- Wet-wrap therapy with halometasone cream for severe adult atopic dermatitis. [Journal Article]
- PMPostgrad Med 2018 May 16
- CONCLUSIONS: WWT can relieve pruritus, reduce skin lesions, and improve quality of life in adult patients with severe AD. Thus, WWT may be effective and safe for severe adult AD. Trial registration No. is ChiCTR1800014909 (http://www.chictr.org.cn/index.aspx).
- Delayed intravenous immunoglobulin treatment increased the risk of coronary artery lesions in children with Kawasaki disease at different status. [Journal Article]
- PMPostgrad Med 2018 May 10; :1-6
- CONCLUSIONS: 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.
- How blockchain technology can change medicine. [Journal Article]
- PMPostgrad Med 2018 May 10; :1-8
- Although the best-known use of blockchain technology (BCT) is in the field of economics and cryptocurrencies in general, its usefulness is extending to other fields, including the biomedical field. T...
Although the best-known use of blockchain technology (BCT) is in the field of economics and cryptocurrencies in general, its usefulness is extending to other fields, including the biomedical field. The purpose of this article is to clarify the role that BCT can play in the field of medicine. We have performed a narrative review of the literature on BCT in general and on medicine in particular. The great advantage of BCT in the health arena is that it allows development of a stable and secure data set with which users can interact through transactions of various types. This environment allows the entry and operation of clinical data without compromising other sensitive data. Another important advantage of BCT is that the entire network is decentralized and is maintained by the users themselves; thus, there is no need to rely on organizations for storage. The Blockchain code is open source and can be used, modified and revised by its users. BCT literature is scarce so far. 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.
- Finally, after 56 years of type 1 diabetes: a regimen that works. [Journal Article]
- PMPostgrad Med 2018 May 14; :1-2
- 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 n...
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 utilizing degludec insulin for basal needs and technosphere before meals and between meals if needed. The availability of degludec and technosphere insulin improved the management of brittle type 1 diabetes.
- Angiopoietin-2 level as a tool for cardiovascular risk stratification in hypertensive type 2 diabetic subjects. [Journal Article]
- PMPostgrad Med 2018 May 08; :1-7
- 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.
- The effect of intravenous insulin, apheresis and oral lipid-lowering agents on non-fasting hypertriglyceridemia and associated pancreatitis. [Journal Article]
- PMPostgrad Med 2018 May 04; :1-7
- CONCLUSIONS: The presence of pancreatitis, hyperglycemia, and hypertriglyceridemia severity influenced selection of therapies like IV insulin and apheresis. We found no superiority of either IV insulin or apheresis in the treatment of severe hypertriglyceridemia among patients hospitalized for pancreatitis.
- Evaluating the clinical value of the hypoxia burden index in patients with obstructive sleep apnea. [Journal Article]
- PMPostgrad Med 2018 Apr 20; :1-6
- CONCLUSIONS: The HBI considers both hypoxia duration and severity during sleep. It may have potential value in predicting the clinical outcomes of OSA based on its correlation with ESS scores and morning blood pressure as well as its independent association with the prevalence of CVDs, whereas the AHI is not significantly associated with CVD prevalence.
- Glycemic control of type 2 diabetes mellitus across stages of renal impairment: information for primary care providers. [Journal Article]
- PMPostgrad Med 2018 Apr 18; :1-13
- Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and elevates individuals' risk for cardiovascular disease, the leading cause of morbidity and mortality in T...
Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and elevates individuals' risk for cardiovascular disease, the leading cause of morbidity and mortality in T2DM. Achieving and maintaining tight glycemic control is key to preventing development or progression of CKD; however, improving glycemic control may be limited by effects of renal impairment on the efficacy and safety of T2DM treatments, necessitating dosing adjustments and careful evaluation of contraindications. Understanding the treatment considerations specific to each class of T2DM medication is important in individualizing therapy and improving glycemic, renal, and cardiovascular outcomes. Traditional glucose-lowering treatments include insulin, metformin, sulfonylureas, meglitinides, and thiazolidinediones. Each of these agents exhibits altered pharmacokinetics in patients with renal impairment except for the thiazolidinediones, which are metabolized by the liver and do not accumulate appreciably in patients with renal impairment. Newer glucose-lowering treatments include GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors. Of these, only the DPP-4 inhibitor linagliptin can be used across all stages of renal impairment without dosing restrictions or concerns regarding dose escalation, and all SGLT2 inhibitors are contraindicated when eGFR <45 mL/min/1.73m2. Several of the newer treatments have also been investigated for effects on renal and cardiovascular outcomes, demonstrating potential benefits of the GLP-1 agonists liraglutide and semaglutide, as well as the SGLT2 inhibitors canagliflozin and empagliflozin, in reducing risk for some adverse renal and cardiovascular events. In addition, some DPP-4 inhibitors have been shown to reduce albuminuria, an indicator of glomerular dysfunction. Consideration of this information is useful in informing optimal management strategies for patients with T2DM and concomitant CKD. More clinical data from future and ongoing clinical trials, including data regarding potential renal and cardiovascular benefits, will be important in clarifying the safety and efficacy profiles of each of these agents in patients with CKD.
- Educational needs in the diagnosis and management of pediatric functional constipation: a US survey of specialist and primary care clinicians. [Journal Article]
- PMPostgrad Med 2018 Apr 27; :1-8
- CONCLUSIONS: CME programs focusing on applying diagnostic criteria, matching diagnostic workup to patient presentation, treatment selection, and identifying patients who may benefit from psychological evaluation may fill knowledge and practice gaps of clinicians who manage pediatric patients with functional constipation.
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- Utility of natriuretic peptides to assess and manage patients with heart failure receiving angiotensin receptor blocker/neprilysin inhibitor therapy. [Review]
- PMPostgrad Med 2018; 130(3):299-307
- Levels of natriuretic peptides (NPs), such as B-type NP (BNP) and the N-terminal fragment of its prohormone (NT-proBNP), are well-established biomarkers for patients with heart failure (HF). Although...
Levels of natriuretic peptides (NPs), such as B-type NP (BNP) and the N-terminal fragment of its prohormone (NT-proBNP), are well-established biomarkers for patients with heart failure (HF). Although these biomarkers have consistently demonstrated their value in the diagnosis and prognostication of HF, their ability to help clinicians in making treatment decisions remains debated. Moreover, some new HF drugs can affect concentrations of NPs, such as the prevention of BNP degradation by angiotensin receptor/neprilysin inhibitors (ARNIs), and may present a challenge in the interpretation of levels of BNP. Use of NT-proBNP measurement has been suggested in the context of ARNI therapy because its concentrations are not affected by neprilysin inhibition. As biomarkers are reconsidered in the context of ARNI therapy, cutoff levels and the effects of individual patient characteristics, such as renal function and age, on biomarker concentrations should be reassessed.