Midtown Morning Report: What is the management script for different populations with pyelonephritis?

The Bottom Line: “Pyelonephritis typically manifests suddenly with signs and symptoms of both systemic inflammation and bladder inflammation. However, consensus is lacking re-
garding diagnostic criteria. Up to 20% of patients do not have bladder symptoms,
and some patients do not have fever; in addition, some studies of pyelonephritis did
not require the presence of flank pain or tenderness as an enrollment criterion. Clinical presentations and disease severity vary widely, from mild flank pain with low-grade or no fever to septic shock. Rates of bacteremia vary widely across studies (ranging from <10 to >50%); rates depend on host factors and are higher among patients who are severely ill, those who are immunocompromised, those who have urinary tract obstruction, and those who are 65 years of age or older.” (Johnson)

Johnson

Krakow Conference: What are the risk factors for acute aortic dissection?

The Bottom Line: “Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. Therefore, its prompt and proper diagnosis is vital to increase a patient’s chance of survival and to prevent grievous complications. Typical symptoms of acute aortic dissection include severe chest pain, hypotension or syncope and, hence, mimic acute myocardial infarction or pulmonary embolism. Advanced age, male gender, long-term history of arterial hypertension and the presence of aortic aneurysm confer the greatest population attributable risk. However, patients with genetic connective tissue disorders such as Marfan, Loeys Dietz or Ehlers Danlos syndrome, and patients with bicuspid aortic valves are at the increased risk of aortic dissection at a much younger age.” (Gawinecka, 2017)