CPD Articles

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Clinical Articles

Chronic Granulomatous Disorder

Chronic granulomatous disease (CGD) is an inherited immunodeficiency that is caused by genetic mutations resulting in the inability of the phagocytes (Neutrophils and Monocytes) to kill certain ingested microbes. CGD results from a mutation in the Nicotinamide Adenine Dinucleotide phosphate (NADPH) oxidase enzyme complex, found in phagocytic cells. This defect results in recurrent, life-threatening bacterial and fungal infections.



Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Cholera remains a global threat to public health and an indicator of inequity and lack of social development.


Herd immunity, vaccination and moral obligation

The public health benefits of herd immunity are often used as the justification for coercive vaccine policies. Yet, ’herd immunity’ as a term has multiple referents, which can result in ambiguity, including regarding its role in ethical arguments. The term ’herd immunity’ can referto (1) the herd immunity threshold, at which models predict the decline of an epidemic; (2) the percentage of a population with immunity, whether it exceeds a given threshold or not; and/or (3) the indirect benefit afforded by collective immunity to those who are less immune.


Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Studies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of the intra-articular injection of PRP combined with HA compared with the intra-articular injection of PRP or HA alone in the treatment of KOA

Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective

The COVID-19 pandemic has exposed the inadequacies of the current healthcare system and needs a paradigm change to one that is holistic and community based, illustrated by the healing wheel. The present paper proposes that existential positive psychology (PP 2.0) represents a promising approach to meet the rising needs in palliative care. This framework has a twofold emphasis on (a) how to transcend and transform suffering as the foundation for wellbeing and (b) how to cultivate our spiritual and existential capabilities to achieve personal growth and flourishing. 


The effect of vitamin D supplementation on depressive symptoms in adults: A systematic review and meta‐analysis of randomized controlled trials

Neurosteroid and immunological actions of vitamin D may regulate depression-linked physiology. Meta‐analyses investigating the effect of vitamin D on depression have been inconsistent. This meta-analysis investigated the efficacy of vitamin D in reducing depressive symptoms among adults in randomized placebo-controlled trials (RCT). General and clinical populations, and studies of ill individuals with systemic diseases were included. Light therapy, co-supplementation (except calcium) and bipolar disorder were exclusionary.


The Role of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA) in Diabetes-Related Neurodegenerative Diseases

Recent clinical guidelines have emphasized the importance of screening for cognitive impairment in older adults with diabetes, however, there is still a lack of understanding about the drug therapy. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are widely used in the treatment of type 2 diabetes and potential applications may include the treatment of obesity as well as the adjunctive treatment of type 1 diabetes mellitus in combination with insulin. 

APR 11, 2023  | CLINICAL: 2 POINTS

Health effects of voluntary exposure to cold water – a continuing subject of debate

This review is based on a multiple database survey on published literature to determine the effects on health following voluntary exposure to cold-water immersion (CWI) in humans. After a filtering process 104 studies were regarded relevant. Many studies demonstrated significant effects of CWI on various physiological and biochemical parameters.


Light therapy for preventing seasonal active disorder (Review)

Seasonal a+ective disorder (SAD) is a seasonal pattern of recurrent major depressive episodes that most commonly occurs during autumn or winter and remits in spring. The prevalence of SAD ranges from 1.5% to 9%, depending on latitude. The predictable seasonal aspect of SAD provides a promising opportunity for prevention. This review - one of four reviews on e+icacy and safety of interventions to prevent SAD - focuses on light therapy as a preventive intervention.


New Therapeutic Horizons for Graves’ Hyperthyroidism
Graves’ hyperthyroidism is characterized by the presence of autoantibodies that stimulate the thy‐ roid-stimulating hormone receptor (TSHR), resulting in uncontrolled secretion of excessive thy‐ roid hormone. Conventional treatments, including antithyroid medication, radioiodine, or surgeryhave remained largely unchanged for the past 70 years and either lack efficacy for many patients,or result in lifelong thyroid hormone replacement therapy, in the case of the latter 2 options.


Multiple sclerosis

Multiple sclerosis (MS) is one of the most common neurological disorders. It has the potential to
disable the brain and spinal cord, meaning the central nervous system. MS affects almost 2.1 million
people worldwide.


Association between early postoperative nutritional supplement utilisation and length of stay in malnourished hip fracture patients

Malnutrition in older hip fracture patients is associated with increased complication rates and mortality. As postoperative nutrition delivery is essential to surgical recovery, postoperative nutritional supplements including oral nutritional supplements or tube feeding formulas can improve postoperative outcomes in malnourished hip/femur fracture patients. The association between early postoperative nutritional supplements utilisation and hospital length of stay was assessed in malnourished hip/femur fracture patients.


Growth and Clinical Outcome in Very Low-Birth-Weight Infants After the Introduction of a Multicomponent Intravenous Lipid Emulsion

Very low-birth-weight (VLBW; birth weight<1500 g) infants are often dependent on intravenous nutrition after birth. Conventional soy-based intravenous lipid emulsions (Soy LE) are associated with inflammatory and metabolic complications that may be harmful to preterm infants. Evidence to support any clinical benefit associated with newer multicomponent emulsions (Mixed LE), remains inconsistent and unsubstantiated in appropriate studies. This retrospective study aimed to determine whether growth and clinical outcomes differed betweenVLBWinfants given Mixed LE vs Soy LE at Auckland City Hospital.


Parenteral nutrition with fish oil-based lipid emulsion reduces the risk of cholestasis in preterm infants

Preterm infants receive long-term parenteral nutrition (PN) for gastrointestinal immaturity. This study aimed to determine if mixed lipid emulsions containing fish oil decrease
the incidence of PN-associated cholestasis by reducing oxidative stress and providing an antiinflammatory effect.

FEB 16, 2023  |  CLINICAL: 3 POINTS

Supplemental parenteral nutrition in cancer care: why, who, when

Malnutrition is an often-overlooked challenge for patients with cancer. It is associated with muscle mass reduction, poor compliance and response to cancer treatments, decreased quality of life, and reduced survival time. The nutritional assessment and intervention should be a vital part of any comprehensive cancer treatment plan.

FEB 16, 2023  |  CLINICAL: 3 POINTS

Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery

The effect of and optimal timing for initiating supplemental parenteral nutrition (SPN) remain unclear after major abdominal surgery for patients in whom energy targets
cannot be met by enteral nutrition (EN) alone.

FEB 15, 2023  |  CLINICAL: 3 POINTS

Effects of glutamine supplementation on critically ill patients: Focus on efficacy and safety. An overview of systematic reviews

The aim of this overview of systematic reviews was to synthesize, appraise, and present all systematic review (SR) evidence on the clinical efficacy of glutamine administration to severely ill patients.

FEB 15, 2023  |  CLINICAL: 3 POINTS

Glutamine for Amelioration of Radiation and Chemotherapy Associated Mucositis during Cancer Therapy

Health promotion is an effective tool for public health. It goes beyond preventing the spread of diseases and reducing the disease burden. It includes interventions encompassing the creation of supportive environments, building public health policy, developing personal skills, reorienting health services and strengthening multisectoral community actions.

FEB 15, 2023  |  CLINICAL: 3 POINTS

Glutamine for Amelioration of Radiation and Chemotherapy Associated Mucositis during Cancer Therapy

 Glutamine is a major dietary amino acid that is both a fuel and nitrogen donor for healing tissues damaged by chemotherapy and radiation. Evidence supports the benefit of oral (enteral) glutamine to reduce symptoms and improve and/or maintain quality of life of cancer patients. Benefits include not only better nutrition, but also decreased mucosal damage (mucositis, stomatitis, pharyngitis, esophagitis, and enteritis).

FEB 15, 2023  |  CLINICAL: 3 POINTS
DiGeorge Syndrome

Malnutrition is highly prevalent in hospitalized patients but seldom recognized and treated. Malnutrition poses several adverse events, such as increased infection rates, length of hospital stay, and mortality, as well as costs. Thus, this study aims to evaluate the cost-effectiveness of nutrition therapy, including oral supplements to at-risk or malnourished adult inpatients admitted to the Brazilian Public System (SUS) hospitals.

NOV 7, 2022  |  CLINICAL: 2 POINTS

Ethics Articles

The POPI Act and the laboratory

The POPI Act is essentially an act which protects people from harm by protecting their personal information. The act regulates the flow of information and sets out a code of conduct pertaining to how personal information is collected, handled, distributed and stored and eventually discarded. The POPI Act sets out the minimum standards regarding accessing and 'processing' of any personal information belonging to another. The Act defines 'processing' as collecting, receiving, recording, organising, retrieving, the use, distribution or sharing of any such information.

OCT 24, 2023 |  ETHICS: 2 POINTS

Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults

Whether video laryngoscopy as compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt among critically ill adults is uncertain.

JUL 11, 2023  |  ETHICS: 2 POINTS

Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I

Each year more than 400 physicians take their lives, likely related to increasing depression and burnout. Burnout—a psychological syndrome featuring emotional exhaustion, depersonalization, and a
reduced sense of personal accomplishment—is a disturbingly and increasingly prevalent phenomenon
in healthcare, and emergency medicine (EM) in particular.

JUL 10, 2023 |  ETHICS: 2 POINTS

Gender Differences in Experiences of Leadership Emergence Among Emergency Medicine Department Chairs

The number of women entering medicine continues to increase, but women remain underrepresented at all tiers of academic rank and chair leadership in EM. The proportion of female chairs in EM has not exceeded 12% in 2 decades.

JUL 10, 2023 |  ETHICS: 2 POINTS

Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US

The prevalence of workplace mistreatment and its association with the well-being of emergency medicine (EM) residents is unclear. More information about the sources of mistreatment might encourage residency leadership to develop and implement more effective strategies to improve professionalwell-being not only during residency but also throughout the physician’s career. To examine the prevalence, types, and sources of perceived workplace mistreatment during training among EM residents in the US and the association between mistreatment and suicidal

JUL 10, 2023 |  ETHICS: 2 POINTS

What We Have Learned from Two Decades of Epidemics and Pandemics: A Systematic Review and Meta-Analysis of the Psychological Burden of Frontline Healthcare Workers

In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers’ mental health could inform appropriate support interventions. Thus, we aimed to synthesize and quantify the psychological
and psychosomatic symptoms among frontline medical staff.

JUL 10, 2023 |  ETHICS: 2 POINTS

ETHICS: Principles of Clinical Ethics and Their Application to Practice

An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence,
nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality
spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). 

APR 6, 2023 |  ETHICS: 2 POINTS

Ethical considerations at the end-of-life care

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients’ desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients’ family members and society as well as the patients, it is important to protect the rights, dignity, and vigor
of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care.

FEB 16, 2023 |  ETHICS: 3 POINTS