The American journal of the medical sciences
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Critical illnesses continue to be major causes of morbidity and mortality worldwide. Recent investigations show that stem cells may be beneficial as prognostic biomarkers and novel therapeutic strategies in these syndromes. This article reviews the use of stem cells in sepsis and acute lung injury as prognostic biomarkers and also as a potential for exogenous cell-based therapy. ⋯ Stem cells have shown significant promise in the field of critical care medicine both for prognostication and treatment strategies. Although recent studies have been done to describe the mechanistic pathways of stem cells in critical illness, further investigation is necessary to fully delineate the mechanisms behind a stem cell's immunomodulatory characteristics and its ability to mobilize and engraft in tissues.
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Many challenges have made it difficult to determine the prevalence of spondyloarthritis (SpA) in North America. They include the ethnic heterogeneity of the population, the lack of feasibility of applying current criteria (such as requirements for human leukocyte antigen-B27 testing and imaging studies such as pelvic radiographs and magnetic resonance imaging scanning) and the transient nature of some SpA symptoms (ie, peripheral arthritis and enthesitis). Current estimates of the prevalence of SpA in the United States range between 0.2% and 0.5% for ankylosing spondylitis, 0.1% for psoriatic arthritis, 0.065% for enteropathic peripheral arthritis, between 0.05% and 0.25% for enteropathic axial arthritis and an overall prevalence of SpA as high as >1%. With newer population-based instruments becoming available, the availability of the widely validated European Spondyloarthropathy Study Group criteria and the lower cost and greater feasibility of genetic testing, opportunities for true population-based studies of SpA are possible and will likely soon ensue.
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Practical complications of chronic systemic corticosteroid (SC) use in patients with sarcoidosis are poorly characterized. The objective of this study was to determine the impact of SC use in patients with sarcoidosis on unscheduled sarcoidosis-attributed and nonsarcoidosis-attributed healthcare utilization (SHCU and NSHCU, respectively). ⋯ Greater SC use is associated with small but significant increase in HCU related to infection and increased unscheduled emergency department visits for complaints not directly attributable to sarcoidosis.
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A traditional method for internal jugular vein catheterization has been through the transjugular approach. These days, ultrasound-guided cannulation is the preferred mode because of the higher success and lower complication rates. ⋯ This complication occurred in one of the patients in whom ultrasound-guided left internal jugular vein catheterization was used. The anatomical basis of this injury is discussed here.
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The most common complications of umbilical hernias in patients with cirrhosis and ascites include leakage, ulceration, rupture and incarceration. If such a complication is present, there is a high mortality rate after surgical repair. Elective repair is the most effective choice, as it prevents complications with a lower mortality. ⋯ Patients with cirrhosis and umbilical hernias should be referred for consideration of an elective surgical repair with mesh, preferably after optimal management of ascites. There should be a low threshold for placement of a TIPS to facilitate surgery and reduce the chance of severe recurrence of ascites. If surgery is contraindicated, a TIPS must be considered for control of ascites.