South Dakota medicine : the journal of the South Dakota State Medical Association
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Review Case Reports
Transfusion-related acute lung injury (TRALI): a case report and literature review.
Transfusion-related acute lung injury (TRALI), a previously ill-defined transfusion reaction, has emerged as the leading cause of transfusion-related morbidity and mortality reported to the Food and Drug Administration (FDA). A 3-year-old male with a history of acute lymphoblastic leukemia (ALL) developed TRALI after receiving three units of platelets and a partial unit of packed red cells. He recovered after 24 hours in the pediatric intensive care unit. ⋯ TRALI is often mistaken for other transfusion reactions, most notably pulmonary edema caused by circulatory overload or congestive heart failure. It is difficult to gauge which transfusion recipients are at risk for TRALI. Good judgment and transfusion practices when ordering blood products and recognition of the clinical manifestations, diagnosis and treatment of TRALI is critical.
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The dramatic increase in the worldwide prevalence of obesity has paralleled the increase in the prevalence of obstructive sleep apnea (OSA). Even with heightened awareness by the lay and medical communities, OSA is still markedly under-diagnosed, as evidenced by the persistent presentation of late-stage cardiovascular complications in obese individuals newly diagnosed with sleep apnea. The clinical sequela of untreated and poorly-treated sleep apnea include conditions that are considered components of the metabolic syndrome for which central obesity is one of the major case-defining features. ⋯ Perhaps, the strongest observational evidence to support a link between sleep apnea and obesity is the similarity in age distribution of symptomatic sleep apnea and metabolic syndrome. The putative causal links between sleep apnea and each individual component of the metabolic syndrome have been extensively evaluated and have implicated bidirectional causality in certain metabolic conditions, such as obesity and sleep apnea, sleep apnea and diabetes mellitus, and obesity and diabetes mellitus. These studies collectively suggest that even modest weight loss improves OSA, and positively affects both metabolic and cardiovascular risk profiles.
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Review
Ambulatory blood pressure monitoring: another tool for the diagnosis and management of hypertension.
Office BP measurements are unable to detect 24-hour variability in blood pressure. ABPM is a tool that can assess BP at extended intervals, aiding in the diagnosis of white coat hypertension, masked hypertension and nighttime non-dipping status. Value exists in knowing a patient's BP variability so the appropriate treatment regimen can be determined or overtreatment can be avoided, all in an effort to decrease a patient's cardiovascular risk and potential for negative outcomes.
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Chronic obstructive pulmonary disease (COPD) is the fourth-leading cause of death in the United States, and the mortality rate continues to rise. Cigarette smoking is the major cause. COPD is preventable and treatable. Early recognition is important to decrease morbidity and mortality.