The American journal of the medical sciences
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The ultimate goal is to identify and target modifiable risk factors that will reduce major cardiovascular events in African American lupus patients. As a first step toward achieving this goal, this study was designed to explore risk factor models of preclinical atherosclerosis in a predominantly African American group of patients with systemic lupus erythematosus (SLE) using variables historically associated with endothelial function in nonlupus populations. Fifty-one subjects with SLE but without a history of clinical cardiovascular events were enrolled. ⋯ Similar results were obtained with machine learning models, but hydroxychlo-roquine use associated with controls in these models. This is the first study to demonstrate an association between atherosclerotic burden and 25(OH)D insufficiency or ACE inhibitor nonuse in lupus patients. These findings provide strong rationale for the study of ACE inhibitors and vitamin D replenishment as preventive therapies in this high-risk population.
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Clinically, retroperitoneal abscesses present insidiously and the diagnosis may be delayed. This, with inadequate drainage, may result in increased morbidity and mortality. Most cases result from a renal or gastrointestinal process, but in a small number of patients there is no identifiable source and the abscess is designated as "primary." Most retroperitoneal abscesses are polymicrobial, and cultures often reveal organisms such as Proteus mirabilis, Staphylococcus species, Peptostreptococcus, Enterococcus, Enterobacter, Escherichia coli and Bacteroides species. Fungal causes appear to be very rare, and in this study, a case of a patient with primary Candida glabrata retroperitoneal abscess is reported.
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Often seen in childhood, Henoch-Schönlein purpura (HSP) is a self-limiting illness, in which complications involving intussusception are rarely found in adults. This study reported a case of HSP initially presented as intussusception in a 60-year-old man. Gastrointestinal manifestations before the onset of rash may prevent an accurate diagnosis and appropriate management. Primary care physicians should be alert for this association between intussusception and HSP, especially in adult patients.
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Case Reports
Anicteric leptospirosis-associated severe pulmonary hemorrhagic syndrome: a case series study.
In leptospirosis, severe pulmonary hemorrhagic syndrome has replaced Weil's disease as the main cause of mortality, with rates of up to 75%. Four men, all farmers, were admitted to the intensive care unit between August 2009 and July 2010 with a diagnosis of acute respiratory distress syndrome. ⋯ Empirical therapy with ceftriaxone was administered immediately to all patients, while implementation of ARDSnet protective mechanical ventilation approach combined with an early goal-directed hemodynamic approach led to a relatively low mortality rate (25%). Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II and Sepsis-Related Organ Failure Assessment scoring systems were unable to predict the outcome of the patients with leptospirosis-associated severe pulmonary hemorrhagic syndrome.
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There has been enormous progress in the understanding of acute kidney injury (AKI) over the past 5 years. This article reviews some of the salient new findings, the challenges revealed by these findings and new insights into the pathogenesis of ischemic AKI. Clinical studies have demonstrated that even a small, transient rise in serum creatinine increases the risk of mortality in hospitalized patients and that a single event of AKI increases the risk for developing chronic kidney disease. ⋯ Current treatment is focused on maintaining renal perfusion and avoiding volume overload. However, new therapeutic targets are emerging for the treatment of AKI as our understanding of the pathogenesis of ischemic injury and inflammation increases. Early diagnosis, however, continues to be challenging as the search continues for sensitive and specific biomarkers.