Chest
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Randomized Controlled Trial
The responsiveness of different exercise tests in Chronic Obstructive Pulmonary Disease: a randomised controlled trial.
COPD is characterized by reduced exercise tolerance, and improving physical performance is an important therapeutic goal. A variety of exercise tests are commonly used to assess exercise tolerance, including laboratory and field-based tests. The responsiveness of these various tests to common COPD interventions is yet to be compared, but the results may inform test selection in clinical and research settings. ⋯ International Standard Randomised Controlled Trial Number (ISRCTN): No. 64759523; URL: https://www.isrctn.com/ISRCTN64759523.
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A 75-year-old patient with autosomal dominant polycystic kidney disease (ADPKD) and hypertension was admitted to the hospital with abdominal pain secondary to a choledochal cyst resulting in biliary dilation. His hospital course was complicated by pneumonia, encephalopathy, and lower gastrointestinal bleeding (LGIB) that initially did not lead to hemodynamic compromise. To further evaluate the LGIB, a colonoscopy was performed, during which he experienced significant hypotension after being placed in the supine position and given anesthesia. The hypotension required treatment with vasoactive medications, termination of the colonoscopy, and transfer to the medical ICU for invasive hemodynamic monitoring and treatment.
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Patients with COPD frequently demonstrate pulmonary hypertension (PH). Severe PH in patients with COPD, identified by pulmonary vascular resistance (PVR) of > 5 Wood units (WU), is closely linked to impaired transplant-free survival. The impact of PH-targeting pharmacotherapy in this context remains unclear. ⋯ Patients with COPD and PH exhibit poor transplant-free survival, with PVR being a predictor of mortality. In this meta-registry, PDE5i therapy was associated with a significant reduction in mortality across all tested models.
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Sarcoidosis is an idiopathic systemic granulomatosis whose evolution is self-limiting in most cases. However, it can progress to organ damage that menaces the vital or functional prognosis of patients. Sarcoidosis itself, but also its comorbidities, can pose a threat to the patient, require rapid initiation of treatment, and justify emergency hospitalization. ⋯ Our findings indicate that the overall mortality of patients with sarcoidosis hospitalized in emergency was high. The presence of comorbidities and the severity of respiratory failure, as reflected by oxygen requirement, are important prognostic determinants.
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People with HIV are at increased risk for lung cancer and multimorbidity, complicating the balance of risks and benefits of lung cancer screening. We previously adapted Decision Precision (screenlc.com) to guide shared decision-making for lung cancer screening in people with HIV. ⋯ gov.