Lemierre's syndrome following peritonsillar abscess : A case report

Lemierre's syndrome is a disorder in which bacterial infection of the head and neck region leads to thrombosis of the internal jugular vein ; left untreated, this condition can also result in metastatic infections in the lungs and joints as well as bacterial sepsis. An early diagnosis and treatment are important for preventing these pathologic outcomes. We herein report the case of a 30-year-old male with internal jugular vein thrombosis secondary to a peritonsillar abscess accompanied by septic emboli in the lung. The criteria proposed by Yamamoto and Sugiura et al. were used to facilitate a rapid diagnosis of his condition prior to obtaining results from blood cultures. While Lemierre's syndrome is a fairly uncommon diagnosis at this time, its incidence has been increasing given the current pressure to limit the use of antibiotics. Antimicrobial use is currently restricted in Japan due to efforts designed to curb the emergence of drug resistance; as such, we may begin to see more cases of this disease. Although rare, some patients with infection of the head and neck region do develop Lemierre's syndrome ; as such, frequent follow-up of all cases of acute pharyngitis is necessary, notably for those patients not treated with antimicrobial agents

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo