The American journal of the medical sciences
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Certain patient populations have a high prevalence of hypertension, including black, elderly, or obese patients; patients with metabolic syndrome, or frank diabetes; and patients with chronic kidney disease. Many of these patients experience renin-angiotensin-aldosterone system (RAAS) dysregulation, which is important because the RAAS plays a pivotal role in the pathogenesis of hypertension, cardiovascular disease, and renal dysfunction. ⋯ Aliskiren, the first direct renin inhibitor, is effective in a number of these patient groups, including those who are black or obese or who have metabolic syndrome, renal impairment, or diabetes. In addition, in the setting of long-term angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, aldosterone receptor antagonists (spironolactone and eplerenone) provide another rational therapeutic approach for patients whose blood pressure is not controlled by standard therapies.
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Clostridium innocuum is an unusual cause of infections in humans. This report describes the first published case of C. innocuum bacteremia in a patient with AIDS and provides a review of the literature. The case suggests that recent C. difficile infection may be a risk factor for the subsequent development of C. innocuum bacteremia among immunosuppressed persons. Because of their intrinsic resistance to several common antibiotics, including vancomycin, C. innocuum infections are important to recognize.