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Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
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Neurologic Complications in Patients with Left Ventricular Assist Devices: Single Institution Retrospective Review.

World neurosurgeryยท2020
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Updated: Dec 24, 2025

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
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Driveline Sepsis Presenting As Gout.

Brittney Toms1

  • 1Nursing, Cardiac/Thoracic/Vascular Surgery, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, USA.

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|April 10, 2020
PubMed
Summary

In patients with ventricular assist devices, methicillin-resistant Staphylococcus aureus (MRSA) driveline infections can mimic gout symptoms, potentially delaying septic arthritis diagnosis. Early recognition is crucial for better outcomes in these complex cases.

Keywords:
arthritisgoutheart failureleft ventricular assist device (lvad)mechanical circulatory support (mcs)sepsisseptic arthritis

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Area of Science:

  • Infectious Diseases
  • Rheumatology
  • Cardiology

Background:

  • Gout history can delay septic joint diagnosis, increasing morbidity and mortality.
  • Coexistent gout and septic arthritis are rare but reported in literature.
  • Ventricular assist devices (VADs) are susceptible to driveline infections, such as MRSA.

Observation:

  • A 64-year-old male with a HeartWare VAD developed MRSA driveline infection.
  • The patient presented with gout-like symptoms four months post-implant.
  • Joint aspirate revealed both MRSA and gout; driveline culture confirmed MRSA.

Findings:

  • Sepsis was diagnosed only after presentation with septic arthritis, complicating initial assessment.
  • The patient lacked typical sepsis symptoms like fever or hypotension.
  • This is the first reported case of a driveline infection seeding a joint to cause septic arthritis.

Implications:

  • Unresolved gout symptoms in patients with known driveline infections warrant evaluation for sepsis and septic arthritis.
  • Unusual presentations of sepsis, like this case, pose diagnostic and management challenges.
  • Highlights the importance of considering VAD-related infections in patients with atypical presentations mimicking other conditions.