Postgraduate medicine
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Postgraduate medicine · Nov 2010
Review Case ReportsAcute intravenous synaptamine complex variant KB220™ "normalizes" neurological dysregulation in patients during protracted abstinence from alcohol and opiates as observed using quantitative electroencephalographic and genetic analysis for reward polymorphisms: part 1, pilot study with 2 case reports.
It is well established that in both food- and drug-addicted individuals, there is dopamine resistance due to an association with the DRD2 gene A1 allele. Evidence is emerging whereby the potential of utilizing a natural, nonaddicting, safe, putative D2 agonist may find its place in recovery from reward deficiency syndrome (RDS) in patients addicted to psychoactive chemicals. Utilizing quantitative electroencephalography (qEEG) as an imaging tool, we show the impact of Synaptamine Complex Variant KB220™ as a putative activator of the mesolimbic system. ⋯ Future studies must await both functional magnetic resonance imaging and positron emission tomography scanning to determine the acute and chronic effects of oral KB220™ on numbers of D2 receptors and direct interaction at the nucleus accumbens. Confirmation of these results in large, population-based, case-controlled experiments is necessary. These studies would provide important information that could ultimately lead to significant improvement in recovery for those with RDS and dopamine deficiency as a result of a multiple neurotransmitter signal transduction breakdown in the brain reward cascade.
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Postgraduate medicine · Nov 2010
ReviewHypogonadism, erectile dysfunction, and type 2 diabetes mellitus: what the clinician needs to know.
Testosterone levels and erectile function are known to decline as men age, leading to hypogonadism and erectile dysfunction (ED). Men with type 2 diabetes mellitus (T2DM) have a particularly high prevalence of hypogonadism and ED. This population also has an increased risk for cardiovascular diseases, as well as exposure to other metabolic and cardiovascular risk factors, such as obesity. ⋯ Hypogonadism is generally suspected when morning levels for total testosterone are < 300 ng/dL and clinical signs and symptoms typically associated with androgen deficiency are present. While hypogonadism and ED have emerged as predictors of cardiovascular disease and may respond to the lifestyle changes commonly recommended for patients with diabetes and the metabolic syndrome, the literature on whether treatment with testosterone supplementation affects outcomes beyond well-being and sexual function is still emerging. Primary care providers should be aware of this dysmetabolic cluster affecting their male patients and its importance, and, given the common occurrence of hypogonadism, ED, and T2DM, diagnosis of 1 of these conditions should elicit inquiry into the other 2 conditions.
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Postgraduate medicine · Nov 2010
Review Meta Analysis Comparative StudyTopical nonsteroidal anti-inflammatory drugs for osteoarthritis.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are mainstays of the treatment of osteoarthritis (OA) but have dose- and age-related risks of gastrointestinal, cardiovascular, and renal adverse events (AEs). As a result, US and international guidelines recommend caution when prescribing oral NSAIDs, particularly in older patients and those with significant comorbidities. For OA of the hands and knees, topical NSAIDs provide efficacy similar to oral NSAIDs, with far less systemic distribution. ⋯ The purpose of this brief review is to examine the data from controlled double-blind trials evaluating the use of topical NSAIDs in patients with OA. Articles included were identified via a search of PubMed covering the period from January 1, 2005 through March 31, 2010. Reference lists from OA treatment guidelines and meta-analyses were reviewed for additional citations of importance.
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Postgraduate medicine · Nov 2010
Review Comparative StudyOpioid therapy for osteoarthritis and chronic low back pain.
Chronic low back pain (CLBP) and osteoarthritis (OA) of any joint are highly prevalent, occurring in > 50% of US adults aged ≥ 60 years. Opioids are prescribed more frequently for CLBP and OA than for any other noncancer pain, and the judicious use of opioids is recommended by treatment guidelines for the management of CLBP and OA pain. ⋯ Prescribers need to understand the place of opioid therapy in a multimodal treatment program that includes patient rehabilitation to reduce pain and improve function. The analgesic benefits of opioids must be balanced against concerns about addiction and abuse, adverse events, and their potential impact on other aspects of treatment.
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Postgraduate medicine · Nov 2010
Randomized Controlled Trial Comparative StudyOvercoming qEEG abnormalities and reward gene deficits during protracted abstinence in male psychostimulant and polydrug abusers utilizing putative dopamine D₂ agonist therapy: part 2.
It is well established that in both food- and drug-addicted individuals there is "dopamine resistance" associated with the DRD2 gene A1 allele. Based on earlier studies, evidence is emerging wherein the potential of utilizing a natural, nonaddicting, safe, putative D2 agonist may play a significant role in the recovery of individuals with reward deficiency syndrome, including those addicted to psychoactive chemicals. ⋯ This seminal work will provide important information that may ultimately lead to significant improvement in the recovery of individuals with psychostimulant and polydrug abuse problems, specifically those with genetically induced dopamine deficiency. Based on this small sample size, we are proposing that with necessary large populations supporting these initial results, and possibly even additional candidate genes and single nucleotide polymorphisms, we may eventually have the clinical ability to classify severity according to genotype and possession of risk alleles, along with offering a safe, nonaddicting, natural dopaminergic receptor agonist that potentially upregulates instead of downregulates dopaminergic receptors, preferably the D2 subtype.