Patients requiring renal replacement therapy remain a significant burden on the healthcare system. A substantial amount of hospitalization costs for these patients are related to vascular complications, especially catheter-related thrombosis, which is associated with a significant increase in morbidity and mortality.We report the case of a male patient with multiple myeloma (MM) and dialysis-dependent renal failure due to light-chain cast nephropathy, who presented recurrent early catheter dysfunction. A large thrombus was detected, extending from the superior vena cava (SVC) to the right atrium (RA) and later at the inferior vena cava (IVC), ultimately leading to exhaustion of vascular capital.To this date, there is limited evidence regarding the best approach to catheter-related thrombosis, which frequently leads to treatment dilemmas in clinical practice and demands careful evaluation and individualized decisions. In patients with a highly thrombotic profile, peritoneal dialysis may be considered earlier to prevent further vascular capital damage.
Peritoneal dialysis-associated-peritonitis remains a major concern, increasing patient morbidity and mortality. Empirical antibiotics should be quickly started to allow a rapid resolution of symptoms and preservation of the peritoneal membrane.We report a case of peritoneal dialysis-associated-peritonitis due to Prevotella salivae and Corynebacterium jeikeium, in a 51-year-old male. Suspected peritonitis led to an immediate prescription of vancomycin and ceftazidime, with no clinical improvement. Prevotella is difficult to identify in culture since it's a gramnegative anaerobic bacterium, so metronidazole administration was delayed over days.New diagnostic techniques have been explored for the early diagnosis of peritonitis, including polymerase chain reaction (PCR) for bacterial DNA fragments. A multiplex PCR panel that includes Prevotella, already available for other applications, could be an advantage in cases like this.
Renal cortical necrosis (RCN) is a rare cause of acute kidney injury (AKI) in developed countries. Drugs, especially non-steroidal antiinflammatory drugs, (NSAIDs) are very rarely described in the literature to cause cortical necrosis. It is characterized by confluent necrosis of the entire cortex apart from a thin rim of viable tissue in the subcapsular, juxtaglomerular areas, and medulla. Although the pathogenesis of the disease remains unclear, the final common pathway is permanent occlusion of afferent arterioles and interlobular arteries in the cortical vasculature. NSAIDs are widely prescribed in general clinical practice. Despite being readily available, a subset of individuals is susceptible to serious renal toxicity and caution should be exercised when these drugs are used. We present the case of a young adult who presented with renal cortical necrosis with irreversible renal failure. Unfortunately, it occurred as a result of inappropriate use of over-the-counter NSAIDs in the setting of the pandemic outbreak of COVID-19.
Aims and ObjectivesTo describe the main acupuncture techniques and parameters that have been used in the most varied symptoms of different types of cancer.BackgroundClinical evidence about the potential effectiveness of acupuncture and related therapies to control signs and symptoms associated with cancer or its treatment has been in several studies. Currently, there is already evidence of the use of acupuncture for the treatment of nausea and vomiting, fatigue, dry mouth, anxiety, depression, insomnia and pain. However, many studies lack firm rights or reproducible guidelines for treatment.DesignThis study performs a systematic review of clinical trials related to the topic, based on the PRISMA protocol. Thus, a search was carried out in the Scopus, Pubmed and Web of Science databases, covering studies since January 2007.MethodsStructured and organised according to PICO standards, using keywords (“cancer” OR “malignant tumour” OR “chemotherapy” OR “radiotherapy”) AND (“acupuncture” OR “electroacupuncture”) AND (“pain” OR “nausea” OR “vomit” OR “fatigue” OR “xerostomia” OR “insomnia” OR “depression” OR “neuropathy”).ResultsAfter the selection and evaluation phase, 23 studies were included and analysed.ConclusionBased on this analysis, it is concluded that acupuncture is safe and there is evidence of the reduction of gastrointestinal symptoms, chemotherapy‐induced peripheral neuropathy, pain, dry mouth, fatigue, insomnia, and improvement of cognitive capacity.Relevance to clinical practiceAcupuncture treatments could act by minimising the side effects of conventional treatments and reducing symptoms induced by tumours.No Patient or Public ContributionThe patients had no direct involvement with the study in question.
Background: Cardiac myxoma is the most frequent benign tumor of the heart and presents an important diagnostic challenge.
Case presentation: A 51-year-old woman was admitted at the hospital for anorexia, fatigue, nausea, and vomiting for the last 10 days. Laboratory results showed hemoglobin 5.26 g/dl, platelets 83× 10^9 μl, Lactate Dehydrogenase (LDH) 348 U/l, bilirubin 2.0 mg/dl, haptoglobin 100 mg/dl, negative Coombs test, blood smear with schistocytes and urea 327 mg/dl, creatinine 8.56 mg/dl. Non-autoimmune hemolytic anemia and acute kidney injury was assumed. After seven plasma exchange treatments, she went into acute pulmonary edema. Body tomography was performed, and revealed a mass in the left atrium. She underwent atriotomy and after surgery hemoglobin values stabilized but kidney function did not improve, and she became dialysis dependent.
Conclusion: Myxomas can mimic other diseases which may delay diagnosis and compromise prognosis. In this particular case, the myxoma manifested with intravascular hemolytic anemia. This is an, especially, interesting case because a myxoma caused kidney failure without recovery.
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