The American journal of the medical sciences
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Comparative Study
A comparison of acute kidney injury classifications in patients with severe sepsis and septic shock.
Acute kidney injury (AKI) is a common and serious complication in patients with severe sepsis and septic shock. AKI can be classified using the RIFLE (Risk, Injury, Failure, Loss and End-stage) and/or the Acute Kidney Injury Network (AKIN) criteria. The aim of this study was to determine which of the 2 systems better predicted 28-day mortality in patients with severe sepsis and septic shock. ⋯ The incidence of AKI in patients with sepsis and septic shock was slightly higher using AKIN than RIFLE criteria. However, using the AKIN criteria did not enhance the ability of AKI to predict 28-day mortality in such patients.
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Frailty syndrome is frequently encountered in elderly populations. Frailty has been defined as a geriatric syndrome of increased vulnerability to environmental factors. Although knowledge of this syndrome continues to develop, there are still many areas of uncertainty. ⋯ Preventative strategies need to be studied. The role of specific biomarkers in early detection of frailty needs to be defined. Clinical trials are needed to find better interventions for this syndrome.
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The objective of this case report is to present a rare association of a mucosa-associated lymphoid tissue lymphoma masquerading as Graves' orbitopathy in a patient with autoimmune hyperthyroidism, without evidence of Graves' ophthalmopathy. A 66-year-old male patient had pain and swelling of the right eye. Evaluation of serum thyroid hormone revealed low thyrotropin, elevated free thyroxin and antithyroperoxidase antibody levels, confirming the diagnosis of Graves' disease. ⋯ Biopsy demonstrated a low-grade, B-cell type non-Hodgkin's lymphoma of the mucosa-associated lymphoid tissue. Treatment included radiotherapy and chemotherapy, with regression of the orbital lesion and medical treatment with methimazole and (131)I. Detailed orbital evaluation should be considered in all patients who present any atypical signs and symptoms of the eyes, to prevent missing important and progressive diagnoses.
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Angioedema is a frequently reported side effect of angiotensin-converting enzyme inhibitors. The literature suggests that immunosuppressed transplant patients are at an increased risk for this adverse condition. ⋯ The cases raised questions regarding evidence-based management of drug-induced angioedema, effectiveness of current medical management regimens and the potential of other treatment options. Our objective was to review the presentation, diagnosis and acute management of a common adverse drug effect based on an uncommon patient presentation.