Postgraduate medicine
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Postgraduate medicine · Sep 2019
Observational StudySmall fiber neuropathy in coeliac disease and gluten sensitivity.
Objectives: The commonest types of peripheral neuropathy in the context of Coeliac Disease (CD) and gluten sensitivity (GS) are length-dependent symmetrical sensorimotor neuropathies and sensory ganglionopathies. In patients with such neuropathy, (gluten neuropathy), peripheral neuropathic pain is prevalent suggesting involvement of small fibers. The purpose of this report was to describe the clinical characteristics of patients with CD or GS and pure small fiber neuropathy (SFN). ⋯ In 8 patients (61.5%) pain was the presenting feature. Neurophysiological assessment suggested a length-dependent small fiber neuropathy in 11 patients, whereas in 2, a non-length dependent pattern was identifying suggesting that the predominant pathology lies in the dorsal root ganglia. Conclusion: SFN can be a presenting feature of CD and GS and, therefore, screening for CD and GS should be included in the diagnostic workup of patients with idiopathic SFN.
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Postgraduate medicine · Aug 2019
Meta AnalysisSerum levels of YKL-40 are increased in patients with psoriasis: a meta-analysis.
Background: YKL-40, also named chitinase-3-like protein 1, has been confirmed as an inflammatory glycoprotein associated with cardiovascular disease, diabetes or metabolic syndrome which are common comorbidities in psoriasis. Growing evidence has demonstrated that serum levels of YKL-40 in psoriatic patients were increased, however the results were appearance contradictory among the current published studies. Methods: Research involved in serum levels of YKL-40 in psoriatic patients and healthy control individuals was searched in PUBMED, EMBASE, and The Cochrane Library databases (up to 31 December 2018). ⋯ Our meta-analysis revealed that psoriatic patients had a higher serum YKL-40 levels compared to the control group, with the WMD of 53.6 ng/ml (95% CI: 31.3 to 75.9, P< 0.001). Furthermore, results of meta-regression analysis and subgroup analysis revealed that the disease duration and the value of psoriasis area and severity index (PASI) were related to the observed YKL-40 differences between two groups. Conclusions: Our meta-analysis indicates that psoriatic patients have higher serum YKL-40 levels when compared to healthy control individuals, and the levels are significantly affected by the disease duration and PASI.
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Postgraduate medicine · Aug 2019
Insulin therapy in patients with type 2 diabetes and high insulin resistance is associated with increased risk of complications and mortality.
Objective: To investigate the relationship between insulin use and clinical outcomes in patients with type 2 diabetes stratified by level of insulin resistance (IR). Methods: Cross sectional analysis of the NHANES database from 2001 to 2010. Sample was comprised of 3,124 individuals with diabetes, representing a US population of 16,713,593. ⋯ Conclusions: Insulin use was associated with increased risk of mortality, MACE, and DKD in patients within the high IR group, but the association was not significant within the low IR group. Our findings indicate that insulin therapy could be less beneficial in patients with high IR. Prospective studies are needed to identify subsets of individuals with type 2 diabetes who would benefit the most from insulin therapy, and for which patients, insulin should be avoided.
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Postgraduate medicine · Aug 2019
Statin-induced new onset of diabetes in dyslipidemic patients: a retrospective study.
Background: Previously conducted studies with statins shows an increased risk of developing new onset of diabetes. This study helps in analyzing the risk of statins to cause new onset of diabetes. Objective: To assess the prevalence, causality, severity, preventability and risk factors of statin-induced new onset of diabetes in dyslipidemic patients. ⋯ Patients who developed statin-induced new onset of diabetes were managed by dose reduction and treatment with anti-diabetic medications. Conclusion The prevalence of statin-induced new onset of diabetes is 7.03%. The main risk factors identified in the study were in older patients (≥60 years), rosuvastatin therapy, high dose and longer duration of statin therapy.
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Postgraduate medicine · Aug 2019
DREEM in primary care: students' perspectives on educational environment of family medicine internship in primary care centres: experiences at Akdeniz University Faculty of Medicine in Turkey.
Objective: In many countries, medical education programmes are expanding, and educational environments are starting to change from hospitals to primary health care centres. International organizations for medical education highlight that medical students should also be educated at primary and secondary care centres in addition to third-step health care. In this study, the evaluation of sixth-year (final year) medical students' perspectives on the educational environment of family medicine internship in primary care is presented, using the Dundee Ready Educational Environment Measurement (DREEM)Material and methods: This descriptive cross-sectional study was conducted with sixth-year medical students. ⋯ The total mean score and subscale scores were not significantly different between males and females. Conclusion: This study suggests that students' perception of the global learning environment in primary care was more positive than negative. The lowest scores were recorded for Students' Perceptions of Learning and Students' Social Self-Perceptions, and the highest score was recorded for Students' Academic Self-Perceptions.