Xanthine oxidase inhibitor urate-lowering therapy titration to target decreases serum free fatty acids in gout and suppresses lipolysis by adipocytes.

Objective: Linked metabolic and cardiovascular comorbidities are prevalent in hyperuricemia and gout. For mechanistic insight into impact on inflammatory processes and cardiometabolic risk factors of xanthine oxidase inhibitor urate-lowering therapy (ULT) titration to target, we performed a prospective study of gout serum metabolomes from a ULT trial.

Methods: Sera of gout patients meeting the 2015 ACR/EULAR gout classification criteria (n = 20) and with hyperuricemia were studied at time zero and weeks 12 and 24 of febuxostat or allopurinol dose titration ULT.

My Patient Wants to Kill Me.

A few years into my practice at the Veterans Affairs (VA) clinic, I was threatened by an angry patient when I had to discontinue his opioids. I placed a civil restraining order against him and when we met in court he admitted to the judge that stopping opioids improved his behavior. I discovered that the legal system could support the medical system's care of threatening patients but found the process stressful.

The Veterans With Diabetes Transition Study. Veterans Experience of the Process of Transition Following Active Duty Diagnosis.

Introduction: Veterans face several potential difficulties upon leaving active duty. Among these is transition of healthcare to a different setting. The transition from active duty to veteran status is often a challenging time for veterans with diabetes.

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup.

Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of >90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process.

Shared decision-making at end-of-life is aided by graphical trending of illness severity.

The Rothman Index (RI) gives a visual picture of patient's condition and progress for the physician and family to view together. This case demonstrates how the RI graph facilitates physician-family communication. An 85-year-old man with normal pressure hydrocephalus and ventriculoperitoneal shunt presented with a subdural haematoma.