Internal and emergency medicine
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Eosinophilic oesophagitis (EoE) is a chronic and progressive immune-mediated condition, typically affecting young atopic male adults and potentially leads to organ dysfunction and fibrosis. The clinical spectrum widely varies -from non-troublesome dysphagia to food impaction- and hence the rate of misdiagnosis and diagnostic delay are high, especially when presenting with minor symptoms, such as heartburn and acid regurgitation. There have been several major therapeutic breakthroughs for the management of EoE in recent years. ⋯ Therefore, the early diagnosis of this disorder and specialist referral is if of great importance. The evaluation of alarm signs and typical presentation patterns should allow a more straightforward recognition. The emergency and internal medicine doctors should actively be involved in this process and take part to the multidisciplinary care of patients with EoE, to allow better patient care and clinical outcomes.
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Review
Diaphragmatic ultrasound: approach, emerging evidence, and future perspectives in non-ICU patients.
Diaphragmatic dysfunction is an important contributor to hypercapnic respiratory failure, but its presence is often challenging to determine at the bedside. Diaphragm ultrasound provides an opportunity to evaluate the function of the diaphragm noninvasively by evaluating the following parameters that can help define diaphragmatic dysfunction: diaphragm excursion, diaphragm muscle thickness, and thickening fraction. ⋯ This article provides an overview on how to perform diaphragm ultrasound, review its pitfalls, and discuss the evidence of its use in patients with neuromuscular disorders and chronic obstructive pulmonary disease. Finally, its potential emerging uses in the perioperative setting and for evaluation of acute heart failure are discussed.
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In patients with pneumonia, lung ultrasound is a useful diagnostic and monitoring tool and has been proven to be superior to physical examination and chest X-ray in terms of feasibility and diagnostic accuracy. Guidelines do not address lung ultrasound as part of the diagnostic workup or as monitoring tool which is surprising. ⋯ Various clinical settings are considered, in addition to limitations, pitfalls and advanced techniques. The aim of this paper is to equip the clinician with the necessary knowledge to maximize lung ultrasound in pneumonia as effective diagnostic and monitoring tool.