The American journal of the medical sciences
-
Acute-on-Chronic Liver Failure(ACLF) is a syndrome characterized by organ dysfunction and high mortality in cirrhotic patients. ACLF has multiple triggers but those precipitated by fungal infection have higher mortality. Early detection and treatment of candidemia have shown mortality benefits in ACLF. The sensitivity of blood cultures ranged from 21 % - 71 %. Given the increase in mortality, it is vital to have a quick yet reliable diagnostic test for the detection of candida. This study examines the risk of developing ACLF and its impact on survival in hospitalized cirrhotic patients with invasive fungal infection via a positive T2Candida Panel. We also examine the effects of earlier treatment on mortality in those with a positive T2Candida Panel. ⋯ Our study shows that a positive T2 Panel leads to more frequent progression of ACLF and worsening survival outcomes. This study shows that earlier treatment of candidiasis via the T2 Panel leads to mortality benefits.
-
Review
The predictive role of neutrophil gelatinase-associated lipocalin in coronary artery disease.
The prognosis holds significant implications for the long-term quality of life among patients suffering from coronary artery disease. However, a pressing challenge lies in the absence of reliable biomarkers that can establish a definitive correlation between these biomarkers and the prognosis of coronary artery heart disease. ⋯ It examines the influence of NGAL on various clinical manifestations, including stable angina, ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and isolated coronary artery dilation. Furthermore, this review provides recommendations aimed at enhancing the rigor and impact of future research, thereby serving as a valuable reference for subsequent studies in this domain.
-
Optimizing long-term graft survival remains a major focus in transplant. Elderly kidney transplant recipients are vulnerable to acute kidney injury (AKI) and graft loss. This study assessed the safety and efficacy of ACEI/ARB in elderly kidney transplant recipients and impact on graft outcomes. ⋯ Initiation of ACEI/ARB within one year of transplant is associated with lower risk of AKI and graft loss, driven by lower risk of death in elderly kidney transplant recipients. Clinicians should maximize ACEI/ARB therapy early on after kidney transplant.
-
As metabolic dysfunction-associated steatotic liver disease (MASLD) management extends into primary care, little is known about patterns of specialty referral for affected patients. We determined the proportion of primary care patients with MASLD that received a gastroenterology (GI) consultation and compared advanced fibrosis risk between patients with and without a referral. ⋯ Only 30% of patients in this primary care MASLD cohort received a GI E/M referral during the study period, and those patients with a referral did not differ by FIB-4 advanced fibrosis risk.