Postgraduate medicine
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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.
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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.
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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.
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Postgraduate medicine · May 2022
Potential public health impact of a Neisseria meningitidis A, B, C, W, and Y pentavalent vaccine in the United States.
Globally, 5 serogroups (A, B, C, W, and Y) cause the majority of invasive meningococcal disease (IMD). Vaccines targeting these serogroups are currently part of the US adolescent immunization platform, which includes 1 + 1 dosing of a MenACWY vaccine routinely at ages 11 and 16 years and 2 doses of a MenB vaccine at age 16-23 years under shared clinical decision-making between the patient and healthcare provider. In 2018, MenACWY vaccination coverage was 86.6% for ≥1 dose and 50.8% for ≥2 doses, whereas MenB vaccination coverage was 17.2% for ≥1 dose and <50% for completion of the multidose series. A pentavalent MenABCWY vaccine could simplify immunization schedules and improve vaccination coverage. We estimated the public health impact of a pentavalent MenABCWY vaccine using a model that considers meningococcal carriage and vaccination coverage. ⋯ Replacing one or more MenACWY/MenB vaccine doses with MenABCWY could reduce IMD caused by all 5 meningococcal serogroups among the US adolescent population, while also reducing the number of injections required.
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Postgraduate medicine · May 2022
ReviewManagement of chronic kidney disease in type 2 diabetes: screening, diagnosis and treatment goals and recommendations.
Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) are at high risk of CKD progression and cardiovascular (CV) disease. Prevalence of CKD in patients with T2D is currently around 40% and continues to grow. The increasing number of people with CKD and T2D will ultimately have a significant impact upon health resource use and costs of care for people with T2D. ⋯ This review highlights the ongoing challenges facing primary care providers in the management of CKD in patients with T2D including the consideration of comorbidities, adoption of new treatment options, and implementation of individualized care. Achieving consensus for optimal treatment of this disease is critical in providing consistent and appropriate care for all patients. Strategies to improve outcomes should also include use of clear referral criteria, use of a multi-disciplinary approach, and patient education.