Abstract:
:Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used to treat inflammatory pain for decades. More recently, newer NSAIDs were developed to target the inducible isoform of cyclooxygenase (COX), COX-2, with the aim of reducing gastrointestinal toxicity. While the COX-2 selective inhibitors were effective in reducing pain and gastrointestinal harm, they soon were associated with an increased risk of adverse cardiovascular events. Initially, the view emerged that selective inhibition of COX-2, and sparing of COX-1, was responsible for the increased cardiovascular harm observed. However, as more data from different human populations has become available this view has begun to be challenged. This review examines the current understanding of the role of prostaglandins and COX-1 and COX-2, particularly in platelets, the vasculature, and the kidney together with an overview of the cardiovascular and renal safety of both traditional NSAIDs and COX-2 selective inhibitors. Available data from active comparator randomized controlled trials, including the data from the PRECISION trial investigating the long term cardiovascular safety of patients exclusively with elevated baseline cardiovascular risk, are presented. The data, when considered holistically, support the idea that all NSAIDs carry some level of cardiovascular risk, be they traditional NSAIDs or COX-2 selective agents. There is also some evidence of heterogeneity of effect with NSAIDs particularly in relation to effects on blood pressure, with no clear demarcation based on the degree of COX-2 selectivity.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Walker C,Biasucci LMdoi
10.1080/00325481.2018.1412799subject
Has Abstractpub_date
2018-01-01 00:00:00pages
55-71issue
1eissn
0032-5481issn
1941-9260journal_volume
130pub_type
杂志文章,评审abstract::Throughout history, societies have circumscribed certain forms of intimacy in the family setting. Transgression has been punished by force of ecclesiastical rules and government statutes. However, no single definition of incest is widely accepted, as the degree of kinship in which marriage is allowed and the age of co...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11700738
更新日期:1989-06-01 00:00:00
abstract::Our diagnostic approach to a patient with dysphagia begins with detailed history taking and physical examination. On the basis of findings, a radiographic and/or endoscopic study of the esophagus is done. We usually have barium-swallow radiography done initially, and if the radiographs are equivocal, upper gastrointes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701537
更新日期:1992-11-15 00:00:00
abstract::Patients with dyslipidemia receive a cardiovascular benefit from lowering low-density lipoprotein cholesterol (LDL-C). Atorvastatin is currently one of the most effective approved medications for lowering LDL-C, and has been shown to significantly reduce cardiovascular risk in many patient groups. However, even with s...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2012.01.2513
更新日期:2012-01-01 00:00:00
abstract::Granulomatous inflammation of the peritoneal surfaces resulting from exposure to cornstarch granules from surgical gloves produces a syndrome of abdominal pair, adynamic ileus, fever, peritonitis, variable white blood cell count, and inflammatory ascites. Symptoms develop three to four weeks after a routine abdominal ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11716541
更新日期:1976-01-01 00:00:00
abstract::The term "enteropathic arthritis" describes joint manifestations that occur in conjunction with gastrointestinal disease. Underlying causes include inflammatory bowel disease, reactive arthritis, iatrogenic disease. Whipple's disease, and other gastrointestinal diseases. A possible association between Reiter's syndrom...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1989.11704368
更新日期:1989-08-01 00:00:00
abstract::Treating rheumatoid arthritis can be very satisfying when patients participate fully in designing and implementing their therapeutic strategy. However, the strategy's success depends on early intervention and disease modification. Many patients do well when education, rest, diet, exercise, and drug therapy are incorpo...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.02.314
更新日期:1998-02-01 00:00:00
abstract::Cataracts are the most common treatable form of reduced vision in older adults. Although the incidence of cataracts is high after age 65, careful history taking and clinical examination are essential to establish the diagnosis. Cataract surgery is medically indicated when the view to the retina is obscured or lens-ind...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.05.478
更新日期:1998-05-01 00:00:00
abstract::Hair loss is a common problem likely to be encountered by a clinical practitioner. The most frequent causes of hair loss in pediatric patients include tinea capitis, alopecia areata, traction alopecia, and trichotillomania. In the adult population, causes to be considered are alopecia areata and hair loss associated w...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699358
更新日期:1986-04-01 00:00:00
abstract::Febrile convulsions affect about 1 child in 30. Most of these children have a good outcome with no sequelae and do not require prophylactic medication. Differential diagnosis should include meningitis, epilepsy, hypoglycemia, and encephalopathies and other central nervous system disorders. Children with a high risk fo...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700905
更新日期:1991-04-01 00:00:00
abstract::The evaluation of the bleeding patient starts with the integration of data from the history and physical examination. From this results either one probable explanation that can easily be substatniated by laboratory studies or, as more commonly occurs in practice, several possibilities that are reasonable and must be i...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11712257
更新日期:1977-07-01 00:00:00
abstract::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...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2019.1650609
更新日期:2019-09-01 00:00:00
abstract::Cecal volvulus is a malrotational abnormality of the intestine that causes obstruction. Diagnosis is difficult and, if delayed, the results may be intestinal ischemia, perforation, sepsis, and even death. Cecal ischemia or gangrene cannot always be determined from physical and laboratory findings. Although not always ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716164
更新日期:1982-08-01 00:00:00
abstract::Even modest alcohol ingestion can increase the risk of steatosis, and long-term, excessive consumption can lead to alcoholic hepatitis and eventually cirrhosis. Most patients with clinically significant alcoholic liver disease have histologic findings typical of all three conditions. The only clearly beneficial treatm...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.04.462
更新日期:1998-04-01 00:00:00
abstract::Diagnosing acute otitis media (AOM) is quite challenging for physicians and especially other healthcare providers. Although the new guidelines from the American Academy of Pediatrics/American Academy of Family Physicians provide some guidance for making the correct diagnosis of AOM, overdiagnosis will still remain a p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.12.2005.suppl42.215
更新日期:2005-12-01 00:00:00
abstract::Persistent hoarseness in a patient should always alert the physician to the possibility of laryngeal carcinoma. Prompt visualization of the larynx is essential, particularly in high-risk patients over 40 years of age without a history of upper respiratory infection. Mirror examination (indirect laryngoscopy) is the us...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715452
更新日期:1980-05-01 00:00:00
abstract::Urinalysis and urine chemistries are most helpful in determining whether acute renal failure is due to a prerenal, renal, or postrenal cause. A plain film of the abdomen should be obtained, with ultrasound or computed tomography also being done if obstruction is suspected. When prerenal and postrenal causes have been ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716292
更新日期:1982-12-01 00:00:00
abstract::Human sexuality is a lifelong process with biologic, psychosocial, and moral consequences. During adolescence, coping with sexual feelings and controlling sexual drive become urgent tasks that are made more difficult by today's society. Recent studies document a dramatic increase in the frequency of sexual activity am...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716039
更新日期:1982-04-01 00:00:00
abstract::Gastroesophageal reflux disease is a very common condition that is usually manifested by heartburn or regurgitation. Reflux esophagitis, caused by mucosal exposure to the backflow of caustic gastric contents, is primarily a result of lower esophageal sphincter dysfunction. Diagnostic workup varies but commonly include...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11700938
更新日期:1991-05-15 00:00:00
abstract::The term "autoimmune thyroid disease" encompasses all of the autoimmune thyroid conditions, including Hashimoto's thyroiditis, Graves' disease, most cases of silent thyroiditis, and postpartum thyroiditis. Extrathyroidal manifestations (e.g., ophthalmopathy, dermopathy) can occur in Graves' disease and, less commonly,...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2000.01.810
更新日期:2000-01-01 00:00:00
abstract::This case report describes prolongation of a patient's prothrombin time and partial thromboplastin time possibly due to coadministration of warfarin and an overdose of an acetaminophen-propoxyphene combination analgesic. Patients receive warfarin for many indications, and concomitant use of an analgesic agent is commo...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700233
更新日期:1988-04-01 00:00:00
abstract::When a patient presents with involuntary weight loss, the etiologic considerations can be overwhelming. To plan a cost-effective workup, physicians need to be aware of the most common causes of weight loss and the tests that yield the most pertinent data. Drs Wise and Craig review the clinical studies on unintentional...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-03-01 00:00:00
abstract::Bronchiectasis is characterized by permanent, abnormal dilation of the bronchi with chronic inflammation and infection. Bronchiectasis is either caused by or associated with several systemic disorders, and in a significant number of cases, the underlying etiology remains unidentified and is subsequently referred to as...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2008.09.1912
更新日期:2008-09-01 00:00:00
abstract::The concurrent use of opioids, benzodiazepines (BZDs), and/or alcohol poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contri...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2013.07.2684
更新日期:2013-07-01 00:00:00
abstract::Successful joint and soft-tissue aspiration and injection rely on the physician's understanding of the indications, contraindications, and general techniques involved in these procedures. The procedures are generally well tolerated and can be used to treat many painful musculoskeletal and soft-tissue conditions. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2001.01.834
更新日期:2001-01-01 00:00:00
abstract::Syncope is a common complaint that is frequently evaluated without identifying a precipitating cause. Gelastic (laughter-induced) syncope is an uncommon and poorly understood condition. We describe 3 patients who experienced loss of consciousness during vigorous laughter. Each patient had an extensive medical evaluati...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2010.11.2231
更新日期:2010-11-01 00:00:00
abstract::Primary adrenal insufficiency due to tumor involvement is very rare. We herein report a case of adrenal insufficiency caused by cancer metastasis to a remaining single adrenal gland in a renal cell carcinoma patient who had undergone radical nephrectomy including removal of the right adrenal gland. The patient present...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2019.1696581
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:Laparoscopic adjustable gastric banding (LAGB) is an established bariatric surgical procedure that produces meaningful weight loss and improvements in patients with type 2 diabetes mellitus (T2DM) and a body mass index (BMI) ≥ 30 kg/m2. This study examined the effect of LAGB on T2DM status in severely obese p...
journal_title:Postgraduate medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.3810/pgm.2012.11.2590
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVE:To review glucose-lowering efficacy and changes in renal function associated with sodium-glucose co-transporter 2 (SGLT2) inhibitors among patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). DATA SOURCES:A literature search of MEDLINE and Cochrane databases was performed from 2000...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2019.1549459
更新日期:2019-01-01 00:00:00
abstract::In addition to sinus and dental abnormalities and stress, several different neurologic conditions can cause facial pain. These include various neuroalgias (trigeminal, vagoglosso-pharyngeal, cranial), carotodynia, and optic neuritis. Pain characteristics and results of specific neurologic tests establish the diagnosis...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1990.11704523
更新日期:1990-01-01 00:00:00
abstract::Preview No physician would treat hypertension without monitoring blood pressure, but some treat bronchial asthma without objectively measuring pulmonary function. This empirical approach is inappropriate, according to the authors, who discuss key measurements that should be taken to assess disease status, guide therap...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1995.11946003
更新日期:1995-06-01 00:00:00