European journal of internal medicine
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Eur. J. Intern. Med. · Feb 2014
Immunological profiles determine neurological involvement in Sjögren's syndrome.
Up to 68% of patients with primary Sjögren's syndrome (pSS) undergo neurological complications, and evidence for distinct immunological subgroups is emerging. We sought to determine systemic and immunological profiles associated with neurological manifestations. ⋯ In pSS, patients with sensorimotor neuropathies and pure sensory neuropathies have distinct extraglandular and immunological profiles.
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Eur. J. Intern. Med. · Feb 2014
ReviewMineralocorticoid receptor blockade in addition to angiotensin converting enzyme inhibitor or angiotensin II receptor blocker treatment: an emerging paradigm in diabetic nephropathy: a systematic review.
Blockade of the renin-angiotensin-aldosterone system (RAAS) is a standard therapeutic intervention in diabetic patients with chronic kidney disease (CKD). Concomitant mineralocorticoid receptor blockade has been studied as a novel approach to further slow down CKD progression. We used PubMed and EMBASE databases to search for relevant literature. ⋯ This effect may be due to the specific properties of the MRB treatment. Clinicians should regularly check potassium levels because of the increased risk of hyperkalemia. Available evidence should be confirmed by an adequately powered comparative trial of the standard treatment (ACEI or ARB) versus combined treatment by an ACEI/ARB and a MRB.
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Eur. J. Intern. Med. · Feb 2014
Case ReportsAll that is red is not cellulitis. Pyoderma gangrenosum.
A 60-year-old patient presented with progressive worsening, non-healing ulcer on her shin with surrounding erythema following a minor trauma and was treated with several antibiotics for presumed cellulitis with no improvement. A skin biopsy eventually suggested pyoderma gangrenosum and a colonic biopsy showed an underlying ulcerative colitis.
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Eur. J. Intern. Med. · Feb 2014
Acute kidney injury in an internal medicine ward in a Portuguese quaternary hospital.
The term acute kidney injury (AKI) was proposed to reflect the wide spectrum of traditional acute renal failure. RIFLE classification stratifies AKI into three classes of severity and two classes of outcome. AKIN classification proposes an improvement regarding RIFLE in the stratification of AKI, while recently published KDIGO guidelines comprise characteristics of both RIFLE and AKIN. There are no published studies on the utility and measure of agreement between classifications in patients admitted to internal medicine wards. ⋯ Our results demonstrate good concordance and correlation between RIFLE, AKIN and KDIGO criteria for the diagnosis of AKI (p<0.001 at initial and final assessment). The authors support the need for further improvement of the classification, ultimately through the use of new biomarkers capable of earlier identification of patients at risk.
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Eur. J. Intern. Med. · Feb 2014
Acute urticaria presenting in the emergency room of a general hospital.
Acute urticaria is a common disorder that often prompts patients to seek treatment in the emergency room (ER). There are few data on acute urticaria presenting in ER. ⋯ Patients with acute urticaria are frequently referred to the emergency room, but only in a few cases urticaria is associated with severe allergic manifestations. Drug and food hypersensitivity, together with anaphylaxis, are the best predictors of the length of stay in ER.