Chest
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We undertook systematic reviews to examine key questions (KQs) related to pediatric chronic wet cough. In children with chronic (>4-weeks) wet/productive cough not related to bronchiectasis; (KQ1)-how effective are antibiotics in improving the resolution of cough? If so, what and for how long? and; (KQ2)-when should they be referred for further investigations? ⋯ There is high quality evidence that in children aged ≤14-years with chronic (>4-weeks duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high quality evidence that when specific cough pointers (e.g. digital clubbing) are present in children with wet cough, further investigations (e.g. flexible bronchoscopy, chest CTs and immunity tests) should be undertaken. When the wet cough does not improve by 4-weeks of antibiotics, there is moderate quality evidence that children should be referred to a major center for consideration of further investigations to determine whether an underlying lung or other disease are present.
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Randomized Controlled Trial
A randomized controlled study to examine the effect of lifestyle modification program in obstructive sleep apnea.
Obesity is an important risk factor for OSA. This study aimed to assess the effect of weight reduction through a lifestyle modification program (LMP) on patients with moderate to severe OSA. ⋯ LMP was effective in reducing the severity of OSA and daytime sleepiness. The beneficial effect was sustained in 12 months.
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A 23-year-old white man was admitted to the hospital for evaluation of recurrent hemoptysis. He denied any other associated symptoms, including dyspnea, chest pain, productive cough, wheezing, fever, or weight loss. He had no significant past medical history and was not taking any medication. He had no significant family history for cardiopulmonary diseases.
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Inhalation/smoking has become the most common method of recreational opiate consumption in the United Kingdom and other countries. Although some heroin smokers appear to develop COPD, little is known about the association. ⋯ Recreational smoking of heroin appears to lead to early onset COPD with a predominant emphysema phenotype. This message is important to both clinicians and the public, and targeted screening and education of this high-risk population may be justified.
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Case Reports
Unusual Acute Sequelae of α1-Antitrypsin Deficiency: A Myriad of Symptoms With One Common Cure.
Panniculitis associated with α1-antitrypsin deficiency (AATD) is well documented but rare. We report the first case, to our knowledge, of successful induction of clinical remission of AATD-related panniculitis following a single 120-mg/kg dose administration of plasma-purified α1-antitrypsin (AAT). A 23-year-old man with known PiZZ AATD presented to the hospital with a diffusely swollen and tender right upper limb. ⋯ There was no tenderness to palpation or induration, and a clinical remission of panniculitis was observed. We report the first case, to our knowledge, of clinical remission following a single treatment with IV AAT at a dose of 120 mg/kg. This opens avenues to more timely and effective treatment of the more severe presentations of AAT-associated panniculitis.