MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Postgraduate Medicine Online' source. Thu, 09 Feb 2012 09:15:16 +0100 http://www.medworm.com/index.php?rid=5672338&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2531 DOI: 10.3810/pgm.2012.01.2531 Morales J. The pharmacologic basis for clinical differences among GLP-1 receptor agonists and DPP-4 inhibitors. Postgrad Med. 2011;123(6):189–201. read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672338 Fri, 03 Feb 2012 14:21:35 +0100 5672338 http://www.medworm.com/index.php?rid=5672335&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2530 Yehia Y. Mishriki, MD, FACP and Brigid Hallinan, DO DOI: 10.3810/pgm.2012.01.2530 read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672335 Fri, 03 Feb 2012 14:21:12 +0100 5672335 http://www.medworm.com/index.php?rid=5672351&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2529 Conclusion: These results emphasize the critical role that formulation type (IR vs OROS) and timing of administration (ascending vs descending phase) play when short- and long-acting formulations are coadministered. Such knowledge provides important information for clinicians about the safety and tolerability of the timing of repeat dosing of various permutations of coadministration of MPH formulations. Keywords: stimulants; drug abuse liability; attention-deficit/hyperactivity disorder read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672351 Fri, 03 Feb 2012 14:18:35 +0100 5672351 http://www.medworm.com/index.php?rid=5672348&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2528 This article provides an introduction to the phenomenology, etiology, and clinical course of OCD. Assessment practices used to evaluate symptom severity are described, and evidence-based treatment options are reviewed, with appropriate distinctions drawn between children and adults. Finally, recommendations for assessment and treatment practices for OCD are explicated. Keywords: obsessive-compulsive disorder; assessment; treatment; phenomenology; etiology read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672348 Fri, 03 Feb 2012 14:18:19 +0100 5672348 http://www.medworm.com/index.php?rid=5672346&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2527 Then and Now Charles Joseph Lane, MD; J. Andrew Grant, MD; and Dane Dougherty, MS DOI: 10.3810/pgm.2012.01.2527 Abstract: Originally identified in 1882, hereditary angioedema (HAE) is a debilitating and potentially fatal disorder. Although a number of therapies have been identified, many are relatively ineffective or are associated with significant side effect concerns that limit their efficacy. Fortunately, the 2008 approval of plasma-derived C1 esterase inhibitor concentrate for disease prophylaxis provides clinicians with a novel and effective treatment unencumbered with severe side effect concerns for those with this debilitating disorder. However, despite advances in modern medicine, HAE remains a condition marked by a myriad of symptoms that mimic a range of other disorder... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672346 Fri, 03 Feb 2012 14:17:05 +0100 5672346 http://www.medworm.com/index.php?rid=5672344&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2526 This article reviews the epidemiology, pathophysiology, comorbidities, pharmacokinetic considerations, treatment goals, guidelines, and treatment options for the elderly population, and highlights the current knowledge gaps complicating the management of T2DM in this population. Keywords: type 2 diabetes mellitus; elderly; metformin; thiazolidinediones; incretin mimetics; DPP-4 inhibitors; GLP-1 read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672344 Fri, 03 Feb 2012 14:16:41 +0100 5672344 http://www.medworm.com/index.php?rid=5672342&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2525 Conclusion: Different OAD classes were associated with different levels of risk for hypoglycemic events. Hypoglycemia was associated with a higher risk of antidiabetic treatment discontinuation and significantly increased health care costs. Keywords: hypoglycemia; type 2 diabetes mellitus; oral antidiabetic drug; treatment discontinuation; health care cost read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672342 Fri, 03 Feb 2012 14:15:42 +0100 5672342 http://www.medworm.com/index.php?rid=5672340&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2524 Conclusion: The novel nano-formulated, lower-dose diclofenac demonstrated lower systemic exposure, comparable Cmax, and faster absorption compared with diclofenac. In light of the advisory issued by worldwide regulatory agencies regarding use of lowest effective doses, these data may permit use of lower NSAID doses that improve safety and tolerability while, at minimum, relieving pain similar to standard formulations. Keywords: NSAID; diclofenac; nanotechnology read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672340 Fri, 03 Feb 2012 14:15:09 +0100 5672340 http://www.medworm.com/index.php?rid=5672337&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2523 This article addresses the contemporary management of overactive bladder, including behavioral and lifestyle modifications, pelvic floor muscle therapy, biofeedback, drug therapy, neuromodulation, and botulinum toxin. We highlight the new drugs and therapies that have been brought into clinical use over the past few years, and discuss important clinical implications of therapy as well as promising new agents that are currently in advanced stages of development. Keywords: overactive bladder; behavioral modification; biofeedback; antimuscarinics; neuromodulation; botulinum toxin read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672337 Fri, 03 Feb 2012 14:14:13 +0100 5672337 http://www.medworm.com/index.php?rid=5672334&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2522 This article gives an overview of HSDD in clinical practice and provides 3 case descriptions to illustrate the treatment of low sexual desire in women with diverse histories. Keywords: primary care provider; metabolic syndrome; breast cancer; androgen insufficiency; female sexual dysfunction; hypoactive sexual desire disorder read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672334 Fri, 03 Feb 2012 14:12:49 +0100 5672334 http://www.medworm.com/index.php?rid=5672350&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2521 Conclusions: Duloxetine appears efficacious and tolerable for the treatment of chronic pain associated with OA. The NNT and NNH can be used to quantify efficacy and tolerability outcomes and help place duloxetine into clinical perspective. Likelihood to be helped or harmed can illustrate to the clinician and patient the trade-offs between obtaining potential benefits versus harms. Head-to-head comparisons of duloxetine with other interventions for OA, as well as controlled trials of duloxetine in combination with other therapies, would be desirable. Keywords: adverse events; duloxetine; efficacy; number needed to harm; number needed to treat; osteoarthritis; pain; safety; tolerability read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672350 Fri, 03 Feb 2012 14:12:10 +0100 5672350 http://www.medworm.com/index.php?rid=5672347&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2520 This article focuses on the safety and efficacy of spironolactone when added to an optimized 3-drug regimen. Additionally, the use of spironolactone in chronic kidney disease and obstructive sleep apnea complicated by resistant hypertension is discussed. These 2 clinical entities are frequently accompanied by resistant hypertension and are indications for the use of spironolactone as well. Keywords: hypertension; resistant hypertension; spironolactone; treatment; chronic kidney disease; obstructive sleep apnea; renin-angiotensin-aldosterone system read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672347 Fri, 03 Feb 2012 14:11:44 +0100 5672347 http://www.medworm.com/index.php?rid=5672345&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2519 Donald Clark III, MD; Jason L. Guichard, MD, PhD; David A. Calhoun, MD; and Mustafa I. Ahmed, MD DOI: 10.3810/pgm.2012.01.2519 Abstract: The 2008 scientific statement from the American Heart Association defined resistant hypertension as blood pressure remaining above goal (< 140/90 mm Hg for the general population and < 130/80 mm Hg for patients with diabetes or renal disease) despite the concurrent use of optimal doses of 3 antihypertensive agents of different classes, ideally including a diuretic. Since then, there has been increasing recognition and characterization of patients with resistant hypertension and development of treatment strategies to treat this high-risk population. The role of aldosterone in resistant hypertension has gained increasing recognition. In particul... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672345 Fri, 03 Feb 2012 14:09:34 +0100 5672345 http://www.medworm.com/index.php?rid=5672343&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2518 This article reviews the comparative clinical data between chlorthalidone and hydrochlorothiazide, the pharmacologic properties that might explain some of their differences regarding half-life and efficacy, and what is known about the effect of chlorthalidone on intermediate endpoints. Keywords: hypertension; diuretics; chlorthalidone; hydrochlorothiazide read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672343 Fri, 03 Feb 2012 14:07:06 +0100 5672343 http://www.medworm.com/index.php?rid=5672341&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2517 Wilbert S. Aronow, MD, FACC, FAHA DOI: 10.3810/pgm.2012.01.2517 Abstract: Hypertension is a major risk factor for cardiovascular disease and is present in 69% of patients with a first myocardial infarction, in 77% of patients with a first stroke, in 74% of patients with chronic heart failure, and in 60% of patients with peripheral arterial disease. Double-blind, randomized, placebo-controlled trials have demonstrated that antihypertensive drug therapy reduces cardiovascular events in patients aged 65 to 79 years. In the Hypertension in the Very Elderly Trial, patients aged ≥ 80 years who were treated with antihypertensive drug therapy had, at 1.8-year follow-up, a 30% reduction in fatal or nonfatal stroke (P = 0.06), a 39% reduction in fatal stroke (P = 0.05), a 21% reduction in a... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672341 Fri, 03 Feb 2012 14:06:20 +0100 5672341 http://www.medworm.com/index.php?rid=5672339&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2516 Conclusion: Traditional cost-effectiveness analysis systematically excludes information related to the safety profiles of these anticoagulants. The efficiency frontier approach presented in this study provides critical information, without substantial effort, to permit a fully informed decision by taking into account all relevant outcomes as they relate to the costs associated with treatment choice. Keywords: orthopedic surgery; efficiency frontier; venous thromboembolism; total knee arthroplasty; total hip arthroplasty read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672339 Fri, 03 Feb 2012 13:58:07 +0100 5672339 http://www.medworm.com/index.php?rid=5672336&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2515 Jeffrey T. Kirchner, DO, FAAFP, AAHIVS DOI: 10.3810/pgm.2012.01.2515 Abstract: Dyslipidemia is common in patients with human immunodeficiency virus (HIV) and may result in significant morbidity, including coronary heart disease (CHD). Treatment of dyslipidemia in these patients is generally based on the National Cholesterol Education Program Adult Treatment Panel III goals for individuals without HIV. For individuals with ≥ 2 cardiovascular risk factors, the risk of CHD should be evaluated using the Framingham risk calculator and managed accordingly. Switching to an antiretroviral regimen with a favorable lipid profile should be considered before pharmacologic management if virologic suppression can be maintained. Statins are the first-choice therapy for elevated low-density lipop... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672336 Fri, 03 Feb 2012 13:57:38 +0100 5672336 http://www.medworm.com/index.php?rid=5672333&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2514 Definition and Therapeutic Implications Hari Prasad, MD; Debra A. Ryan, MD; Ma Florence Celzo, MD; and Dwight Stapleton, MD DOI: 10.3810/pgm.2012.01.2514 Abstract: The collection of impaired glucose metabolism, central obesity, elevated blood pressure, and dyslipidemia is identified as metabolic syndrome (MetS). It is estimated that approximately 25% of the world’s population has MetS. In the United States, MetS is more common in men and Hispanics, and its incidence increases with age. Metabolic syndrome increases the risk of developing cardiovascular disease and type 2 diabetes mellitus. The underlying risk factors include insulin resistance and abdominal obesity. Confusion about MetS exists in part due to the lack of a consensus definition and treatment protocol. Treatme... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672333 Fri, 03 Feb 2012 13:56:38 +0100 5672333 http://www.medworm.com/index.php?rid=5672349&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2012.01.2513 A Literature Review James M. McKenney, PharmD DOI: 10.3810/pgm.2012.01.2513 Abstract: Patients with dyslipidemia receive a cardiovascular benefit from lowering low-density lipoprotein cholesterol (LDL-C). Atorvastatin is currently one of the most effective approved medications for lowering LDL-C, and has been shown to significantly reduce cardiovascular risk in many patient groups. However, even with substantial lowering of LDL-C with atorvastatin, patients still have a residual risk for coronary heart disease. Elevated triglyceride levels and low high-density lipoprotein cholesterol (HDL-C) levels may contribute to this risk. Approved medications targeting these secondary lipid parameters include fibrates, omega-3 fatty acids, and niacin. Among these medications, niacin provide... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5672349 Fri, 03 Feb 2012 13:54:43 +0100 5672349 http://www.medworm.com/index.php?rid=5663267&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.11.2496 Conclusion: The results of this study indicate that along with its antihypertensive and cholesterol-lowering effects, combination therapy with amlodipine and atorvastatin appears to increase plasma adiponectin levels and improve endothelial function. Keywords: blood pressure; amlodipine; atorvastatin; adiponectin; endothelial function read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663267 Tue, 15 Nov 2011 16:20:51 +0100 5663267 http://www.medworm.com/index.php?rid=5663269&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.11.2504 A Narrative Review Matthew J. Bair, MD, MS and Tamara R. Sanderson, BS DOI: 10.3810/pgm.2011.11.2504 Abstract: Chronic pain is inadequately treated in many patients, which has led clinicians and researchers to investigate new indications for existing medications with pain-relieving or adjuvant properties. These medications are known as coanalgesics. This review provides an evidence-based overview of select coanalgesics that are used in clinical practice for a variety of neuropathic and musculoskeletal pain disorders. The coanalgesics include antidepressants, anticonvulsants, topical agents, skeletal muscle relaxants, and antispasmodic agents. An update on emergent treatments and uses is also presented. The goals of this article are to highlight coanalgesic treatment options that... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663269 Tue, 15 Nov 2011 16:05:37 +0100 5663269 http://www.medworm.com/index.php?rid=5663266&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.11.2494 This article provides an up-to-date summary of epidemiological and treatment aspects of high blood pressure in the US Hispanic population. Because Mexican Americans constitute approximately 66% of US Hispanics, data sources that focus on Mexican Americans are also discussed. Keywords: Hispanics; Mexican Americans; hypertension; epidemiology; treatment; cardiovascular diseases read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663266 Tue, 15 Nov 2011 16:04:52 +0100 5663266 http://www.medworm.com/index.php?rid=5663265&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.11.2508 Javier Morales, MD DOI: 10.3810/pgm.2011.11.2508 Abstract: The incretin system plays an important role in glucose homeostasis, largely through the actions of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). Unlike GIP, the actions of GLP-1 are preserved in patients with type 2 diabetes mellitus, which has led to the development of injectable GLP-1 receptor (GLP-1R) agonists and oral dipeptidyl peptidase-4 (DPP-4) inhibitors. GLP-1R agonists—which can be dosed to pharmacologic levels—act directly upon the GLP-1R. In contrast, DPP-4 inhibitors work indirectly by inhibiting the enzymatic inactivation of native GLP-1, resulting in a modest increase in endogenous GLP-1 levels. GLP-1R agonists generally lower the fasting and postprandial g... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663265 Tue, 15 Nov 2011 16:03:17 +0100 5663265 http://www.medworm.com/index.php?rid=5663268&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.11.2509 Nasir Shariff, MD; Ashish Kabra, MD; Martin E. Matsumura, MD; and Yehia Y. Mishriki, MD, FACP DOI: 10.3810/pgm.2011.11.2509 read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663268 Tue, 15 Nov 2011 16:02:42 +0100 5663268 http://www.medworm.com/index.php?rid=5663283&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2480 An Introduction to Liraglutide Thomas Repas, DO, FACP, FACOI, FACE, CDE DOI: 10.3810/pgm.2011.09.2480 Abstract: Liraglutide, a once-daily human glucagon-like peptide-1 (GLP-1) analog, was approved by the US Food and Drug Administration in 2010 for the treatment of type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 enhances insulin secretion and inhibits glucagon in a glucose-dependent manner. The efficacy and safety of liraglutide were evaluated in 6 phase 3 trials in > 4000 patients in the Liraglutide Effect and Action in Diabetes (LEAD) program, in another trial in comparison with sitagliptin, and in another trial where basal insulin was added to liraglutide + metformin. At liraglutide doses of 1.2 mg or 1.8 mg once daily, significant mean reductions in g... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663283 Thu, 15 Sep 2011 04:00:00 +0100 5663283 http://www.medworm.com/index.php?rid=5663282&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2479 Vanita R. Aroda, MD and Mary Beth DeYoung, PhD DOI: 10.3810/pgm.2011.09.2479 Abstract: Exenatide (exendin-4) is a 39-amino acid peptide belonging to the glucagon-like peptide-1 (GLP-1) receptor agonist class that has been demonstrated to improve glycemic control in patients with type 2 diabetes mellitus. Exenatide can be injected twice daily (ExBID) before meals or once weekly (ExQW) when encompassed within dissolvable poly-(D,L-lactide-co-glycolide) microspheres. The primary difference between these formulations is the plasma concentration of exenatide over time, with the long-acting form providing continuous delivery. Clinical trials have examined the similarities and differences in the efficacy and safety/tolerability outcomes of these formulations. In 2 clinical studies spanning ... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663282 Thu, 15 Sep 2011 04:00:00 +0100 5663282 http://www.medworm.com/index.php?rid=5663281&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2476 Conclusions: A behavioral intervention with a low-energy diet including 5 meal replacements and 5 servings of fruits or vegetables enabled obese individuals to lose 13 kg more than control subjects over a 24-week period. Keywords: obese, adults, low-energy diet, behavioral intervention, nutritional intervention, weight loss read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663281 Thu, 15 Sep 2011 04:00:00 +0100 5663281 http://www.medworm.com/index.php?rid=5663280&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2475 A Narrative Review Craig A. Umscheid, MD, MSCE; David J. Margolis, MD, PhD, MSCE; and Craig E. Grossman, MD, PhD DOI: 10.3810/pgm.2011.09.2475 Abstract: The recent focus of federal funding on comparative effectiveness research underscores the importance of clinical trials in the practice of evidence-based medicine and health care reform. The impact of clinical trials not only extends to the individual patient by establishing a broader selection of effective therapies, but also to society as a whole by enhancing the value of health care provided. However, clinical trials also have the potential to pose unknown risks to their participants, and biased knowledge extracted from flawed clinical trials may lead to the inadvertent harm of patients. Although conducting a well-designed cl... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663280 Thu, 15 Sep 2011 04:00:00 +0100 5663280 http://www.medworm.com/index.php?rid=5663279&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2473 George N. Coritsidis, MD, FACP; Ellena Linden, MD; and Aaron S. Stern, MD DOI: 10.3810/pgm.2011.09.2473 Abstract: Recent increases in obesity, diabetes, and hypertension, along with the aging of the US population, are driving a dramatic rise in the prevalence of chronic kidney disease (CKD). Despite this increase, the majority of Americans with early-stage CKD remain unaware of their disease. Primary care physicians are at the forefront of efforts for early recognition of CKD and management to control its progression. Patients with CKD should be referred to nephrologists no later than the point at which their estimated glomerular filtration rate reaches 30 mL/min. Nephrology evaluation at this point is essential to facilitate timely preparation for care of end-stage renal disease thr... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663279 Thu, 15 Sep 2011 04:00:00 +0100 5663279 http://www.medworm.com/index.php?rid=5663278&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2457 Conclusions: In this naturalistic setting, transitioning from IR MPH to OROS® MPH, in patients who showed previously insufficient response and/or poor tolerability, was successful. Patients’ and parents’ HRQoL as well as burden of disease showed a clinically relevant improvement. OROS® MPH was generally safe and well tolerated. Keywords: ADHD , children/adolescents , OROS® methylphenidate , transition read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663278 Thu, 15 Sep 2011 04:00:00 +0100 5663278 http://www.medworm.com/index.php?rid=5663277&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2483 H. Richard Barthel, MD and Robert A. Axford-Gatley, MD DOI: 10.3810/pgm.2011.09.2483 Abstract: read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663277 Thu, 15 Sep 2011 04:00:00 +0100 5663277 http://www.medworm.com/index.php?rid=5663276&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2468 Conclusions: The high prevalence of patients meeting full criteria for BD and the low rate of identification of BD in primary care patients are consistent with estimates using self-administered questionnaires, but the interview revealed a substantial additional population that could be considered to have subsyndromal BD. Because subsyndromal forms of BD are associated with significant impairment and comorbidity as well as progression to frank BD, recognition of both full and subthreshold BD in primary care practice should be improved. Keywords: depression, bipolar disorder, primary care, antidepressant, mood stabilizer, diagnosis read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663276 Thu, 15 Sep 2011 04:00:00 +0100 5663276 http://www.medworm.com/index.php?rid=5663275&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2470 Robert L. Barkin, MBA, PharmD, FCP; Stacy J. Barkin, MEd, MA, PsyD; Gordon A. Irving, MD, FFA(SA); and Allan Gordon, MD, FRCP(C) DOI: 10.3810/pgm.2011.09.2470 Abstract: Many patients with chronic noncancer pain present with comorbid depression, which can greatly complicate the treatment of pain. Chronic pain and depression each increase the risk of licit and illicit substance abuse, including the abuse of opioids, and of suicide. Patients attempting suicide may overdose on opioids, which are commonly perceived as potentially harmful, or acetaminophen, an agent that is believed to be safe but is actually the leading cause of liver failure in the United States. Opioids, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) have the potential to interact with antidepressants,... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663275 Thu, 15 Sep 2011 04:00:00 +0100 5663275 http://www.medworm.com/index.php?rid=5663274&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2482 The Importance of Differentiating Between Topical NSAIDs Sanford H. Roth, MD DOI: 10.3810/pgm.2011.09.2482 Abstract: read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663274 Thu, 15 Sep 2011 04:00:00 +0100 5663274 http://www.medworm.com/index.php?rid=5663273&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2467 Kurt B. Angstman, MS, MD; Kathy L. MacLaughlin, MD; Norman H. Rasmussen, EdD; Ramona S. DeJesus, MD; and David J. Katzelnick, MD DOI: 10.3810/pgm.2011.09.2467 Abstract: Clinical response and remission for the treatment of depression has been shown to be improved utilizing collaborative care management (CCM). Prior studies have indicated that the presence of mental health comorbidities noted by self-rated screening tools at the intake for CCM are associated with worsening outcomes; few have examined directly the impact of age on clinical response and remission. The hypothesis was that when controlling for other mental health and demographic variables, the age of the patient at implementation of CCM does not significantly impact clinical outcome, and that CCM shows consistent efficacy ... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663273 Thu, 15 Sep 2011 04:00:00 +0100 5663273 http://www.medworm.com/index.php?rid=5663272&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2469 Charles E. Argoff, MD DOI: 10.3810/pgm.2011.09.2469 Abstract: An unfortunate minority of patients with acute herpes zoster (AHZ) experience pain beyond the typical 4-week duration, and roughly 10% develop the distressing complication of postherpetic neuralgia (PHN), often defined as pain persisting for > 4 months after the onset of the rash. Elderly patients are at increased risk of PHN. The pathophysiology of PHN is complex, likely involving both peripheral and central processes. This complexity may create opportunities for pharmacologic interventions with multiple differing mechanisms of action. Consequently, complementary combinations of pharmacologic agents are frequently more effective than any monotherapy. Current US and international guidelines on the care of p... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663272 Thu, 15 Sep 2011 04:00:00 +0100 5663272 http://www.medworm.com/index.php?rid=5663271&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2481 Yehia Y. Mishriki, MD, FACP DOI: 10.3810/pgm.2011.09.2481 Abstract: read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663271 Thu, 15 Sep 2011 04:00:00 +0100 5663271 http://www.medworm.com/index.php?rid=5663270&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2459 Conclusions: The CBCL-DESR profile helped identify a subgroup of children with ADHD who had a psychopathological and functional profile consistent with the clinical concept of DESR. Keywords: attention-deficit/hyperactivity disorder; affective symptoms; severity of illness index; youth; emotional self-regulation read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663270 Thu, 15 Sep 2011 04:00:00 +0100 5663270 http://www.medworm.com/index.php?rid=5633700&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2457 Conclusions: In this naturalistic setting, transitioning from IR MPH to OROS® MPH, in patients who showed previously insufficient response and/or poor tolerability, was successful. Patients’ and parents’ HRQoL as well as burden of disease showed a clinically relevant improvement. OROS® MPH was generally safe and well tolerated. Keywords: ADHD , children/adolescents , OROS® methylphenidate , transition read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5633700 Thu, 15 Sep 2011 04:00:00 +0100 5633700 http://www.medworm.com/index.php?rid=5615457&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2480 An Introduction to Liraglutide Thomas Repas, DO, FACP, FACOI, FACE, CDE DOI: 10.3810/pgm.2011.09.2480 Abstract: Liraglutide, a once-daily human glucagon-like peptide-1 (GLP-1) analog, was approved by the US Food and Drug Administration in 2010 for the treatment of type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 enhances insulin secretion and inhibits glucagon in a glucose-dependent manner. The efficacy and safety of liraglutide were evaluated in 6 phase 3 trials in > 4000 patients in the Liraglutide Effect and Action in Diabetes (LEAD) program, in another trial in comparison with sitagliptin, and in another trial where basal insulin was added to liraglutide + metformin. At liraglutide doses of 1.2 mg or 1.8 mg once daily, significant mean reductions in g... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615457 Thu, 15 Sep 2011 04:00:00 +0100 5615457 http://www.medworm.com/index.php?rid=5615456&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2457 Conclusions: In this naturalistic setting, transitioning from IR MPH to OROS® MPH, in patients who showed previously insufficient response and/or poor tolerability, was successful. Patients’ and parents’ HRQoL as well as burden of disease showed a clinically relevant improvement. OROS® MPH was generally safe and well tolerated. Keywords: ADHD , children/adolescents , OROS® methylphenidate , transition read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615456 Thu, 15 Sep 2011 04:00:00 +0100 5615456 http://www.medworm.com/index.php?rid=5615455&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2479 Vanita R. Aroda, MD and Mary Beth DeYoung, PhD DOI: 10.3810/pgm.2011.09.2479 Abstract: Exenatide (exendin-4) is a 39-amino acid peptide belonging to the glucagon-like peptide-1 (GLP-1) receptor agonist class that has been demonstrated to improve glycemic control in patients with type 2 diabetes mellitus. Exenatide can be injected twice daily (ExBID) before meals or once weekly (ExQW) when encompassed within dissolvable poly-(D,L-lactide-co-glycolide) microspheres. The primary difference between these formulations is the plasma concentration of exenatide over time, with the long-acting form providing continuous delivery. Clinical trials have examined the similarities and differences in the efficacy and safety/tolerability outcomes of these formulations. In 2 clinical studies spanning ... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615455 Thu, 15 Sep 2011 04:00:00 +0100 5615455 http://www.medworm.com/index.php?rid=5615454&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2476 Conclusions: A behavioral intervention with a low-energy diet including 5 meal replacements and 5 servings of fruits or vegetables enabled obese individuals to lose 13 kg more than control subjects over a 24-week period. Keywords: obese, adults, low-energy diet, behavioral intervention, nutritional intervention, weight loss read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615454 Thu, 15 Sep 2011 04:00:00 +0100 5615454 http://www.medworm.com/index.php?rid=5615453&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2475 A Narrative Review Craig A. Umscheid, MD, MSCE; David J. Margolis, MD, PhD, MSCE; and Craig E. Grossman, MD, PhD DOI: 10.3810/pgm.2011.09.2475 Abstract: The recent focus of federal funding on comparative effectiveness research underscores the importance of clinical trials in the practice of evidence-based medicine and health care reform. The impact of clinical trials not only extends to the individual patient by establishing a broader selection of effective therapies, but also to society as a whole by enhancing the value of health care provided. However, clinical trials also have the potential to pose unknown risks to their participants, and biased knowledge extracted from flawed clinical trials may lead to the inadvertent harm of patients. Although conducting a well-designed cl... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615453 Thu, 15 Sep 2011 04:00:00 +0100 5615453 http://www.medworm.com/index.php?rid=5615452&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2473 George N. Coritsidis, MD, FACP; Ellena Linden, MD; and Aaron S. Stern, MD DOI: 10.3810/pgm.2011.09.2473 Abstract: Recent increases in obesity, diabetes, and hypertension, along with the aging of the US population, are driving a dramatic rise in the prevalence of chronic kidney disease (CKD). Despite this increase, the majority of Americans with early-stage CKD remain unaware of their disease. Primary care physicians are at the forefront of efforts for early recognition of CKD and management to control its progression. Patients with CKD should be referred to nephrologists no later than the point at which their estimated glomerular filtration rate reaches 30 mL/min. Nephrology evaluation at this point is essential to facilitate timely preparation for care of end-stage renal disease thr... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615452 Thu, 15 Sep 2011 04:00:00 +0100 5615452 http://www.medworm.com/index.php?rid=5615451&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2483 H. Richard Barthel, MD and Robert A. Axford-Gatley, MD DOI: 10.3810/pgm.2011.09.2483 Abstract: read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615451 Thu, 15 Sep 2011 04:00:00 +0100 5615451 http://www.medworm.com/index.php?rid=5615450&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2468 Conclusions: The high prevalence of patients meeting full criteria for BD and the low rate of identification of BD in primary care patients are consistent with estimates using self-administered questionnaires, but the interview revealed a substantial additional population that could be considered to have subsyndromal BD. Because subsyndromal forms of BD are associated with significant impairment and comorbidity as well as progression to frank BD, recognition of both full and subthreshold BD in primary care practice should be improved. Keywords: depression, bipolar disorder, primary care, antidepressant, mood stabilizer, diagnosis read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615450 Thu, 15 Sep 2011 04:00:00 +0100 5615450 http://www.medworm.com/index.php?rid=5615449&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2470 Robert L. Barkin, MBA, PharmD, FCP; Stacy J. Barkin, MEd, MA, PsyD; Gordon A. Irving, MD, FFA(SA); and Allan Gordon, MD, FRCP(C) DOI: 10.3810/pgm.2011.09.2470 Abstract: Many patients with chronic noncancer pain present with comorbid depression, which can greatly complicate the treatment of pain. Chronic pain and depression each increase the risk of licit and illicit substance abuse, including the abuse of opioids, and of suicide. Patients attempting suicide may overdose on opioids, which are commonly perceived as potentially harmful, or acetaminophen, an agent that is believed to be safe but is actually the leading cause of liver failure in the United States. Opioids, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) have the potential to interact with antidepressants,... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615449 Thu, 15 Sep 2011 04:00:00 +0100 5615449 http://www.medworm.com/index.php?rid=5615448&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2482 The Importance of Differentiating Between Topical NSAIDs Sanford H. Roth, MD DOI: 10.3810/pgm.2011.09.2482 Abstract: read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615448 Thu, 15 Sep 2011 04:00:00 +0100 5615448 http://www.medworm.com/index.php?rid=5615447&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2467 Kurt B. Angstman, MS, MD; Kathy L. MacLaughlin, MD; Norman H. Rasmussen, EdD; Ramona S. DeJesus, MD; and David J. Katzelnick, MD DOI: 10.3810/pgm.2011.09.2467 Abstract: Clinical response and remission for the treatment of depression has been shown to be improved utilizing collaborative care management (CCM). Prior studies have indicated that the presence of mental health comorbidities noted by self-rated screening tools at the intake for CCM are associated with worsening outcomes; few have examined directly the impact of age on clinical response and remission. The hypothesis was that when controlling for other mental health and demographic variables, the age of the patient at implementation of CCM does not significantly impact clinical outcome, and that CCM shows consistent efficacy ... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615447 Thu, 15 Sep 2011 04:00:00 +0100 5615447 http://www.medworm.com/index.php?rid=5615446&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2469 Charles E. Argoff, MD DOI: 10.3810/pgm.2011.09.2469 Abstract: An unfortunate minority of patients with acute herpes zoster (AHZ) experience pain beyond the typical 4-week duration, and roughly 10% develop the distressing complication of postherpetic neuralgia (PHN), often defined as pain persisting for > 4 months after the onset of the rash. Elderly patients are at increased risk of PHN. The pathophysiology of PHN is complex, likely involving both peripheral and central processes. This complexity may create opportunities for pharmacologic interventions with multiple differing mechanisms of action. Consequently, complementary combinations of pharmacologic agents are frequently more effective than any monotherapy. Current US and international guidelines on the care of p... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615446 Thu, 15 Sep 2011 04:00:00 +0100 5615446 http://www.medworm.com/index.php?rid=5615445&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2481 Yehia Y. Mishriki, MD, FACP DOI: 10.3810/pgm.2011.09.2481 Abstract: read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615445 Thu, 15 Sep 2011 04:00:00 +0100 5615445 http://www.medworm.com/index.php?rid=5615444&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.09.2459 Conclusions: The CBCL-DESR profile helped identify a subgroup of children with ADHD who had a psychopathological and functional profile consistent with the clinical concept of DESR. Keywords: attention-deficit/hyperactivity disorder; affective symptoms; severity of illness index; youth; emotional self-regulation read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615444 Thu, 15 Sep 2011 04:00:00 +0100 5615444 http://www.medworm.com/index.php?rid=5663287&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.07.2315 What You Should Know When Counseling Patients Sarah A. Stechschulte, MD; Robert S. Kirsner, MD, PhD; and Daniel G. Federman, MD DOI: 10.3810/pgm.2011.07.2315 Abstract: Ultraviolet (UV) radiation is a notorious environmental carcinogen. Acute and chronic UV radiation exposure increase the risk for skin cancer. Protecting oneself from both UVA and UVB radiation with broad-based sunscreen can prevent certain skin cancers, their precursors, and photoaging. Although sun protection factor only measures UVB protection, it is essential to consider protection from UVA radiation when deciding on a particular sunscreen product. Awareness of particular controversies associated with sunscreen, such as vitamin D deficiency and sunscreen toxicity, is necessary to adequately counsel patients w... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663287 Fri, 15 Jul 2011 04:00:00 +0100 5663287 http://www.medworm.com/index.php?rid=5663286&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.07.2311 Conclusion: As of now, African health care systems are not prepared to deal with the increasing burden of diabetes and its complications. With inappropriate glycemic or blood pressure control, most patients will only seek care once micro- or macrovascular complications have already developed. Given the current difficulty in providing costly therapeutic interventions, a well-planned, cost-effective prevention strategy is required. Keywords: diabetes , diabetic retinopathy , Africa read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663286 Fri, 15 Jul 2011 04:00:00 +0100 5663286 http://www.medworm.com/index.php?rid=5663285&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.07.2308 In conclusion, OneTouch® Delica™ was either less painful or no different than the comparator devices when used for fingertip lancing. Innovative lancing devices that cause less pain may improve compliance and persistence with prescribed SMBG. Keywords: diabetes , blood glucose , SMBG , lancing read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663285 Fri, 15 Jul 2011 04:00:00 +0100 5663285 http://www.medworm.com/index.php?rid=5663284&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.07.2299 Comparison of Insulin Analog Premixes and Human Insulin Premixes Andrew J. Martorella, MD DOI: 10.3810/pgm.2011.07.2299 Abstract: Severe iatrogenic—or therapy-induced—hypoglycemia has been associated with mortality rates as high as 10% in patients with type 2 diabetes mellitus (T2DM), and is therefore one of the most significant barriers to glucose management in this patient population. Therapy with modern insulin analogs has been shown to cause significantly less hypoglycemic episodes than human insulins in basal-bolus regimens. This systematic review examines whether a similar benefit has been observed with the insulin analog premixes (aspart 70/30, lispro 75/25, or lispro 50/50) relative to human insulin premix (human 70/30). Consistent with a prior m... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663284 Fri, 15 Jul 2011 04:00:00 +0100 5663284 http://www.medworm.com/index.php?rid=5615461&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.07.2315 What You Should Know When Counseling Patients Sarah A. Stechschulte, MD; Robert S. Kirsner, MD, PhD; and Daniel G. Federman, MD DOI: 10.3810/pgm.2011.07.2315 Abstract: Ultraviolet (UV) radiation is a notorious environmental carcinogen. Acute and chronic UV radiation exposure increase the risk for skin cancer. Protecting oneself from both UVA and UVB radiation with broad-based sunscreen can prevent certain skin cancers, their precursors, and photoaging. Although sun protection factor only measures UVB protection, it is essential to consider protection from UVA radiation when deciding on a particular sunscreen product. Awareness of particular controversies associated with sunscreen, such as vitamin D deficiency and sunscreen toxicity, is necessary to adequately counsel patients w... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615461 Fri, 15 Jul 2011 04:00:00 +0100 5615461 http://www.medworm.com/index.php?rid=5615460&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.07.2311 Conclusion: As of now, African health care systems are not prepared to deal with the increasing burden of diabetes and its complications. With inappropriate glycemic or blood pressure control, most patients will only seek care once micro- or macrovascular complications have already developed. Given the current difficulty in providing costly therapeutic interventions, a well-planned, cost-effective prevention strategy is required. Keywords: diabetes , diabetic retinopathy , Africa read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615460 Fri, 15 Jul 2011 04:00:00 +0100 5615460 http://www.medworm.com/index.php?rid=5615459&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.07.2308 In conclusion, OneTouch® Delica™ was either less painful or no different than the comparator devices when used for fingertip lancing. Innovative lancing devices that cause less pain may improve compliance and persistence with prescribed SMBG. Keywords: diabetes , blood glucose , SMBG , lancing read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615459 Fri, 15 Jul 2011 04:00:00 +0100 5615459 http://www.medworm.com/index.php?rid=5615458&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.07.2299 Comparison of Insulin Analog Premixes and Human Insulin Premixes Andrew J. Martorella, MD DOI: 10.3810/pgm.2011.07.2299 Abstract: Severe iatrogenic—or therapy-induced—hypoglycemia has been associated with mortality rates as high as 10% in patients with type 2 diabetes mellitus (T2DM), and is therefore one of the most significant barriers to glucose management in this patient population. Therapy with modern insulin analogs has been shown to cause significantly less hypoglycemic episodes than human insulins in basal-bolus regimens. This systematic review examines whether a similar benefit has been observed with the insulin analog premixes (aspart 70/30, lispro 75/25, or lispro 50/50) relative to human insulin premix (human 70/30). Consistent with a prior m... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615458 Fri, 15 Jul 2011 04:00:00 +0100 5615458 http://www.medworm.com/index.php?rid=5663293&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2283 Maria F. Tanaka, MD and Guru Sonpavde, MD DOI: 10.3810/pgm.2011.05.2283 Abstract: Bladder carcinoma is the fourth most common cancer in men and the ninth most common cancer in women in the United States. In 2010, approximately 70 000 new cases of bladder carcinoma (52 000 in men and 18000 in women) and approximately 14000 deaths were expected in the United States. More than 90% of bladder carcinomas are classified as urothelial carcinoma (UC), which arise from the urothelium. This epithelium, also known as transitional cell epithelium, lines the urinary tract, which extends from the renal pelvis through the ureters, bladder, and urethra. Urothelial carcinoma of the bladder may present as a non–muscle-invasive, muscle-invasive, or metastatic malignancy. In noninvasive ... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663293 Sun, 15 May 2011 04:00:00 +0100 5663293 http://www.medworm.com/index.php?rid=5663292&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2282 Gregory Lieser, MD and Matthew N. Simmons, MD, PhD DOI: 10.3810/pgm.2011.05.2282 Abstract: With the widespread use of computed tomography imaging, the majority of renal tumors are currently detected incidentally at lower grade and stage. Partial nephrectomy has become the preferred treatment for many of these smaller, lower-stage, organ-confined tumors. Compared with radical nephrectomy, partial nephrectomy is more technically difficult to perform. Specific tumor features such as tumor size, depth, location, and proximity to the kidney vasculature and urinary collecting system affect the difficulty of resection. Classically, feasibility of resection has been determined subjectively. Recently, 3 methodologies have been proposed to provide standard, more objective preoperative assessme... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663292 Sun, 15 May 2011 04:00:00 +0100 5663292 http://www.medworm.com/index.php?rid=5663291&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2295 Runyawan Chotenimitkhun, MD and W. Gregory Hundley, MD, FACC, FAHA DOI: 10.3810/pgm.2011.05.2295 Abstract: Over the past decade, cardiovascular magnetic resonance (CMR) has evolved into a cardiac stress testing modality that can be used to diagnose myocardial ischemia using intravenous dobutamine or vasodilator perfusion agents such as adenosine or dipyridamole. Because CMR produces high-resolution tomographic images of the human heart in multiple imaging planes, it has become a highly attractive noninvasive testing modality for those suspected of having myocardial ischemia. The purpose of this article is to review the clinical, diagnostic, and prognostic utility of stress CMR testing for patients with (or suspected of having) coronary artery disease. Keywords: stress CMR , dobuta... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663291 Sun, 15 May 2011 04:00:00 +0100 5663291 http://www.medworm.com/index.php?rid=5663290&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2294 Peter Hsu, MS; George I. Litman, MD; and Robert T. Brodell, MD DOI: 10.3810/pgm.2011.05.2294 Abstract: Acne vulgaris is a common skin disease that is most effectively treated with a combination of topical products and, in some cases, systemic antibiotics. While it is important to treat papules, pustules, nodules, and cysts with topical or systemic antibiotics to suppress bacterial infection, all of these lesions develop from microcomedones. In fact, comedolytic agents enhance the effectiveness of antibiotics and limit the potential for recurrent acne lesions. Because of the superior comedolytic effects of topical retinoids, most patients with acne should be treated with a retinoid unless there is a specific contraindication. Interestingly, only 55% of patients with acne who a... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663290 Sun, 15 May 2011 04:00:00 +0100 5663290 http://www.medworm.com/index.php?rid=5663289&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2292 This study was undertaken in 2008 in departments of family medicine at universities (n = 21) and training and research hospitals of the Ministry of Health (n = 11). Approximately 250 family practice residents in Turkey were approached. In total, 174 residents participated (70% response rate). The survey instruments included a questionnaire with 25 queries and 2 scales: The Postgraduate Hospital Educational Environment Measure and the Maslach Burnout Questionnaire–Human Services Survey. The average age of the participants was 32.2 years (standard deviation, 4.5 years; range, 24–57 years). The gender distribution was 57.6% women and 42.4% men. Marital status was 34.7% single, 62.9% married, and 2.4% divorced/wido... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663289 Sun, 15 May 2011 04:00:00 +0100 5663289 http://www.medworm.com/index.php?rid=5663288&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2286 This article summarizes the current literature on the effects of both acute and chronic opioid use on sleep, sleep-disordered breathing, and the current evidence on various treatment options for breathing disorders related to chronic opioid use. Keywords: opioid analgesics , sleep , sleep-disordered breathing read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663288 Sun, 15 May 2011 04:00:00 +0100 5663288 http://www.medworm.com/index.php?rid=5615466&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2283 Maria F. Tanaka, MD and Guru Sonpavde, MD DOI: 10.3810/pgm.2011.05.2283 Abstract: Bladder carcinoma is the fourth most common cancer in men and the ninth most common cancer in women in the United States. In 2010, approximately 70 000 new cases of bladder carcinoma (52 000 in men and 18000 in women) and approximately 14000 deaths were expected in the United States. More than 90% of bladder carcinomas are classified as urothelial carcinoma (UC), which arise from the urothelium. This epithelium, also known as transitional cell epithelium, lines the urinary tract, which extends from the renal pelvis through the ureters, bladder, and urethra. Urothelial carcinoma of the bladder may present as a non–muscle-invasive, muscle-invasive, or metastatic malignancy. In noninvasive ... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615466 Sun, 15 May 2011 04:00:00 +0100 5615466 http://www.medworm.com/index.php?rid=5615465&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2282 Gregory Lieser, MD and Matthew N. Simmons, MD, PhD DOI: 10.3810/pgm.2011.05.2282 Abstract: With the widespread use of computed tomography imaging, the majority of renal tumors are currently detected incidentally at lower grade and stage. Partial nephrectomy has become the preferred treatment for many of these smaller, lower-stage, organ-confined tumors. Compared with radical nephrectomy, partial nephrectomy is more technically difficult to perform. Specific tumor features such as tumor size, depth, location, and proximity to the kidney vasculature and urinary collecting system affect the difficulty of resection. Classically, feasibility of resection has been determined subjectively. Recently, 3 methodologies have been proposed to provide standard, more objective preoperative assessme... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615465 Sun, 15 May 2011 04:00:00 +0100 5615465 http://www.medworm.com/index.php?rid=5615464&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2295 Runyawan Chotenimitkhun, MD and W. Gregory Hundley, MD, FACC, FAHA DOI: 10.3810/pgm.2011.05.2295 Abstract: Over the past decade, cardiovascular magnetic resonance (CMR) has evolved into a cardiac stress testing modality that can be used to diagnose myocardial ischemia using intravenous dobutamine or vasodilator perfusion agents such as adenosine or dipyridamole. Because CMR produces high-resolution tomographic images of the human heart in multiple imaging planes, it has become a highly attractive noninvasive testing modality for those suspected of having myocardial ischemia. The purpose of this article is to review the clinical, diagnostic, and prognostic utility of stress CMR testing for patients with (or suspected of having) coronary artery disease. Keywords: stress CMR , dobuta... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615464 Sun, 15 May 2011 04:00:00 +0100 5615464 http://www.medworm.com/index.php?rid=5615463&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2294 Peter Hsu, MS; George I. Litman, MD; and Robert T. Brodell, MD DOI: 10.3810/pgm.2011.05.2294 Abstract: Acne vulgaris is a common skin disease that is most effectively treated with a combination of topical products and, in some cases, systemic antibiotics. While it is important to treat papules, pustules, nodules, and cysts with topical or systemic antibiotics to suppress bacterial infection, all of these lesions develop from microcomedones. In fact, comedolytic agents enhance the effectiveness of antibiotics and limit the potential for recurrent acne lesions. Because of the superior comedolytic effects of topical retinoids, most patients with acne should be treated with a retinoid unless there is a specific contraindication. Interestingly, only 55% of patients with acne who a... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615463 Sun, 15 May 2011 04:00:00 +0100 5615463 http://www.medworm.com/index.php?rid=5615462&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.05.2292 This study was undertaken in 2008 in departments of family medicine at universities (n = 21) and training and research hospitals of the Ministry of Health (n = 11). Approximately 250 family practice residents in Turkey were approached. In total, 174 residents participated (70% response rate). The survey instruments included a questionnaire with 25 queries and 2 scales: The Postgraduate Hospital Educational Environment Measure and the Maslach Burnout Questionnaire–Human Services Survey. The average age of the participants was 32.2 years (standard deviation, 4.5 years; range, 24–57 years). The gender distribution was 57.6% women and 42.4% men. Marital status was 34.7% single, 62.9% married, and 2.4% divorced/wido... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615462 Sun, 15 May 2011 04:00:00 +0100 5615462 http://www.medworm.com/index.php?rid=5663295&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.03.2275 Conclusions:In adults studied in the AWE, medium-to-large model-based effect sizes were maintained from 2 to 14 hours postdose, on a performance-based measure of productivity, suggesting participants experienced improvement in sustained attention throughout the day and into the evening hours. Lisdexamfetamine dimesylate demonstrated a safety profile consistent with long-acting stimulants. Keywords: lisdexamfetamine dimesylate , LDX , Vyvanse , ADHD , amphetamine , stimulant read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663295 Tue, 15 Mar 2011 04:00:00 +0100 5663295 http://www.medworm.com/index.php?rid=5663294&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.03.2265 James M. Backes, PharmD; Robert J. Padley, MD; and Patrick M. Moriarty, MD DOI: 10.3810/pgm.2011.03.2265 Abstract: Niacin is a water-soluble B vitamin (B3) known to have favorable effects on multiple lipid parameters, including raising high-density lipoprotein cholesterol (HDL-C) levels and lowering triglycerides (TGs), lipoprotein(a), and low-density lipoprotein cholesterol (LDL-C). Although LDL-C remains the primary target of lipid-altering therapy, current guidelines emphasize HDL-C and other modifiable lipid factors as key secondary targets. Thus, niacin is considered an important therapeutic option to help reduce the risk of cardiovascular disease in patients with mixed dyslipidemia who, in addition to high LDL-C, have elevated TGs and low HDL-C. Although available prescription... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663294 Tue, 15 Mar 2011 04:00:00 +0100 5663294 http://www.medworm.com/index.php?rid=5615469&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.03.2275 Conclusions:In adults studied in the AWE, medium-to-large model-based effect sizes were maintained from 2 to 14 hours postdose, on a performance-based measure of productivity, suggesting participants experienced improvement in sustained attention throughout the day and into the evening hours. Lisdexamfetamine dimesylate demonstrated a safety profile consistent with long-acting stimulants. Keywords: lisdexamfetamine dimesylate , LDX , Vyvanse , ADHD , amphetamine , stimulant read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615469 Tue, 15 Mar 2011 04:00:00 +0100 5615469 http://www.medworm.com/index.php?rid=5615468&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.03.2265 James M. Backes, PharmD; Robert J. Padley, MD; and Patrick M. Moriarty, MD DOI: 10.3810/pgm.2011.03.2265 Abstract: Niacin is a water-soluble B vitamin (B3) known to have favorable effects on multiple lipid parameters, including raising high-density lipoprotein cholesterol (HDL-C) levels and lowering triglycerides (TGs), lipoprotein(a), and low-density lipoprotein cholesterol (LDL-C). Although LDL-C remains the primary target of lipid-altering therapy, current guidelines emphasize HDL-C and other modifiable lipid factors as key secondary targets. Thus, niacin is considered an important therapeutic option to help reduce the risk of cardiovascular disease in patients with mixed dyslipidemia who, in addition to high LDL-C, have elevated TGs and low HDL-C. Although available prescription... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615468 Tue, 15 Mar 2011 04:00:00 +0100 5615468 http://www.medworm.com/index.php?rid=5663299&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.01.2256 We present 1) an overview of lead exposure; 2) a detailed summary of current research on the molecular synergy of toxicity caused by lead and stress; 3) a review of human studies that appear to correlate with these molecular findings, including understanding nutrition, environmental enrichment, and caregiving as risk modifiers; and 4) a systematic approach for mental health practitioners in managing children presenting with multiple symptoms and risk factors for mental health conditions. In this article, we review some of the clinical and scientific challenges that relate to the assessment and treatment of children presenting for mental health care who may have potential lead exposure. Keywords: lead , pediatric mental health , developmental psychopathology , environment read mor... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663299 Wed, 02 Feb 2011 23:29:54 +0100 5663299 http://www.medworm.com/index.php?rid=5663298&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.01.2252 This article addresses the causes of CRP elevation and the use of different CRP assays in internal medicine, including cardiology, gastroenterology, rheumatology, infectious diseases, and oncology. We focus on the recent medical literature on the use of hs-CRP in cardiovascular disease risk stratification and management, including updated screening guidelines on the use of hs-CRP, such as those issued in 2009 by the Canadian Cardiovascular Society. We also discuss the Reynolds Risk Score, which incorporates hs-CRP and family history with more standard cardiovascular risk factors (eg, tobacco use, hypertension, and dyslipidemia) and frequently leads to improved recategorization of cardiovascular disease risk levels. As the recently completed Justification for the Use of Statins in Preventio... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663298 Wed, 02 Feb 2011 23:28:31 +0100 5663298 http://www.medworm.com/index.php?rid=5615470&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fpostgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.01.2248 Conclusion Treatment with low- and high-dose OM achieved superior SeBP reductions compared with low- and high-dose LOS, resulting in significantly more patients achieving SeBP goal, with similar tolerability. Keywords: ambulatory BP , angiotensin II receptor blocker , antihypertensives , olmesartan read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5615470 Wed, 02 Feb 2011 23:17:35 +0100 5615470 http://www.medworm.com/index.php?rid=5663297&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.01.2246 Conclusions: Acculturation was not associated with glycemic control in this population. Family physicians should not assume that acculturation difficulties explain poor glycemic control in their Mexican American patients with T2DM. Keywords: acculturation , Mexican , Mexican Americans , type 2 diabetes mellitus , glycemic control , hemoglobin A1c read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663297 Wed, 02 Feb 2011 23:09:59 +0100 5663297 http://www.medworm.com/index.php?rid=5663296&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.01.2243 This article summarizes current lifestyle modifications, pharmacological treatment, and surgical options for the management of obesity and discusses the benefits, limitations, and risks of each. As insights are gained into the pathophysiology of a gut–brain neurochemical feedback axis governing satiety and feeding behavior, targets for new pharmacotherapies are being developed. In particular, gut hormone analogs are an attractive antiobesity therapy because they appear to lack the adverse effects historically associated with central nervous system-acting agents. Keywords: obesity; metabolic syndrome; pharmacological management; comorbidity; diabetes read more (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663296 Wed, 02 Feb 2011 22:48:43 +0100 5663296 http://www.medworm.com/index.php?rid=5663300&cid=s_38819_49_f&fid=38819&url=https%3A%2F%2Fwww.postgradmed.org%2Fdoi%2F10.3810%2Fpgm.2011.01.2242 A Viable Option Randall A. Colucci, MS, MPH, DO DOI: 10.3810/pgm.2011.01.2242 Abstract: The prevalence of obesity is increasing and is co-epidemic with type 2 diabetes mellitus (T2DM). Treatment of obesity has been less than adequate, particularly when managing morbidly obese patients. Research on T2DM has shown a number of new pharmacologic therapies along with the rapid employment of bariatric surgery. Improvement of T2DM, including its remission, after bariatric surgery has been recognized for more than a decade. However, not all procedures are the same. Restrictive procedures, malabsorptive procedures, or a combination of both procedures have their own categorical risks and benefits. Which procedure to choose has to do with many patient selection factors, notwithstanding in... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=5663300 Wed, 02 Feb 2011 22:42:09 +0100 5663300 http://www.medworm.com/index.php?rid=3300939&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fartfull%3Dpgm_01_2010%3Farticle%3D2091 Heart disease is the primary cause of death in the United States. Fortunately, intervention measures can reduce the risk of cardiovascular disease (CVD) after a patient has been accurately assessed. Atherosclerotic disease, one of the driving forces behind CVD, is not always detected by traditional risk assessment. Carotid intima-media thickness (CIMT), as measured by B-mode ultrasound, is a surrogate marker for atherosclerosis and can be used to detect an accelerated disease process and subclinical disease. Advantages of CIMT are that it is noninvasive, relatively inexpensive, and can be repeatedly performed with no adverse effects on the patient. Carotid intima-media thickness is associated with CVD and is an independent predictor of stroke and myocardial infarction. Therefore, CIMT is v... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=3300939 Wed, 24 Feb 2010 08:47:00 +0100 3300939 http://www.medworm.com/index.php?rid=2687367&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_01_2009%3Farticle%3D1969 The objective of a study performed by four Nigerian researchers was to examine the quality of "poor sleep" among Nigerian hypertensive patients; specifically, to examine the association between quality of sleep and the severity of hypertension in this population. The researchers hypothesized that severity of hypertension directly influences quality of sleep, and poor quality of sleep may worsen hypertensive conditions. In the study, quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) in chronic hypertensive patients attending a tertiary hospital in Nigeria, and was compared with the PSQI of normal control subjects. The researchers concluded that poor sleep is not only common in hypertensive patients, but may also be associated with a lower health-related quality o... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687367 Mon, 10 Aug 2009 08:47:00 +0100 2687367 http://www.medworm.com/index.php?rid=2687366&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_01_2009%3Farticle%3D1953 Dipeptidyl peptidase-4 inhibitors (DPP-4s), or gliptins, a relatively new class of drugs for the treatment of type 2 diabetes, work in a unique way to improve insulin secretion from the β-cells of the pancreas in response to an increase in blood sugar and simultaneously decrease glucagon output from the a-cells of the pancreas and decrease hepatic glucose output. This results in a significant improvement in glucose tolerance. Since gliptins improve insulin secretion in response to an increase in blood glucose, it seems appropriate to pair them with drugs that have a different mechanism of action, such as insulin sensitizers or metformin. According to Dr. Nancy Bohannon, improvements in fasting and postprandial glucose levels, improved cell function, and improvement in hemoglobin level... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687366 Mon, 10 Aug 2009 08:47:00 +0100 2687366 http://www.medworm.com/index.php?rid=2687365&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_11_2008%3Farticle%3D1947 An article published in the July 2008 issue of Postgraduate Medicine demonstrated the importance of vaccinating patients against human papillomavirus (HPV) in order to prevent the development of cervical cancer. The authors of this study tested the quadrivalent vaccine Gardasil&#174 and the bivalent vaccine Cervarix&#174 to determine their efficacy in preventing infection with high-risk HPV strains in females. As a result of their research, the authors found that the new vaccines were indeed highly effecting in preventing infections and their sequelae; thus, individuals should be vaccinated prior to becoming sexually active. In her commentary on this particular article, Dr. Ellen Miller validates and elucidates the research done, but adds facts pertinent to vaccine usage in different age g... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687365 Mon, 10 Aug 2009 08:47:00 +0100 2687365 http://www.medworm.com/index.php?rid=2687364&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_11_2008%3Farticle%3D1930 Human immunodeficiency virus (HIV) infection has become a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Metabolic complications such as dyslipidemia, insulin resistance, diabetes mellitus, obesity, and fat distribution abnormalities are associated with increased risk of cardiovascular disease, which is now a leading cause of death among HIV-infected patients. Furthermore, many antiretroviral drugs are associated with lipid abnormalities. The management of complications such as dyslipidemia includes lifestyle modifications, lipid-lowering therapy, and switching antiretroviral therapy (ART). Findings by Canadian doctors Mazen S. Bader and Deborah V. Kelly point out ... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687364 Mon, 10 Aug 2009 08:47:00 +0100 2687364 http://www.medworm.com/index.php?rid=2687363&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_11_2008%3Farticle%3D1937 Although hyperglycemia is often under-recognized and suboptimally managed, it is prevalent in the inpatient setting and is associated with increased morbidity and mortality in patients with and without diabetes. Even slight improvements in hyperglycemia management in hospitalized patients can provide the hospitalist with an opportunity to positively affect morbidity, mortality, and health care costs. However, intensive insulin therapy can increase the risk of hypoglycemia, which often results in the early abandonment of tight glycemic control strategies, or in some cases, no emphasis on glucose control at all. Consequently, the question that Dr. Rattan Juneja presents in this issue of Postgraduate Medicine is whether tight glycemic control strategies should focus on achieving tight glycemi... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687363 Mon, 10 Aug 2009 08:47:00 +0100 2687363 http://www.medworm.com/index.php?rid=2687362&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Ffree%3Dpgm_11_2008%3Farticle%3D1928 Despite cervical cancer being considered a preventable disease, it still remains the second most common malignancy in women worldwide, with a higher incidence in underdeveloped countries. Research shows that human papillomavirus (HPV) is considered to be the causative agent of cervical cancer. However, according to Drs. Deepthi Subramanya and Petros Grivas of Hahnemann University Hospital in Philadelphia, HPV infection alone is not sufficient to induce malignant transformation, and other significant cofactors contribute to the multi-step process of tumor formation, such as individual genetic variations as well as environmental factors. Papanicolaou testing (Pap smear) and HPV DNA testing are effective tools used in the screening and diagnosis of cervical neoplastic lesions. In the November... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687362 Mon, 10 Aug 2009 08:47:00 +0100 2687362 http://www.medworm.com/index.php?rid=2687361&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_07_2009%3Farticle%3D2032 Physicians treating chronic noncancer pain often face the discrepancy between relieving pain and suffering but also doing no harm. In this manner, many physicians have embraced the concept of long-term opioid treatment for chronic noncancer pain (CNCP), as evidenced by increased prescribing, and many patients have benefitted from these prescriptions. However, prescription opioid abuse has also risen significantly coincident with increased prescribing. Because of the potentially serious adverse effects of opioids, Drs. Stephen Colameco, Joshua Coren, and Carman Ciervo urge physicians to balance potential benefits against risks, especially in individuals at risk for opioid misuse, abuse, or dependence. Their article, published in the July 2009 issue of Postgraduate Medicine, reviews long-ter... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687361 Mon, 10 Aug 2009 08:47:00 +0100 2687361 http://www.medworm.com/index.php?rid=2687360&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_07_2009%3Farticle%3D2030 Research shows that osteoarthritis affects more than 20 million Americans with an anticipated increase of up to 40 million by the year 2020. The Glucosamine/Chondroitin Sulfate Osteoarthritis Intervention Trial (GAIT), originally published in the New England Journal of Medicine in 2006, evaluated the safety and efficacy of these two drugs and a combination of the two compared to use of a placebo. The authors' findings showed that joint swelling and/or effusion was reduced most significantly by chondroitin sulfate and celecoxib, and the combination of glucosamine and CS was also significant. However, the most statistically significant reduction in osteoarthritis knee pain came from the placebo. Dr. Nicholas DiNubile comments in his Practice Pearl that this study can yield a considerable amo... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687360 Mon, 10 Aug 2009 08:47:00 +0100 2687360 http://www.medworm.com/index.php?rid=2687359&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_07_2009%3Farticle%3D2026 Research has shown that, among infants of mothers with type 1 and type 2 diabetes mellitus, the rate of perinatal mortality tends to be very high. A study published by three doctors in the July 2009 issue of Postgraduate Medicine aims to identify the causes of these stillbirths, compare the rates between type 1 and type 2 diabetes sufferers, and to ascertain the relationship between perinatal mortality and maternal glycemic control. Their research indicated that congenital anomalies were less common in women with type 1 diabetes than those with type 2 diabetes. Furthermore, they conclude that hyperglycemia not only causes fetal macrosomia but also an angiopathy and, consequently, fetal hypoxia. From these results, the doctors are able to relay information to female patients regarding the i... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687359 Mon, 10 Aug 2009 08:47:00 +0100 2687359 http://www.medworm.com/index.php?rid=2687358&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_07_2009%3Farticle%3D2027 Obstructive sleep apnea (OSA), a common and debilitating condition characterized by upper airway constriction, snoring, disturbed sleep, and excessive sleepiness, can have potentially detrimental consequences if left untreated. As most individuals affected by OSA will initially present in the primary care setting, Dr. Joseph A. Lieberman of Jefferson Medical College suggests that primary care physicians should be able to recognize the condition and thereby refer patients for any necessary treatment. His writings on the subject, featured in the latest issue of Postgraduate Medicine, focus on tips for management, intervention, and treatment of the condition and its resulting effects on the patient's health. Dr. Lieberman concludes that effective intervention for OSA not only provides symptom... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687358 Mon, 10 Aug 2009 08:47:00 +0100 2687358 http://www.medworm.com/index.php?rid=2687357&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_07_2009%3Farticle%3D2025 Emerging data from clinical studies has evidenced that the use of long-acting reversible contraception (LARC) is the most effective method of contraception with the highest continuation rates and levels of patient satisfaction. Additionally, the appropriate target population for the use of the intrauterine device now includes nulliparous women and adolescents. An article published in the July 2009 issue of Postgraduate Medicine by three doctors from Washington University in St. Louis suggests to such patients that, when initiating a new contraceptive method, one should consider the characteristics of each method, including side effects, effectiveness, and patient acceptability. To be safe, say the researchers, medical comorbidities must be evaluated prior to choosing a method in order to h... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687357 Mon, 10 Aug 2009 08:47:00 +0100 2687357 http://www.medworm.com/index.php?rid=2687356&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Ffree%3Dpgm_07_2009%3Farticle%3D2021 Numerous medical studies indicate that measures for osteoporosis prevention should begin at childhood and include balanced nutrition, physical activity, and avoidance of risk factors such as smoking. In adulthood, early recognition of osteoporosis followed by timely and effective management can reduce fracture risk; however, the rates of screening and treatment for osteoporosis are surprisingly low. According to Dr. Frank Bonura, the director of Obstetrics and Gynecology at St. Catherine of Siena Medical Center, comprehensive fracture risk assessment should be part of routine patient care. Dr. Bonura explains that several pharmacological therapies are currently available, and clinicians should consider the efficacy and safety profiles of each therapy as well as the individual patient's nee... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2687356 Mon, 10 Aug 2009 08:47:00 +0100 2687356 http://www.medworm.com/index.php?rid=2652654&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_03_2009%3Farticle%3D1983 A study published in the March issue of Postgraduate Medicine compiled and examined data about HIV-positive patients admitted to the hospital with cryptococcosis, a potentially fatal fungal disease. In the article, doctors reviewed the records of 202 HIV-positive patients who were admitted to both the University of Maryland Medical Center and the Baltimore VA Medical Center for a case of primary cryptococcosis from 1993 to 2004. The study found that although the prevalence of cryptococcosis in the United States is decreasing, the number of HIV-positive patients admitted to these two hospitals did not decline during this period. Many of the patients with this infection also developed meningitis, fungemia (the presence of yeast or fungi in the blood), or pneumonia, leading to further health ... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652654 Wed, 08 Jul 2009 08:47:00 +0100 2652654 http://www.medworm.com/index.php?rid=2652653&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_03_2009%3Farticle%3D1981 Myocardial dysfunction is a well-known entity in patients presenting with severe sepsis and can be easily recognized by the release of troponin or by echocardiographic findings. Three researchers from Galveston, Texas, present a case of a 59-year-old woman with ST-segment elevations and increased levels of cardiac troponin from Escherichia coli septic shock in the setting of normal coronary angiography in the March issue of Postgraduate Medicine. The case report indicates that elevated cardiac biomarkers in conjunction with electrocardiographic changes are valuable in diagnosing acute coronary syndrome (ACS). Furthermore, high troponin levels in patients with sepsis result from various mechanisms, including hypoperfusion or direct extension of infection to cardiac tissue, and can also serv... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652653 Wed, 08 Jul 2009 08:47:00 +0100 2652653 http://www.medworm.com/index.php?rid=2652652&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_03_2009%3Farticle%3D1973 An article published by three doctors from the Ochsner Medical Center in New Orleans provides information and commentary on recent clinical trials related to primary prevention in cardiovascular diseases including lipids, hypertension, and diabetes. It also focuses on novel therapeutic advances in heart failure with devices and therapeutic agents. In addition, the researchers explore trials looking at the effects of the investigational agents azimilide and dronedarone in the treatment of arrhythmias, application of established therapies and devices to larger populations, and the impact of hypercoagulability and aortic arch plaques on the incidence of stroke. The doctors compared the use of percutaneous coronary intervention with coronary artery bypass grafting surgery in patients with diab... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652652 Wed, 08 Jul 2009 08:47:00 +0100 2652652 http://www.medworm.com/index.php?rid=2652651&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_03_2009%3Farticle%3D1988 The propensity for addiction to the pain medication OxyContin® and the recent trend of increased prescription drug abuse have made it imperative for physicians and health care providers to recognize the clinical presentation of overdose and know how to manage associated complications. In this review of OxyContin®, published in the March issue of Postgraduate Medicine, four researchers from New Jersey discuss current trends in its abuse and the clinical presentation of overdose, as well as the specific effects of the drug on body systems and the recognition of symptomatology, differential diagnosis, and management. OxyContin® overdose presents with a typical opiate toxidrome, including decreased respirations, miosis, hypothermia, bradycardia, hypotension, and altered mental s... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652651 Wed, 08 Jul 2009 08:47:00 +0100 2652651 http://www.medworm.com/index.php?rid=2652650&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_03_2009%3Farticle%3D1977 In a new study published in the March issue of Postgraduate Medicine, doctors from the Department of Cardiology at the University of North Texas Medical Center investigated the different ways that cardiovascular disease, specifically coronary artery disease (CAD), presents itself in men and women. The article discusses the atypical symptoms that women with CAD exhibit, a fact that often leads doctors to underdiagnose the disease. By illuminating these sex-based distinctions, these doctors hope to help others realize the importance of critical investigation in women demonstrating these differing symptoms. The study reveals that women who are diagnosed with CAD typically receive fewer medications for treatment on admission to the hospital and after being discharged, and they are also less li... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652650 Wed, 08 Jul 2009 08:47:00 +0100 2652650 http://www.medworm.com/index.php?rid=2652649&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Ffree%3Dpgm_03_2009%3Farticle%3D1980 It is well known that diabetes mellitus is an independent risk factor for cardiovascular disease. In a patient with diabetes, hypertension and hyperglycemia compound and greatly increase the risk of microvascular complications. Thus, early recognition and aggressive treatment of both hyperglycemia and hypertension may prevent vision loss and chronic kidney disease, the devastating outcomes of these microvascular complications. A PubMed search was conducted by Dr. Janet B. McGill of Washington University School of Medicine to identify randomized controlled trials that evaluated hypertension control and microvascular outcomes in patients with diabetes. Several clinical trials yielded promising data with renin-angiotensin-aldosterone system (RAAS) inhibitors, and attainment of BP control with... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652649 Wed, 08 Jul 2009 08:47:00 +0100 2652649 http://www.medworm.com/index.php?rid=2652648&cid=s_38819_49_f&fid=38819&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Ffree%3Dpgm_03_2009%3Farticle%3D1972 Recent findings show that even the most advanced improvements in blood pressure control in the United States today are inadequate in relation to the prevalence of hypertension today. Patients with moderate-to-severe hypertension frequently require 2 or more antihypertensives to achieve blood pressure control. An angiotensin receptor blocker (ARB) plus a calcium channel blocker (CCB) combination seems particularly attractive for these difficult-to-control patients. A study published in the March issue of Postgraduate Medicine found that blood pressure reductions were significantly greater with combination therapies than respective monotherapies. More specifically, the combination of telmisartan plus amlodipine provides effective blood pressure reduction at all clinically relevant doses, all... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652648 Wed, 08 Jul 2009 08:47:00 +0100 2652648 http://www.medworm.com/index.php?rid=2652647&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_05_2009%3Farticle%3D2018 It is well documented that acute bacterial respiratory infections require treatment with antibiotics, which can often be purchased over-the-counter. The original study on extended-release oral guaifenesin/pseudoephedrine aimed to assess its safety and efficacy during treatment of ten respiratory symptoms for patients in the study presenting with acute respiratory infection (ARI). The researchers concluded, and Dr. George Kikano agrees, that the drug treatment shortened the time to relief and improved respiratory symptoms better than placebo. However, says Kikano, the use of antibiotics alone may not be a sufficient approach for symptom relief, and the use of simultaneous adjunctive therapies can further alleviate symptoms such as excessive mucus, respiratory congestion, and cough. The ful... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652647 Wed, 08 Jul 2009 08:47:00 +0100 2652647 http://www.medworm.com/index.php?rid=2652646&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_05_2009%3Farticle%3D2017 Puzzles in Practice Encourages Doctors to Form Diagnoses Based on Case Reports A 63-year-old white man is seen for a routine examination. His medical history is significant for type 2 diabetes mellitus of 16 years duration, diabetic peripheral sensory neuropathy, hypertension, and hyperlipidemia. He smoked 1 pack of cigarettes daily for 20 years but quit many years ago. Salient findings on physical examination include decreased light touch and vibratory sense in the feet, decreased pedal pulses, and hyperpigmented patches on the lower legs. The patches have normal sensation and a hint of atrophy. There is no overlying scale. What is your diagnosis? This case report is presented to readers of Postgraduate Medicine, particularly primary care physicians, in order to determine a diagnosis ba... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652646 Wed, 08 Jul 2009 08:47:00 +0100 2652646 http://www.medworm.com/index.php?rid=2652645&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_05_2009%3Farticle%3D2016 In a study published in the May issue of Postgraduate Medicine, six researchers from South Dakota, Texas, and New York evaluated the impact of a 15-hospital, rural, multi-state intensive care unit (ICU) telemedicine program. Acute Physiology, Age, and Chronic Health Evaluation (APACHE® III) scores, raw mortality rates, and actual-to-predicted length of stay (LOS) ratios and mortality ratios were used in research. Their surveys evaluated program impact in smaller facilities and satisfaction of the physicians staffing the remote center. Smaller facilities' staff reported improvements in the quality of critical care services and reduced transfers. In regional hospitals, acuity scores increased (retention of sicker patients) while raw mortality was the same or lower. Length of stay ratios... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652645 Wed, 08 Jul 2009 08:47:00 +0100 2652645 http://www.medworm.com/index.php?rid=2652644&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Ffree%3Dpgm_05_2009%3Farticle%3D2015 African Americans with high blood pressure (BP) can benefit greatly from therapeutic lifestyle changes (TLC) such as diet modification, physical activity, and weight management; however, they and their health care providers face many barriers in modifying health behaviors. A multidisciplinary panel consisting of thirteen American researchers synthesized the scientific data on TLC in African Americans for efficacy in improving BP control, barriers to behavioral change, and strategies to overcome those barriers. They assert that therapeutic lifestyle change interventions should emphasize patient self-management, supported by providers, family, and the community, and should be tailored to an individual's cultural heritage, beliefs, and behavioral norms. The panel cited limited progress with i... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652644 Wed, 08 Jul 2009 08:47:00 +0100 2652644 http://www.medworm.com/index.php?rid=2652643&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_05_2009%3Farticle%3D2002 This article, co-written by doctors Ziauddin Ahmed, Barbara Simon, and Devasmita Choudhury, discusses proper screening, identification, and management in the different stages of DKD, including special considerations for dialysis and transplant patients. The authors also review information on altered metabolism of medications and the appropriate use of diabetic agents, including recommendations for management of glucose control in CKD. The full article can be accessed on Postgraduate Medicine's website at www.postgradmed.com. (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652643 Wed, 08 Jul 2009 08:47:00 +0100 2652643 http://www.medworm.com/index.php?rid=2652642&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Fart%3Dpgm_05_2009%3Farticle%3D2001 This article, written by four authors from SUNY Buffalo's Division of Endocrinology, Diabetes, and Metabolism, discusses the pathophysiology, signs, and symptoms of hypogonadotropic hypogonadism. The authors report that clinical trials are required to determine whether testosterone replacement therapy alleviates insulin resistance, inflammation, and symptoms related to sexual dysfunction care. The full article can be accessed on Postgraduate Medicine's website at www.postgradmed.com. (Source: Postgraduate Medicine Online) Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652642 Wed, 08 Jul 2009 08:47:00 +0100 2652642 http://www.medworm.com/index.php?rid=2652641&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Ffree%3Dpgm_05_2009%3Farticle%3D1998 Over 180 million people worldwide suffer from diabetes mellitus and experts expect that number to double within the next 20 years. Even though many acknowledge the growing danger of diabetes, few medications effectively target the underlying cause of the disorder's progression, the deterioration of beta-cell function. Scientists searching for more effective treatments of diabetes published their most recent findings in the May issue of Postgraduate Medicine in an article named "Insights from the Liraglutide Clinical Development Program- the Liraglutide Effect and Action in Diabetes (LEAD) Studies." By using a study group of 4400 patients suffering from diabetes, the scientist were able to prove that liraglutide, either by itself or combined with other diabetes medications, is able to impro... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652641 Wed, 08 Jul 2009 08:47:00 +0100 2652641 http://www.medworm.com/index.php?rid=2652640&cid=s_38819_49_f&fid=38820&url=http%3A%2F%2Fwww.postgradmed.com%2Findex.php%3Ffree%3Dpgm_05_2009%3Farticle%3D1997 In a new study published in the May issue of Postgraduate Medicine entitled "Adding Liraglutide to Oral Antidiabetic Drug Monotherapy: Efficacy and Weight Benefits", scientists in Europe conducted a study to see the effect of liraglutide, a substance used for glycemic control, when used in tandem with other oral antidiabetic drugs (OADs). On their own, these drugs, which are prescribed after someone has initially been diagnosed with type 2 diabetes, often have adverse side effects, including unwanted weight gain and a higher occurrence of hypoglycemic episodes. On the other hand, liraglutide has a history of helping diabetes patients achieve weight loss and a greater level of glycemic control. After studying the effect of the combination therapy on 386 patients, the scientists concluded t... Postgraduate Medicine Online journals http://www.medworm.com/rss/comments.php?id=2652640 Wed, 08 Jul 2009 08:47:00 +0100 2652640