Uremic Encephalopathy Secondary to Medical Noncompliance
BY GREGORY TAYLOR, DO, &CHRISTOPHER COOLEY, DOA 66-year-old woman with a history of type 1 diabetes, hypertension, and end-stage renal disease (ESRD) on hemodialysis presented via EMS to the emergency department with altered mental status. She lived with her family, and they noted that she refused to go to dialysis for her past four sessions and had increasing lethargy for two days.She was afebrile, and her other vital signs were blood pressure 136/92 mmHg, heart rate 77 bpm, respiratory rate 20 bpm, and oxygen saturation 96% on room air. She was agitated and reaching for objects in the sky. Her cardiopulmonary exam was notable for a regular rate and rhythm with coarse breath sounds bilaterally, and she was alert and oriented x 1 (baseline of AOx3). Her speech was slurred, and her exam was limited due to little patient cooperation and altered mental status.She was also experiencing asterixis to her arms, and she had 2+ pitting edema bilaterally to her legs, extending to distal knees. An ECG revealed a normal sinus rhythm of 82 and peaked T-waves, with a prolonged PR interval and QT interval concerning for hyperkalemia.Chest radiography revealed bilateral pulmonary vascular congestion and bilateral pleural effusions. (Images A and B.) A CT of the head without IV contrast was negative for any acute process. Pertinent laboratory evaluation was notable for a white blood cell count of 11.2, hemoglobin of 6.8 g/dL, hematocrit of 21.3, and a platelet level of 370. Basic metab...
Publication date: Available online 24 January 2020Source: Journal of Genetics and GenomicsAuthor(s): Qianru Huang, Xu Liu, Yujia Zhang, Jingyao Huang, Dan Li, Bin LiAbstractRegulatory T (Treg) cells, a subtype of CD4+ T cells with distinct immunosuppressive, are vital for maintaining immune homeostasis in healthy people. FOXP3 (Forkhead box protein P3), a member of the forkhead–winged-helix family, is the pivotal transcriptional factor of Treg. The expression, post-translational modifications and protein complex of FOXP3 present a great impact on the functional stability and immune plasticity of Treg in vivo. In part...
This article describes details of each stage of the mission and includes a discussion of key aspects of logistics and patient care posed by such evacuations. PMID: 31977424 [PubMed - in process]
PMID: 31977420 [PubMed - in process]
This article explores the factors that contribute to polypharmacy and discusses its negative physiological, psychological, and economic effects. It also describes strategies for reducing polypharmacy, including both "explicit" approaches, which are grounded in the findings of literature reviews and expert opinion, and "implicit" approaches, which are based on the provider's interpretation of clinical data and the patient's medication regimen. PMID: 31977416 [PubMed - in process]
This article describes key characteristics of nonpermanent contraceptive methods, including mechanism of action, correct use, failure rates with perfect and typical use, contraindications, benefits, side effects, discontinuation procedures, and innovations in the field. We also discuss how contraceptive care is related to nursing ethics and health inequities. PMID: 31977414 [PubMed - in process]
ConclusionsThis is the largest series to date reporting>30-day follow-up for patients undergoing venous ablation procedures while receiving anticoagulation and the longest follow-up reported of any series. Durability, safety, and efficacy of vein ablation in patients receiving anticoagulation are comparable to those in control patients. Anticoagulation should not be considered a contraindication to endothermal ablation of the GSV or SSV for symptomatic venous reflux.
“Although the United States leads the world in health care spending, it fares far worse than its peers on coverage and most dimensions of value. Cost and coverage are intertwined. Many Americans cannot afford health insurance, and even those with insurance face substantial cost-related barriers to care. Employer-sponsored insurance is less prevalent and more expensive than in the past, and in response, deductibles have grown and benefits have been cut. The long-term solvency of U.S. public... ACP Endorses Single-Payer system
Abstract For older adults, heart failure (HF) has the highest 30-day hospital readmission rate of any chronic illness. Despite research into strategies to reduce readmissions, no single program has emerged as sustainable. The purpose of the current study was to test a researcher-developed home health nurse HF intervention (CareNavRN™) on 30-day readmission rates, HF knowledge, self-care, and quality of life (QOL) among 40 older adults transitioning home. Home health nurses received specialized HF training and visited patients once per week at home for 4 weeks. The control group (n = 21) had six readmissions ...
This article reviews the state of the art and major unanswered questions related to ocular vascular anatomy and physiology, ocular imaging techniques, clinical findings in glaucoma and other eye diseases, and mechanistic modeling predictions, while laying a path for integrating clinical observations with mathematical models and artificial intelligence. Viable alternatives for integrated data analysis are proposed that aim to overcome the limitations of standard statistical approaches and enable individually tailored precision medicine in ophthalmology.
Publication date: March 2020Source: Journal of Functional Foods, Volume 66Author(s): Gisela Gerardi, Mónica Cavia-Saiz, Raquel del Pino-García, María D. Rivero-Pérez, María L. González-SanJosé, Pilar MuñizAbstractVascular remodeling in hypertension and diabetes is characterized by a low-grade inflammation of the arterial wall and enhanced oxidative stress. Wine pomace products attenuate hyperglycemia and hypertension through reduction of oxidative stress and inflammation by their polyphenol composition. The aim of the study was to assess the influence of the wine poma...
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