Safely Ambulating Patients with a Pulmonary Artery Catheter: Changing Practice and Improving Care
ConclusionsBy utilizing and inclusion/exclusion criteria, setting limits on the frequency a patient is allowed to ambulate and creating a protocol to ensure a controlled setting, patients with PACs can safely ambulate without monitoring the PA waveforms. The use of a standard dressing and immobilization technique prevents catheter dislodgement during ambulation. By increasing physical activity, patients will gain strength to help prevent deconditioning during prolonged hospitalizations
Changes in indices of mineral metabolism, bone protein expression, and bone turnover were assessed between pre – and post–renal transplant bone biopsies obtained 12 months apart. Circulating sclerostin and fibroblast growth factor 23 (FGF-23) levels decreased, and a low bone turnover state was highly prevalent on follow-up. In contrast, bone sclerostin expression increased, whereas FGF-23 bone expression was unchanged/decreased. These findings underscore the limitations of circulating biomarkers and the critical role of bone biopsy to understand osteocyte biology in chronic kidney disease–mineral bone disorder.
Renin –angiotensin–aldosterone system inhibitors have proven clinical benefit in management of patients with heart failure with reduced ejection fraction. However, there are no guidelines to manage decline in kidney function that occurs with initiation and titration of renin–angiotensin–aldosteron e system agents during management of heart failure. We discuss the complex interplay of kidney function and heart failure in the presence of renin–angiotensin–aldosterone system agents and suggest a clinical algorithm for management of acute decline in kidney function.
A 63-year-old man was admitted 2 months after a deceased-donor kidney transplantation with an acute rise of his creatinine from a baseline of 1.9 mg/dl to 3.7 mg/dl. The patient had received basiliximab induction, followed by maintenance with belatacept, mycophenolic acid, and steroids. Physical examination and an ultrasound of the kidney transplant were unremarkable. Kidney biopsy revealed Banff acute cellular rejection grade IIB. Belatacept was replaced with tacrolimus, and steroid pulse and rabbit antithymocyte globulin were administered.
A 36-year-old female recipient of simultaneous pancreas-kidney transplantation 2 months previously was admitted to the emergency room because of a fever of unknown origin. Physical examination was unremarkable. Klebsiella pneumoniae was isolated in urine culture and treated with ceftriaxone according to antibiogram. High-grade fever persisted despite the increase in antibiotic spectrum with meropenem. Blood cultures were negative (including mycobacteria), as were quantiferon, cytomegalovirus, BK virus, Epstein –Barr virus polymerase chain reaction, and Toxoplasma gondii serologies.
I got my second rejection letter of this application cycle today. It bothers me that programs won’t even give me a chance (especially those that offer interviews) because my GPA is slightly lower than average. There’s more to being a good PT than having good grades in undergrad. I’m feeling more than a little discouraged and I don’t know what to do.
AbstractPurpose of ReviewLiver transplantation (LT) has been utilized in the last two decades for the treatment of selected patients with hepatocellular carcinoma (HCC). Currently, in most jurisdictions worldwide, only tumor size and number determine transplant candidacy, which may not sufficiently predict tumor behavior. Both tumor downstaging and expanding transplant criteria play an important role in expanding access to LT for HCC patients.Recent FindingsNew downstaging protocols are emerging that incorporate response to locoregional therapies (LRT) among those that initially present beyond the accepted Milan criteria. ...
ConclusionsLinagliptin showed cardiovascular and renal safety in Asian patients with T2DM and established CVD with albuminuria and/or kidney disease.
AbstractThe use of hypomethylating agents (HMAs) prior to hematopoietic stem cell transplantation (HSCT) in patients with myelodysplastic syndromes (MDS) was still controversial. Therefore, we sought to evaluate the impact of hypomethylation therapy before HSCT, with a special focus on long-term outcome. Databases, including PubMed, Embase Ovid, and the Cochrane Library, were searched for studies published up to 4 November 2018. Overall survival (OS) was selected as the primary endpoint, and relapse-free survival (RFS) was the secondary endpoint. A total of 6 cohort studies were included in the final meta-analysis. Our res...
Publication date: Available online 20 October 2019Source: Best Practice &Research Clinical HaematologyAuthor(s): Richard J. JonesAbstractClose HLA matching of donors and recipients has been the dogma for successful allogeneic blood or marrow transplantation (BMT), to limit the complications of graft rejection and graft-versus-host disease (GVHD). However, many patients in need, especially those in certain racial and ethnic groups such as African-Americans and Hispanics, are unable to find matches despite increased availability of unrelated donors. Unfortunately, despite many early attempts to develop safe, related hapl...
Conclusions: Heart remodelling related to a high cardiac output state cardiomyopathy was more pronounced in patients with homozygous β°/β° genotype. Osteoporososis was significantly more frequent in patients with homozygous β°/β° genotype, treated for more than two-thirds with DFO therapy. These data support the knowledge of different phenotypic groups in the management of NTDT patients.TableDisclosuresPepe: Chiesi Farmaceutici S.p.A., ApoPharma Inc., and Bayer: Other: No profit support.