Occluding the left atrial appendage during cardiac surgery for other indications reduced the risk of ischemic stroke or systemic embolism in patients with atrial fibrillation in LAAOS III (the third Left Atrial Appendage Occlusion Study) (N Engl J Med 2021; 384(22):2081-2091). But questions remain.
Preoperative management of noninsulin glucose-lowering medications can be challenging as clinicians navigate adjustment amid decreased oral intake while maintaining euglycemia and avoiding hyper- or hypoglycemia. The authors review current published guidelines, along with the local protocol currently in place at Cleveland Clinic, to help clinicians determine which noninsulin glucose-lowering drugs may need to be held preoperatively and for how long.
The pathogenesis of immunoglobulin (Ig) A nephropathy is described through a "4-hit" model involving production of galactose-deficient IgA, production of autoantibodies to galactose-deficient IgA, and subsequent deposition of immune complexes in the kidney glomerulus. Diagnosis remains dependent on a kidney biopsy, often after hematuria or proteinuria is detected on urinalysis. The cornerstone of therapy still involves renin-angiotensin-aldosterone system inhibitors or corticosteroids; however, new therapies targeting key aspects of the pathogenesis of IgA nephropathy are being introduced.
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