Postgraduate medicine
-
Postgraduate medicine · May 2022
Adjuvant radiotherapy did not increase the risk of coronary heart disease in patients with non-metastatic breast cancer.
Adjuvant radiotherapy (RT) in patients with breast cancer can adversely cause the heart to receive some radiation doses, which may lead to cardiovascular diseases. The results of previous research regarding this issue are not consistent. Therefore, we conducted a nationwide population-based study in Taiwan to evaluate whether adjuvant RT for breast cancer patients increased the risk of developing coronary heart disease (CHD). ⋯ This large, nationwide cohort study suggests that adjuvant RT in patients with breast cancer did not increase the risk of CHD.
-
Postgraduate medicine · May 2022
ReviewPotential Neurological Manifestations of COVID-19: A Narrative Review.
Neurological manifestations are increasingly reported in a subset of COVID-19 patients. Previous infections related to coronaviruses, namely Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS) also appeared to have neurological effects on some patients. The viruses associated with COVID-19 like that of SARS enters the body via the ACE-2 receptors in the central nervous system, which causes the body to balance an immune response against potential damage to nonrenewable cells. ⋯ Treating neurological symptoms can pose clinical challenges as drugs that suppress immune response may be contraindicated in COVID-19 patients. It is possible that in some COVID-19 patients, neurological symptoms are being overlooked or misinterpreted. To date, neurological manifestations of COVID-19 have been described largely within the disease trajectory and the long-term effects of such manifestations remain unknown.
-
Postgraduate medicine · May 2022
ReviewWhat is clinically relevant weight loss for your patients and how can it be achieved? A narrative review.
Obesity is a chronic disease with increasing prevalence. It affects quality of life and renders those affected at increased risk of mortality. For people living with obesity, weight loss is one of the most important strategies to improve health outcomes and prevent or reverse obesity-related complications. ⋯ However, some obesity-related comorbidities and complications, such as non-alcoholic steatohepatitis, obstructive sleep apnea, gastroesophageal reflux disease and remission of type 2 diabetes, require a greater magnitude of weight loss to achieve clinically meaningful improvements. In this review, we assessed the available literature describing the effect of categorical weight losses of ≥5%, ≥10%, and ≥15% on obesity-related comorbidities and complications, and challenge the concept of clinically meaningful weight loss to go beyond percentage change in total body weight. We discuss weight-loss interventions including lifestyle interventions and therapeutic options including devices, and pharmacological and surgical approaches as assessed from the available literature.
-
Postgraduate medicine · May 2022
ReviewAbuse of immediate-release opioids and current approaches to reduce misuse, abuse and diversion.
Deaths from opioid overdoses have increased dramatically over the past few years. Given that immediate-release (IR) opioids account for most of the U. S. market share, and that abusers generally prefer IR opioids over extended-release (ER) opioids, it is not surprising that rates of abuse are higher for IR than ER opioids. ⋯ Food and Drug Administration regulations, state legislation, insurance company policies, the use of multimodal analgesic therapy, patient risk assessment and monitoring, limiting access to opioids by reducing IR opioid prescription quantity and length, prescription drug monitoring programs, patient education on proper disposal of unused medication and risks of diversion, as well as abuse-deterrent formulations. Albeit, most abuse-deterrent formulations have focused on ways to prevent the circumvention of ER characteristics rather than placing obstacles to abuse of IR opioid formulations. Reducing opioid abuse requires the combined efforts of multiple stakeholders, including prescribing clinicians, patients, pharmacists, nurses, insurance companies, government agencies, and pharmaceutical companies.
-
Postgraduate medicine · May 2022
ReviewThe impact of physical activity on well-being, lifestyle and health promotion in an era of COVID-19 and SARS-CoV-2 variant.
We must recognize the limitations of the current situation and vaccines where SARS-CoV-2 variants continue to transform and spread and need to build strategies to maintain and promote health in adherence to the suggested recommended action of the WHO. The purpose of this review is to examine the literature and latest research on the effects of physical activity (PA) on health in preparation for the SARS-CoV-2 strain and future infectious diseases era. In addition, it provides some general guidelines for actionable PA. ⋯ As a result, PA suggests opportunities to not only maintain and promote health by strengthening the immune system in an era where the COVID-19 variant is a crisis but also implement opportunities for well-being (WB), healthy lifestyles, and long-term health improvement. In particular, maintaining a regular PA routine outdoors or at home could be an important means to lower infection rates and maintain health during the potential impact of the current COVID-19 crisis and future pandemics (i.e. dramatic moments). The clinical relevance of the present review is crucial to understanding the impact of PA on WB, lifestyle, physical and mental health, maintaining regular PA, and important preventive factor to better prepare for the era of COVID-19 variants and similar pandemics in the future as it is emphasized as a prevention strategy and key strategy for continuous health promotion.