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General Critical Care

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Severe hydroureteronephrosis bilaterally, left greater than right. 5.1 cm complex fluid collection or mass in the left retroperitoneum possibly arising from the left kidney.


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Ibrahim Ameen

Phase-3 trial of recombinant human alkaline phosphatase for patients with sepsis-associated acute kidney injury (REVIVAL) | Intensive Care Medicine (springer.com)

Ilofotase alfa, a human recombinant alkaline phosphatase with potential reno-protective effects, was evaluated for efficacy and safety in the REVIVAL phase-3 trial involving sepsis-associated acute kidney injury (SA-AKI) patients. The trial was a double-blinded, randomized-controlled study focusing on patients with SA-AKI, enrolled within 72 hours of vasopressor use and 24 hours of AKI onset. Its primary goal was to assess 28-day all-cause mortality, with secondary goals including the Major Adverse Kidney Events within 90 days (MAKE90), days alive and free of organ support, days alive and out of the ICU by day 28, and time to death by day 90.


The trial involved 650 patients (330 treated with ilofotase alfa and 319 with a placebo). The 28-day and 90-day mortality rates were similar in both groups (27.9% and 33.9% for…

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Ibrahim Ameen
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Multicenter study of hospital admissions in greater Toronto: Osmotic Demyelination Syndrome occurrence and rapid correction of serum sodium


This multicenter study which was published in NEJM Evidence this month examined 22,858 hospital admissions in greater Toronto for patients with hyponatremia (low sodium levels). Osmotic Demyelination Syndrome (ODS) occurred in a small proportion of patients (0.14%), even when they underwent rapid correction of serum sodium. The study found that rapid correction of serum sodium did not generally cause ODS, and that other unidentified factors must be involved in ODS development. Certain factors were more frequent in the ODS group, including initial serum sodium levels below 110 mmol/l, positive alcohol level, and hypokalemia. The study had several limitations, including possible lack of generalizability, missing data, and the small number of ODS patients, which limited the ability to identify specific risk factors or define safe rates of serum sodium correction. The authors concluded…

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