The American journal of the medical sciences
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Comparative Study
Clinical predictors and risk factors for relapsing Clostridium difficile infection.
Clostridium difficile infection (CDI) is a common cause of morbidity among hospitalized patients. Multiple factors have been associated with primary CDI, but risk factors for CDI relapses are less well described. ⋯ Fluoroquinolone use and prior stroke are associated with an increased risk of relapsing CDI. Relapsing CDI and severe CDI are both associated with increased 90-day mortality.
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Randomized Controlled Trial Multicenter Study Comparative Study
Tacrolimus combined with corticosteroids in treatment of nephrotic idiopathic membranous nephropathy: a multicenter randomized controlled trial.
Idiopathic membranous nephropathy (IMN), a common cause of nephrotic syndrome in adults, is usually treated with corticosteroids in combination with cyclophosphamide or cyclosporine. A recent placebo-controlled study suggested that tacrolimus monotherapy was effective in IMN. However, the effectiveness of tacrolimus versus classic regimen and its potential nephrotoxicity remain inconclusive. This study evaluated the efficacy and safety of tacrolimus plus prednisone in patients with nephrotic IMN. ⋯ Tacrolimus plus corticosteroids is an alternative therapeutic regimen for nephrotic IMN. The short-term efficacy might be better than cyclophosphamide plus prednisone.
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Immunoglobulin A nephropathy is the most common primary glomerulonephritis worldwide. The pathogenesis is still unknown and newer treatments are being researched. ⋯ Its association with hereditary lymphedema has been reported on one occasion but never with lymphedema-distichiasis syndrome. We report a patient with hereditary lymphedema-distichiasis syndrome and immunoglobulin A nephropathy occurring simultaneously.
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Multicenter Study Comparative Study
Association of hypoglycemia with mortality for subjects hospitalized with pneumonia.
Previous research has shown that hypoglycemia is associated with worse outcomes for the elderly, in sepsis, and in children with pneumonia. The purpose of this study was to examine whether hypoglycemia (<70 mg/dL) is associated with increased 30-day mortality, after adjusting for potential confounders, for adults hospitalized with pneumonia. ⋯ After adjusting for severity of illness and other potential confounders, hypoglycemia is significantly associated with 30-day mortality for patients hospitalized with pneumonia. Patients with hypoglycemia should be placed in closely monitored settings even when by pneumonia specific risk systems they would normally be discharged.
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In clinical practice, poisoning with ethylene glycol, methanol, and isopropyl alcohol is common. These alcohol-related intoxications can present with high anion gap metabolic acidosis and increased osmolality. Toxicity and clinical symptoms are due to the accumulation of their metabolites, causing increased anion gap, rather than the parent compounds that are associated with an increase of serum osmolality. ⋯ Fomepizole and ethanol are potent inhibitors of alcohol dehydrogenase and reduce generation of toxic metabolites. Hemodialysis is an effective way of detoxification because it can remove unmetabolized alcohol in addition to the organic anions. High index of suspicion and early diagnosis can prevent the significant morbidity and mortality associated with these intoxications.