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8, referent, 60-89 mL/min 11.8 HR 1.41; eGFR 30-59 39.8, HR 4.37; eGFR 15-29 133.6, 13.65) and with an increasing urine albumin-to-creatinine ratio (ACR, mg/mmol; ACR< 3 14, referent, ACR 3-30 35.1, HR 1.98; ACR >30 93.7, 4.71). The 1-year event rate and adjusted risk of recurrent hyperkalemia was similarly inversely associated with eGFR (eGFR ≥ 90 10.1, referent, eGFR 60-89 14.4, HR 1.47; eGFR 30-59 54.8, HR 4.90; eGFR 15-29 208.0, HR 12.98). Among individuals with a baseline eGFR of 30 to 59 and 15 to 29, 0.9 and 3.8% had greater than 2 hyperkalemia events. The relative risk of initial and recurrent hyperkalemia was marginally higher with RAAS blockade. Roughly 1 in 4 individuals with hyperkalemia required hospitalization the day of or within 30 days after their hyperkalemia event.

Limited to individuals aged 66 years and above.

Patients with low eGFR are at a high risk of initial and recurrent hyperkalemia.

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N/A.Femoral venous aneurysms are a rare disease entity, yet they carry the risk of significant mortality due to venous thromboembolism, as demonstrated by a case report of an otherwise fit and well 74-year-old gentleman.Twin girls born at term were noted to have hypertrophic and erythematous mucosal sulci extending from the posterior vaginal fourchette to the anterior ridge of the anus on their newborn exams. Pregnancy was complicated by gestational hypertension and dichorionic diamniotic twin pregnancy. No known traumas were sustained during delivery to either twin. Dermatology and obstetrics/gynecology were consulted who confirmed the diagnosis of perineal groove. Primary care follow-up was recommended, with referral to pediatric gynecology if the lesions did not epithelize by 2 years of age. learn more Our case of perineal grooves is unique in that, to our knowledge, it is the first reported case of perineal grooves identified in both twins. Clinicians in the newborn nursery and primary care settings should perform routine genitourinary and anal examinations on all newborns to identify this benign lesion, which may limit misdiagnosis, inappropriate treatments, and invasive workups in the future.An 11-month-old male child with a complex past medical history presented for admission due to failure to thrive. He had hair loss throughout his scalp, and his abdomen was distended. There was parental report of hair pulling and hair in his stool. An upper gastrointestinal (GI) radiograph with fluoroscopy was performed and showed a filling defect in the gastric lumen. On endoscopy, he was found to have a gastric bezoar consisting of hair, nail, and food material. The trichobezoar was removed, and he began to tolerate feeds and showed consistent weight gain. There were no recurrence of symptoms 8 months following removal. While inadequate caloric intake is a common reason for failure to thrive, mechanical obstruction from a trichobezoar as a cause is rare and to our knowledge has not been reported in a child this young.In this case, it is described the importance of ultrasound in children with sliding ovaries in inguinal hernias. If the child has no symptoms, an emergency ultrasound could suggest the manner of the operation, scheduled or emergency.Clozapine is gold standard for the management of treatment-resistant schizophrenia. It can offer life-changing symptom reduction where other antipsychotics have failed, and for these patients, treatment with clozapine should be maintained, if in any possible way. However, treatment with clozapine comes with a risk of developing potentially fatal adverse reactions, for example, severe neutropenia or agranulocytosis, in which case, treatment must be discontinued. Here, we present a case of clozapine-related neutropenia that commenced after the addition of sodium valproate. A subsequent re-challenge to clozapine resulted in severe neutropenia and led to the permanent cessation of clozapine treatment. The patient had been tolerating clozapine for more than a year before the addition of sodium valproate. The awareness of an interaction between clozapine and sodium valproate could help reduce the risk of clozapine-induced neutropenia and subsequent clozapine discontinuation.Bartter syndrome is a rare autosomal recessive disorder characterized by hypokalaemia. Hypokalaemia is defined as low serum potassium concentration ˂3.5 mmol/L, which may lead to arrhythmia and death if left untreated. The aim of this case report was to normalize serum potassium concentration without the need for intravenous intervention. A 5-month-old male of 2.7 kg body weight diagnosed with Bartter syndrome was admitted to the general paediatric ward with acute severe hypokalaemia and urinary tract infection. The main challenge was the inability to administer drugs through intravenous route due to compromised body size. Therefore, we shifted the route of administration to the nasogastric tube/oral route. A total of 2 mL of concentrated intravenous potassium chloride (4 mEq potassium) were dissolved in distilled water and administered through nasogastric tube. Serum potassium concentration was rapidly normalized, which culminated in patient discharge. In conclusion, shifting drug administration from intravenous to oral route in a paediatric patient with Bartter syndrome includes numerous advantages such as patient convenience, minimized risk of cannula-induced infection, and reduced nurse workload.Rabies is a neglected tropical disease that causes mortality and high economic burden in many developing countries. Rabies is a vaccine-preventable disease if timely post-exposure prophylaxis is available after animal exposure. The control of rabies requires limiting the transmission of the virus in the animal reservoir, effective public health measures to control outbreaks and increasing accessibility and uptake of rabies post-exposure prophylaxis. Bhutan is a small Himalayan country where rabies is endemic. In this article, we describe the death of a 3-year-old female child due to probable rabies in a Bhutanese village located along the border with India. The child had a furious form of rabies with encephalitic syndrome developing 57 days after a category III dog bite on the chest. The child was managed at a district hospital with the available resources. This is the first rabies death in Bhutan in the last 5 years and the 18th since 2006. This case report focuses on the efforts required to increase the timely uptake of post-exposure prophylaxis in a free healthcare system in Bhutan.