Postgraduate medicine
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Postgraduate medicine · Aug 2021
ReviewOutpatient treatment of emergency department patients diagnosed with venous thromboembolism.
Venous thromboembolism (VTE) includes the diagnosis of either deep venous thrombosis (DVT) and/or pulmonary embolism (PE). This review discusses an evidence-based approach to the outpatient treatment of VTE in the emergency care setting. Main findings: The majority of patients diagnosed with VTE in the acute care setting are at low risk for an adverse event. ⋯ Many acute care clinicians remain wary of discharging patients with PE, concerned about drug access, adherence, and follow-up. Patients with VTE should be risk stratified identically as emerging evidence has demonstrated efficacy and safety in the interdependence of acute care protocols for the outpatient treatment of low-risk DVT and PE. Clinicians who practice in the acute care setting should be comfortable with risk stratification, anticoagulation, and discharge of low-risk VTE.
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Postgraduate medicine · Aug 2021
ReviewThe importance of recognizing and managing a rare form of angioedema: hereditary angioedema due to C1-inhibitor deficiency.
The majority of angioedema cases encountered in clinical practice are histamine-mediated (allergic); however, some cases are bradykinin-related (non-allergic) and do not respond to standard anti-allergy medications. Among bradykinin-related angioedema, hereditary angioedema (HAE) is a rare, but chronic and debilitating condition. The majority of HAE is caused by deficiency (type 1) or abnormal function (type 2) of the naturally occurring protein, C1-inhibitor (C1-INH)-a major inhibitor of proteases in the contact (kallikrein-bradykinin cascade), fibrinolytic pathway, and complement systems. ⋯ Subcutaneous (SC) C1-INH, SC monoclonal antibody (mAb)-based therapies, and an oral kallikrein inhibitor offer effective alternatives for HAE attack prevention and may facilitate self-administration. HAE management should be individualized, with QoL improvement being a key goal. This can be achieved with broader availability of existing options for routine prophylaxis, including greater global availability of C1-INH(SC), mAb-based therapy, oral treatments, and multiple on-demand therapies.
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Postgraduate medicine · Aug 2021
Association Between Kidney Function and Hearing Impairment Among Middle-aged and Elderly Individuals: A Cross-sectional Population-based Study.
As age-related diseases, chronic kidney disease and hearing impairment (HI) cause a serious socioeconomic burden. Due to structural similarities, there is a certain connection between kidney function and hearing, but there has been no large-scale epidemiological study in China that further explored this connection. Thus, this study aimed to explore the association between indicator levels of kidney function and hearing impairment among middle-aged and elderly individuals in Tianjin, China. ⋯ These findings suggest that eGFR and serum Cre are effective predictors of hearing loss. Thus, to decrease the burden of HI, hearing should be carefully monitored for people aged ≥45 years with elevated serum Cre and eGFR.
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Postgraduate medicine · Aug 2021
A predictive nomogram incorporating gait speed for all-cause mortality in hospitalized cirrhotics.
No tailored model incorporating physical frailty for 2-year mortality in cirrhosis is available for practitioners in general practice. Thus we aimed to develop a model based on laboratory results and physical frailty allowing clinicians for stratifying cirrhotics by using individual estimate. ⋯ In conclusion, the nomogram incorporating 5MGS may represent an individualized tool for predicting mortality in cirrhosis for primary care physicians.
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Postgraduate medicine · Aug 2021
ReviewCatheter-directed thrombolysis and mechanical intervention in deep venous thrombosis: what is the status after the ATTRACT trial?
Deep venous thrombosis (DVT) is a major cause of acute and chronic morbidity, mortality, and increased healthcare costs. Endovascular methods for thrombus removal and reestablishing venous patency are increasing in both scope and usage. ⋯ The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial is the largest and most comprehensive randomized-controlled trial to date evaluating CDT compared to anticoagulation alone for the treatment of acute symptomatic proximal lower extremity DVT. This review discusses the current status of CDT and adjunctive endovascular interventions for DVT, particularly in the context of the ATTRACT trial.