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By Erica Yama Nephrologist
O Goren, I Matot
Perioperative acute kidney injury (AKI) is not uncommon and is associated with considerable morbidity and mortality. Recently, several definition systems for AKI were proposed, incorporating both small changes of serum creatinine and urinary output reduction as diagnostic criteria. Novel biomarkers are under investigation as fast and accurate predictors of AKI. Several special considerations regarding the risk of AKI are of note in the surgical patient. Co-morbidities are important risk factors for AKI. The surgery in itself, especially emergency and major surgery in the critically ill, is associated with a high incidence of AKI...
December 2015: British Journal of Anaesthesia
Jadwiga A Wedzicha, Marc Miravitlles, John R Hurst, Peter M A Calverley, Richard K Albert, Antonio Anzueto, Gerard J Criner, Alberto Papi, Klaus F Rabe, David Rigau, Pawel Sliwinski, Thomy Tonia, Jørgen Vestbo, Kevin C Wilson, Jerry A Krishnan
This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts...
March 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Elena Prina, Otavio T Ranzani, Antoni Torres
Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria...
September 12, 2015: Lancet
Rabih O Darouiche, Matthew J Wall, Kamal M F Itani, Mary F Otterson, Alexandra L Webb, Matthew M Carrick, Harold J Miller, Samir S Awad, Cynthia T Crosby, Michael C Mosier, Atef Alsharif, David H Berger
BACKGROUND: Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine. METHODS: We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint...
January 7, 2010: New England Journal of Medicine
Ala A Abudayyeh, Amit Lahoti, Abdulla K Salahudeen
No abstract text is available yet for this article.
May 2014: Kidney International
Detlef Schlöndorff
No abstract text is available yet for this article.
May 2014: Kidney International
Neeraj Dhaun, Christopher O Bellamy, Daniel C Cattran, David C Kluth
Characterizing chronic kidney disease (CKD) at all stages is an essential part of rational management and the renal biopsy plays a key role in defining the processes involved. There remain no global guidelines available to the renal community on indications for this important diagnostic, prognostic, and relatively safe test. Although most nephrologists recognize several clear indications for a renal biopsy, it is still underutilized. It not only helps the clinician to manage the patient with CKD, but it can also help clarify the epidemiology of CKD, and aid research into the pathobiology of disease with the aim of discovering new therapies...
May 2014: Kidney International
Bertram L Kasiske
No abstract text is available yet for this article.
September 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Thiruvengadam Muniraj, Sabitha Vignesh, Shilpa Shetty, Sudha Thiruvengadam, Harry R Aslanian
No abstract text is available yet for this article.
January 2013: Disease-a-month: DM
Stephen Boateng
No abstract text is available yet for this article.
March 2013: Disease-a-month: DM
Stephen Boateng, Timothy Sanborn
No abstract text is available yet for this article.
March 2013: Disease-a-month: DM
Jingyi Liu, Jared Novack, Robert Aitchison, Pamela Aitchison, Ernest Wang, Morris Kharasch
No abstract text is available yet for this article.
May 2013: Disease-a-month: DM
Goce Spasovski, Raymond Vanholder, Bruno Allolio, Djillali Annane, Steve Ball, Daniel Bichet, Guy Decaux, Wiebke Fenske, Ewout J Hoorn, Carole Ichai, Michael Joannidis, Alain Soupart, Robert Zietse, Maria Haller, Sabine van der Veer, Wim Van Biesen, Evi Nagler
Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment...
April 2014: Nephrology, Dialysis, Transplantation
Sengwee Toh, Marsha E Reichman, Monika Houstoun, Mary Ross Southworth, Xiao Ding, Adrian F Hernandez, Mark Levenson, Lingling Li, Carolyn McCloskey, Azadeh Shoaibi, Eileen Wu, Gwen Zornberg, Sean Hennessy
BACKGROUND Although certain drugs that target the renin-angiotensin-aldosterone system are linked to an increased risk for angioedema, data on their absolute and comparative risks are limited to the use of most drugs that target the system. We assessed the risk for angioedema associated with the use of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and the direct renin inhibitor aliskiren. METHODS We conducted a retrospective, observational, inception cohort study of patients 18 years or older from 17 health plans participating in the Mini-Sentinel program who had initiated the use of an ACEI (n = 1 845 138), an ARB (n = 467 313), aliskiren (n = 4867), or a β-blocker (n = 1 592 278) between January 1, 2001, and December 31, 2010...
October 15, 2012: Archives of Internal Medicine
Cees G M Kallenberg, Peter Heeringa, Coen A Stegeman
Wegener's granulomatosis and microscopic polyangiitis are idiopathic systemic vasculitides strongly associated with antineutrophil cytoplasmic autoantibodies (ANCA). In Wegener's granulomatosis, ANCA are mostly directed against proteinase 3 (PR3), whereas in microscopic polyangiitis ANCA are directed against myeloperoxidase; increases in levels of these autoantibodies precede or coincide with clinical relapses in many cases. In vitro, ANCA can further activate primed neutrophils to release reactive oxygen species and lytic enzymes, and, in conjunction with neutrophils, can damage and lyse endothelial cells...
December 2006: Nature Clinical Practice. Rheumatology
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