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Prostate Abscesses and Staphylococcus aureus Bacteremia

A 55-year-old man with poorly controlled type 2 diabetes was admitted with 8 days of lower urinary tract symptoms, including burning micturition and frequency, and 2 days of fever and rigors. Examination was normal, except for fever (38.5°C) and tachycardia. No loin tenderness or penile discharge was found, and digital rectal examination showed +1 elastic, nontender […]

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Association Between High-Density Lipoprotein Cholesterol and Hyponatremia

In this issue of The American Journal of Medicine Israel and Grossman1 report an interesting observation based on their analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) and the National Health and Nutrition Examination Survey (NHANES) datasets. They used gradient boosting machines to build predictive models for hyponatremia based on SPRINT participant high-density lipoprotein cholesterol (HDL-C) levels, […]

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Urine Tests for Chronic Hypokalemia: When in Doubt, Check Urine-Sodium-to-Chloride Ratio

Urine tests are very helpful for the diagnosis of renal and electrolyte disorders. However, ordering and interpreting urine tests properly have been an Achilles heel for many primary care physicians and residents. It is particularly difficult for chronic hypokalemia because the pathophysiological mechanisms behind it can be rather complicated. Traditionally, we use transtubular K+ gradient (TTKG) […]

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Blood in Urine: A Hard Nut to Crack

A 34-year-old woman presented with a 2-week history of intermittent painless macroscopic hematuria. She had a similar episode of macroscopic hematuria 5 years ago during her last pregnancy, which resolved spontaneously. Apart from this, she had no significant medical history. She was not taking any regular medications or supplements. On examination, she appeared well. She […]

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‘Urinary Tract Infection’ and the Microbiome

The current paradigm for managing uncomplicated “urinary tract infection” (“UTI”) is deeply flawed. “UTI” is ambiguously defined, and coupled with a belief that “bacteria are not normal inhabitants of the urinary tract,”1 the diagnosis often leads to unnecessary, harmful antibiotic treatment. Although bacteriuria identified by standard clinical cultures (which we will call standard bacteriuria) is central […]

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