ABSTRACT
Background: Every July, new residents begin training across the United States, but it is unclear whether this affects the mortality rate of critically ill patients such as those with diabetes ketoacidosis (DKA). Methods: This national retrospective cohort study included patients aged 18 years or older admitted to acute care with DKA between 2016 and 2020. Data were obtained from the National Inpatient Sample Database. We compared patients admitted in July and August with those admitted during the remaining months and assessed the primary endpoint of all-cause inpatient mortality. We also obtained an odds ratio adjusted for confounders using multivariate logistic regression analysis. Secondary endpoints included length of hospital stay, total hospital charges, the crude rate of mechanical ventilation, acute kidney injury requiring hemodialysis, and vasopressor requirement. Hypothesis testing was conducted using the chi-square test for categorical variables and Student's t test for continuous variables. A two-tailed P value of < 0.05 was considered statistically significant. Results: Of the 269,095 hospitalizations identified over 5 years with a discharge diagnosis of DKA, 250,990 met the inclusion criteria. During July and August, 42,668 (17%) hospitalizations occurred, and 208,322 (83%) occurred during the remaining months. The mean age of the patients was 47 years, and there was no significant difference among the cohorts (P = 0.41). Female patients represented 54% of the total patients, and there was no difference between the cohorts (P = 0.68). Of the admitted patients, 61% were White, 21% were Black, and 11% were Hispanic, with no differences between the cohorts (P = 0.38). Medicare (35%) and Medicaid (30%) were the primary payers for most patients, and approximately 25% had private insurance. There were no differences between the cohorts in terms of primary payers (P = 0.49). The mean length of stay was 7 days, and the total hospitalization cost was $85,509. Admission in July or August did not increase the odds of inpatient mortality (adjusted odds ratio 0.96, P = 0.58). Conclusions: In this retrospective cohort study of patients admitted with DKA, inpatient care during July and August did not increase the odds of inpatient mortality.
ABSTRACT
Coincidences in medicine are not so common. We are presenting a case of a patient diagnosed with Moya-Moya disease and antiphospholipid syndrome (APS) who presented with clinical and laboratory characteristics of catastrophic APS versus TTP. The diagnosis was a challenge because characteristics were overlapping. Nevertheless, a decision to treat the patient for TTP was made with afterward improvement. MMD has been associated with multiple immune disorders; however, only one case of acquired thrombotic thrombocytopenic purpura has been documented in association with this disease. None has been associated with catastrophic antiphospholipid syndrome. We are presenting a challenging case where all these three medical conditions were present at the same time.
ABSTRACT
Leukocytoclastic vasculitis is an entity associated with drugs, infections, cryoglobulinemia, and connective tissue diseases but can also be idiopathic, systemic, or organ localized. Moreover, LCV associated with drugs is a rare disorder. When it is present usually has an elevation of anti-neutrophil cytoplasmic antibody, most likely anti-myeloperoxidase, which can be helpful to orient the diagnosis. We are presenting a 55-year-old female with a past medical history of diabetes mellitus (DM) and hyperlipidemia (HLD) who presented with a painful and pruritic rash localized in the abdomen and lower extremities that started 1 week after initiated atorvastatin for management of hyperlipidemia. This is the first case ever reported of leukocytoclastic vasculitis ANCA negative associated with atorvastatin, to our best knowledge.
ABSTRACT
La enfermedad del coronavirus 2019 (COVID-19) causada por la infección por el nuevo coronavirus (SARS-CoV-2) ha creado una pandemia que ha llevado a una lucha mundial para hacer frente al gran número de personas infectadas, muchas de las cuales requieren cuidados intensivos. Hasta la fecha, no existe un tratamiento antivirus específico para COVID-19. El uso de transfusiones de plasma de convalecientes podría ser de gran valor en la pandemia actual. Los pacientes con SRAS-CoV-2 recuperados recientemente que pueden ser donantes adecuados se someten a aféresis para obtener plasma de convalecencia que contenga anticuerpos con títulos elevados, siempre que cumplan los criterios de donación de sangre. En esta revisión, resumimos la literatura existente sobre el plasma convaleciente como una opción terapéutica para COVID-19. Es importante señalar que es necesario estudiar más a fondo el momento adecuado para la administración de plasma de convalecencia y la gravedad de sus efectos adversos. El plasma de convalecencia ofrece la posibilidad de convertirse en una opción de tratamiento prometedora inmediata al evaluar los medicamentos existentes y desarrollar nuevas vacunas y terapias específicas.
The coronavirus disease 2019 (COVID-19) caused by novel coronavirus (SARS-CoV-2) infection has created a pandemic leading to a global struggle to cope with the sheer numbers of infected persons, many of whom require intensive care support. To date, there is no specific antivirus treatment for COVID-19. The use of convalescent plasma transfusions could be of great value in the current pandemic. Recently recovered SARS-CoV-2 patients who may be suitable donors undergo apheresis in order to obtain convalescent plasma containing high-titer antibodies, granted they meet blood donation criteria. In this review, we summarize existing literature around convalescent plasma as a therapeutic option for COVID-19. It is important to note that the appropriate timing on convalescent plasma administration and the severity of its adverse effects needs to be further studied. Convalescent plasma provides the potential to render an immediate promising treatment option while evaluating existing drugs and developing new specific vaccines and therapies.
ABSTRACT
La tuberculosis se encuentra en estrecha relación con enfermedades que provocan estados de inmunodeficiencia como la enfermedad renal crónica terminal. El objetivo principal de la investigación realizada, es describir el perfil epidemiológico de los pacientes con tuberculosis en terapia de sustitución renal, a través de la descripción de variables sociodemográficas, factores de riesgo, tipo de terapia dialítica recibida y el tiempo de la misma y frecuencia de terapia dialítica. La población estudiada fueron los pacientes con enfermedad renal terminal en terapia de sustitución renal con diagnóstico de tuberculosis. La obtención de los datos se realizó por medio de la revisión de expedientes clínicos y libros de registro de resultados de baciloscopías (PCT-1), ADA, Cultivos y GeneXpert del departamento de tuberculosis; libro de resultados de estudios histopatológicos en el departamento de patología. Se llevó a cabo la revisión de 30 expedientes que cumplían los criterios de inclusión, encontrando como principales características de la población estudiada: hipoalbuminemia, uremia evidenciada con niveles de creatinina mayores de 10 mg/dl, incidencia en pacientes jóvenes y principalmente en los que se encuentran en diálisis peritoneal intermitente con catéter rígido. El procesamiento de los datos se realizó en Microsoft Excel y Epi Info, por medio de tablas y gráficos
