg, or sitagliptin 100 mg. After 26 weeks in PIONEER 1, patients randomized to 3, 7, or 14 mg doses of oral semaglutide monotherapy had statistically significant reductions in glycated hemoglobin (HbA1c) of 0.9%, 1.2%, and 1.4%, respectively, versus 0....
Source: Postgraduate Medicine - August 21, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Oral semaglutide in patients with type 2 diabetes and cardiovascular disease, renal impairment, or other comorbidities, and in older patients.
This article reviews data from: PIONEER 6, a phase 3a cardiovascular outcomes trial in patients at high cardiovascular risk; PIONEER 5, a phase 3a trial in patients with moderate renal impairment; a post-hoc analysis of PIONEER data by age; and pharmacokinetic trials investigating the effects of renal impairment, gastrointestinal disease, and hepatic impairment on the exposure of oral semaglutide. PIONEER 6 demonstrated the cardiovascular safety of oral semaglutide compared with placebo (hazard ratio: 0.79; 95% confidence interval [CI]: 0.57, 1.11; p
Source: Postgraduate Medicine - August 21, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Integrating oral semaglutide into clinical practice in primary care: for whom, when, and how?
This article provides guidance on integrating oral semaglutide into clinical practice in primary care. Patient populations with T2D who may gain benefit from oral semaglutide include those with inadequate glycemic control taking one or more oral glucose-lowering medication (e.g. after metformin), patients for whom weight loss would be beneficial, patients at risk of hypoglycemia, those who would historically have been considered for treatment with a subcutaneous GLP-1RA, and those receiving basal insulin who require treatment intensification. Like other GLP-1RAs, oral semaglutide is contraindicated in those with personal/f...
Source: Postgraduate Medicine - August 21, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

GLP-1 receptor agonists in the treatment of type 2 diabetes: role and clinical experience to date.
This article reviews the evidence for subcutaneous GLP-1RAs and their role in T2D treatment, and explores the rationale for an oral GLP-1RA from a primary care perspective. Clinical trials and real-world studies with subcutaneous GLP-1RAs indicate that these agents have good glycated hemoglobin (HbA1c)-lowering efficacy, an inherently low potential for hypoglycemia, and reduce body weight. Cardiovascular outcomes trials have established cardiovascular safety, and three GLP-1RAs have been proven to reduce the risk of major adverse cardiovascular events (MACE) in patients with established cardiovascular disease or at high ca...
Source: Postgraduate Medicine - August 21, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Hypogonadism management and cardiovascular health.
This article summarizes the current evidence regarding the cardiovascular safety of testosterone therapy for the management of hypogonadism, as well as the proposed mechanisms that may explain testosterone's underlying effects. PMID: 32799602 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 19, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Interventional pain management in patients with cancer-related pain.
Authors: Bhaskar A Abstract Invasive interventional procedures for managing pain in cancer patients are often under-utilised following the popularisation of the WHO analgesic ladder. The procedures that were successfully used until then were relegated away from mainstream palliative care practice, with the advent of newer opioids and adjuvants. Even though nerve blocks, intrathecal pumps and spinal cord stimulation were re-introduced as the fourth step of the WHO ladder, often referrals for these procedures are too late to produce a meaningful effect on quality of life. At this point most patients have advanced dis...
Source: Postgraduate Medicine - August 19, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Oral glucagon like peptide- receptor agonists (glp1-ra) counselling: Comparison with insulin counselling.
Authors: Kalra S, Kalhan A, Berard L PMID: 32781867 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 14, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Predictors of early progression after curative resection followed by platinum-based adjuvant chemoradiotherapy in oral cavity squamous cell carcinoma.
In this study, 346 patients with OCSCC, who underwent curative surgical resection and platinum-based adjuvant CRT at the Taipei Veterans General Hospital (202 patients, training cohort) and Chung Shan Medical University Hospital (144 patients, validation cohort) were enrolled. The clinical-pathological variables were compared using the χ2 test. Cox proportional-hazards analyses were performed for DFIs. Survival was estimated using the Kaplan-Meier method and log-rank tests, and a scoring system for predicting early progression was established. Results One-fifth (20.5%, 71/346) of all patients experienced progression wi...
Source: Postgraduate Medicine - August 14, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Significance of serrated epithelial change in inflammatory bowel disease.
CONCLUSION: Our data, in the context of other studies, neither prove nor conclusively exclude an increased risk of dysplasia in IBD patients with SEC. But cancer risk appears low and continued surveillance at usual intervals seems reasonable. PMID: 32746680 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 13, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Exploring patient safety culture in the community pharmacy setting: A national cross-sectional study.
CONCLUSIONS: The study revealed that all dimensions are scope for further improvement, and critical consideration ought to be given to the areas of weakness, for the most part in the dimension of Staffing, Work Pressure, and Pace. PMID: 32755512 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 13, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Relationships among pancreatic beta cell function, the Nrf2 pathway, and IRS2: a cross-sectional study.
This study aimed to investigate the relationships among islet function, the Nrf2 pathway, and insulin receptor substrate 2 (IRS2) in type 2 diabetes mellitus (T2DM), prediabetes mellitus (IGR), and normal glucose tolerance (NGT) populations. METHODS: Three hundred cases each were selected for the NGT, IGR, and T2DM groups; FBG, 2hPG, HbA1 c, FINS, TG, TC, HDL-C, and LDL-C levels and serum levels of nuclear factor in E2-related factor 2 (Nrf2), insulin receptor substrate 2 (IRS2), tumor necrosis factor alpha (TNF-α), and heme oxygenase 1 (HO-1) were evaluated. RESULTS: The T2DM group had lower islet &beta...
Source: Postgraduate Medicine - August 13, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Validity, reliability, and application of the electronic version of a chronic kidney disease patient awareness questionnaire: a pilot study.
CONCLUSION: The e-version is reliable but was not shown to be a valid approach. Audiences with higher education levels and less advanced disease condition may prefer to respond to the e-version. Adaptation of this e-questionnaire, from its original paper version, may not be a direct transition and meticulous modifications may be required during the transition process. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR1900024633). PMID: 32758047 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 13, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The case for adding eicosapentaenoic acid (icosapent ethyl) to the ABCs of cardiovascular disease prevention.
Authors: Trivedi K, Le V, Nelson JR Abstract The high-purity eicosapentaenoic acid (EPA) prescription fish oil-derived omega-3 fatty acid (omega-3), icosapent ethyl (IPE), was recently approved by the United States Food and Drug Administration (FDA) for cardiovascular disease (CVD) prevention in high-risk patients. This approval is based on the 25% CVD event risk reduction observed with IPE in the pre-specified primary composite endpoint (cardiovascular [CV] death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) in the landmark Reduction of Cardio...
Source: Postgraduate Medicine - August 13, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Communicating value to patients-a high value care communication skills curriculum.
Conclusion: There was no difference in overall performance on the CARE empathy scale. Our HVC high intensity skills curriculum was well received by interns and provided opportunities to practice structured conversations and debrief around testing stewardship. PMID: 32762590 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 13, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The relevance of practical laboratory markers in predicting gastrointestinal and renal involvement in children with Henoch-Sch ├Ânlein Purpura.
CONCLUSIONS: This study had shown that platelet counts, neutrophil counts, NLR and PLR were increasing and lymphocyte counts, MPV and MPR were decreasing when the patients had GIS involvement. However, these parameters were not relevant in distinguishing severe and mild GIS involvement. When patients had renal involvement NLR was the unique elevated parameter. PMID: 32772751 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 13, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Physicians' knowledge of potential covid-19 drug-drug interactions: An online survey in turkey.
This study aimed to shed light on physicians' knowledge of potential DDIs related to COVID-19 treatment, to determine the effect of an information brief about these DDIs on their correct response rates, and to identify factors associated with higher levels of knowledge about these DDIs. METHODS: The knowledge of physicians regarding the clinical significance and intervention of 7 common potential DDIs during COVID-19 treatment was evaluated via an online survey. Using a pretest-posttest design, the physicians completed a multiple-choice questionnaire first using their existing knowledge, then received an information br...
Source: Postgraduate Medicine - August 13, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Awareness, treatment rates, and compliance to treatment in patients with serum LDL cholesterol higher than 250 mg/dl, and possible, probable or definite familial hypercholesterolemia.
CONCLUSION: A significant proportion of patients with LDL-C≥250 mg/dL were not taking lipid-lowering drugs. Similar with many other studies, diagnosis and treatment rates of FH patients were very low in our study. Further national studies are required to increase awareness of the disease in both physicians and patients. PMID: 32744105 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - August 4, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The effect of prophylactic thoracic duct ligation during esophagectomy on the incidence of chylothorax and survival of the patients: an updated review.
CONCLUSIONS: The present review provided updated evidence opposing prophylactic TDL during esophagectomy for lowering chylothorax. Considering the harmful effect of TDL on survival of the patients, further well-designed trials should be considered in selected cases under strict supervision. PMID: 32729759 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - July 31, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Pulmonary embolism complicated the course of anti-N-methyl-D aspartate receptor encephalitis in a pediatric intensive care unit setting: A case report.
CONCLUSION: Pulmonary embolism should be kept in mind as a possible cause of respiratory insufficiency in pediatric anti-NMDAR encephalitis patients along with altered consciousness, breathing instability, hypersalivation, status epilepticus or dystonia and their treatment. PMID: 32703058 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - July 28, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Trends and outcomes of Peptic Ulcer Disease in patients with Cirrhosis.
Authors: Shah H, Yang TJ, Wudexi I, Solanki S, Patel S, Rajan D, Rodas A, Dajjani M, Chakinala RC, Shah P, Sarker K, Patel A, Aronow W Abstract BACKGROUND: Peptic ulcer disease (PUD) is more prevalent in cirrhotic patients and it has been associated with poor outcomes. However, there are no population-based studies from the United States (U.S.) that have investigated this association. Our study aims to estimate the incidence trends, predictors, and outcomes PUD patients with underlying cirrhosis. METHODS: We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data for y...
Source: Postgraduate Medicine - July 14, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Primary prevention for acute kidney injury in ambulatory patients.
Authors: Musso CG, Rosell C, Gonzalez-Torres H, Ordonez JD, Aroca-Martinez G Abstract Acute kidney injury (AKI) is a heterogeneous group of conditions characterized by a sudden decrease in the glomerular filtration rate. Even though many strategies have been proposed to achieve an early AKI diagnosis and its effective treatment, both objectives remain unachieved. Consequently, AKI prevention continues to be the best "therapeutic" strategy for this condition. Therefore, this article suggests a series of recommendations for achieving AKI primary prevention in ambulatory patients. PMID: 32657222 [PubMed ...
Source: Postgraduate Medicine - July 14, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The knowledge level and perceptions towards COVID-19 among Turkish final year medical students.
CONCLUSION: We determined that final year medical students are knowledgeable and aware of this pandemic. We, medical educators, should inculcate relevant knowledge and educate the medical students to improve practices in the current pandemic, as well as for future epidemics. Different learning techniques should be added to the curriculum, especially at the time which widespread panic and uncertainty are prevalent. PMID: 32657235 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - July 14, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Practical guidance for use of oral semaglutide in primary care: a narrative review.
This article provides practical guidance on the use of oral semaglutide in the primary care setting, based on evidence from clinical studies, including the phase 3a PIONEER program, and the authors' clinical experience. PMID: 32643514 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - July 11, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Dipeptidyl Peptidase-4 Inhibitor treatment could decrease Klebsiella pneumoniae Pneumonia in patients with type 2 diabetes.
CONCLUSIONS: For public health issue with type2 diabetes and infection, DPP4i use decreased KP pneumonia. Male gender, patients with co-morbidities, patients with higher DSCI score and higher DDD of DPP4i were observed to decrease KP pneumonia infection in our analysis. The possible role of DPP4i causing immunological disturbances should be considered. PMID: 32633173 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - July 8, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The clinical significance of isolated diastolic hypertension.
Authors: Chrysant SG Abstract The prevalence of isolated diastolic hypertension (IDH) has been increased in hypertensive subjects with the new 2017 ACC/AHA blood pressure treatment guidelines to 6.5% from 1.3% by the JNC-7 guidelines. However, its clinical significance as a cause of adverse cardiovascular (CV) events especially in older subjects has been debated by several investigators, who have demonstrated no adverse CV effects of untreated IDH, but not by other. It is also more common in the young subjects who are at low CV risk and quite rare in the older subjects, who are at increased CV risk. Treatment of ID...
Source: Postgraduate Medicine - July 1, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Contemporary Prevalence and Risk Factors of Carotid Artery Stenosis in Asymptomatic Low-Income Chinese Individuals: A Population-based Study.
Authors: Zhang K, Lin Q, Zhang T, Guo D, Cao L Abstract OBJECTIVE: Carotid artery stenosis (CAS) is an established risk factor for cerebrovascular disease. However, the contemporary prevalence and risk factors of CAS in asymptomatic rural Chinese individuals, especially low-income populations, remains unclear. Therefore, we aimed to explore the present prevalence and risk factors of CAS in a low-income Chinese population. METHODS: A total of 3126 people aged ≥ 45 years without history of stroke or cardiovascular disease were recruited for this study. B-mode ultrasonography was performed to evaluate the prese...
Source: Postgraduate Medicine - June 28, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

COVID-19 and comorbidities: A systematic review and meta-analysis.
Authors: Gold MS, Sehayek D, Gabrielli S, Zhang X, McCusker C, Ben-Shoshan M Abstract 1.0 Abstract SARS-CoV-2 has caused a worldwide pandemic that began with an outbreak of pneumonia cases in the Hubei province of China. Knowledge of those most at risk is integral for treatment, guideline implementation and resource allocation. We conducted a systematic review and meta-analysis to evaluate comorbidities associated with severe and fatal cases of COVID-19. A search was conducted on PubMed and EmBase on April 20, 2020. Pooled estimates were collected using a random effects model. Thirty three studies were included in ...
Source: Postgraduate Medicine - June 24, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Scientific independence and objectivity: many questions linger about treatment of type 2 diabetes, such as scientific study design, optimal glucose control and the safety of injecting exogenous insulin.
Authors: Currie CJ Abstract Whilst clinical guidelines exist for the treatment of people with type 2 diabetes, many underlying assumptions are still not qualified by convincing evidence. In this commentary it is argued that fundamental issues still cloud clinical practice, such as biases in the design of clinical studies, the association between glucose control & clinical outcomes, and the safety of exposure to exogenous insulin and other glucose lowering drugs. Relevant scientific evidence and alternative opinions about important issues continue to be largely ignored, and no effort has been made to resolve the...
Source: Postgraduate Medicine - June 21, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Beta-cell failure in type 2 diabetes: mechanisms, markers, and clinical implications.
In conclusion, significant beta-cell dysfunction is likely in individuals with certain clinical characteristics of T2D, such as long duration of disease, high glycated hemoglobin (≥9%), and/or long-term use of therapies that continuously stimulate the beta cell. In these people, measurement of beta-cell status could assist with choice of appropriate therapy to delay or potentially reverse beta-cell dysfunction and the progression of T2D. PMID: 32543261 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - June 18, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Obesity at a young age is associated with development of diabetes mellitus: A prospective cohort study in rural China.
CONCLUSIONS: These findings suggest that obesity is associated with developing DM in rural China, especially among adults aged
Source: Postgraduate Medicine - June 7, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Advances in the use of chloroquine and hydroxychloroquine for the treatment of COVID-19.
Authors: Sun J, Chen Y, Fan X, Wang X, Han Q, Liu Z Abstract Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading worldwide. Antiviral therapy is the most important treatment for COVID-19. Among the drugs under investigation, anti-malarials, chloroquine (CQ) and hydroxychloroquine (HCQ), are being repurposed as treatment for COVID-19. CQ/HCQ were shown to prevent receptor recognition by coronaviruses, inhibit endosome acidification, which interferes with membrane fusion, and exhibit immunomodulatory activity. These multiple mechanisms may work tog...
Source: Postgraduate Medicine - June 6, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Lessons from mass vaccination response to meningococcal B outbreaks at US universities.
Authors: Alderfer J, Isturiz RE, Srivastava A Abstract College students in the United States are at an increased risk for meningococcal serogroup B disease or MenB, which causes the majority of invasive meningococcal disease in the country among adolescents and young adults (62%) and also across all age groups (36%) as of 2018. Approximately one-third of MenB cases among college students occur during campus outbreaks, which trigger substantial public health concern and costs associated with conducting rapid mass vaccination campaigns in an emergency setting. Eleven US college outbreaks of MenB disease have occurred...
Source: Postgraduate Medicine - June 3, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The current state of acute treatment for migraine in adults in the United States.
The objective of this narrative review is to familiarize primary care clinicians with the variety of acute treatment options available in the United States today based on clinical trial findings, meta-analyses, evidence-based guidelines, and professional society consensus statements. PMID: 32459561 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - May 29, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Assessment of Adequacy of Respiratory Infection Prevention in Hospitals of Inner Mongolia, China: A Cross-sectional Study using Unannounced Standardized Patients.
CONCLUSIONS: There is a need to improve respiratory infectious disease procedures in our study hospitals, especially in outpatient and emergency departments. PMID: 32459978 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - May 29, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

COVID-19: An unprecedented pandemia with a potential arrhythmic undertone.
Authors: Lopez-Candales A, Mounsey JP PMID: 32449876 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - May 26, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Redesigning Primary Care in an Academic Medical Center: Lessons, Challenges, and Opportunities.
Conclusions: While this project was limited to one site, the inclusion of a set of well-planned metrics, and tracking of processes over time can provide insight for ongoing primary care redesign efforts at similar sites seeking to balance the academic mission with clinical productivity and high patient satisfaction. PMID: 32441180 [PubMed - as supplied by publisher] (Source: Postgraduate Medicine)
Source: Postgraduate Medicine - May 24, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research