Postgraduate medicine
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Postgraduate medicine · Apr 2021
Review Meta AnalysisThe effect of prophylactic thoracic duct ligation during esophagectomy on the incidence of chylothorax and survival of the patients: an updated review.
The role of thoracic duct ligation (TDL) during esophagectomy remains controversial. This review aimed to elucidate the effect of TDL on chylothorax and survival of the patients after esophagectomy for cancer. ⋯ The present review provided updated evidence opposing prophylactic TDL during esophagectomy for lowering chylothorax. Considering the harmful effect of TDL on survival of the patients, further well-designed trials should be considered in selected cases under strict supervision.
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Postgraduate medicine · Apr 2021
ReviewA brief guide to pustular psoriasis for primary care providers.
Pustular psoriasis refers to a heterogeneous group of chronic inflammatory skin disorders that are clinically, histologically, and genetically distinct from plaque psoriasis. Pustular psoriasis may present as a recurrent systemic illness (generalized pustular psoriasis [GPP]), or as localized disease affecting the palms and/or soles (palmoplantar pustulosis [PPP], also known as palmoplantar pustular psoriasis), or the digits/nail beds (acrodermatitis continua of Hallopeau [ACH]). These conditions are rare, but their possible severity and consequences should not be underestimated. ⋯ PPP is associated with impaired health-related quality of life and psychiatric morbidity, while ACH threatens irreversible nail and/or bone damage. These conditions can be difficult to diagnose; thus, primary care providers should not hesitate to contact a dermatologist for advice and/or patient referral. The role of corticosteroids in triggering and leading to flares of GPP should also be noted, and physicians should avoid the use of systemic corticosteroids in the management of any form of psoriasis.
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Postgraduate medicine · Apr 2021
Hearing impairment prevalence and risk factors among adults in rural China: a population-based cross-sectional study.
Objective: Over the past few decades, the prevalence of hearing impairment (HI) has rapidly increased, making HI one of the most common causes of disability, globally. The burden of HI is particularly heavy in low socioeconomic status populations. Despite extensive research into the range of HI prevalence in low socioeconomic status populations, worldwide, population-based studies have been rare. ⋯ Compared with the 45-54-year-old group, the risk of HI in individuals in the 55-64-year-old, 65-74-year-old, and ≥75-year-old groups were 25.8%, 109.9%, and 373.7% higher, respectively. Moreover, increased with each 1-mmHg SBP, the risk of HI increase 0.7% (95%CI: 1.001-1.013; P = 0.017); while increased with each 1-mmHg DBP, the risk of HI decrease 1.7% (95%CI: 0.973-0.993; P = 0.001)Conclusions: The burden of HI in rural northern China is heavy, especially among elderly men and people with elevated systolic blood pressure (SBP). Addressing HI prevention is critical for reducing the HI burden and improving quality of life.
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Postgraduate medicine · Apr 2021
Usefulness of Atherogenic index of plasma for estimating Reduced eGFR risk: Insights from the National Health and Nutrition Examination Survey 2009-2016.
Previous studies have identified Atherogenic index of plasma (AIP) as a simple measure of atherosclerosis. Because atherosclerosis plays a role in the development of renal damage, our study aims to evaluate the effect of AIP on the risk of reduced eGFR and assess its usefulness to refine the risk stratification of reduced estimated glomerular filtration rate (eGFR). ⋯ The present work suggested a linear association between AIP and reduced eGFR. Furthermore, the results showed that the association was stronger in black race and people aged less than 50 years old. Most importantly, our work implicated the usefulness of AIP to refine the risk stratification of reduced eGFR.
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Postgraduate medicine · Apr 2021
Similar clinical outcome of AMA immunoblot-M2-negative compared to immunoblot-positive subjects over six years of follow-up.
Background: The detection of anti-mitochondrial antibodies (AMA) is considered a hallmark in diagnosing primary biliary cholangitis (PBC). The most important AMA-subtype is AMA-M2 directed against the E2-subunit of pyruvate dehydrogenase. It is common clinical interpretation that lack of M2 due to immunoblotting (IB) indicates absence of specific auto-reactivity. ⋯ According to the clinical course by the time of FU, subjects were allocated to one of four groups: a) 34 patients had known PBC with n = 16 having an adequate and 18 an inadequate treatment response, b) 1 de novo PBC was detected, c) 13 were AMA-positive without biochemical evidence of PBC and d) 9 subjects were tested AMA-negative at FU. These numbers were comparable to M2-positive subjects with similar long-term clinical outcome. Conclusion: Our data suggest that the clinical value of confirmatory M2 immunoblotting in the diagnostic routine of PBC is overestimated as the clinical course appears not to be related to the test result.