Chest
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Review
WHO's in Second?: A Practical Review of World Health Organization Group 2 Pulmonary Hypertension.
World Health Organization (WHO) group 2 pulmonary hypertension (PH) due to left-side heart disease (ie, heart failure or left-sided valvular heart disease) is the most common form of PH in western countries. Distinguishing patients with WHO group 2 PH, particularly the subset of patients with PH due to heart failure with preserved ejection fraction (HFpEF), from those with WHO group 1 pulmonary arterial hypertension (PAH) is challenging. Separating the two conditions is of vital importance because treatment strategies differ completely. ⋯ We review contemporary studies that focus on clinical and echocardiographic findings that help to distinguish HFpEF from PAH in the patient with PH. We discuss the typical, and sometimes atypical, hemodynamic profiles that characterize these two groups, review challenges in the interpretation of data obtained by right-sided heart catheterization, and highlight special maneuvers that may be required for accurate diagnosis. Finally, we review the largely disappointing studies on the use of PAH-specific therapies in patients with WHO group 2 PH, including the use of prostacyclins, endothelin receptor antagonists, and the more promising phosphodiesterase-5 inhibitors.
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Review Case Reports
Seizure-induced acute urate nephropathy: case report and review.
Urate nephropathy is observed primarily in patients treated for malignancy, but several other predisposing conditions are recognized. We report a case in which urate nephropathy complicated status epilepticus and review the literature regarding previous similar cases. In addition, we discuss current views of the pathophysiology of acute kidney injury due to urate nephropathy. This case illustrates the value of carefully examining the urine of patients with acute kidney injury to identify causes that may have a specific treatment.
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Aspiration of a medication in the airways in any form produces a variety of adverse effects, both local and systemic. Furthermore, specific reaction of the airways to each type of pill strongly affects the outcome. It is crucial for pulmonologists and emergency medicine specialists to acknowledge this clinical entity. ⋯ These aerosolized medications can also cause local as well as systemic side effects. We review the local and systemic reactions of these "pills" accessing the airways either by incidental aspiration or iatrogenic administration. We address clinical presentation, mechanism of injury, diagnosis, and management of complications of these pills in the air passages.
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The quality and potential impact of available clinical guidelines for asthma management have not been systematically evaluated. We, therefore, evaluated the quality of clinical practice guidelines (CPGs) for asthma. ⋯ The quality of guidelines for asthma care is low, although it has improved over time. Greater efforts are needed to provide high-quality guidelines that can be used as reliable tools for clinical decision-making in this field.
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Hyponatremia is common in critical care units. Avoidance of neurologic injury requires a clear understanding of why the serum sodium (Na) concentration falls and why it rises, how the brain responds to a changing serum Na concentration, and what the goals of therapy should be. A 4 to 6 mEq/L increase in serum Na concentration is sufficient to treat life-threatening cerebral edema caused by acute hyponatremia. ⋯ In patients with hyponatremia with oliguric kidney failure, controlled correction can be achieved with modified hemodialysis or continuous renal replacement therapies. ODS is potentially reversible, even in severely affected patients who are quadriplegic, unresponsive, and ventilator dependent. Supportive care should be offered several weeks before concluding that the condition is hopeless.