Ischemic Stroke Prevention: ALH–eGFR Framework for Precision

PLEURAL EFFUSION :- • Pleural effusion is the abnormal accumulation of fluid in the pleural space, impairing gas exchange and lung expansion. It is classified as either:🔹 Transudative (Watery Fluid) :-• Caused by systemic factors (↑ hydrostatic or ↓ oncotic pressure)  • Common causes:     - Heart failure     - End-stage renal disease     - Liver cirrhosis with ascites  🔹 Exudative (Protein-Rich/Thicker Fluid) :-• Caused by local inflammation or malignancy  • Common causes:     - Malignancy     - Pulmonary embolism     - Tuberculosis  🔍 Signs & Symptoms :-• May be asymptomatic  • Dyspnea (SOB)  • Pleuritic chest pain  • ↓ Breath sounds or absent on auscultation  🧪 Diagnostic Tests :-• Chest X-ray, ultrasound  • Thoracentesis for fluid analysis  • Physical exam (↓ breath sounds, dull percussion)  💉 Treatment :-  • Thoracentesis  • Treat underlying cause (e.g., antibiotics)  💡 Nursing Interventions :-  • Monitor respiratory status, vital signs  • Position in High Fowler’s  • Administer O2 as needed  • Pain control  • Encourage deep breathing, incentive spirometry  📚 Client Education :-• Report worsening symptoms: SOB, cyanosis, bloody sputum⚠️ Complications :-• Pneumothorax  • Empyema  • Lung fibrosis  

𝗜𝗻𝗰𝗿𝗲𝗮𝘀𝗲𝗱 𝗣𝗿𝗲𝘃𝗮𝗹𝗲𝗻𝗰𝗲 𝗼𝗳 𝗘𝗼𝘀𝗶𝗻𝗼𝗽𝗵𝗶𝗹𝗶𝗮 𝗶𝗻 𝗛𝗲𝗺𝗼𝗱𝗶𝗮𝗹𝘆𝘀𝗶𝘀 𝗣𝗮𝘁𝗶𝗲𝗻𝘁𝘀 ➖️➖️➖️➖️➖️➖️➖️➖️➖️➖️➖️ 𝗘𝗼𝘀𝗶𝗻𝗼𝗽𝗵𝗶𝗹𝗶𝗮 remains not uncommon in hemodialysis patients, often linked to allergic reactions to dialysis circuit components. Prevalence increased from 1.5% (historical cohort) to 4.7% in current patients. Patients with eosinophilia were more likely to use ACE inhibitors (41.7% vs. 12.5%) and had lower CRP levels (10 vs. 24 mg/L). Prognosis: Generally favorable for asymptomatic cases; no significant difference in mortality or hospitalization compared to controls. Source: Hemodialysis International, DOI: 10.1111/hdi.12395 #Hemodialysis #Eosinophilia #Nephrology #ClinicalResearch #DialysisCare #OldButGold

Last week we saved another patient from the clutches of long-term dialysis ⸻ 🌡️ Rhabdomyolysis, Myoglobin Toxicity & Acute Kidney Injury Last week I treated a patient with a CPK of 30,000 from statin-associated rhabdomyolysis. His urine output dropped sharply, kidney function worsened, and we had to start dialysis early. After ~10 days of treatment, he recovered fully. This case highlights how fast rhabdomyolysis can progress—and why early intervention saves kidneys. ⸻ 🧬 What Rhabdomyolysis Actually Means Rhabdomyolysis is the breakdown of skeletal muscle, releasing massive amounts of myoglobin into the bloodstream. Why myoglobin is toxic • Precipitates in renal tubules (especially in acidic urine) • Forms obstructing pigmented casts • Generates free radicals → direct tubular damage • Worsens ischemia by promoting renal vasoconstriction When urine flow is poor, these effects accelerate dramatically. ⸻ 🚨 Minimal Urine Output = Dialysis Now Once a rhabdomyolysis patient becomes oliguric, kidney injury can become irreversible within hours. Low urine output means: • Myoglobin concentrates and becomes more nephrotoxic • Electrolytes (K⁺, PO₄³⁻, urate) rise rapidly • Tubular obstruction worsens • The kidney can no longer clear toxins This is why in my clinical practice, early dialysis is essential in oliguric rhabdomyolysis—not as a last step, but as a kidney-saving intervention. ⸻ 📜 What Wartime Medicine Taught Us Our modern approach comes directly from battlefield observations: 1941 – London Blitz Bywaters & Beall identified “crush syndrome” and discovered that myoglobin is the nephrotoxin causing renal failure. Korean & Vietnam Wars The critical lesson: Immediate, aggressive fluids prevent kidney failure. Delays dramatically increased dialysis and mortality. Modern disasters Earthquakes, bombings, and collapses still show the same truth: Late fluids = more rhabdo-AKI that needs dialysis. ⸻ 🧠 Key Takeaway Rhabdomyolysis can destroy kidney function rapidly. Early recognition, early fluids, and early dialysis in oliguric patients are the difference between recovery and irreversible injury.

Smart Research Review: Non-pharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration "Chronic pain is a well-established risk factor for suicide ideation and suicide attempts, as well as for opioid use disorder and opioid-related overdose, especially in the presence of already existing substance use disorder." "Our results suggest that non-pharmacological treatments provided to active duty service members with chronic pain may reduce their odds of long-term adverse outcomes. Given known associations of these adverse outcomes with morbidity and mortality, providing NPT to service members with chronic pain could potentially save lives." "Our results provide further support for the role of non-pharmacological treatments as a risk mitigation strategy when long-term opioid therapy is initiated, which is only briefly mentioned in the VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain." https://lnkd.in/eJBRvD_M

Today, November 14, is the World Diabetes Day. Diabetic retinopathy affects lives of millions of people. It is one of the most common complications of diabetes and among the leading causes of blindness holding the first place in working-age adults. During the early stages diabetic retinopathy remains often without symptoms and can therefore go unnoticed. Regular and efficient screenings are crucial for saving the vision of the patients with diabetes. Early detection of the signs of the pathology can empower the patients to change their lifestyle in order to gain better control of the disease improving the quality of life. Modern solutions provide diabetologists, endocrinologists, and general practitioners with advanced tools for a holistic view of patients’ health, including eye health. With the help of instant screening results, they can identify the patients in need of specialized care and refer them to the ophthalmologist for treatment. The seamless collaboration between the screener and the ophthalmologists can lead to better outcomes and prevent blindness – keeping the wonderful world visible for their patients. Read more: https://hubs.la/Q03SLSWy0

In addition to treating inflammation in patients with polymyalgia rheumatica (PMR), clinicians should include mobility and independence as explicit targets of care due to the associated functional decline in this population. A proposed function modification PMR model includes the following steps: 1. Assess and track functional performance in the clinic using feasible and prognostic measures (e.g., gait speed, 5-times sit-to-stand, and Short Physical Performance Battery). 2. Provide early education on the importance of staying active, with referral to physiotherapy as needed, to prescribe individualized progressive resistance training for girdle muscles, balance/coordination exercises, and aerobic conditioning—dosing tailored to disease status. Physiotherapists emphasize the value of physical therapy in supporting people with PMR. 3. Assess fracture risk, including pharmacologic interventions and fall-prevention strategies. These steps should run parallel to pharmacologic management, including glucocorticoids and glucocorticoid-sparing therapies, aiming for remission or low disease activity while optimizing daily function. *From: O’Brien AV, Sattui SE. From symptom amelioration to function modification: is it time to expand the treatment focus in polymyalgia rheumatica? Rheumatology (Oxford), 2025.  🔗https://lnkd.in/dBiuZr5i

Post Title: Personalising Dialysis in Acute Kidney Injury For hemodynamically stable patients with dialysis-requiring acute kidney injury (AKI‑D), tailoring dialysis frequency based on clinical and metabolic indications—rather than following a fixed thrice-weekly schedule—may reduce treatment burden. While no randomized trial has definitively shown improved renal recovery with this approach, observational and mechanistic evidence suggest that: • Preserving residual nephron function • Minimising dialysis-related inflammation and oxidative stress • Avoiding intradialytic hypotension may support kidney recovery. Artificial intelligence could assist clinicians by monitoring lab trends, urine output, and hemodynamics to help identify when dialysis is needed, while clinical judgment remains essential. Disclaimer: This content is for professional discussion and education only and does not constitute individual patient advice. #Nephrology #AcuteKidneyInjury #Dialysis #IndividualisedCare #AIinHealthcare #MedicalEducation

Prof. Carel Le Roux reminds us that obesity is a relapsing disease with over 220 complications. Yet, unlike hypertension or diabetes, obesity has long lacked clear treatment targets, limiting the ability to deliver structured and effective care. Thanks to advances such as metabolic bariatric surgery and new medications like semaglutide and tirzepatide, achieving 20–25% weight loss is now possible. For the first time, this allows clinicians to set meaningful treatment targets, helping track progress, improve clinician–patient alignment, and integrate obesity care into a chronic disease model. Recent qualitative research also revealed five key factors influencing patient decisions in obesity treatment. The takeaway message is clear: Provide tailored, transparent information. Ask not only about weight-loss goals, but also about health gains and quality of life. Understand patients’ fears and support needs.

🔬 One of the Silent Risks Hiding Behind “Normal” Lab Results Did you know that some of the patients with early liver disease have normal liver enzymes? In clinical practice, we often reassure patients based on AST and ALT alone — but emerging evidence shows this may give a false sense of security. Key Insight: Subclinical liver fibrosis can progress quietly. Reliance on liver enzymes alone misses the bigger picture: fibrosis can be present even when AST and ALT are within normal range. What clinicians should consider: 👉 Use of non-invasive fibrosis scores (FIB-4, NAFLD score) 👉 Early use of transient elastography in at-risk patients (diabetics, metabolic syndrome, obesity) 👉 Lifestyle intervention before biochemical derangement appears Takeaway: Normal lab values do not guarantee normal organ function. In modern medicine, we must move from reactive treatment to predictive detection. Question for colleagues: ➡️ Are we ready to integrate fibrosis risk scoring as a standard screening tool in primary care? What barriers do you see in your practice?