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https://www.readbyqxmd.com/read/28329088/short-course-adjunctive-gentamicin-as-empirical-therapy-in-patients-with-severe-sepsis-and-septic-shock-a-prospective-observational-cohort-study
#1
David S Y Ong, Jos F Frencken, Peter M C Klein Klouwenberg, Nicole Juffermans, Tom van der Poll, Marc Bonten, Olaf Cremer
Background.: Meta-analyses failed to demonstrate clinical benefits of beta lactam plus aminoglycoside combination therapy, compared to beta lactam monotherapy, in patients with sepsis. However, few data exist on the effects of short-course adjunctive aminoglycoside therapy in sepsis patients with organ failure or shock. Methods.: We prospectively enrolled consecutive patients with severe sepsis or septic shock in two intensive care units in the Netherlands from 2011 to 2015...
February 28, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28329085/renal-sodium-avidity-in-heart-failure-from-pathophysiology-to-treatment-strategies
#2
Wilfried Mullens, Frederik Hendrik Verbrugge, Petra Nijst, Wai Hong Wilson Tang
Increased neurohumoral stimulation resulting in excessive sodium avidity and extracellular volume overload are hallmark features of decompensated heart failure. Especially in case of concomitant renal dysfunction, the kidneys often fail to elicit effective natriuresis. While assessment of renal function is generally performed by measuring serum creatinine-a surrogate for glomerular filtration-, this only represents part of the nephron's function. Alterations in tubular sodium handling are at least equally important in the development of volume overload and congestion...
February 23, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28320990/comorbidities-and-complications-in-nonagenarians-undergoing-coronary-angiography-and-intervention
#3
Mohamed Gayed, Nour Yadak, Waad Qamhia, Yunis Daralammouri, Marc-Alexander Ohlow
Elderly people represent the fastest growing portion of cardiovascular patients. We aimed to analyze the clinical presentation, risk factors, co-morbidities, complications, and mortality in patients 90 years or more who underwent coronary angiography and intervention.We retrospectively studied 108 (0.25% of 43,385) consecutive patients ≥ 90 years undergoing cardiac catheterization and/or intervention in a tertiary specialist hospital between 2003 and 2014.Most patients (68.5%) were introduced on an emergency basis, especially with acute coronary syndrome (ACS) (63...
March 21, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28288051/long-term-effects-of-remote-ischemic-preconditioning-on-kidney-function-in-high-risk-cardiac-surgery-patients-follow-up-results-from-the-renalrip-trial
#4
Alexander Zarbock, John A Kellum, Hugo Van Aken, Christoph Schmidt, Mira Küllmar, Peter Rosenberger, Sven Martens, Dennis Görlich, Melanie Meersch
BACKGROUND: In a multicenter, randomized trial, the authors enrolled patients at high-risk for acute kidney injury as identified by a Cleveland Clinic Foundation score of 6 or more. The authors enrolled 240 patients at four hospitals and randomized them to remote ischemic preconditioning or control. The authors found that remote ischemic preconditioning reduced acute kidney injury in high-risk patients undergoing cardiac surgery. The authors now report on the effects of remote ischemic preconditioning on 90-day outcomes...
March 13, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28280700/allograft-loss-from-acute-page-kidney-secondary-to-trauma-after-kidney-transplantation
#5
Kazuhiro Takahashi, Rohini Prashar, Krishna G Putchakayala, William J Kane, Jason E Denny, Dean Y Kim, Lauren E Malinzak
We report a rare case of allograft loss from acute Page kidney secondary to trauma that occurred 12 years after kidney transplantation. A 67-year-old Caucasian male with a past surgical history of kidney transplant presented to the emergency department at a local hospital with left lower abdominal tenderness. He recalled that his cat, which weighs 15 lbs, jumped on his abdomen 7 d prior. On physical examination, a small tender mass was noticed at the incisional site of the kidney transplant. He was producing a normal amount of urine without hematuria...
February 24, 2017: World Journal of Transplantation
https://www.readbyqxmd.com/read/28258441/tnf-%C3%AE-il-6-and-il-10-expressions-responsible-for-disparity-in-action-of-curcumin-against-cisplatin-induced-nephrotoxicity-in-rats
#6
Parveen Kumar, Kunjbihari Sulakhiya, Chandana C Barua, Nitin Mundhe
Cisplatin is a regularly employed effective chemotherapeutic agent for the treatment of many types of cancer. The main drawback of cisplatin treatment is kidney toxicity which affects 25-35% of treated patients. Many mechanisms are believed to be involved in this kidney damage, but inflammation plays a significant role in this event. Curcumin is a polyphenol and has antioxidant and anti-inflammatory effects. The purpose of this study was to determine the protective effects of curcumin on cisplatin-induced nephrotoxicity...
March 3, 2017: Molecular and Cellular Biochemistry
https://www.readbyqxmd.com/read/28257549/analysis-of-intensive-care-unit-admission-and-sequelae-in-patients-intravenously-abusing-extended-release-oral-oxymorphone
#7
Matthew W Wilson, Alex K Bonnecaze, Ajay Dharod, Peter J Miller
OBJECTIVES: Prescription drug abuse is a major public health problem in the United States, with the rate of opioid-related deaths nearly quadrupling between 2000 and 2014. Extended-release oral oxymorphone hydrochloride (Opana ER) is a long-acting opioid prescribed for chronic pain; however, it also has the potential to be abused via intravenous injection. This retrospective review sought to analyze specific complications and sequelae requiring intensive care unit resources for patients intravenously abusing extended-release oral oxymorphone...
March 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28236080/what-are-the-frequency-associated-factors-and-mortality-of-amputation-and-arthrodesis-after-a-failed-infected-tka
#8
Min-Sun Son, Edmund Lau, Javad Parvizi, Michael A Mont, Kevin J Bozic, Steven Kurtz
BACKGROUND: For patients with failed surgical treatment of an infected TKA, salvage operations such as arthrodesis or above-knee amputation (AKA) may be considered. Clinical and institutional factors associated with AKA and arthrodesis after a failed TKA have not been investigated in a large-scale population, and the utilization rate and trend of these measures are not well known. QUESTIONS/PURPOSES: (1) How has the frequency of arthrodesis and AKA after infected TKA changed over the last 10 years? (2) What clinical or institutional factors are associated with patients undergoing arthrodesis or AKA? (3) What is the risk of mortality after arthrodesis or AKA? METHODS: The Medicare 100% National Inpatient Claims Database was used to identify 44,466 patients 65 years of age or older who were diagnosed with an infected TKA and who underwent revision between 2005 and 2014 based on International Classification of Diseases, 9(th) Revision, Clinical Modification codes...
February 24, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28224376/a-case-of-atypical-hemolytic-uremic-syndrome-in-a-second-renal-transplant
#9
Nicholas A Zwang, Bing Ho, Yashpal S Kanwar, Brad Lewis, Matthew Cusick, John J Friedewald, Lorenzo Gallon
Atypical hemolytic uremic syndrome (aHUS) has gained increased visibility over several years as an important cause of renal failure. Unfortunately, diagnosis is often difficult because individual courses can be highly variable depending the causative genetic mutations. Here we present the case of a patient with a failed renal allograft and acute failure of a second allograft who was ultimately diagnosed with aHUS. Interestingly, he developed early de novo donor specific antibodies (DSA) after the second renal transplant in context of likely recurrent aHUS...
February 21, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#10
Aaron Weinberg, Victor F Tapson, Danny Ramzy
Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hemodynamic stability, and successfully treat massive PE...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28183805/klotho-expression-in-long-bones-regulates-fgf23-production-during-renal-failure
#11
Jovana Kaludjerovic, Hirotaka Komaba, Tadatoshi Sato, Reinhold G Erben, Roland Baron, Hannes Olauson, Tobias E Larsson, Beate Lanske
Circulating levels of bone-derived fibroblast growth factor 23 (FGF23) increase early during acute and chronic kidney disease and are associated with adverse outcomes. Membrane-bound Klotho acts as a permissive coreceptor for FGF23, and its expression was recently found in osteoblasts/osteocytes. We hypothesized that Klotho in bone cells is part of an autocrine feedback loop that regulates FGF23 expression during renal failure. Thus, we induced renal failure in mice with targeted deletion of Klotho in long bones...
February 9, 2017: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
https://www.readbyqxmd.com/read/28155015/nitrofurantoin-safety-and-effectiveness-in-treating-acute-uncomplicated-cystitis-auc-in-hospitalized-adults-with-renal-insufficiency-antibiotic-stewardship-implications
#12
B A Cunha, C B Cunha, B Lam, J Giuga, J Chin, V F Zafonte, S Gerson
Nitrofurantoin remains a key oral antibiotic stewardship program (ASP) option in the treatment of acute uncomplicated cystitis (AUC) due to multi-drug resistant (MDR) Gram negative bacilli (GNB). However, there have been concerns regarding decreased nitrofurantoin efficacy with renal insufficiency. In our experience over the past three decades, nitrofurantoin has been safe and effective in treating AUC in hospitalized adults with renal insufficiency. Accordingly, we retrospectively reviewed our recent experience treating AUC in hospitalized adults with decreased renal function (CrCl < 60 ml/min) with nitrofurantoin...
February 2, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28129461/bullous-pemphigoid-associated-with-nivolumab-a-programmed-cell-death-1-protein-inhibitor
#13
Chase W Kwon, Anna S Land, Bruce R Smoller, Glynis Scott, Lisa A Beck, Mary Gail Mercurio
Checkpoint inhibitors, such as nivolumab, are revolutionary new drugs in cancer therapy. Mild dermatologic toxicities are commonly reported adverse events. Herein, we highlight the development of the autoimmune blistering condition, bullous pemphigoid (BP) in a patient undergoing treatment with nivolumab. A 60-year-old man, who was being treated with nivolumab (3mg/kg intravenously every 2 weeks) after failing chemotherapy for metastatic renal cell carcinoma, presented acutely with a blistering rash. This article is protected by copyright...
January 27, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/28119255/limitations-of-current-liver-transplant-immunosuppressive-regimens-renal-considerations
#14
Wei Zhang, John Fung
BACKGROUND: The use of calcineurin inhibitor (CNI)-based immunosuppressive regimens following liver transplantation (LTx) has improved the outcomes of the recipients. However, CNI has nephrotoxicity and causes short- and long-term renal complications. The progressive structural changes can be irreversible in the long-term, leading to chronic kidney dysfunction. The present review was to evaluate the different strategies of CNI application to renal function in liver recipients. DATA SOURCES: PubMed database was searched for relevant articles in English on the issue of immunosuppressive regimen and kidney injury that related to early minimization of CNI after LTx...
February 2017: Hepatobiliary & Pancreatic Diseases International: HBPD INT
https://www.readbyqxmd.com/read/28054732/liver-transplantation-is-associated-with-good-clinical-outcome-in-patients-with-active-tuberculosis-and-acute-liver-failure-due-to-anti-tubercular-treatment
#15
REVIEW
Michele Bartoletti, Giulia Martelli, Sara Tedeschi, Mariacristina Morelli, Valentine Bertuzzo, Marina Tadolini, Paolo Pianta, Francesco Cristini, Maddalena Giannella, Russell E Lewis, Antonio D Pinna, Pierluigi Viale
BACKGROUND: Active tuberculosis (TB) is commonly considered a contraindication for liver transplantation (LT). However, in patients with TB who develop acute liver failure (ALF) due to toxicity induced by anti-tubercular treatment (ATT), LT could be the only opportunity. The aim of this study was to evaluate the feasibility of LT in this scenario. METHODS: We described 2 cases and comprehensively reviewed the literature finding 26 cases of LT performed in patients having a concomitant active TB and liver failure secondary to ATT toxicity...
January 5, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28033261/elevated-thrombopoietin-and-platelet-indices-confirm-active-thrombopoiesis-but-fail-to-predict-clinical-severity-of-puumala-hantavirus-infection
#16
Outi Laine, Lotta Joutsi-Korhonen, Riitta Lassila, Heini Huhtala, Antti Vaheri, Satu Mäkelä, Jukka Mustonen
We evaluated the mechanisms of thrombocytopenia and procoagulant changes in relation with clinical variables in a cohort of patients with acute hantavirus disease.Blood samples of 33 prospectively recruited, consecutive, hospitalized patients with acute Puumala virus-induced hemorrhagic fever with renal syndrome (HFRS) were collected acutely and at the recovery visit (control). Serum thrombopoietin (TPO) and activity of plasma microparticles (MPs) from various cell sources were measured with enzyme-linked immunosorbent assay-based methods...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27959707/epidemiology-of-acute-kidney-injury-in-critically-ill-children-and-young-adults
#17
MULTICENTER STUDY
Ahmad Kaddourah, Rajit K Basu, Sean M Bagshaw, Stuart L Goldstein
Background The epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe acute kidney injury. Methods We used the Kidney Disease: Improving Global Outcomes criteria to define acute kidney injury. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury (plasma creatinine level ≥2 times the baseline level or urine output <0...
January 5, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/27942395/current-outcomes-of-off-pump-coronary-artery-bypass-grafting-evidence-from-real-world-practice
#18
REVIEW
Piroze M Davierwala
Coronary artery bypass grafting (CABG) can be performed conventionally using cardiopulmonary bypass (CPB) and aortic clamping or on a beating heart (BH) without the use of CPB, the so-called off-pump CABG. Some surgeons, who are proponents of off-pump CABG, preferentially use this technique for the majority of operations, whereas others use it only in certain situations which warrant avoidance of CPB. Ever since the conception of off-pump CABG, the never-ending debate about which technique of CABG is safe and efficacious continues to date...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27927599/angiotensin-converting-enzyme-2-amplification-limited-to-the-circulation-does-not-protect-mice-from-development-of-diabetic-nephropathy
#19
Jan Wysocki, Minghao Ye, Ahmed M Khattab, Agnes Fogo, Aline Martin, Nicolae Valentin David, Yashpal Kanwar, Mark Osborn, Daniel Batlle
Blockers of the renin-angiotensin system are effective in the treatment of experimental and clinical diabetic nephropathy. An approach different from blocking the formation or action of angiotensin II (1-8) that could also be effective involves fostering its degradation. Angiotensin-converting enzyme 2 (ACE2) is a monocarboxypeptidase that cleaves angiotensin II (1-8) to form angiotensin (1-7). Therefore, we examined the renal effects of murine recombinant ACE2 in mice with streptozotocin-induced diabetic nephropathy as well as that of amplification of circulating ACE2 using minicircle DNA delivery prior to induction of experimental diabetes...
December 4, 2016: Kidney International
https://www.readbyqxmd.com/read/27888551/selective-targeting-of-high-affinity-lfa-1-does-not-augment-costimulation-blockade-in-a-nonhuman-primate-renal-transplantation-model
#20
K P Samy, D J Anderson, D J Lo, M S Mulvihill, M Song, A B Farris, B S Parker, A L MacDonald, C Lu, T A Springer, S C Kachlany, K A Reimann, T How, F V Leopardi, K S Franke, K D Williams, B H Collins, A D Kirk
Costimulation blockade (CoB) via belatacept is a lower-morbidity alternative to calcineurin inhibitor (CNI)-based immunosuppression. However, it has higher rates of early acute rejection. These early rejections are mediated in part by memory T cells, which have reduced dependence on the pathway targeted by belatacept and increased adhesion molecule expression. One such molecule is leukocyte function antigen (LFA)-1. LFA-1 exists in two forms: a commonly expressed, low-affinity form and a transient, high-affinity form, expressed only during activation...
November 26, 2016: American Journal of Transplantation
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