Postgraduate medicine
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Postgraduate medicine · Jan 2023
ReviewType 2 diabetes and cardiovascular disease: risk reduction and early intervention.
People with type 2 diabetes (T2D) have a higher risk of cardiovascular (CV) disease (CVD) than those without. This increased risk begins with pre-diabetes, potentially 7-10 years before T2D is diagnosed. Selecting medication for patients with T2D should focus on reducing the risk of CVD and established CVD. ⋯ This article reviews the approved agents with CV indications, with a focus on injectable GLP-1RAs, and their place in the T2D treatment paradigm according to current guidelines. We aim to provide primary healthcare providers with in-depth information on subsets of patients who would benefit from this type of therapy and when it should be initiated, taking into consideration safety and tolerability and other disease factors. An individualized treatment approach is increasingly recommended in the management of T2D, employing a shared decision-making strategy between patients and healthcare professionals.
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Giant cell arteritis (GCA, also known as temporal arteritis) is classified as a vasculitis of large and medium sized vessels and can involve the cranial vessels as well as the aorta and great vessels. It is a systemic rheumatic disease that virtually never occurs in adults younger than 50 years of age. GCA is the most common idiopathic systemic vasculitis. ⋯ Glucocorticoids have been the longstanding treatment option for GCA but relatively recent studies have proven additional agents like Tocilizumab are effective steroid sparing agents. GCA is a disease that is of variable duration and length of treatment differs from patient to patient. This article will review the epidemiology, pathogenesis, clinical manifestations, work up and treatment options for GCA.
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Postgraduate medicine · Jan 2023
ReviewBehcet disease: an undifferentiating and complex vasculitis.
Behçet Disease is a relapsing and remitting variable vessel vasculitis characterized by recurrent mucocutaneous ulcers that can involve almost every organ system in the body. Indeed, the presence of recurrent oral or genital ulcers with other auto-inflammatory symptoms should raise suspicion for this elusive disease. ⋯ Classically seen in Mediterranean, Middle-Eastern, and eastern Asian countries, and relatively rare in the United States, prevalence has been increasing, prompting an increased need for internists to be aware of Behcet's clinical presentation and treatment. As early recognition and diagnosis of the disease is key to successful treatment and better prognosis, this review provides a brief summary of the current etiological theories, important clinical manifestations, and treatments including newer biologic alternatives.
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This review aims to describe the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of eosinophilic granulomatosis with polyangiitis (EGPA). Eosinophilic granulomatosis with polyangiitis is a small to medium vessel necrotizing vasculitis, typically classified with granulomatosis with polyangiitis (GPA) and microscopic polyangitis (MPA) as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, less than 50% of patients with EGPA have a positive ANCA test. ⋯ More severe disease frequently requires the use of aggressive therapy such as cyclophosphamide. Once treatment is initiated, patients can achieve good control of symptoms; unfortunately, disease relapses are common and prolonged treatment with corticosteroids is often necessary for asthma management. A better understanding of the disease heterogeneity is needed for the development of better therapies.
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Postgraduate medicine · Jan 2023
ReviewA "health message" on sustainable physical and mental health for the prolonged COVID-19 and other pandemics.
The world has been living with another pandemic physical inactivity (PI) and sedentary behavior (SB) and of other nature for years. As social measures to prevent the spread of COVID-19 have been strengthened, the physical activity (PA) barrier has been hit and the PI/SB pandemic has been exacerbated, and in the current situation, triggered by its prolonged period, it is emerging as a problem to be considered in order to combat the PI/SB pandemic through PA and to maintain continuous physical and mental health. This review aims to summarize existing and recent studies on the effects of PA/SB on physical and mental health in preparation for the context of prolonged COVID-19 and provides an easy and fun way to motivate, access PA, and PA recommendations for maintaining physical and mental health. ⋯ The clinical relevance of this review shows that integrating PA into daily life and reducing prolonged sitting time is an important strategy for continuing a healthy life physically and mentally. As a result, for those who have not yet incorporated exercise as part of their daily routine, fun and easy access to PA suggests that in the long run, may be an opportunity to implement newer habits. In addition, in an emergency such as the COVID-19 quarantine period or other pandemics, it is essential for one to maintain health through PA at home, and underscore the 'health message' of the current review that reducing SB, progressively increasing PA, and doing more PA regularly in the current context prolonged COVID-19 can bring significant benefits to long-term habits and physical and mental health.