The American journal of the medical sciences
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Review Case Reports
Disseminated Cryptococcosis in An Immunocompetent Host Presenting As Osteomyelitis and Leading to Adrenal Insufficiency.
Disseminated cryptococcosis infection typically occurs in immunocompromised patients, often through pneumonia or meningoencephalitis. Cases in immunocompetent patients are uncommon, and presentation in either bone or adrenal glands are rare. ⋯ Clinicians should be aware of atypical presentations of cryptococcal disease. In this review of the literature on cryptococcosis in immunocompetent patients, we find that while rare, cryptococcosis can affect varied organs and should be considered in the differential of infectious diseases.
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Review Case Reports
Immune Thrombocytopenia in a Kidney Transplant Recipient Treated with Romiplostim.
We present a case of immune thrombocytopenia following a living donor kidney transplant. Thrombocytopenia started two days after transplant and continued up to seven weeks after transplant, despite an extensive workup, treatment with steroids, intravenous immune globulin, and alterations in immunosuppression and other medications. ⋯ The patient's graft function has also been stable. This experience suggests romiplostim is safe and effective for persistent immune thrombocytopenia in kidney transplant recipients.
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A 77-year-old woman presented with a 2-year history of denture sores at the left mandibular gingiva. She had no smoking history or alcohol use. Intraoral examination showed a cauliflower-like, 28 × 20 mm mass on the left mandibular gingiva without induration. ⋯ An incisional biopsy was performed, and she was diagnosed with squamous cell carcinoma (SCC)(cT2N1M0, stage 2). She underwent segmental mandibulectomy, selective neck dissection, and immediate reconstruction under general anesthesia. At the 2 years follow-up, she remained free of disease.
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Benzodiazepines are the gold standard for alcohol withdrawal treatment but choice and dosing vary widely. In 2015, our institution implemented a Minnesota detoxification scale (MINDS) and single standardized high-dose diazepam based protocol for treatment of alcohol withdrawal to replace multiple Clinical Institute Withdrawal Assessment for Alcohol (CIWA) based protocols using lower dose benzodiazepines. We compared use of MINDS versus CIWA assessment protocols with high front loading diazepam treatment in care of patient experiencing alcohol withdrawal during hospitalization. ⋯ Higher dose front loading long acting benzodiazepine can be safely used with beneficial outcomes in hospitalized alcohol withdrawal patients.
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Observational Study
Hip Fracture Risk in Elderly with Non-End-Stage Chronic Kidney Disease: A Fall Related Analysis.
The aim of this study was to evaluate the risk of fracture as a consequence of trauma and its association with kidney function status in a cohort of elderly patients. ⋯ Our study confirms that patients with non-end stage CKD have an increased risk of femur fracture after a fall. Our data supports the hypothesis that this risk could be associated with increased bone fragility in CKD patients. Active osteoporosis therapy was found to be an effective preventive factor in our cohort.