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Thiazolidinediones probably increase risk for pneumonia, minimally

 Infectious Disease and Sepsis, Review Articles  Comments Off on Thiazolidinediones probably increase risk for pneumonia, minimally
May 192011
 

Singh et al’s meta-analysis of 13 randomized trials of pioglitazone or rosiglitazone lasting for at least one year. There were 130 pneumonias among the 8,163 treated patients, and 100 among the 9,464 controls, for a relative risk of 1.40 for the thiazolidinedione group (CI 1.1-1.8, p=0.01). Pioglitazone showed more of a signal with a significant RR of [… read more]

Data sketchy on prolonged antibiotics for bronchiectasis

 Clinic and Consults, Infectious Disease and Sepsis, Review Articles  Comments Off on Data sketchy on prolonged antibiotics for bronchiectasis
May 172011
 

Evans et al attempted a meta-analysis of 9 randomized trials (7 in adults) testing prolonged (4 to 52 weeks) antibiotics in people with bronchiectasis. There was an improvement in “clinical response rate,” a poorly-defined endpoint, in 2 trials, but no difference in exacerbation rates or lung function. Emergence of resistant bacteria was not tested or [… read more]

Does incentive spirometry actually work?

 Clinic and Consults, Review Articles  Comments Off on Does incentive spirometry actually work?
May 162011
 

An attempted meta-analysis of 11 heterogeneous, moderate-quality randomized trials could demonstrate no benefit of incentive spirometry in preventing postoperative pulmonary complications or mortality, in 1,160 patients undergoing upper abdominal surgery, report Guimaraes et al. Cochrane Database Sys Rev 2011;3:CD006058.

Docs don’t discuss end-of-life care preferences with patients in clinic

 Clinic and Consults  Comments Off on Docs don’t discuss end-of-life care preferences with patients in clinic
May 152011
 

Janssen et alsurveyed and prospectively followed 105 Dutch patients with severe COPD and 80 with severe heart failure. Seventy percent of the respondents with COPD wanted full life support in the event of an arrest; ~64% of the CHF patients did. Sixteen to 20% of the doctors reported they had discussed these issues. However, only 4-6% [… read more]

Proning plus recruitment improved oxygenation in ARDS

 ARDS and ALI, Critical Care, Mechanical Ventilation  Comments Off on Proning plus recruitment improved oxygenation in ARDS
May 152011
 

Prone positioning improves oxygenation in ARDS patients without improving outcome. Recruitment maneuvers do too. Rival et al prospectively tested the effects of both strategies together in 16 ARDS patients. Two extended sighs of 45 cm H2O in pressure control mode while lying prone improved PaO2/FiO2 from 98 to 166 mm Hg, without obvious adverse (or positive) effects. Critical [… read more]

Rapid tests for aspergillus in BAL

 Infectious Disease and Sepsis, Lung Transplantation  Comments Off on Rapid tests for aspergillus in BAL
May 142011
 

Invasive aspergillosis is often lethal in lung transplant patients, and early diagnosis and treatment improve survival. Luong M et al showed that testing bronchoalveolar lavage fluid with new rapid-result Aspergillus PCR and galactomannan tests bring both sensitivity and specificity into the 93-100% range. 150 BAL samples from lung transplant patients at Pitt were tested (there were only [… read more]

The utility of cardiopulmonary exercise testing in difficult asthma

 Asthma  Comments Off on The utility of cardiopulmonary exercise testing in difficult asthma
May 132011
 

A retrospective and somewhat subjective case series (n=39) reporting successful reduction in steroid doses in those with a diagnosis of difficult asthma who were found to have non-pulmonary causes of dyspnea on CPET. CHEST 2011;139:1117-1123.

Extent of lymph node dissection during lung ca resections

 Lung Cancer, Review Articles  Comments Off on Extent of lymph node dissection during lung ca resections
May 122011
 

Complete mediastinal lymph node dissection (MLND) is recommended during all surgical reactions of lung cancer — yet “complete” has never been defined, and in a community study, 43% of patients got no MLND. In prospective randomized clinical trial data on 524 patients, Darling et al found that 99% of patients had at least 6 LNs removed, and 90% had 10 [… read more]

Beta-blockers associated with improved survival in COPD

 Cardiovascular Disease, COPD  Comments Off on Beta-blockers associated with improved survival in COPD
May 122011
 

Retrospectively looking at a database of 5,977 COPD patients’ hospital admissions (TARDIS), pharmacy data, and death records in Scotland, Short et al found an overall 22% lower mortality in those taking beta blockers (88% were cardioselective BBs). The benefit was seen equally in those also taking long-acting beta agonists or antimuscarinics. For those 2,712 patients with serial [… read more]

U.S. antibiotic-fed meat crawling with resistant S. aureus

 Infectious Disease and Sepsis, Policy, Ethics, Education  Comments Off on U.S. antibiotic-fed meat crawling with resistant S. aureus
May 102011
 

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]

Anticholinergic inhalers associated with slightly increased risk for acute urinary retention

 COPD  Comments Off on Anticholinergic inhalers associated with slightly increased risk for acute urinary retention
May 102011
 

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]

Grow your own new lungs — just add some (newly discovered) stem cells!

 Uncategorized  Comments Off on Grow your own new lungs — just add some (newly discovered) stem cells!
May 102011
 

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]

Culture may miss most PCR-confirmed, often-resistant Aspergillus

 Critical Care, Infectious Disease and Sepsis, Lung Transplantation  Comments Off on Culture may miss most PCR-confirmed, often-resistant Aspergillus
May 092011
 

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]

CPAP for OSA after stroke improved neuro outcome, reduced cardiovascular risk

 Cardiovascular Disease, Randomized Controlled Trials, Sleep, Obesity-related disease  Comments Off on CPAP for OSA after stroke improved neuro outcome, reduced cardiovascular risk
May 092011
 

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]

GOLD spirometry criteria overdiagnosed COPD

 COPD  Comments Off on GOLD spirometry criteria overdiagnosed COPD
May 082011
 

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]