The American journal of medicine
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Vancomycin-associated nephrotoxicity was reported in 0% to 5% of patients in the 1980s. This has been confirmed by numerous clinical trials comparing novel anti-methicillin-resistant Staphylococcus aureus agents with vancomycin at the Food and Drug Administration-approved dosage of 1 g every 12 hours. Treatment failures of vancomycin in patients with methicillin-resistant S. aureus infections have been reported despite in vitro susceptibility. ⋯ These increased rates are confounded by concomitant nephrotoxins, renal insufficiency, or changing hemodynamics. These studies also have demonstrated that vancomycin's nephrotoxicity risk is minimal in patients without risk factors for nephrotoxicity. Clinicians unwilling to dose vancomycin in accordance with clinical practice guidelines should use an alternative agent because inadequate dosing increases the likelihood of selecting heteroresistant methicillin-resistant S. aureus isolates.
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Multicenter Study
Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease.
Common autoimmune disorders tend to coexist in the same subjects and to cluster in families. ⋯ This is one of the largest studies to date to quantify the risk of diagnosis of coexisting autoimmune diseases in more than 3000 index cases with well-characterized Graves' disease or Hashimoto's thyroiditis. These risks highlight the importance of screening for other autoimmune diagnoses if subjects with autoimmune thyroid disease present with new or nonspecific symptoms.
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Few studies have examined the relationship between ethnicity and tolerance of hypertension medications. We investigated the perception that Chinese-Americans may have a higher incidence of chronic cough from angiotensin-converting enzyme inhibitors. ⋯ We observed that our Chinese group was more than twice as likely as the general population to discontinue lisinopril due to cough, controlling for the influence of sex, age, and smoking.