Postgraduate medicine
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Postgraduate medicine · Mar 2020
Cardiologists' and cardiovascular surgeons' attitudes toward managing endodontic infections and oral health in patients with cardiovascular diseases.
Objective: A relationship between dentists and medical doctors should be encouraged to reduce cardiovascular risk in cardiac patients with dental infection. The aim of this study was to evaluate the attitudes of cardiologists and cardiovascular surgeons (cardiac specialists) toward managing endodontic infections and oral health in patients with cardiovascular diseases (CVDs). Methods: A survey of 16 questions assessing knowledge of endodontic infection, dental examination, timing of endodontic treatment, and antibiotic prophylaxis was sent to cardiac specialists in Turkey. ⋯ Cardiac patients were referred to a dentist by 66.6% of the cardiologists and 80.3% of the cardiovascular surgeons (p = 0.002). Almost all participants (97.3%) believed that the heart health of cardiac patients with endodontic infections could be negatively affected by this infection. Conclusion: Although there is not yet any conclusive evidence on whether the presence of an endodontic infection may have an impact on CVDs, this study showed that most cardiac specialists attached importance to endodontic infections.
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Postgraduate medicine · Mar 2020
Immune checkpoint inhibitors and endocrine side effects, a narrative review.
Immune checkpoint inhibitors (ICPIs) are novel drugs in the field of oncology however carry the risk of immune-related dermatologic, gastrointestinal, and endocrine side effects which can be fatal. These new innovative immunoregulatory drugs have intertwined the fields of oncology and endocrinology. CTLA-4 and PD-1 are co-inhibitory receptors on T cells that turn the T cell 'off' when binding to receptors on APCs. ⋯ ICPIs have been used in a variety of malignancies including melanoma, kidney cancer, and non-small cell lung cancer. A unique underrecognized side effect of the autoimmune response is hypophysitis leading to central adrenal insufficiency which can be fatal. Additional immune-related adverse events (irAEs) include hypothyroidism, hyperthyroidism, diabetes, and hypoparathyroidism.
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Postgraduate medicine · Mar 2020
Case ReportsMycobacterium chimaera chorioretinitis as a biomarker of systemic disease activity following nosocomial acquisition during cardiopulmonary bypass.
Objectives: To understand the role of ophthalmoscopic examination (dilated retina examination and widefield fundus photography) in the diagnosis and management of nosocomial acquisition of Mycobacterium chimaera following open heart surgery with cardiopulmonary bypass utilizing a heater-cooler unit, an entity that is associated with >50% mortality during the worldwide outbreak that has occurred since 2013. Methods: Case report with review of previous cases. Results: Signature Mycobacterium chimaera chorioretinal lesions can be used as a diagnostic sign and a biomarker for assessment of treatment efficacy. Conclusions: Ophthalmologic examination can play a key role in diagnosis and management of systemic Mycobacterium chimaera following cardiopulmonary bypass; such examinations may yield earlier diagnosis, diminishing mortality rates.
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Postgraduate medicine · Mar 2020
The influence of value reference point and risk preference on adherence in hypertensive patients in a low-income area of China.
Aims: Prevention and control of hypertension can be achieved by improving patient adherence to long-term treatment regimens. Non-adherence is an obstacle to chronic disease management. We studied the impact of value reference point and risk preference on patient adherence and influencing factors from the perspective of behavioral economics so as to offer targeted recommendations to improving patient adherence in low-income areas. ⋯ Satisfaction with current services and relationship with physicians, as well as type of drugs also influenced adherence. Conclusions: Adherence may be improved by changing patients' value reference points and perceptions through health education and better health service resources. One of the key to increasing adherence is through identifying and eliminating bias.
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Postgraduate medicine · Mar 2020
Influence of relative wall thickness on electrocardiographic voltage measures in left ventricular hypertrophy: a novel factor contributing to poor diagnostic accuracy.
Objective: To characterize the influence of relative wall thickness (RWT) on Cornell, Sokolow-Lyon and Peguero-Lo Presti voltages and elucidate its potential impacts on their diagnostic accuracy for LVH in a large general Chinese population. Methods: A total of 10,614 permanent residents aged ≥ 35 years were recruited for this study. All the participants were subjected to ECG and echocardiogram during the same visit. ⋯ Besides, subjects with RWT > 0.42 exhibited higher rates of LVH diagnosed by Cornell (OR = 1.78, 95% CI: 1.45-2.20), Sokolow-Lyon (OR = 1.30, 95% CI: 1.08-1.56), and Peguero-Lo Presti voltage (OR = 1.48, 95% CI: 1.29-1.70) after adjustments for age, gender and echocardiographic LVH. Furthermore, concentric remodeling or concentric hypertrophy displayed higher rates of LVH diagnoses via Cornell and Peguero-Lo Presti voltage criteria, as compared with normal geometry or eccentric hypertrophy, respectively (all Ps < 0.05), findings of which were independent of age, gender and LVMI. Conclusion: Echocardiographic RWT was independently correlated with electrocardiographic voltage measures of LVH, which influenced their positive rates and contributed to poor diagnostic performance.