Postgraduate medicine
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Postgraduate medicine · Nov 2021
Observational StudyIn-patient outcomes of patients with diabetic ketoacidosis and concurrent protein energy malnutrition: A national database study from 2016 to 2017.
Introduction:Patients often present to the hospital with a well-known complication of diabetes mellitus, namely diabetic ketoacidosis (DKA). In this study, we assess the clinical outcomes of DKA hospitalizations with and without protein-energy malnutrition (PEM). Methods:This was a population-based, retrospective observational study using data gathered from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. ⋯ Patients with DKA and PEM had an increased risk of developing sepsis (aOR 2.99, 95% CI: 2.49-3.58, p < 0.001), septic shock (aOR 3.37, 95% CI: 2.31-4.91, p < 0.001), acute kidney failure (aOR 1.27, 95% CI: 1.17-1.37, p < 0.001), acute respiratory failure (aOR 2.23, 95% CI: 1.83-2.73, p < 0.001), deep vein thrombosis (aOR 1.91, 95% CI: 1.43-2.54, p < 0.001), and pulmonary embolism (aOR 2.36, 95% CI: 1.42-3.94, p = 0.001). Patients with DKA and PEM also had an increased mean THC (aOR 19,200, 95% CI 16,000-22,400, p < 0.001) in US dollars and increased LOS (aOR 2.26, 95% CI 1.96-2.57, p < 0.001) in days when compared to patients without PEM. Conclusion:Patients hospitalized for DKA with a secondary diagnosis of PEM within the same admission had a statistically significantly higher in-hospital mortality.
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Postgraduate medicine · Nov 2021
Impact of chronic medications in the perioperative period -mechanisms of action and adverse drug effects (part i).
Background: This review article discusses the pharmacology of the most commonly 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), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, and psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs) will be reviewed. Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups. ⋯ These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also effect the morbidity, mortality, and recovery time of surgical patients. Part I of this two-part review article focuses on the mechanisms of action and adverse side effects of the chronic medications most commonly taken by surgical patients in the preoperative period.
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Postgraduate medicine · Nov 2021
Randomized Controlled Trial Comparative StudyEffect of video-based patient information on patients' anxiety and pain levels before skin biopsy: a randomized controlled study.
Effective use of technology can provide advantages for both patients and physicians in skin biopsy practice. We aimed to investigate the effects of video-based information on the anxiety, pain and satisfaction levels of patients undergoing biopsy. ⋯ Video-based information prior to skin biopsy may be more useful in managing anxiety and pain in patients than traditional verbal information.
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Postgraduate medicine · Nov 2021
ReviewImpact of chronic medications in the perioperative period -anesthetic implications (part ii).
Background: This review article discusses 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, linezolid.), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing 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. Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups. ⋯ These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also affect the morbidity, mortality, recovery time of surgical patients and acute relapse of chronic illnesses which could lead to last minute cancellation of surgical procedures. Part II of this two-part review article focuses on the reported interactions between most commonly taken chronic medications by surgical patients and anesthetic and analgesic drugs, as well as recommendations regarding the handling these chronic medications during the perioperative period.
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Postgraduate medicine · Nov 2021
Comparative StudySex-disparities in risk factors and atherosclerosis cardiovascular disease in diabetic patients.
Objective: The current study was to evaluate risk factors and atherosclerotic cardiovascular disease (ASCVD) among diabetic patients by sex. Methods: Patients with type 2 diabetes mellitus were enrolled, and baseline characteristics and prevalent ASCVD (including coronary heart disease [CHD], ischemic stroke [IS], and peripheral vascular disease [PVD]) were collected and compared by sex. Results: Females accounted for 48.5% (n = 284) of the current study. ⋯ Females had a higher prevalence of CHD (9.9% vs 8.6%) and composite ASCVD (21.8% vs 18.9%). After adjustment for potential covariates, female sex remained independently associated with composite ASCVD (odds ratio [OR]: 1.21 and 95% confidence interval [CI]: 1.05-1.57) and CHD (OR: 1.13 and 95% CI: 1.01-1.38). Conclusion: Among diabetic people, compared to males, females had a higher comorbid burden but received less optimal treatment, which might partly explain their higher prevalence of composite ASCVD and CHD.