Diagnostic value of halo and reversed-halo signs in immune-compromised hosts. Georgiadou SP et al, Clin Infect Dis 2011;52:1144-1155. Review.
Analyzing six minute walk distances from 822 people with idiopathic pulmonary fibrosis in an interferon-gamma-1b clinical trial, du Bois et al found those whose decline in six minute walk test distance was >50 meters in 24 weeks had a four-fold risk of death within one year. In everyone but those with the very worst functional status, 6MWT [... read more]
Diffuse parenchymal lung disease, Update for 2010: Markart P et al, AJRCCM 2011;183:1316-1321.
Waters et al tested 136 meat and poultry samples in U.S. grocery stores, and found 77% of the turkey, 42% of pork, 41% of chicken, and 37% of beef were contaminated with S. aureus. 96% of the isolates were resistant to at least one drug, and 52% of isolates were resistant to 3 antibiotic classes. In the Netherlands, [... read more]
Using Canadian population-linked databases including 565,073 people with COPD aged 66 or older, Stephenson et al identified cases of acute urinary retention in 9,432 men and 1,806 women. The episodes were serious enough to result in an ED visit, hospitalization, or same-day surgery. Cross-matching against a drug claims benefit database, the odds ratio for AUR in those [... read more]
Using expression of the c-kit antigen as an identifier, Brigham researchers Kajstura et al identified stem cells in adult human lungs (from unused donor lungs and a Brigham tissue bank), established a clonal cell line from the isolated stem cells, and infected those cells with a fluorescing lentivirus. With a cryoprobe, they destroyed some mice’s [... read more]
End-stage liver disease, critical care management of: Al-Khafaji A et al. Crit Care Med 2011;39:1157-1166. Hepatic failure review.
Using PCR testing on BAL fluid, Denning et al (in Manchester UK) found Aspergillus DNA in 4 of 11 (36%) healthy volunteers; 21 of 22 patients with culture/microscopy-proven invasive aspergillosis; and 70-80% of patients with allergic bronchopulmonary aspergillosis or chronic pulmonary aspergillosis. Culture was positive in none of the ABPA patients, and only 17% of the CPA [... read more]
PARC/CCL-18 is a protein with unknown function, secreted predominantly by lung macrophages. Sin et al analyzed the relationship of PARC/CCL-18 to COPD using two large preexisting cohorts, the Lung Health Study and ECLIPSE, which they used as derivation and replication cohorts, respectively. PARC/CCL-18′s associations with outcomes were inconsistent across the cohorts. In ECLIPSE, the protein was elevated [... read more]
Parra et al diagnosed OSA in 140 patients hospitalized for stroke in Spain and randomized them to nasal auto-titrating CPAP or no therapy. The CPAP-treated patients had better Rankin and Canadian stroke outcome scores at all follow-up visits. They had the same rate of subsequent cardiovascular events, but events occurred at a median 15 months [... read more]
Lung cancer diagnosis and treatment: summary of updated NICE guidance. Baldwin DR et al, BMJ 2011;342:d2110. Lung cancer review.
Last month we reported the success of the MTB/RIF test in identifying tuberculosis when smears are negative, which occurs ~40% of the time in TB-HIV coinfection. Shah et al publish their success with the sputum MODS assay in an all-HIV clinic in South Africa. The MODS is a rapid (~7-day) culture that also identifies multi-drug resistant TB. The test was 85% sensitive [... read more]
In a community-based sample of 3,802 Spaniards aged 40-80, 4.6% had FEV1/FVC <0.7 but above the lower limit of normal. Mostly older men, they had the same respiratory exacerbation frequency, activity levels, cardiovascular risk, and 6-minute walk distances as matched controls with a ratio >0.7. They did report lower health-related quality of life in all [... read more]
Lung cancer in COPD: enhancing surgical options and outcomes, Raviv S et al, AJRCCM 2011;183:1138-1146.
De Smet et al reheat the data from their 2009 NEJM study, in which they cluster-randomized and crossed-over 5,939 patients staying >48hrs in 13 Dutch ICUs to receive either 1) standard care; 2) selective oropharyngeal decontamination (topical amphotericin B, colistin, and tobramycin in the oropharynx), or 3) selective digestive tract decontamination (the same drugs in the mouth, stomach, [... read more]
Nocturnal monitoring of home non-invasive ventilation: Janssens JP, Thorax 2011;66:438-445. Sleep and obesity hypoventilation review.
Rich et al from U. of Chicago add to the “we said, they said” record on echocardiography’s accuracy in measuring PA pressures (and by implication, whether it can be used to justify oral therapy for PAH without invasive testing). They measured 160 people’s PAP by right heart catheterization and ECHO, both tests within one month; they then [... read more]
Non-CPAP therapies in obstructive sleep apnea, European Respiratory Society task force statement. ERJ 2011;37:1000-1028. Sleep review, OSA review.
CF patients are instructed to inhale dornase alpha 30 minutes before airway clearance techniques. This has always been based on lore and plausibility. Dentice & Elkins publish their meta-analysis of 5 studies, including a total of 122 patients who were randomized and crossed-over to test the effect of the timing of dornase inhalation on outcomes. [... read more]
Rubboli et al summarize the (weak) evidence and current guidelines. General avoidance of drug-eluting stents in those with need of long-term warfarin is still the party-line recommendation, with triple therapy (warfarin, aspirin, clopidogrel) for those who receive a DES due to a strong indication. While TT is clearly superior for high risk patients (e.g., mechanical valve), the [... read more]