The American journal of the medical sciences
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Idiopathic edema (IE), a disorder of females, is characterized by edema and weight gains exceeding 1.4 kg while assuming an upright position followed by nocturia and returning to a non-edematous baseline weight in the morning. There is no successful treatment of IE and the importance of nocturia needs to be emphasized. The major underlying abnormality is an increase in vascular membrane permeability (VMP). ⋯ All four cases virtually eliminated daily weight gains and nocturia to improve quality of life considerably, two with the assistance of daily hydrochlorothiazide (HCTZ) and all four by furosemide to accelerate recovery from the weight gain to permit occasional dietary indiscretions to improve quality of life. Two cases with milder forms of IE did not quantify sodium intake as meticulously as cases one and four, who appeared to have greater increases in VMP. IE can be treated successfully by sodium restriction with or without use of HCTZ and furosemide to eliminate the distressing edema, weight gain and nocturia with marked improvement in emotional instability after understanding that the weight gains and nocturia were linked to dietary intake of sodium.
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As COVID-19 continues to cause an increasing number of deaths worldwide, it is important that providers stay abreast with new research related to the pathophysiology of COVID-19 disease presentation states and clinical management. It is now well recognized that COVID-19 affects extrapulmonary organs, particularly the cardiovascular system. ⋯ We have highlighted the cardiovascular risk factors associated with disease prognostication in COVID-19 patients. We have also briefly discussed vasopressors and inotropes used for treating shock and presented their mechanism of action, contraindications, and side effects in the hopes of providing a quick reference to help the provider optimize management of COVID-19 patients presenting with cardiovascular complications such as shock.
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The expression of various isoforms of aquaporins (AQPs) in different tissues and organs of the body makes it a viable candidate for being responsible for maintaining cell stability and integrity as their involvement has been well documented in a number of pathophysiological conditions of the human body. Any alteration in the cellular environment brought about by these AQPs creates severe downstream effects like changes in cellular osmolality, volume, ionic composition, signaling pathways and even in the levels of intracellular second messengers and, as such, facilitates the occurrence of diseases like cancer. The altered equilibrium of water, extracellular ions and amino acid neurotransmitters caused by neuronal destruction and oxidative stress in neurodegenerative diseases proposed the role of these AQPs in these diseased conditions as well. ⋯ Renal diseases like nephrogenic diabetes inspidus, autosomal dominant polycystic kidney disease and acute kidney injury are some of the pathophysiological conditions related to malfunctioning of aquaporins. Besides, the malfunctioning of aquaglyceroporins like AQP7 and AQP9 makes them responsible for disorders like obesity, nonalcoholic fatty liver disease and non-alcoholic steatohepatitis. In this review article, we present our current understanding of the role of AQPs in the causation of these metabolic disorders and how targeting them holds promising therapeutic potential for most of these diseases like cancer, renal diseases and even cardiovascular disorders.
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This study examined three methods for retrospectively identifying infection in emergency department (ED) patients: modified objective definitions of infection (MODI) from the CDC/NHSN, physician adjudication determination of infection, and ED treating physician behavior. ⋯ Retrospective identification of infection poses a significant challenge in sepsis clinical trials. Using modified definitions of infection provides a standardized, less time consuming, and equally effective means of identifying infection compared to having multiple physicians adjudicate a patient's chart.