RESUMEN
Background: This study aims to investigate the safety and efficacy of guideline-directed fluid resuscitation (GDFR) compared with conservative fluid management in end-stage renal disease (ESRD) patients with sepsis by evaluating 90-day mortality and intubation rate. Methods: Following PRISMA guidelines, a systematic review was conducted across multiple databases using specific keywords and controlled vocabulary. The search strategy, implemented until October 1, 2023, aimed to identify studies examining fluid resuscitation in ESRD patients with sepsis. The review process was streamlined using Covidence software. A fourth reviewer resolved discrepancies in study inclusion. A random-effects model with the generic Mantel-Haenszel method was preferred for integrating odds ratios (ORs). Sensitivity analysis and publication bias analysis were performed. Results: Of the 1274 identified studies, 10 were selected for inclusion, examining 1184 patients, 593 of whom received GDFR. Four studies were selected to investigate the intubation rate, including 304 patients. No significant mortality or intubation rate difference was spotted between both groups [OR = 1.23; confidence interval (CI) = 0.92-1.65; I2 = 0% and OR = 1.91; CI = 0.91-4.04]. In most studies, sensitivity analysis using the leave-one-out approach revealed higher mortality and intubation rates. The Egger test results indicated no statistically significant publication bias across the included studies. Conclusion: Our research contradicts the common assumption about the effectiveness of GDFR for sepsis patients with ESRD. It suggests that this approach, while not superior to the conservative strategy, may potentially be harmful.
RESUMEN
Dual exemestane-everolimus therapy has been shown to confer a progression-free survival benefit in women with refractory advanced hormone-receptor-positive breast cancer. Patients with breast cancer may experience several other comorbidities, including hypertension, for which angiotensin-converting enzyme inhibitors (ACE-I) are a first-line therapy for hypertension of cardiovascular and/or renal etiology. One rare but feared side effect of ACE-I is severe angioedema due to decreased bradykinin degradation, which can lead to respiratory collapse. Several single-center case series have previously suggested that the use of everolimus in conjunction with ACE-I may lower the threshold for angioedema development. We report our experiences managing a 71-year-old with metastatic breast carcinoma and hypertension who presented with severe angioedema after the combined use of exemestane-everolimus with lisinopril.
RESUMEN
Coronaviruses are a well-known cause of upper and lower respiratory disease, and since 2002 have been a recognized source of potential pandemic spread. Over the past two decades, since the Severe Acute Respiratory Syndrome (SARS) outbreak, a large body of research has accumulated on the virology, clinical symptoms and signs, and experimental treatments of Coronaviruses. In 2020, a new form of Coronaviruses (SARS-CoV-2) emerged and spread rapidly throughout the globe. Given the wide-ranging clinical presentations of those infected with SARS-CoV-2, other viruses might be overlooked when evaluating at-risk patients. Furthermore, due to suboptimal testing capabilities, an early clinical diagnosis is not always possible. Here, we present a case of a patient with pneumonia thought to be caused by SARS-CoV-2 only to be found to have another Coronavirus. This emphasizes the need to be vigilant when evaluating patients with viral-like respiratory infections.