The American journal of the medical sciences
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Although awareness of chronic kidney disease (CKD) is low in outpatient settings, the prevalence of unrecognized CKD in the inpatient setting is unknown. ⋯ A large proportion of individuals with CKD are going unrecognized in the hospital setting. Automatic laboratory reporting of GFR and education about CKD may help increase awareness in both the inpatient settings.
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Lumbar puncture is a commonly practiced bedside technique for acquiring cerebrospinal fluid for the purposes of examination, spinal anesthesia, and as therapeutic trial for normal pressure hydrocephalus. Headache and backache after lumbar puncture are not uncommon. We report an elderly woman who suffered from altered consciousness and acute neurologic deficit after a difficult lumbar puncture. ⋯ Clinicians should be aware of these rare but life-threatening complications after lumbar puncture. A cranial unenhanced CT is mandatory for patients having acute altered consciousness after lumbar puncture. A thorough vascular imaging evaluation from the lumbar spine to the brain is warranted in selected cases.
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Symmetric skin thickening of the limbs with deep fascial inflammation is the hallmark of eosinophilic fasciitis. We describe a woman who presented with unilateral progressive skin thickening. ⋯ It is possible that unilateral eosinophilic fasciitis is under-recognized and can easily be misdiagnosed as another scleroderma variant if a full-thickness biopsy is not reviewed by a dermatopathologist. Recognition of this subtype of eosinophilic fasciitis is important given the profound differences in prognosis of eosinophilic fasciitis and other scleroderma variants.
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Idiopathic dilated cardiomyopathy frequently coexists with anemia and high plasma NT proBNP levels. However, the prognostic impact of these features on the disease course is uncertain, especially in patients with normal renal function. ⋯ Tracking plasma NT proBNP levels is a useful strategy during routine follow-ups of patients with nonischemic dilated cardiomyopathy. Its predictive value for prognosis needs more evaluation in larger controlled studies. In addition, the importance of anemia in those patients needs more study.
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Although the prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing, there have been few studies of long-term changes in NAFLD in large numbers of subjects. This study was performed to assess the long-term changes in severity of fatty liver and to analyze the association with changes in body weight and lifestyle factors. ⋯ Even a small weight reduction was associated with improvements in NAFLD and related metabolic abnormalities such as dyslipidemia and hyperglycemia. Subjects with fatty liver should be advised to lose weight through lifestyle modifications.