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Postgraduate Medicine

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https://read.qxmd.com/read/30845866/pulmonary-complications-of-influenza-infection-a-targeted-narrative-review
#1
Asil Daoud, Amir Laktineh, Corey Macrander, Ammara Mushtaq, Ayman O Soubani
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...
March 8, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30843457/heart-failure-readmissions-a-losing-battle-or-an-opportunity-for-improvement
#2
Gabriel E Marrero-Rivera, Pedro Vargas, Angel López-Candales
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 survival statistics...
March 7, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30807247/high-frequency-spinal-cord-stimulation-at-10-khz-for-widespread-pain-a-retrospective-survey-of-outcomes-from-combined-cervical-and-thoracic-electrode-placements
#3
John Salmon
OBJECTIVE: To report on the long-term outcomes for patients receiving paraesthesia-free high-frequency spinal cord stimulation (HF10-SCS) at 10 kHz for the treatment of combined upper and lower body neuropathic/nociplastic pain syndromes including chronic widespread pain/fibromyalgia. MATERIALS AND METHODS: Forty-five patients with widespread (both upper and lower body) neuropathic/nociplastic pain syndromes underwent a trial of combined cervical and thoracic HF10-SCS leads placed over the C2/T2 or C2/T9 vertebral levels, or three leads placed over the C2/T2/T9 vertebral levels...
February 26, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30806122/correlation-between-hypocalcemia-and-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-in-the-elderly
#4
Jinqiu Qin, Xuelian Deng, Aiqiu Wei, Yuanyuan Qin, Yangyang Wu, Lin Liao, Faquan Lin
INTRODUCTION: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an important disease of hospitalized elderly patients, who often have electrolyte imbalances. 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...
February 26, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30798634/the-prognostic-impact-of-tp53-comutation-in-egfr-mutant-lung-cancer-patients-a-systematic-review-and-meta-analysis
#5
Rui Zhang, Panwen Tian, Bojiang Chen, Tao Wang, Weimin Li
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 were included...
February 24, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30794760/real-world-misuse-abuse-and-dependence-of-abuse-deterrent-versus-non-abuse-deterrent-extended-release-morphine-in-medicaid-non-cancer-patients
#6
T J Cicero, Mario Mendoza, Michael Cattaneo, Richard Dart, Jack Mardekian, Michael Polson, Carl L Roland, Sidney Schnoll, Lynn R Webster, Peter W Park
OBJECTIVE: Opioids with abuse-deterrent properties may reduce widespread abuse, misuse, and diversion of these products. This study aimed to quantify misuse, abuse, dependence, and health resource use of extended-release morphine sulfate with sequestered naltrexone hydrochloride (ER-MSN; EMBEDA®), compared with non-abuse-deterrent extended-release morphine (ERM) products in Medicaid non-cancer patients. METHODS: Administrative medical and pharmacy claims data were analyzed for 10 Medicaid states from January 1, 2015, to June 30, 2016...
February 22, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30757937/sglt2-inhibitors-and-cardioprotection-a-matter-of-debate-and-multiple-hypotheses
#7
Theodosios D Filippatos, Angelos Liontos, Ioanna Papakitsou, Moses S Elisaf
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 act as diuretics with unique properties leading to a reduction in preload and myocardial stretch (the diuretic hypothesis); ii) decrease blood pressure and afterload (the blood pressure lowering hypothesis), iii) favor the production of ketones, which can act as a "superfuel" in the cardiac and renal tissue (the "thrifty substrate" hypothesis), iv) improve many metabolic variables (the metabolic effects hypothesis), v) exert many anti-inflammatory effects (the anti-inflammatory effects hypothesis), vi) can act through the angiotensin II type II receptors in the context of simultaneous renin-angiotensin-aldosterone-system (RAAS) blockade leading to vasodilation and positive inotropic effects (the RAAS hypothesis), vii) directly decrease the activity of the upregulated in heart failure Na+ -H+ exchanger in myocardial cells leading to restoration of mitochondrial calcium handling in cardiomyocytes (the sodium hypothesis)...
February 13, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30724638/management-of-hypoglycemia-in-older-adults-with-type-2-diabetes
#8
Jeffrey Freeman
Treatment of older adults with type 2 diabetes (T2D) is complex because they represent a heterogeneous group with a broad range of comorbidities, functional abilities, socioeconomic status, and life expectancy. Older adults with T2D are at high risk of recurring hypoglycemia, a condition associated with marked morbidity and mortality, because their counter-regulatory mechanism to hypoglycemia is attenuated, and recurring hypoglycemic episodes can lead to hypoglycemia unawareness. In addition, polypharmacy, a result of multiple chronic comorbidities (including heart disease, stroke, and chronic kidney disease), can increase the risk of severe hypoglycemia, especially when patients are taking sulfonylureas or insulin...
February 6, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30700198/reframing-chronic-pain-as-a-disease-not-a-symptom-rationale-and-implications-for-pain-management
#9
Daniel J Clauw, Margaret Noyes Essex, Verne Pitman, Kim D Jones
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 the 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...
January 31, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30700196/apremilast-efficacy-and-safety-in-a-psoriatic-arthritis-patient-affected-by-hiv-and-hbv-virus-infections
#10
Valeria Manfreda, Maria Esposito, Elena Campione, Luca Bianchi, Alessandro Giunta
Treatment of psoriasis and psoriatic arthritis in patients with concomitant chronic, severe viral infections, particularly HIV or HBV, represents a challenge, due to contraindication to conventional immunomodulating systemic drugs and biologics, including anti-TNF alpha, anti-IL12/23 and anti-IL17 agents. Recently, apremilast, a selective inhibitor of phosphodiesterase E4 has been suggested to be a safe and effective therapeutic option in HIV-infected population with psoriatic arthritis. We report the case of a patient with psoriatic arthritis and concomitant HIV and HBV infection successfully treated with apremilast...
January 31, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30691343/pharmacokinetic-and-pharmacodynamic-differences-of-new-generation-longer-acting-basal-insulins-potential-implications-for-clinical-practice-in-type-2-diabetes
#11
Marcus Hompesch, Dhiren K Patel, James R LaSalle, Geremia B Bolli
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 (PK) and pharmacodynamic (PD) characteristics of new diabetes drugs play an important role in advancing our understanding of the interactions between a drug and the human body...
January 29, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30681017/a-randomized-double-blind-3-way-crossover-analog-classroom-study-of-shp465-mixed-amphetamine-salts-extended-release-in-adolescents-with-adhd
#12
Sharon Wigal, Frank Lopez, Glen Frick, Brian Yan, Brigitte Robertson, Manisha Madhoo
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...
January 25, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30678534/a-proposed-anti-maladaptive-aggression-agent-classification-improving-our-approach-to-treating-impulsive-aggression
#13
Adelaide S Robb, Stefan Schwabe, Gianpiera Ceresoli-Borroni, Azmi Nasser, Chungping Yu, Ronald Marcus, Shawn A Candler, Robert L Findling
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 been used to treat maladaptive aggression, few have been tested distinctly in patients with IA, and there is no drug specifically indicated by the US Food and Drug Administration (US FDA) for IA...
January 24, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30644788/early-and-late-relapses-of-cutaneous-melanoma-patients
#14
Faruk Tas, Kayhan Erturk
BACKGROUND: Recurrence may most likely develop during the course of the disease in patients presented with early stage melanoma at initial diagnosis. The specific risk factors for early and late recurrences following definitive surgical excision have yet to be determined. The aim of this study was to analyze the early and late relapses in stage I-III cutaneous melanoma patients. METHODS: Of 365 patients with relapses -189 developed within the first 18 months following surgical intervention (early relapse [ER]) and the remaining 176 occurred later (late relapse [LR])- were analyzed...
January 15, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30638425/high-burden-and-low-awareness-of-toxoplasmosis-in-the-united-states
#15
Ruben R Ben-Harari, Mark P Connolly
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...
January 14, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30633608/impact-of-treatment-modality-on-clinical-outcome-in-metastatic-colorectal-cancer-patients-stratified-by-metastatic-sites
#16
Hsin-Wu Lai, James Cheng-Chung Wei, Hung-Chang Hung, Chun-Che Lin
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...
January 11, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30632444/the-single-use-of-body-mass-index-for-the-obesity-paradox-is-misleading-and-should-be-used-in-conjunction-with-other-obesity-indices
#17
Steven G Chrysant, George S Chrysant
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 established CVD, CHD, HF, and hypertension, compared to normal weight persons, the so called "obesity paradox"...
January 11, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30632442/multifocal-gastrointestinal-varices-a-rare-manifestation-of-immunoglobulin-g4-related-disease
#18
Tien-Ching Lin, Wei-Lun Chang
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 challenging...
January 11, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30632433/cardio-oncology-in-search-of-the-right-balance
#19
Angel López-Candales
No abstract text is available yet for this article.
January 11, 2019: Postgraduate Medicine
https://read.qxmd.com/read/30587057/treating-patients-with-pain-how-to-make-it-less-painful
#20
Daniel Glenn Federman
No abstract text is available yet for this article.
December 27, 2018: Postgraduate Medicine
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