In a 3-center observational study, Pareek et al report that 20% of new immigrants to the UK (224 of 1229) had latent tuberculosis infection as detected by interferon-gamma release assay. Standing screening policy may miss ~70% of these cases. Lancet Infect Dis 2011;11:435-444.
Douma et al compared the Wells score, Geneva score, and the simplified versions of each, combined with D-dimer, on a prospective cohort of 807 patients with suspected PE (~23% of whom were found to have PE). With a negative D-dimer and a low-probability score using any rule, risk of pulmonary embolism was ~0.5%. However, only [… read more]
Survival of trauma patients after massive red blood cell transfusion using a high or low red blood cell to plasma transfusion ratio. Rajasekhar et al. Crit Care Med 2011;39:1507-1513. Meta-analysis.
No one knows, say Lee et al. They report on 27 Korean soldiers who were exposed to 5 barracks-mates with active TB; 26 eventually “converted” by tuberculin skin test/PPD or by interferon-gamma release assay. One-time TST/PPD identified 21, or 78%. IGRA every two weeks eventually diagnosed 26 (96%), but it took 14 weeks for 3 [… read more]
Gershengorn et al retrospectively compared two MICUs at Beth Israel: one with “midlevels” (nurse practitioners and physician assistants during the day with attending coverage overnight) and one that was all house staff 24/7. There were no differences in important outcomes (mortality, MICU or hospital LOS), although the study was nonrandomized and subject to bias. CHEST [… read more]
Salaun et al publish their experience using a simple algorithm for management of 321 consecutive patients with suspected pulmonary embolism at one center in France. The tool sought to avoid CT-angiography (and associated radiation) wherever possible, instead favoring leg ultrasounds and ventilation-perfusion scans. Only the indeterminate cases (a mere 35, or 11%) underwent CT-A. In [… read more]
In association with United Biosource Corp., Jones et al are championing a patient questionnaire called EXACT-PRO that seeks to standardize the definition of a COPD exacerbation. Here, they report on the production of their proposed 14-item measure to diagnose and grade the severity of COPD exacerbations. Breathlessness, cough-and-sputum, and chest symptoms form the core of [… read more]
Lung vasculitis and alveolar hemorrhage. Ten articles in 103 pages. Semin Resp Crit Care Med 2011;32:243-346. Review.
Taveira-DaSilva reports an observational series of 19 women treated with sirolimus for lymphangioleiomyomatosis. Of 12 women with chylous pleural effusions, most had a large improvement or resolution in their effusions. Ann Intern Med 2011;154:797-805. In a randomized trial of 89 LAM patients published in NEJM March 2011, sirolimus reduced decline of lung function.
The New York Times reported that hundreds of community hospitals frequently perform two chest CT scans back-to-back (one with, one without IV contrast), while academic centers almost never do. More than 70,000 patients were double-scanned; some hospitals did it >80% of the time on their Medicare chest patients. Defenders say they don’t do it to [… read more]
Pileggi et al analyzed 28 studies and concluded that decontaminating the GI/respiratory tract with antiseptics reduced ventilator-associated pneumonia by 27%; decontamination with antibiotics reduced VAP by 36%. Antibiotic decontamination also reduced ICU infections in general, by 29%. Critical Care 2011;15:R155. FREE FULL TEXT Also see last month’s “Oral / gastric antibiotic decontamination reduced bacteremias in [… read more]
Singh et al analyzed 5 randomized trials comparing tiotropium mist to placebo, and found a 46% relative increased risk of all-cause mortality among the treated arms. The Respimat inhaler is available in Europe, but the FDA has not approved it in the US. BMJ 2011;342:d3215.
Toward a better diagnosis of idiopathic pulmonary fibrosis. Valeyre D, Eur Resp Rev 2011;20:108-113.
Chinellato et al report that among 45 children with intermittent asthma, only 11% had “adequate” levels of 25-OH-vitamin D (30-40 ng/mL). Low vitamin D was associated with low FEV1, FVC, and exercise bronchospasm. Eur Resp J 2011;37:1366-1370.
Toxic epidermal necrolysis and Stevens-Johnson syndrome. Gerull et al. Crit Care Med 2011;39:1507-1513.
Free et al randomized 5,800 UK ready-to-quit smokers to get regular motivational text messages and help-line access, vs. placebo (texts thanking them for participating). At 6 months, those getting motivational text messages had biochemically-verified continuous abstinence of 11%, vs. 5% in the controls. Verification was by salivary cotinine at 6 months (& showed that 28% [… read more]
Cardiopulmonary arrest and cardiopulmonary monitoring. Sixteen articles, 104 pages. Curr Opin Crit Care 2011;17:211-315. Cardiac arrest review.
Of 421 patients admitted to ICUs after cardiac arrest, 281 (67%) developed 373 infections, mostly pneumonias, report Mongardon et al. Crit Care Med 2011;39:1359-1364.
Meijvis et al randomized 304 people hospitalized with CAP in the Netherlands to receive dexamethasone (5 mg) or placebo daily for 4 days on admission. Those getting steroids had a ~1 day shorter length of stay and no adverse effects, besides hyperglycemia. Patients were ill, with almost half having a pneumonia severity index/PORT class of [… read more]
TNF-alpha can be elevated in severe asthmatics’ sputum and bronchial tissue. Could blocking it help? Holgate et al randomized 132 people with moderate or severe persistent asthma to receive 25 mg etanercept or placebo injections for 12 weeks. There was no difference in the primary endpoint (change in FEV1 at 12 weeks) nor in exacerbations, [… read more]