A 43-year-old African American woman presented to the emergency department with severe dyspnea, wheeze, and cough productive of white sputum. Three years earlier, she had been given a diagnosis of asthma based on symptoms of wheeze and cough; her treatment regimen included intermittent use of albuterol.
A 61-year-old man with arthritis and an 80-pack-year smoking history presented with fever, dyspnea, and productive cough of a week’s duration that did not respond to outpatient treatment with levofloxacin.
A 6-month-old boy has a 1-week history of dry cough that worsens at night. He has been wheezing intermittently for the past month. A 2-year-old girl has had severe nighttime cough, congestion, and fever for 2 days. She recently recovered from a respiratory illness of 1 month's duration. Chest radiographs of both patients are shown… Read More
Find out the pathological distinction between this 43-year-old African American woman's ultimate diagnosis and a diagnosis of desquamative interstitial pneumonia. Read More
Patients with asthma may be reluctant to exercise for fear of triggering an attack. You can reassure them that adequate control can allow them to participate in almost any physical activity they wish. Recommendations from the NIH offer guidance on prevention of exercise-induced bronchospasm… Read More
A 61-year-old man was admitted with the diagnosis of right lower lobe (RLL) pneumonia on the basis of RLL consolidation on his radiograph. He was treated with intravenous ceftriaxone and azithromycin. However, there was no improvement in his symptoms... Read More
PEDIATRIC SPIROMETRY OVERVIEW
Prof. Dominic Fitzgerald, a pediatric respiratory and sleep physician, reviews the basics about spirometry, and explains its use in children.
A 2-month-old infant had right submandibular swelling with inflammation and induration up to the nape of neck. Ultrasonography showed multiple enlarged lymph nodes with soft tissue swelling. Blood cultures grew Gram-positive cocci, which were identified as group B streptococci. Late-onset GBS... More »
Botox approved for urinary incontinence or frequency; screening for partner violence; Norovirus update; immunization schedule update; new name for PCOS? More »
An update to the adult immunization schedule has been released by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practice. More »
The FDA requires reductions in recommended doses of zolpidem; update on the flu; new BP goals for patients with diabetes; selective use of D-Dimer for suspected DVT; new food safety standards. . . here: 5 quick summaries of medical news headlines with links out to original sources. More »
The authors describe the case of a 2-year-old girl with severe persistent asthma whose disease management was complicated by this rare clinical diagnosis. More »
Physicians are being under-reimbursed for vaccinations nearly half the time, according to new data released by athenahealth. Most physicians are properly reimbursed for the cost of the vaccine itself, but getting paid for administration of the vaccine is another matter.
A 56-year old was seen in the ED after 4 days of hemoptysis and intermittent left chest pain. He also complained of exertional dyspnea and arthralgias. He had been treated for “pneumonia” twice during the past month. Histories were unremarkable.
Advances in tuberculosis diagnostics: the Xpert MTB/RIF assay and future prospects for a point-of-care test. By - Stephen D Lawn FRCP, Peter Mwaba FRCP, Matthew Bates PhD, Amy Piatek MS, Heather Al...
Purpose of review: This overview highlights recent experimental and epidemiological evidence for the programming effects of outdoor air pollution exposures during early development on lung function and chronic respiratory disorders, such as a
It is not known how many stroke patients die from fatal pulmonary complications such as aspiration pneumonia (AP) and choking each year in the United States. This study aimed to determine the frequency of reporting of AP or choking as a cause of death on death certificates with mention of stroke in the United States as a proxy measure of the incidence of dying from AP or choking among patients with stroke.
Respiratory syncytial virus (RSV) remains the leading cause of serious viral bronchiolitis and pneumonia in infants and young children throughout the world. The burden of disease is significant, with 70% of all infants being infected with RSV within the first year of their life. 40% of those children discharged from hospital have recurrent, repeated respiratory symptoms and wheezing for at least 10 years. The infection is also an important illness in the elderly and immunocompromised individuals. Ongoing symptoms relate to continued lung inflammation. One cytokine that is associated with RSV infection is IL-1, but the mechanism of activation remain unclear.|In the current study, we set out to decipher the molecular mechanisms of RSV-induced inflammasome activation.|Using deletion mutants of the virus and measuring IL-1 secretion, as well as caspase 1 expression via western blotting, we demonstrate that the NLRP3 inflammasome is activated through the small hydrophobic (SH) RSV
Rotaviruses are the leading cause of community-acquired and nosocomial gastroenterocolitis in children. There is little data concerning the epidemiology of nosocomial rotavirus gastroenterocolitis (NRVG) in Central European countries. The aim of our study was to analyze the epidemiology of NRVG in a pediatric hospital in Warsaw, Poland, where the majority of children was admitted due to respiratorytract infections. Retrospective chart analysis of 49,697 patients aged 0-18 hospitalized during 2006-2009 was performed. NRVG was defined as acute gastroeneterocolitis (>3 loose stools in 24 h or vomiting), confirmed with A rapid immunochromatographic test, if symptoms developed >48 h after admission. In total, 469 cases of NRVG were diagnosed. The cumulative attack rate of NRVG for the hospital was calculated as 0.97% (CI 0.86-1.02), the cumulative incidence density was 2.07/1000 bed-days (CI 2.01-2.13). The majority of NRVG were diagnosed at the General Pediatrics Ward (206 cases, 44%)
The purpose of this study was to estimate the incidence of postoperative pulmonary complications after hysterectomy for benign indications.|This was a retrospective cohort study of all women who underwent hysterectomy for benign indications at the Cleveland Clinic from Jan. 1, 2001, to Dec. 31, 2009. Exclusion criteria incorporated patients who underwent hysterectomy for premalignant or malignant conditions. Pulmonary complications were defined as postoperative pneumonia, respiratory failure, atelectasis, and pneumothorax based on International classification of diseases, ninth revision, codes.|In the 9-year study period, 3226 women underwent hysterectomy for benign indications (abdominal, 38.4%; vaginal, 39.3%; laparoscopic, 22.3%). Ten of the 3226 women (0.3%; 95% confidence interval, 0.17-0.57%) who underwent hysterectomy were identified with postoperative pulmonary complications. Among the different types of hysterectomy, the incidence of pulmonary complications was not different
Specific International Classification of Diseases, Ninth Revision, codes for laparoscopic procedures introduced in 2008 allow a more accurate evaluation of laparoscopic colorectal surgery.|Using the Nationwide Inpatient Sample 2009, a retrospective analysis of surgical colorectal cancer and diverticulitis patients was conducted. Logistic regression was used to estimate odds ratios comparing the outcomes of laparoscopic, open, and converted surgery.|A total of 121,910 patients underwent resection for cancer and diverticulitis, 35.41% of whom underwent laparoscopic surgery. Compared with open surgery, laparoscopic surgery had lower postoperative complication rates, lower mortality, shorter hospital stays, and lower costs. Compared to open surgery, laparoscopic surgery independently decreased mortality, postoperative anastomotic leak, urinary tract infection, ileus or obstruction, pneumonia, respiratory failure, and wound infection. Converted surgery was independently associated with
Obstructive respiratory diseases, mainly the chronic obstructive pulmonary disease (COPD) and asthma, are associated with functional polymorphisms of xenobiotic-metabolizing enzymes (XMEs). To date, association for obstructive bronchitis has not been described.|In this study, we investigated the genotypes from 26 functional polymorphisms of 20 XMEs in children (n, 1028) at the age of 6 years from the German prospective birth cohort study (LISAplus) and analyzed the associations between genotypes and obstructive bronchitis.|For the first time, we found noteworthy gene-disease associations for the functional PON1 M55L and EPHX1 H139R polymorphisms and gene-environment associations for the functional COMT V158M and NQO1 P187S polymorphisms after stratification for maternal active smoking behaviour during pregnancy. The noteworthy associations were substantiated by the biological findings that all the risk genotypes belong to genes involved in oxidative stress and code for proteins with a
These include, but are not limited to, asthma, emphysema, chronic bronchitis, pneumonia irrnormal and immunocompromised hosts, pulmonary emboli, sleep-related breathing disorders, lung nodules and masses, tuberculosis, fungal infections, and
Another clue that a respiratorytract infection is due to a cold or flu is that these types of infections are very contagious, and can be spread from person-to-person. ... Anthrax is not contagious. Therefore, if family members and co-workers have
Primary Care Can't Thrive Without Nurse Practitioners Courtney H. Lyder, ND, May 17, 2013 With a projected shortfall of primary-care physicians, it's time for alternate solutions to patient care. Nurse practitioners are one logical remedy.
Physicians are being under-reimbursed for vaccinations nearly half the time, according to new data released by athenahealth. Most physicians are properly reimbursed for the cost of the vaccine itself, but getting paid for administration of the vaccine is another matter.
A 56-year old was seen in the ED after 4 days of hemoptysis and intermittent left chest pain. He also complained of exertional dyspnea and arthralgias. He had been treated for “pneumonia” twice during the past month. Histories were unremarkable. 
