ABSTRACT
Sustained low-efficiency dialysis (SLED) is usually performed over 6-12 h among hemodynamically unstable patients. Conduction of 4-h SLED may spare time and manpower during hospitalization. Therefore, we conducted a retrospective observational study to explore the appropriateness and clinical outcomes of 4-h SLED among critically ill patients admitted to our center from 1/06/2016 to 1/06/2020. Renal parameters including blood urea nitrogen, serum creatinine, sodium, phosphorus, potassium, and bicarbonate were determined on the day of dialysis before SLED and within 24 h after SLED, and clinical outcomes including, acute kidney injury (AKI) recovery, in-hospital mortality, 30-day mortality, 180-day mortality, and re-admission with AKI, were evaluated. Of the 304 patients included, 69.4% were male. The majority of patients were from the Middle East (65.8%), followed by 28.6% from Asia. Four-hour SLED resulted in a significant improvement in the renal parameters. Recovery from AKI was observed in 25.4%, in-hospital mortality rate was 48.7%, while the 30- and 180-day mortality outcomes were 3.2 and 9.6%, respectively, and re-admission with AKI was observed in 16.9%. Our findings suggest that 4-h SLED significantly improved renal parameters and was associated with favorable clinical outcomes in terms of survival and AKI recovery, suggesting possible utilization of SLED shorter than 6 h in the acute settings to preserve time and manpower for procedures.
ABSTRACT
Statin-induced necrotizing autoimmune myopathy is an immune-mediated necrotizing myopathy related to the use of statins. It is a very rare disease, which usually presents with proximal muscle weakness and frank elevation in creatine kinase levels. Stopping statin and the use of immunosuppressive therapy are considered the mainstay therapy. Use of steroids in patients with inflammatory myopathy can be complicated by steroid-induced myopathy. Herein, we present a case of a 55-year-old patient with statin-induced necrotizing autoimmune myopathy based on the presence of proximal muscle weakness, magnetic resonance findings, suggestive muscle biopsy features, and positive anti-HMGCR autoantibodies. The patient was treated with triple immunosuppressive therapy with a particularly good response to intravenous immunoglobulin. This report highlights the importance of timely diagnosis and early use of combined immunosuppressive therapy to improve patients' outcome affected by this rare disease.
ABSTRACT
A cholesterol granuloma is a benign lesion that can occur in various organs, mimicking other pathologies. We present the case of a 35-year-old man presenting with asymptomatic lung and pleural lesions which were suspected to be pulmonary tuberculosis but found to be cholesterol granuloma on biopsy. Cholesterol granulomas are a rare mimic of common lung pathology and should be considered in the differential diagnosis if the initial investigations are not informative. LEARNING POINTS: Pulmonary cholesterol granuloma is a benign lesion that radiologically mimics many sinister pathologies.The pathogenesis of pulmonary cholesterol granuloma remains obscure and extensive work-up is usually needed to rule out malignancy and infectious aetiology.
ABSTRACT
Invasive aspergillosis (IA) is a fatal disease and is related to immunocompromised patients like HIV, solid organ/allogeneic stem cell transplant patients, patients on immunosuppressive therapy or chemotherapy agents, burn patients and malnourished patients. Diagnosis is challenging due to the non-specific nature of symptoms. Usually, the patient presents with fever and respiratory symptoms such as cough and haemoptysis. We present a case of IA in a 49-year-old man with end-stage renal disease who presented with fever and developed a submandibular swelling. Further imaging studies supported the possibility of having underlying IA and accordingly he was promptly treated with systemic antifungal therapy with good response. As per our knowledge, IA presenting as submandibular swelling has not been reported in the literature. Our main aim is to highlight the significance of early diagnosis and management in such a rare presentation associated with a life-threatening condition like IA.
