Postgraduate medicine
-
Postgraduate medicine · Sep 2013
ReviewHerpes zoster: diagnostic, therapeutic, and preventive approaches.
Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. ⋯ Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz.
-
Postgraduate medicine · Sep 2013
Review Case ReportsAsterixis related to gabapentin intake: a case report and review.
Asterixis has been reported as a side effect of toxic and metabolic abnormalities. The current literature contains very little evidence of gabapentin-related neurotoxicity. Our observations reveal that neurotoxic side effects of gabapentin use may be seen even when dose adjustments are made for patients with mild-to-moderate renal dysfunction. Clinical vigilance for possible neurotoxic effects of gabapentin therapy in patients with renal dysfunction is warranted.
-
Postgraduate medicine · Sep 2013
ReviewImpact of sodium glucose cotransporter 2 inhibitors on weight in patients with type 2 diabetes mellitus.
Most patients with type 2 diabetes mellitus (T2DM) are overweight or obese. Both T2DM and overweight/obesity are associated with increased patient risk of cardiovascular events and mortality. Despite being the recognized cornerstone of treatment, weight loss and maintenance of weight loss are difficult for patients with T2DM, particularly as treatments for T2DM may cause weight gain. ⋯ Due to the caloric loss associated with decreased glucose in urine, treatment with SGLT2 agents offers the benefit of weight loss to patients, as well as reduction in hyperglycemia. Clinical trials of SGLT2 inhibitors in patients with T2DM, ranging in length from 4 to 90 weeks, have shown patient weight reductions from baseline of up to 4.7 kg. Such weight loss may have beneficial effects on adherence to medication, glycemic control, and cardiovascular risk in patients with T2DM.