Summary
Post‐transplant erythrocytosis (PTE) can occur in up to 10–16% after kidney transplant (KT). However, the post‐transplant outcomes of recipients with PTE in the literature were conflicting. ...We performed systematic review and meta‐analysis of published studies to evaluate risk factors of PTE as well as outcomes of recipients who developed PTE compared with controls. A literature search was conducted evaluating all literature from existence through February 2, 2021, using MEDLINE and EMBASE. Data from each study were combined using the random‐effects model. (PROSPERO: CRD42021230377). Thirty‐nine studies from July 1982 to January 2021 were included (7,099 KT recipients). The following factors were associated with PTE development: male gender (pooled RR = 1.62 1.38, 1.91, I2 = 39%), deceased‐donor KT (pooled RR = 1.18 1.03, 1.35, I2 = 32%), history of smoking (pooled RR = 1.36 1.11, 1.67, I2 = 13%), underlying polycystic kidney disease (PKD) (pooled RR=1.56 1.21, 2.01, I2=44%), and pretransplant dialysis (pooled RR=1.6 1.02, 2.51, I2=46%). However, PTE was not associated with outcomes of interest, including overall mortality, death‐censored graft failure, and thromboembolism. Our meta‐analysis demonstrates that male gender, deceased‐donor KT, history of smoking, underlying PKD, and pretransplant dialysis were significantly associated with developing PTE. However, with proper management, PTE has no impact on prognosis of KT patients.
Male gender, deceased‐donor KT, history of smoking, underlying PKD, and pretransplant dialysis were significantly associated with developing PTE. However, with proper management, PTE has no impact on the prognosis of KT patients.
A 60-year-old man with no significant medical history was found unresponsive by his neighbour; he had neck stiffness on physical examination in the emergency department. He later developed acute ...hypoxic respiratory failure requiring endotracheal intubation. He is a binge drinker on weekends, and methamphetamine was detected in his urine. Contrast-enhanced CT of the chest, abdomen and pelvis revealed multifocal pneumonia, bilateral psoas abscesses and right infraspinatus muscle abscess. Blood, sputum and cerebrospinal fluid cultures grew Streptococcus pneumoniae. Transthoracic echocardiography (TTE) revealed tricuspid endocarditis with mild valve insufficiency. He was initially treated with intravenous antibiotics and underwent incision and drainage of right psoas abscess. However, he still had recurrent fever and confusion. Repeat TTE showed larger vegetation, and he also developed septic emboli at the posterior basal right lower lobe pulmonary artery. The patient underwent tricuspid valve debridement and was finally discharged after completing 6 weeks of intravenous antibiotic treatment.
A wide range of cardiac arrhythmias were reported in the setting of active infection or as a complication of COVID-19. The main pathophysiology can be attributed to dysautonomia or autonomic nervous ...system dysfunction. Postural orthostatic tachycardia syndrome (POTS) is a complex, multisystemic disorder affecting usually younger age with tachycardia at rest or with minimal effort being the main symptom. Data regarding the safety and efficacy of ivabradine in POTS treatment is limited to small studies and case reports.
This prospective observational study included a total of 55 COVID-19-associated POTS patients after the exclusion of other causes of tachycardia. Ivabradine 5 mg twice daily was initiated. Re-assessment of patients' symptoms, heart rate, and heart rate variability (HRV) parameters' changes after 3 days of ivabradine therapy was done.
The mean age of the included patients was 30.5±6.9 years with 32 patients being males (58.2%). 43 of 55 (78%) of the included patients reported significant improvement of the symptoms within 7 days of ivabradine therapy. 24-hour heart rate (minimum, average, and maximum) was significantly lower (
-value < 0.0001*, = 0.001*, < 0.0001* consecutively) with a significant difference in HRV time-domain parameters (SDNN, rMSSD) (
-value < 0.0001*) after ivabradine therapy.
In a prospective study that evaluated the effects of ivabradine in post-COVID-19 POTS, patients treated with ivabradine reported improvement of their symptoms within 7 days of ivabradine treatment with a significant reduction of 24-hour average, minimum, and maximum heart rate, and improvement of HRV time domains parameters. Ivabradine might be a useful option to relieve symptoms of tachycardia in COVID-19 POTS. Further research is required to confirm the safety and efficacy of ivabradine in POTS treatment.
Eosinophilia with pulmonary involvement is characterized by the presence of peripheral blood eosinophilia, typically >500 cells/mm3, nonspecific pulmonary symptoms, and radiographic evidence of ...pulmonary disease. Clinical, laboratory, and radiologic features can be overlapping in these diseases, thus, it is wise to approach eosinophilia with pulmonary involvement systematically to determine the diagnosis and provide definitive treatment for a better outcome. The authors present a case of idiopathic chronic eosinophilic pneumonia in a patient with a long history of chronic obstructive pulmonary disease (COPD) which was resolved by corticosteroid.
Introduction: Posttransplant anemia is a common finding after kidney transplantation. A previous meta-analysis reported an association between anemia and graft loss. However, data on cardiovascular ...outcomes have not yet been reported. Objective: We conducted an updated meta-analysis to examine the association between posttransplant anemia and outcomes after transplantation including cardiovascular mortality in adult kidney transplant recipients. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to November 2021. Data from each study were combined using the random-effects model. Generic inverse variance method of DerSimonian and Laird was employed to calculate the risk ratios and 95% CIs. Results: Seventeen studies from August 2006 to April 2019 were included (16 463 kidney transplantation recipients). Posttransplant anemia was associated with overall mortality (pooled risk ratio = 1.72 1.39, 2.13, I2 = 56%), graft loss (pooled risk ratio = 2.28 1.77, 2.93, I2 = 94%), cardiovascular death (pooled risk ratio = 2.06 1.35, 3.16, I2 = 0%), and cardiovascular events (pooled risk ratio = 1.33 1.10, 1.61, I2 = 0%). Early anemia (≤6 months), compared with late anemia (>6 months), has higher risk of overall mortality and graft loss with a pooled risk ratio of 2.63 (95% CI 1.79-3.86; I2 = 0%) and 2.96 (95% CI 2.29-3.82; I2 = 0%), respectively. Discussion: In addition to increased risk of graft loss, our updated meta-analysis demonstrated that posttransplant anemia was significantly associated with poor outcomes after kidney transplantation including overall mortality, graft loss, cardiovascular death, and cardiovascular events. Future studies are required to assess the effects of treatment strategies for posttransplant anemia on posttransplant outcomes including cardiovascular mortality.
Central diabetes insipidus (DI) is an uncommon condition caused by reduced or lack of vasopressin secretion from the posterior pituitary gland, typically caused by gland destruction. Several other ...causes for central DI have also been proposed. Here we present a case of transient central DI after discontinuation of vasopressin used for septic shock without evidence of overt pituitary damage in a cystic fibrosis patient. The serum sodium concentration peaked at 137 mmol/L in the setting of polyuria within 3 days of vasopressin discontinuation without other identified alternative etiologies. Sodium levels and urine output trended down dramatically with desmopressin administration.
Idiopathic spontaneous pneumoperitoneum Deb, Anasua; Ghosh, Binita; Cavazos, Annia ...
Proceedings - Baylor University. Medical Center,
2022, Letnik:
35, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Spontaneous pneumoperitoneum is the presence of free air in the peritoneum without evidence of any perforation of hollow viscera. The usual presentation includes acute abdominal pain with ...leukocytosis and elevated inflammatory markers. Here we present a case of spontaneous pneumoperitoneum occurring recurrently in a 58-year-old man with inclusion body myositis and hypertension who presented with cellulitis of both legs. Abdominal computed tomography demonstrated retroperitoneal free air; however, colonoscopy, esophagogastroduodenoscopy, and a prior laparoscopy did not demonstrate any perforation of hollow viscera. Conservative management with antibiotics and symptom control with antiemetics and pain medicines led to clinical improvement, and the patient was discharged home in stable condition.
Fungal empyema is an uncommon condition associated with high morbidity and mortality.
empyema thoracis is rare and is usually associated with preexisting chronic empyema, pulmonary tuberculosis, or ...rupture of aspergilloma cavity. This case describes a healthy 20-year-old man presenting with chronic intractable back pain and constitutional symptoms for 6 months who was eventually diagnosed with
empyema thoracis, complicated by empyema necessitans extending into multiple ribs and paravertebral areas. He was treated with surgical decortication, chest tube drainage, and systemic antifungal agents. The diagnostic difficulties of fungal empyema thoracis are highlighted.
