Postgraduate Medicine

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ISSN / EISSN : 0032-5481 / 1941-9260
Published by: Informa UK Limited (10.1080)
Total articles ≅ 22,408
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, Oya Topaloglu, Alparslan Altunoglu, Salim Neselioglu,
Published: 15 October 2021
Abstract:
In this study, we aimed to evaluate the frequency of Euthyroid Sick Syndrome (ESS) before and after renal transplantation in patients with end stage renal disease (ESRD), and its association with oxidative stress (OS) by evaluating thiol-disulphide levels. Free triiodothyronine (fT3), free thyroxine (fT4) thyroid stimulating hormone (TSH), thiol and disulphide levels were recorded before and after renal transplantation in patients with ESRD. ESS was diagnosed in patients with unresponsive TSH to low fT3 and/ or fT4 levels. 121 patients were included in the study. Of these, 69 (57%) were males and 52 (43%) were females. The mean age was 45±12.61 years. ESS was detected in 39 (32%) of 121 patients. Of 39 patients, 24 (61%) had ESS before transplantation and 15 (39%) after transplantation. Sixteen of 24 (66.7%) patients with ESS before transplantation reached to normal thyroid functions after transplantation. In posttransplantation period, patients with ESS had significantly higher urea and creatinine (p= 0.025 and p= 0.009, respectively) compared to patients without ESS. Furthermore, thiol- disulphide levels of 20 patients with ESS at any time compared with 68 patients without ESS. It was found that native thiol and total thiol were significantly lower in patients with ESS (p=0.025 and p=0.044, respectively). The present study is an initial evaluation of the OS and antioxidation status in etiology of ESS in patients with renal transplantation. These patients have markedly low levels of antioxidation products, which support the possible role of OS in ESS.
Published: 12 October 2021
Abstract:
Managing chronic pain remains a major unmet clinical challenge. Patients can be treated with a range of interventions but pharmacotherapy is the most common. These include opioids, anti-depressants, calcium channel modulators, sodium channel blockers and nonsteroidal anti-inflammatory drugs. Many of these drugs target a particular mechanism, however chronic pain like many diseases is multifactorial and induces plasticity throughout the sensory neuroaxis. Furthermore, co-morbidities such as depression, anxiety and sleep disturbances worsen quality of life. Given the complexity of mechanisms and symptoms in patients, it is unsurprising that many fail to achieve adequate pain relief from a single agent. The efforts to develop novel drug classes with better efficacy has not always proved successful; a multimodal or combination approach to analgesia is an important strategy in pain control. Many patients frequently take more than one medication but high quality evidence to support various combinations is often sparse. Ideally, combining drugs would produce synergistic action to maximise analgesia and reduce side effects, although sub-additive and additive analgesia is still advantageous if additive side-effects can be avoided. In this review we discuss pain mechanisms, drug actions and the rationale for mechanism-led treatment selection.
Ombretta Para, , Giulia Pestelli, Flavio Tangianu, Davide Carrara, Lucia Maddaluni, Antonio Tamburello, Laura Castelnovo, Giacomo Fedi, Stefano Guidi, et al.
Published: 6 October 2021
Abstract:
In COVID-19 patients the progressive clinical deterioration seems secondary to the activation of a cytokine storm. Ferritin is considered a direct mediator of the immune system and some evidences suggested a shared physio-pathogenic basis between COVID-19 and “Hyperferritinemic Syndromes”. The aim of our study was to evaluate the prognostic role of ferritin in COVID-19 patients. We retrospectively studied consecutive COVID-19 patients admitted to 4 Italian Internal Medicine Units. Role of potential prognostic markers was evaluated with binary logistic regression analysis and results were expressed as odds ratios (ORs) with the corresponding 95% confidence intervals (CIs). Poor outcome was defined as death or need to transfer in the intensive care unit. Two hundred patients were included (mean age 68.75 ± 13.22 years). Ferritin value was ​​highly elevated (> 3000 ng/mL) in 8% of our population; 13% of patients were transferred to intensive care units and 12% of patients died. At multivariate analysis, highly elevated ferritin levels (OR 16.67 C.I. 4.89 – 57.57 p<0.001) and hemoglobin < 10 g/dL (OR 8.88 C.I. 2.02 – 39.09 p=0.004) were independently associated with a bad outcome. Patients with ferritin values > 3000 ng/ml appeared to have an inflammatory activation with elevated values of CRP and D-dimer and low values of lymphocyte count. Our results confirm the prognostic role of ferritin in hospitalized COVID-19 patients. Patients with high ferritin levels should be considered critically-ill and treated in an adequate setting. Furthermore, COVID-19 seems to share some characteristics with hyperferritinemic syndromes with potential therapeutic implications.
, Şengül Çağlayan, Vildan Atasayan, Kadir Ulu, Taner Coşkuner, Özge Pelin Akbay, Canan Hasbal Akkuş, Gürkan Atay, Enes Salı, Mehmet Karacan, et al.
Published: 4 October 2021
Abstract:
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition resulting in excessive response of the immune system after SARS-CoV-2 infection. We report a single center cohort of children with MIS-C, describing the spectrum of presentation, therapies, clinical course, and short-term outcomes. This is a prospective observational study from to a tertiary pediatric rheumatology center including patients (aged 1 month to 21 years) diagnosed with MIS-C between April 2020-April 2021. Demographic, clinical, laboratory results and follow-up data were collected through the electronic patient record system and analyzed. A total of 67 patients with MIS-C were included into the study. Fever was detected in all patients; gastrointestinal system symptoms was found in 67.2% of the patients, rash in 38.8%, conjunctivitis in 31.3%, hypotension in 26.9% myocarditis and/or pericarditis in 22.4%, respectively. Respiratory symptoms were only in 5 patients (7.5%). Kawasaki Disease like presentation was found 37.3 % of patients. The mean duration of hospitalization was 11.8 7.07 days. Fifty- seven patients (85%) received intravenous immunoglobulin (IVIG), 45 (67%) received corticosteroids, 17 (25.3%) received anakinra, and one (1.5%) received tocilizumab. Seven of the patients (10.4%) underwent therapeutic plasma exchange (TPE). In 21 (31.3%) patients, a pediatric intensive care unit (PICU) was required in a median of 2 days. The first finding to improve was fever, while the first parameter to decrease was ferritin (median 6.5 days (IQR, 4-11.2 days)). Sixty-five patients were discharged home with a median duration of hospital stay of 10 days (IQR, 7-15 days). The patients with MIS-C may have severe cardiac findings and intensive care requirements in admission and hospital follow-up. The vast majority of these findings improve with effective treatment without any sequelae until discharge and in a short time in follow-up. Although the pathogenesis and treatment plan of the disease are partially elucidated, follow-up studies are needed in terms of long-term prognosis and relapse probabilities.
Published: 4 October 2021
Postgraduate Medicine pp 1-8; https://doi.org/10.1080/00325481.2021.1978704

Abstract:
Uncontrolled diabetes and/or hyperglycemia is associated with severe COVID-19 disease and increased mortality. It is now known that poor glucose control before hospital admission can be associated with a high risk of in-hospital death. By achieving and maintaining glycemic control, primary care physicians (PCPs) play a critical role in limiting this potentially devastating outcome. Further, despite the hope that mass vaccination will help control the pandemic, genetic variants of the virus are causing surges in some countries. As such, PCPs will treat an increasing number of patients with diabetes who have symptoms of post–COVID-19 infection, or even have new-onset type 2 diabetes as a result of COVID-19 infection. However, much of the literature published focuses on the effects of COVID-19 in hospitalized patients, with few publications providing information and advice to those caring for people with diabetes in the primary care setting. This manuscript reviews the current knowledge of the risk and outcomes of individuals with diabetes who are infected with COVID-19 and provides information for PCPs on the importance of glucose control, appropriate treatment, and use of telemedicine and online prescription delivery systems to limit the potentially devastating effects of COVID-19 in people with hyperglycemia.
, Hamza Tariq, Jacob Mitchell, Azad Mohammed, Włodzimierz Samborski
Published: 30 September 2021
Postgraduate Medicine pp 1-11; https://doi.org/10.1080/00325481.2021.1979873

Abstract:
Background: relapsing polychondritis (rpc) is a complex immune-mediated systemic disease affecting cartilaginous tissue and proteoglycan-rich organs. The most common and earliest clinical features are intermittent inflammation involving the auricular and nasal regions, although all cartilage types can be potentially affected. The life-threatening effects of rpc involve the tracheobronchial tree and cardiac connective components. Rpc is difficult to identify amongst other autoimmune comorbidities; diagnosis is usually delayed and based on nonspecific clinical symptoms with limited laboratory aid and investigations. Medications can vary, from steroids, immunosuppressants, and biologics, including anti-tnf alpha antagonist drugs. Method: information on updated etiology, clinical symptoms, diagnosis, and treatment of rpc has been obtained via extensive research of electronic literature published between 1976 and 2019 using pubmed and medline databases. English was the language of use. Search inputs included ‘relapsing polychondritis,’ ‘polychondritis,’ ‘relapsing polychondritis symptoms,’ and ‘treatment of relapsing polychondritis.’ published articles in english that outlined and reported rpc’s clinical manifestations and treatment ultimately met the inclusion criteria. Articles that failed to report the above and reported on other cartilaginous diseases met the exclusion criteria. Result: utilizing an extensive overview of work undertaken in critical areas of rpc research, this review intends to further explore and educate the approach to this disease in all dimensions from pathophysiology, diagnosis, and management. Conclusion: RPC is a rare multi-systemic autoimmune disease and possibly fatal. The management remains empiric and is identified based on the severity of the disease per case. The optimal way to advance is to continue sharing data on RPC from reference centers; furthermore, clinical trials in randomized control groups must provide evidence-based treatment and management. Acquiring such information will refine the current knowledge on RPC, which will improve not only treatment but also diagnostic methods, including imaging and biological markers.
, , Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
Published: 30 September 2021
Postgraduate Medicine pp 1-14; https://doi.org/10.1080/00325481.2021.1982297

Abstract:
This review article will discuss the pharmacology of the most common used chronic medications in patients undergoing elective surgical procedures. The mechanism of action and adverse side effects of cardiovascular medications (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics, etc), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid, etc), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction drugs, psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and psychotropic drugs will be briefly reviewed.
, , Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
Published: 30 September 2021
Postgraduate Medicine pp 1-19; https://doi.org/10.1080/00325481.2021.1982298

Abstract:
This review article will discuss the pharmacodynamic effects of the most commonly used chronic medications by patients undergoing elective surgical procedures, namely cardiovascular drugs (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics, etc.), lipid-lowering drugs, gastrointestinal medications (h2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, etc.), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction drugs, psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and psychotropic drugs. In addition, the potential adverse drug-interactions between these chronic medications and commonly used anesthetic drugs during the perioperative period will be reviewed. Finally, recommendations regarding the management of chronic medications during the preoperative period will be provided.
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