Postgraduate medicine
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Postgraduate medicine · Jan 2025
ReviewPreoperative intravenous versus oral iron supplementation for elective surgery: evidence based on 12 randomized trials.
This study aims to clarify hematological parameters, transfusion requirements, and adverse events of preoperative intravenous (IVIS) versus oral iron supplementation (OIS) in elective surgery patients. ⋯ PROSPERO CRD42023483284.
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Postgraduate medicine · Jan 2025
Factors associated with renal involvement in adult immunoglobulin a vasculitis: what is it?
The objective of this study is to examine the potential of specific parameters in determining renal involvement in adult patients diagnosed with Immunoglobulin A vasculitis (IgAV). ⋯ The initial BVAS above 7.5, and baseline FAR above 24.97 are factors associated with renal involvement. The results of this study may provide the basis for identifying individuals at high risk for renal involvement and, consequently, for more rigorous monitoring.
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Postgraduate medicine · Jan 2025
Trends of primary health care practitioners toward bleeding management in Saudi Arabia: a cross-sectional analysis.
High rates of morbidity and mortality are a result of trauma being a significant health burden in Saudi Arabia. We evaluated the current trends of primary healthcare (PHC) physicians in Saudi Arabia toward patients with bleeding and their referral awareness for percutaneous endovascular arterial embolization (EAE). ⋯ PHC physicians in Saudi Arabia require a better understanding of the indications of EAE to avoid referral and triage errors, inefficient use of healthcare resources, and suboptimal patient outcomes.
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Postgraduate medicine · Jan 2025
Metabolic, hormonal profiles and comorbidities in pituitary Cushing's syndrome, adrenal Cushing's syndrome and mild autonomous cortisol secretion: a comparative study.
Our study aimed to discern disparities in metabolic, hormonal profiles, and comorbidities among patients with pituitary Cushing (PC), adrenal Cushing (AC), and Mild autonomous cortisol secretion (MACS). ⋯ Our findings suggest that urinary cortisol levels were significantly higher in the PC group than in the AC and MACS groups, potentially indicating that high-amplitude adrenocorticotropic hormone stimulation may lead to increased cortisol secretion in PC patients. The increased utilization of imaging methods has facilitated the earlier detection of adrenal incidentalomas, enabling the diagnosis of adrenal Cushing's cases with milder cortisol elevations. Additionally, the severity of disease symptoms worsens with increasing cortisol levels.Notably, moderate increases in cortisol are associated with heightened comorbidities, underscoring the importance of vigilant management in Cushing's syndrome patients. Despite a lower degree of hypercortisolism in MACS, there were no differences in comorbidities, suggesting that even mild cortisol secretion abnormalities are sufficient to establish the presence of comorbidities. Even moderate increases in cortisol levels can impact bone metabolism.
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Postgraduate medicine · Jan 2025
Post cardiac surgery acute kidney injury and the role of intravenous amino acids infusions.
Acute kidney injury (AKI) is a well-established and serious complication associated with cardiovascular revascularization procedures, regardless of its severity. According to the 2023 annual report of the National Institute of Diabetes and Digestive and Kidney Diseases - United States Renal Data System, the incidence of cardiovascular disease-related AKI hospitalizations has been steadily increasing over the past decade. Coronary artery bypass grafting (CABG), on the other hand, remains one of the most frequently performed major surgical procedures in the United States, with an estimated 400,000 surgeries conducted annually. ⋯ The reported incidence in literature is anywhere between 1% to 50%. Although healthcare teams employ various supportive measures to prevent its occurrence, a single universally effective preventive intervention for AKI-CABG remains elusive. This article focuses on a critical evaluation of the PROTECTION trial, a pioneering study evaluating the hypothesis that intravenous amino acid infusion would reduce the incidence of AKI-CABG using intravenous amino acid therapy (Isopuramin 10%, Baxter) in patients undergoing elective CABG surgery.