Annals of the American Thoracic Society
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Review Case Reports
Positive end-expiratory pressure. When more may not be better.
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Randomized Controlled Trial Multicenter Study
Abdominal and general adiposity and level of asthma control in adults with uncontrolled asthma.
Abdominal adiposity may be an important risk factor for uncontrolled asthma in adults, controlling for general obesity. Whether the relationship, if present, is explained by other factors (e.g., asthma onset age, sex, and/or coexisting conditions) is unclear. ⋯ Abdominal adiposity by waist-to-height ratio and poor sleep quality correlated with poorer asthma control in adults with uncontrolled asthma, after controlling for BMI and sociodemographics. These results warrant replication in larger studies of diverse populations. Clinical trial registered with www.clinicaltrials.gov (NCT 01725945).
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Review Case Reports
Hypervitaminosis A causing hypercalcemia in cystic fibrosis. Case report and focused review.
Hypercalcemia is a rare complication of hypervitaminosis A. We report a pediatric patient with cystic fibrosis (CF) and pancreatic insufficiency who was found to have hypervitaminosis A causing hypercalcemia, complicated by nephrocalcinosis and renal impairment. The patient is a 4-year-old girl with pancreatic-insufficient CF, gastroesophageal reflux, oral aversion, and failure to thrive requiring gastrostomy tube placement. ⋯ Diagnosis of chronic hypervitaminosis A complicated by hypercalcemia was made and was managed by holding vitamin A supplements, aggressive diuresis, and prednisolone. This case emphasizes the importance of regular vitamin A monitoring in patients with CF. There is a wide variability for the lowest intake required to cause toxicity, and the lower limit to cause toxicity has not been determined.
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Multicenter Study
Increasing global mortality from idiopathic pulmonary fibrosis in the twenty-first century.
Evidence from the United Kingdom suggests that the number of deaths from idiopathic pulmonary fibrosis is increasing, although comparable international data are limited. ⋯ Mortality from idiopathic pulmonary fibrosis is increasing steadily worldwide, despite the fact that death certification will almost certainly underestimate true mortality. We estimate that there will be between 28,000 and 65,000 deaths in Europe and between 13,000 and 17,000 deaths in the United States from idiopathic pulmonary fibrosis clinical syndrome in 2014. Variation between countries remains but is less than previously reported.
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Recent studies on video laryngoscopy have demonstrated improvements in both safety and success of endotracheal intubation in the critically ill. ⋯ The majority of internal medicine critical care program directors who recently responded to an e-mail survey reported that they have changed their approach to teaching endotracheal intubation, driven largely by the adoption of video laryngoscopy for upper airway visualization. Nevertheless, despite widespread availability, video laryngoscopy is used uncommonly as the primary visualization device for intubation at the programs represented by the respondents to this survey.