Mixed cryoglobulinemia is a chronic immune complex-mediated disease strongly associated with hepatitis C virus infection. Clinical features include skin lesions, glomerulonephritis, peripheral neuropathy, and widespread vasculitis.
Abstract
Mixed cryoglobulinemia is a chronic immune complex-mediated disease strongly associated with hepatitis C virus (HCV) infection. Mixed cryoglobulinemia is a vasculitis of small and medium-sized arteries and veins, due to the deposition of complexes of antigen, cryoglobulin and complement in the vessel walls. The main clinical features of mixed cryoglobulinemia vasculitis include the triad of palpable purpura, arthralgias, and weakness, and other pathological conditions such as glomerulonephritis, peripheral neuropathy, skin ulcers, and widespread vasculitis. The treatment of HCV-related mixed cryoglobulinemia is difficult due to the multifactorial origin and clinical polymorphism of the syndrome. It can be directed to eradicate the HCV infection, suppress the B-cell clonal expansion and cryoglobulin production, or ameliorate symptoms. The choice of the most appropriate treatment is strictly related to the assessment of disease activity, and to the extent and severity of organ involvement.
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-- F. Iannuzzella, A. Vaglio, G. Garini.
This article originally appeared in the May 2010 issue of The American Journal of Medicine.
Selasa, 25 Mei 2010
Emphysematous Pyelonephritis Caused by Candida tropicalis
Emphysematous pyelonephritis is a severe necrotizing infection characterized by gas formation within the renal parenchyma, collecting system, and perinephric tissues.1, 2, 3 This condition commonly occurs in women with diabetes mellitus and obstructive uropathy.(1, 2, 3, 4, 5) Escherichia coli and Klebsiella are the most common organisms cultured.(1, 2, 3, 4, 5) Rarely, Candida species have been reported to cause emphysematous pyelonephritis.(6)
Case Report
A 51-year-old African-American transgender male with history of intravenous drug abuse presented to the emergency department with nausea, vomiting, and oliguria for 10 days. She had severe abdominal pain in the right upper quadrant and generalized weakness. She denied fever, dysuria, and flank pain.
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-- Prasanna V. Krishnasamy, Christopher Liby III
This article originally appeared in the April 2010 issue of The American Journal of Medicine.
Case Report
A 51-year-old African-American transgender male with history of intravenous drug abuse presented to the emergency department with nausea, vomiting, and oliguria for 10 days. She had severe abdominal pain in the right upper quadrant and generalized weakness. She denied fever, dysuria, and flank pain.
To read this article in its entirety, please visit our website.
-- Prasanna V. Krishnasamy, Christopher Liby III
This article originally appeared in the April 2010 issue of The American Journal of Medicine.
Kamis, 06 Mei 2010
“Dear Editor: Can You Please Expedite My Manuscript's Publication in the AJM?”
Each week, I receive the message cited in the title from one or more of our authors whose manuscripts have been accepted and are scheduled for publication in The American Journal of Medicine. Reasoning behind these requests varies but often has to do with desires on the author's part for priority in the medical literature, grant application timing, and a variety of other reasonable and pressing issues. Of course, if we move this manuscript ahead in the publication queue, another author's publication date has to be delayed because we decide which material will be published in a specific issue a number of months in advance of the actual publication date. In an ideal world, we would publish manuscripts as soon as they had been accepted and copy edited by the team here in Tucson and in New York at Elsevier headquarters. However, the process leading to publication requires time spent in manuscript revision, copy editing, typesetting, proofreading, approval of the galley proofs by authors, and other more minor administrative issues related to the publication process. I actually have been very impressed with how quickly Elsevier and the printer who actually prints the Journal respond to our digitally transmitted publication materials.
In an effort to speed publication and to help our authors communicate with the medical scientific world as quickly as possible, we have instituted a process whereby manuscripts are posted on our journal website as soon as copy editing is finished, and the authors approve the galley proof.
To read this article in its entirety, please visit our website.
-- Joseph S. Alpert, MD, Editor-in-Chief
This article originally appeared in the May 2010 issue of The American Journal of Medicine.
In an effort to speed publication and to help our authors communicate with the medical scientific world as quickly as possible, we have instituted a process whereby manuscripts are posted on our journal website as soon as copy editing is finished, and the authors approve the galley proof.
To read this article in its entirety, please visit our website.
-- Joseph S. Alpert, MD, Editor-in-Chief
This article originally appeared in the May 2010 issue of The American Journal of Medicine.
Senin, 03 Mei 2010
Are Atrial Fibrillation Patients Receiving Warfarin in Accordance with Stroke Risk?
In this study, less than half of patients with atrial fibrillation/atrial flutter received warfarin following their diagnosis. Similar proportions of patients with low, moderate, and high stroke risk received warfarin. This suggests that it may be underused in patients with high stroke risk and overused among patients with low stroke risk.
Abstract
Background
Clinical guidelines for the management of atrial fibrillation and atrial flutter provide recommendations for anticoagulation based on patients' overall risk of stroke. To determine the real-world compliance of physicians with these recommendations, we conducted a retrospective cohort study examining the utilization of warfarin in atrial fibrillation/flutter patients by stroke risk level.
Methods
Patients with a qualifying atrial fibrillation/flutter diagnosis during ≥18 months' continuous enrollment between January 2003 and September 2007, and with ≥6 months' eligibility after the first atrial fibrillation/flutter diagnosis, were identified from the US MarketScan database (Thomson Reuters, New York, NY). Warfarin use within 30 days of the first diagnosis was assessed according to stroke risk, estimated using the Congestive heart failure, Hypertension, Age >75 years, Diabetes, Stroke (CHADS2) score.
Results
Of 171,393 patients included in the analysis, 20.0% had a CHADS2 score of 0 (low risk), 61.6% a score of 1-2 (moderate risk), and 18.4% a score of 3-6 (high risk). Warfarin, recommended for high stroke-risk patients, was given to only 42.1% of those with a CHADS2 score of 3-6. A similar percentage of patients with moderate (43.5%) or low stroke risk (40.1%) received warfarin. Only 29.6% of high-risk, 33.3% of moderate-risk, and 34.1% of low-risk patients who were started on warfarin received uninterrupted therapy for 6 months following their initial prescription.
Conclusions
These data suggest that guideline recommendations that anticoagulation should be provided in accordance with stroke risk in atrial fibrillation patients are not routinely followed in clinical practice. The causes and clinical implications of under-utilization of anticoagulation in atrial fibrillation patients with high stroke risk warrant further study.
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-- Peter J. Zimetbaum, MD Amit Thosani, MD, Hsing-Ting Yu, MPH, Yan Xiong, MS, Jay Lin, PhD, Prajesh Kothawala, MD, MPH, Matthew Emons, MD, MBA
This article originally appeared in the May 2010 issue of The American Journal of Medicine.
Abstract
Background
Clinical guidelines for the management of atrial fibrillation and atrial flutter provide recommendations for anticoagulation based on patients' overall risk of stroke. To determine the real-world compliance of physicians with these recommendations, we conducted a retrospective cohort study examining the utilization of warfarin in atrial fibrillation/flutter patients by stroke risk level.
Methods
Patients with a qualifying atrial fibrillation/flutter diagnosis during ≥18 months' continuous enrollment between January 2003 and September 2007, and with ≥6 months' eligibility after the first atrial fibrillation/flutter diagnosis, were identified from the US MarketScan database (Thomson Reuters, New York, NY). Warfarin use within 30 days of the first diagnosis was assessed according to stroke risk, estimated using the Congestive heart failure, Hypertension, Age >75 years, Diabetes, Stroke (CHADS2) score.
Results
Of 171,393 patients included in the analysis, 20.0% had a CHADS2 score of 0 (low risk), 61.6% a score of 1-2 (moderate risk), and 18.4% a score of 3-6 (high risk). Warfarin, recommended for high stroke-risk patients, was given to only 42.1% of those with a CHADS2 score of 3-6. A similar percentage of patients with moderate (43.5%) or low stroke risk (40.1%) received warfarin. Only 29.6% of high-risk, 33.3% of moderate-risk, and 34.1% of low-risk patients who were started on warfarin received uninterrupted therapy for 6 months following their initial prescription.
Conclusions
These data suggest that guideline recommendations that anticoagulation should be provided in accordance with stroke risk in atrial fibrillation patients are not routinely followed in clinical practice. The causes and clinical implications of under-utilization of anticoagulation in atrial fibrillation patients with high stroke risk warrant further study.
To read this article in its entirety, please visit our website.
-- Peter J. Zimetbaum, MD Amit Thosani, MD, Hsing-Ting Yu, MPH, Yan Xiong, MS, Jay Lin, PhD, Prajesh Kothawala, MD, MPH, Matthew Emons, MD, MBA
This article originally appeared in the May 2010 issue of The American Journal of Medicine.
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