Postgraduate medicine
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Postgraduate medicine · Jan 2025
Trends of primary health care practitioners toward bleeding management in Saudi Arabia: a cross-sectional analysis.
High rates of morbidity and mortality are a result of trauma being a significant health burden in Saudi Arabia. We evaluated the current trends of primary healthcare (PHC) physicians in Saudi Arabia toward patients with bleeding and their referral awareness for percutaneous endovascular arterial embolization (EAE). ⋯ PHC physicians in Saudi Arabia require a better understanding of the indications of EAE to avoid referral and triage errors, inefficient use of healthcare resources, and suboptimal patient outcomes.
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Postgraduate medicine · Jan 2025
Metabolic, hormonal profiles and comorbidities in pituitary Cushing's syndrome, adrenal Cushing's syndrome and mild autonomous cortisol secretion: a comparative study.
Our study aimed to discern disparities in metabolic, hormonal profiles, and comorbidities among patients with pituitary Cushing (PC), adrenal Cushing (AC), and Mild autonomous cortisol secretion (MACS). ⋯ Our findings suggest that urinary cortisol levels were significantly higher in the PC group than in the AC and MACS groups, potentially indicating that high-amplitude adrenocorticotropic hormone stimulation may lead to increased cortisol secretion in PC patients. The increased utilization of imaging methods has facilitated the earlier detection of adrenal incidentalomas, enabling the diagnosis of adrenal Cushing's cases with milder cortisol elevations. Additionally, the severity of disease symptoms worsens with increasing cortisol levels.Notably, moderate increases in cortisol are associated with heightened comorbidities, underscoring the importance of vigilant management in Cushing's syndrome patients. Despite a lower degree of hypercortisolism in MACS, there were no differences in comorbidities, suggesting that even mild cortisol secretion abnormalities are sufficient to establish the presence of comorbidities. Even moderate increases in cortisol levels can impact bone metabolism.
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Postgraduate medicine · Jan 2025
Post cardiac surgery acute kidney injury and the role of intravenous amino acids infusions.
Acute kidney injury (AKI) is a well-established and serious complication associated with cardiovascular revascularization procedures, regardless of its severity. According to the 2023 annual report of the National Institute of Diabetes and Digestive and Kidney Diseases - United States Renal Data System, the incidence of cardiovascular disease-related AKI hospitalizations has been steadily increasing over the past decade. Coronary artery bypass grafting (CABG), on the other hand, remains one of the most frequently performed major surgical procedures in the United States, with an estimated 400,000 surgeries conducted annually. ⋯ The reported incidence in literature is anywhere between 1% to 50%. Although healthcare teams employ various supportive measures to prevent its occurrence, a single universally effective preventive intervention for AKI-CABG remains elusive. This article focuses on a critical evaluation of the PROTECTION trial, a pioneering study evaluating the hypothesis that intravenous amino acid infusion would reduce the incidence of AKI-CABG using intravenous amino acid therapy (Isopuramin 10%, Baxter) in patients undergoing elective CABG surgery.
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Venous thromboembolism (VTE), consisting of both deep vein thrombosis (DVT) and pulmonary embolism (PE), is an extremely common condition both in the United States and worldwide. Not only is the diagnosis associated with significant morbidity and mortality for patients but it also imposes a deleterious financial burden on the US healthcare system. Diagnosis may be challenging due to variability in clinical presentation and requires a sequential workup including assessment of clinical pretest probability for VTE, D-dimer testing, and imaging. ⋯ First-line treatment for most patients is anticoagulation with a direct oral anticoagulant (DOAC) for a minimum of 3-6 months. In multiple clinical trials, DOACs have proven to be non-inferior to vitamin K antagonists for the treatment of VTE with a lower risk of bleeding. Special consideration should be taken in the choice of agent and duration of treatment for patients who have underlying thrombophilias or malignancy and who are pregnant.
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Postgraduate medicine · Jan 2025
ReviewQuality of guidelines for hyperthyroidism: systematic quality assessment using the AGREE II tool.
The aim of this study was to systematically assess the quality of different guidelines for the management of patients with hyperthyroidism and to explore and analyze the recommendations and key evidence in different guidelines. ⋯ The quality of hyperthyroidism treatment guidelines is variable, and treatment recommendations vary greatly from guideline between guidelines. Analyzing and improving the causes of inconsistencies in recommendations for patients with hyperthyroidism could be a reasonable and effective way for developers to improve the quality of guidelines for the management of hyperthyroidism.