Use of Immunoglobulin Replacement Therapy in Clinical Practice: A Review.

Immunoglobulins (Igs) are produced by B lymphocytes and play a key role in humoral immunity. Igs are classified into five isotypes (IgG, IgA, IgM, IgE, and IgD). Their primary function is to recognize and bind to foreign antigens.

Safety and Efficacy of Transsternal Core Biopsy of Anterior Mediastinal Masses.

Background: The study evaluated the safety and adequacy of percutaneous transsternal anterior mediastinal core biopsy.

Methods: All percutaneous computed tomography-guided transsternal mediastinal 18-gauge core biopsies performed at 2 academic centers were retrospectively reviewed. Procedural, clinical, and pathology data were recorded.

Guidelines for Seizure Prophylaxis in Patients Hospitalized with Nontraumatic Intracerebral Hemorrhage: A Clinical Practice Guideline for Health Care Professionals from the Neurocritical Care Society.

Background: There is practice heterogeneity in the use, type, and duration of prophylactic antiseizure medications (ASM) in patients hospitalized with acute nontraumatic intracerebral hemorrhage (ICH).

Methods: We conducted a systematic review and meta-analysis assessing ASM primary prophylaxis in adults hospitalized with acute nontraumatic ICH. The following population, intervention, comparison, and outcome (PICO) questions were assessed: (1) Should ASM versus no ASM be used in patients with acute ICH with no history of clinical or electrographic seizures? (2) If an ASM is used, should levetiracetam (LEV) or phenytoin/fosphenytoin (PHT/fPHT) be preferentially used? and (3) If an ASM is used, should a long (> 7 days) versus short (≤ 7 days) duration of prophylaxis be used? The main outcomes assessed were early seizure (≤ 14 days), late seizures (> 14 days), adverse events, mortality, and functional and cognitive outcomes.

Kidney consequences of obesity.

Herein, we review the devastating consequences of the worldwide obesity epidemic on kidney health and outcomes. We submit that the obesity epidemic is the most pressing public health crisis facing the nephrology community today. A historical approach has been undertaken, wherein major breakthroughs in the recognition and understanding of obesity-related kidney disease (ORKD) are highlighted.

Management of carotid disease in the end-stage renal disease patient.

Chronic kidney disease (CKD) has been increasing in incidence as a result of the growing prevalence of diabetes and other risk factors for cardiovascular disease. This study highlights reports related to management of carotid disease in patients with CKD, with a special emphasis on end-stage renal disease (ESRD). Several earlier studies found that patients with CKD are more likely to die from cardiovascular causes than progress to ESRD requiring dialysis.

Using a mixed-reality headset to elicit and track clinically relevant movement in the clinic.

Background: 21st century neurology will require scalable and quantitative tools that can improve neurologic evaluations over telehealth and expand access to care. Commercially available mixed-reality headsets allow for simultaneous presentation of stimuli via holograms projected into the real world and objective and quantitative measurement of hand movement, eye movement, and phonation.

New Method: We created 6 tasks designed to mimic standard neurologic assessments and administered them to a single participant via the Microsoft HoloLens 2 mixed-reality headset.

Kinetic sand! A tale of sandy times.

Kinetic magnetic sand, composed of ultra-fine sand and dimethicone in a 98%-2% ratio, is a versatile sensory toy known for its moldable properties and structural stability (1). Despite the name, it lacks actual magnetic features. Ingesting kinetic sand can pose risks, including choking and gastrointestinal issues, especially in young children.

Readmission Rate, Predictors, Outcomes, and Burden of Readmission of Hepatorenal Syndrome in the United States: A Nationwide Analysis.

Background: Nationwide US data on readmission rates for patients with cirrhosis admitted with hepatorenal syndrome (HRS) is lacking. We reviewed 30-day readmission rates after HRS-related hospitalizations, the associated predictors of readmissions, and their impact on resource utilization and mortality in the United States.

Methods: We identified all adults admitted with HRS between 2016 and 2019 using the Nationwide Readmission database of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project.

Severe Hemorrhagic Cholecystitis in the Absence of Common Predisposing Factors.

Hemorrhagic cholecystitis is a rare and potentially life-threatening complication of acute cholecystitis. It lacks specific diagnostic and management guidelines due to its rarity. We present the case of a 70-year-old male with no typical risk factors who developed hemorrhagic cholecystitis.

Comparison of Point-of-Care Ultrasound Guidance and the Traditional Approach in Performing Simulated Emergent Cricothyroidotomy Among Emergency Medicine Physicians, Residents, and Students.

Objective  Emergency cricothyroidotomy (EC) is a rare procedure used to establish airway access when both endotracheal intubation and bag-mask ventilation have failed. Point-of-care ultrasound (POCUS) has been proposed as an adjunct to aid in identifying anatomical landmarks. However, its impact on emergency physicians when performing EC remains unclear.

Comparing Two Vancomycin Loading Dose Regimens in Patients With Obesity: A Single-Center Prospective Clinical Trial.

Background: Obesity can significantly influence the pharmacokinetics of several medications, including vancomycin. Consequently, specialized dosing strategies may be required to ensure efficacy and safety in patients with obesity (PwO) requiring treatment with vancomycin. This single-center, prospective study evaluated two vancomycin loading dose regimens in PwO, comparing serum vancomycin concentrations, adverse events, and the impact on renal function.

HIV-Associated Thrombotic Thrombocytopenic Purpura in a Virally Suppressed Patient With Normal CD4 Count: A Rare Presentation.

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic process characterized by multiorgan failure secondary to microvascular thrombi comprising platelets and von Willebrand factor. HIV is a known risk factor for TTP. However, patients generally have low CD4+ count during initial presentation or subsequent flare-ups.

An International, Expert-Based Delphi Consensus Document on Controversial Issues about TransCarotid Artery Revascularization (TCAR).

Background: Transcarotid artery revascularization (TCAR) has emerged as an alternative therapeutic modality to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TFCAS) for the management of patients with carotid artery stenosis. However, certain issues regarding the indications and contraindications of TCAR remain unanswered or unresolved. The aim of this international, expert-based Delphi consensus document was to attempt to provide some guidance on these topics.

Improve time to anti-coagulation reversal for hemorrhagic strokes.

Background: Oral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely because of the associated larger stroke volumes, higher propensity to intraventricular hemorrhage, and a higher risk of rebleeding. Although current guidelines recommend that OAC should be reversed quickly, many health care systems have not developed a process for optimizing that aspect of care.

Rare Case of Idiopathic Thrombocytopenia Causing Retrobulbar Hemorrhage.

Immune thrombocytopenia purpura (ITP) is defined as a platelet count lower than 100 × 10ˆ9/L, in the absence of known abnormalities in white blood cells, normal hemoglobin with generalized purpuric rash: making it a diagnosis of exclusion.1-2 ITP is due to destruction of platelets in the spleen via autoantibodies, resulting in reduced platelet counts.3 Though rare, ITP is linked with spontaneous retrobulbar hemorrhage (SRH).

Sump Syndrome: The Forgotten Cause of Painless Jaundice in the Elderly.

Painless jaundice is a common presentation of abdominal malignancy seen in elderly patients. While malignancy may be a common cause of obstructive jaundice in that population group, anchor bias should always be avoided. We present a case of an elderly woman who presented with painless jaundice and weight loss.

Outpatient use of antibiotics in uncomplicated diverticulitis decreases hospital admissions.

Introduction: Recently, antibiotics use in uncomplicated acute diverticulitis (AD) has been controversial in Europe. The American Gastroenterological Association (AGA) in their 2015 guidelines recommend their selective use. Our study highlights their role in outpatient management.