IgA nephropathy (IgAN) is the most common glomerulonephritis in the Western world. Generally, the diagnosis of IgAN is based on clinical history, laboratory data, and histopathological reports. The rapidly progressing and crescentic subtype is quite uncommon. The clinical picture and spectrum of severity upon presentation varies between individual cases. In this case report, we present a previously healthy 20-year-old Latin American male with anti-neutrophil cytoplasmic antibodies seropositive rapidly progressing IgAN leading to severe acute renal impairment, uremic pericarditis, and uremic encephalopathy. Prognostic markers and histopathological types of injury have been proposed as tools to assess severity of disease and in guiding therapeutic options. This case report highlights histopathological, serological, and clinical characteristics of severe IgAN. J Med Cases. 2016;7(6):230-233 doi: http://dx.doi.org/10.14740/jmc2498w
The incidence of new human immunodeficiency virus (HIV) infections is declining and is half of what it was in the mid 1990s. We present a case of newly diagnosed HIV with acquired immune deficiency syndrome (AIDS), Neurosyphilis, Kaposi Sarcoma, and multiple opportunistic infections. Although this type of patient was not uncommon in the pre-antiretroviral era, we do not often see such a constellation of conditions in a single individual. The significance of this case lies not in the diagnosis, but rather in the number of the diagnoses and the thought process used to attain them.
Background and Objective: Marijuana use causes catecholamine surge with consequent tachycardia and elevation of both systolic and diastolic blood pressure. It is unclear if the catecholamine surge associated is sufficient to cause left ventricular wall apical ballooning (TakoTsubo Cardiomyopathy (TTC)). Given the similarity in the pathophysiology of TTC and mechanism of action of cannabis, we sought to investigate if there is any association. Methods: We obtained data from the HCUP-NIS of all patients older than 45 years hospitalized between 2012 - 2014. Our main outcome was diagnosis of TTC, and main exposure variables was cannabis use both identified using the ICD-9 codes. Using the SURVEYLOGISTICS procedure, we performed logistic regressions to estimate the odds of TTC diagnosis and in-hospital mortality among cannabis users adjusting for demographics, comorbidities, and other recreational drugs. Results: Of the 7,805,400 hospitalized patients who were > 45 years, 10,160 (0.1%) had a diagnosis of TTC, 54,311 (0.7%) were nondependent cannabis user and 5,045 (0.1%) were dependent cannabis users. We observed a significant association between TTC and nondependent cannabis use (OR 1.35, 95% CI: 1.10-1.65), but the association was nonsignificant for dependent cannabis use. After adjusting for potential confounders such as age, race, gender, comorbidities, cocaine, amphetamine and alcohol, nondependent cannabis use was associated with a 2-fold increased odds of TTC (AOR 2.00, 95% CI: 1.61-2.40). However, the association remained nonsignificant for dependent cannabis users (AOR 0.70, 95% CI: 0.25-1.92). Also, among patients diagnosed with TTC, there was no significant difference in the odds of in-hospital mortality among cannabis users (dependent and nondependent) when compared to nonusers (AOR 1.04, 95% CI: 0.39 - 2.70). Conclusion: In our study population, nondependent cannabis use was associated with significantly increased odds of TTC. However, among patients with TTC, in-hospital mortality rate was the same irrespective of cannabis exposure.
Background: In light of rising healthcare costs and evidence of inefficient use of medical resources, there is growing interest in reducing healthcare waste by clinicians. Unwarranted lab tests may lead to further tests, prolonged hospital stays, unnecessary referrals and procedures, patient discomfort, and iatrogenic anemia, resulting in significant economic and clinical effects. Blood tests are essential in guiding medical decisions, but they are also associated with significant financial and clinical costs. We designed a quality improvement study that attempted to decrease inappropriate ordering of laboratory tests while maintaining quality of care in a large residency program. Methods: An algorithm outlining indications for complete blood count (CBC), coagulation profile (PT/INR) and basic metabolic profile (BMP) was created by the study team. Data from 1,312 patients over a 3-month period in the pre-intervention phase and 1,255 patients during the selected intervention phase were analyzed. The primary endpoint was mortality rate and secondary endpoints were length of stay and laboratory costs. Results: There were significant decreases in the number of PT/INR orders (20.6%), followed by BMP orders (12.4%), and CBC orders (9.3%). The mortality rate was 5.3% for the pre-intervention phase and 5.8% for the selected intervention phase, with a difference of 0.5% (P = 0.44). Conclusion: Our approach leads to a decrease in costs, preventing unnecessary downstream testing, and improving patient experience. It also brought a mental discipline while ordering blood tests amongst residents. J Clin Med Res. 2017;9(12):965-969 doi: https://doi.org/10.14740/jocmr3210w
