The American journal of the medical sciences
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Review Case Reports
A Fatal Case of Thrombotic Microangiopathy Without Schistocytosis and Absent Biochemical Markers of Hemolysis.
Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia with thrombocytopenia. In addition to the primary TMA syndromes, microangiopathic hemolytic anemia with thrombocytopenia can be seen in many systemic diseases. Transplant associated TMA (TA-TMA) affects patients following stem cell or solid organ transplant. ⋯ An autopsy revealed TMA involving all clinically affected organ systems and was deemed to be the cause of his demise. The absence of typical blood work suggestive of hemolysis does not rule out a diagnosis of TA-TMA. Knowledge of this rare disease entity will help physicians identify and treat this life-threatening condition early and effectively.
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The significance of effective renal perfusion is relatively underemphasized in the current literature. From a renal standpoint, besides optimizing cardiac output, renal perfusion should be maximized as well. ⋯ Therefore, to optimize nephron-protective therapies, nephrologists and intensive care physicians should be familiar with the concept of net renal perfusion pressure. This review appraises the background literature on renal perfusion pressure, including the initial animal data and historical human studies up to the most current developments in the field, exploring potential avenues to assess and improve renal blood supply.
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Case Reports
An Unexpected Case of Lagochilascariasis: Interdisciplinary Management and Use of 12S and 18S rDNA Analysis.
A Mexican 24-year-old male patient was referred to our hospital due to increased left retroauricular volume with skin fistulisation, resembling an infection by the uncommon worm Lagochilascaris minor. The patient was submitted to lateral skull base surgery. No adult worms or eggs were observed during light and scanning electron microscopy analysis, as well as by histopathologic examination of the small piece of removed tissue, only L3 stage larvae of Lagochilascaris spp. were identified. ⋯ The molecular analysis identified the worm as L minor. According to previous reports, lagochilascariasis is a complicated infection that requires an interdisciplinary management by different clinical specialists. This is the first time that 12S and 18S rDNA genes are reported as molecular markers for diagnosis of L minor.
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This study aimed to describe the prevalence of type 2 diabetes and combinations of multiple chronic conditions (MCCs) that are leading causes of death (LCD) and confirm that disparities exist between groups based on race and sex. ⋯ Race and sex disparities occur in the prevalence of type 2 diabetes and MCCs that are LCD in Medicare beneficiaries in the state of Michigan.