Postgraduate medicine
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Postgraduate medicine · Jun 2021
Tiotropium in asthma - perspectives for the primary care physician.
Asthma is a heterogeneous disease characterized by airway inflammation resulting from complex interactions between multiple hosts as well as environmental factors. As a chronic respiratory condition, asthma exerts a significant impact on patients and the healthcare system. Per the Global Initiative for Asthma (GINA), inhaled corticosteroids (ICS) with/without long-acting beta2-agonists (LABAs) should be used as the preferred controllers for the management of asthma. ⋯ Add-on tiotropium was found to be well tolerated and efficacious in all RCTs. Moreover, the findings from real-world studies complement results from RCTs, showing beneficial effects of tiotropium in reducing exacerbations, hospitalization, emergency room visits, and asthma worsening. In this review article, we discuss the pathophysiology of asthma and the role of tiotropium in the management of asthma from the perspective of a primary care physician.
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Postgraduate medicine · Jun 2021
Case ReportsAnesthetic consideration for airway management in patient undergoing tracheal resection and reconstruction for severe postintubation tracheal stenosis: a case report.
Introduction Severe postintubation tracheal stenosis (PITS) is a rare iatrogenic complication after endotracheal intubation. Case presentation A case of PITS in a 51-year-old male undergoing partial pericardiectomy with a principal diagnosis of tuberculous constrictive pericarditis. Within 6 hours of extubation, a second emergency intubation lasting 120 hours was performed. ⋯ Mechanical ventilation with a ProSeal laryngeal mask airway (PLMA) and preparation for extracorporeal circulation as a final rescue option were performed to maximize patient safety. The patient underwent a tracheal resection and reconstruction without complications. Conclusion A supraglottic airway mode may be a practical and worthwhile alternative for patients with severe PITS.
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Postgraduate medicine · Jun 2021
Serum uric acid and arterial lactate levels in patients with obstructive sleep apnea syndrome: the effect of CPAP treatment.
Objectives: Serum uric acid (UA) and arterial lactate acid (LA) are markers of oxidative stress and tissue hypoxia that are present in patients with obstructive sleep apnea syndrome (OSAS). The aim of the study was to evaluate the associations between UA and LA levels and OSAS characteristics as well as the effect of their levels after continuous positive airway pressure (CPAP) treatment. Methods: This is a retrospective of newly diagnosed patients with OSAS. ⋯ Several sleep parameters were independent predictors of UA and LA levels. Conclusion: In OSAS patients increased serum UA and arterial LA levels are found. CPAP therapy resulted in significant reductions in levels of both biomarkers.
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Postgraduate medicine · May 2021
EditorialThe necessary evolution of diabetes fellowships in the united states.
The number of Americans affected by diabetes continues to increase but the number of endocrinologists with specialty training to treat this population has not kept up with demand. Primary care outpatient visits can also not meet the projected diabetes population demands or the needs for other complex diabetes management issues. ⋯ This can fill some of the gaps left by a lack of resources in the U. S. healthcare system.
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Postgraduate medicine · May 2021
ReviewDiagnosis and conservative management of great toe pathologies: a review.
Acute great toe (Hallux) pain is a common complaint encountered by the primary care physician. Pathological conditions can vary from acute trauma to acute exacerbation of underlying chronic conditions. ⋯ The acute pathologies discussed in this review are hallux fractures and dislocations, turf toe, sand toe, and sesamoid disorders. The chronic pathologies discussed include hallux rigidus, hallux valgus, and chronic sesamoiditis.