European journal of internal medicine
-
Eur. J. Intern. Med. · Jul 2012
ReviewThe role of lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia.
CAP may be diagnosed and followed up by lung sonography (LUS), a technique that shows excellent sensitivity and specificity that is at least comparable with that of chest X-ray in two planes. LUS may be performed with any abdomen-sonography device. Therefore, LUS is a readily available diagnostic tool that does not involve radiation exposure and has wide applications especially in situations where X-ray is not available and/or not applicable. An X-ray or CT of the chest should be performed in cases of negative lung sonography and if other differential diagnoses or complications are suspected.
-
Eur. J. Intern. Med. · Jul 2012
ReviewThe use of non-invasive ventilation during acute respiratory failure due to pneumonia.
The use of non-invasive ventilation in patients with community-acquired pneumonia is controversial since this is associated with high rates of treatment failure, compared with other causes of severe acute respiratory failure. The populations of patients with community-acquired pneumonia who have demonstrated better response to non-invasive ventilation are those with previous cardiac or respiratory disease, particularly chronic obstructive pulmonary disease. By contrast, the use of non-invasive ventilation in patients with community-acquired pneumonia without these pre-existing diseases should be very cautious and under strict monitoring conditions, since there are increasing evidences that the unnecessary delay in intubation of those patients who fail treatment with non-invasive ventilation is associated with lower survival. ⋯ Continuous positive airway pressure has been used to treat acute respiratory failure in several conditions characterised by alveolar collapse. While this is extremely useful in patients with acute cardiogenic pulmonary oedema, the efficacy in pneumonia seems limited to immunosuppressed patients with pulmonary complications. Conversely, there are no sufficient evidences on the efficacy of continuous positive airway pressure in immunocompetent patients with pneumonia and severe acute respiratory failure.
-
Eur. J. Intern. Med. · Jul 2012
Multicenter StudyEffectiveness of varenicline for smoking cessation at 2 urban academic health centers.
Smoking is a major cause of morbidity in lower socioeconomic groups. In randomized trials, varenicline improves long term quit rates, but effectiveness in a clinic setting is unknown. ⋯ In an inner city clinic, abstinence rates were lower than those in clinical trials and did not differ between varenicline and NRT.
-
Eur. J. Intern. Med. · Jul 2012
Randomized Controlled TrialD-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial.
D-dimer levels are in several studies elevated in patients with CAP. In this study we assess the use of D-dimer levels and its association with severity assessment and clinical outcome in patients hospitalised with community-acquired pneumonia. ⋯ D-dimer levels are elevated in patients with CAP. Significantly higher D-dimer levels are found in patients with clinical failure and with severe CAP. D-dimer levels as single biomarker or as addition to the CURB-65 have no added value for predicting clinical outcome or mortality. D-dimer levels<500 μg/l may identify candidates at low risk for complications.
-
Eur. J. Intern. Med. · Jul 2012
Review Meta AnalysisVitamin D and gestational diabetes: a systematic review and meta-analysis.
Conflicting results currently exists on the association between vitamin D and glucose metabolism. The role of maternal vitamin D status in gestational diabetes mellitus (GDM) is not clear. This meta-analysis aimed to examine this role in women with GDM compared with normal glucose tolerance (NGT). ⋯ This meta-analysis indicates a significant inverse relation of serum 25OHD and the incidence of GDM. However, it remains unclear whether this association is causal due to the observational study design of the studies. Clinical trials are needed to examine whether vitamin D supplementation will improve glycemic control in women with GDM.