Internal and emergency medicine
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Addison disease is due to the destruction or dysfunction of the entire adrenal cortex. Nowadays, the causes of adrenal insufficiency are autoimmune disease for 70-90% and tuberculosis for 7-20%. Many typical signs and symptoms, such as hyponatremia, hyperkalaemia, or renal insufficiency can represent the reasons for a nephrology consultation, especially in conditions of urgency, and they can easily be confused with other causes. ⋯ The blood tests showed in all three patients severe electrolyte disorders and acute renal failure which will be discussed in their physiopathogenetic mechanisms. In a peculiar way, these alterations were not controlled with repolarizing solutions, fluid replacement and increased volemia, but only after steroid administration. In conclusion, in this review all the known pathogenic mechanisms causing disorders of nephrological interest in adrenal insufficiency are discussed.
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To investigate the prognostic role of procalcitonin (PCT) assessment and blood culture (BC) acquisition in the emergency department (ED) in patients with urinary tract infection (UTI) or urosepsis. We enrolled patients admitted for UTI to our ED over a 10-year period. Mortality and in hospital length of stay (LOS) were compared between patients with UTI or urosepsis who had sampling for PCT levels and BC taken in the ED (ePCT group-eBC group) and those who had not (no-ePCT group-no-eBC group). 1029 patients were analyzed, 52.7% of which were female. ⋯ Performance of ePCT or eBC testing made no significant difference in terms of improvement of mortality rates in septic patients (11.4% vs. 7.2%; p = 0.397 and 8.8% vs. 9.8%; p = 0.845, respectively). The prognostic relevance of early evaluation of PCT and BC in the ED of patients with febrile UTI appears limited. In complicated UTI patients, PCT and BC testing may be more appropriate in the context of improving antibiotic stewardship, or as an integral component of PCT-guided standardized protocols.
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Whether there is a link between venous and arterial thrombotic disorders is still a matter of debate. They share common risk factors, such as old age, male sex and obesity. Endothelial dysfunction and inflammation are likely to play a role in determining the simultaneous involvement of the two vascular compartments. ⋯ In particular, the direct oral anticoagulants have recently been shown to reduce the risk of both vascular disorders. In conclusion, recent evidence provides compelling evidence in support of the link between venous and arterial thrombosis. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice.
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Ketogenic enteral nutrition (KEN™) is a modification of Blackburn's protein-sparing modified fast, using a hypocaloric, ketogenic liquid diet. The study is about ketogenic enteral nutrition (KEN) in overweight and obese patients receiving a short treatment of the nutritional solution as a 24-h infusion. It is a retrospective analysis that examines safety, weight loss and body composition changes after three sequential 10-day cycles of KEN therapy. ⋯ Results might be restricted to a British cohort only and should not be universally applied. Long-term results need to be explored in controlled studies. KEN treatment is safe, well tolerated and results in rapid fat loss without detriment to dry lean mass.