Chest
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Review Meta Analysis
Warfarin anticoagulation and outcomes in patients with atrial fibrillation: a systematic review and metaanalysis.
To examine the relationship between international normalized ratio (INR) and outcomes (major bleeding events and strokes) in patients with atrial fibrillation (AF) receiving anticoagulation with warfarin. ⋯ Available evidence indicates that in patients with nonvalvular AF, the risk of ischemic stroke with insufficient warfarin anticoagulation (INR < 2), and the risk of bleeding events with overanticoagulation (INR > 3) are significantly higher relative to patients with AF maintained within the recommended INR of 2 to 3. However, the published data are sparse, heterogeneous, and primarily reported from clinical trials. More studies evaluating clinical outcomes in relation to INR are needed, especially in a real-world setting.
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(1) To compare the performance of three spirometric algorithms developed to predict whether the total lung capacity (TLC) is reduced vs normal or increased, (2) to determine if forced expiratory volume at 6 s (FEV(6)) can be substituted for FVC in these algorithms, and (3) to determine if ascertainment bias was present in patients referred for the measurement of spirometry and TLC compared to patients referred for spirometry only. ⋯ This study provides evidence that spirometry-based algorithms can accurately predict when TLC is either normal or increased, and can also increase the a priori probability that TLC is reduced to approximately 50%. FEV(6) is equivalent to FVC in these predictions.
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Lymphangioleiomyomatosis (LAM), a disease affecting women and causing cystic lung lesions, and, in some instances, leading to respiratory failure and death, appears to be exacerbated by estrogens. Hence, hormonal therapy with progesterone is frequently employed; however, efficacy has not been demonstrated. Our aim was to determine whether progesterone administration slowed the decline in lung function in LAM. ⋯ Within the limitations of a retrospective study, our data suggest that progesterone therapy does not slow the decline in lung function in LAM.
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To develop and evaluate an observer-rated instrument, the Minnesota Sedation Assessment Tool (MSAT), which is a measure of arousability, spontaneous muscle activity, and global sedation quality of mechanically ventilated adults. ⋯ The MSAT combines the efficiency of a single-item response format while permitting the separate reliable measurement of distinct observable characteristics of intubated patients. The level of consciousness of intubated patients influences the future administration of sedative medications. Spontaneous motor activity is less important in determining subsequent sedative use but may be useful as a comparative measure of patients' kinesiologic state during critical illness.
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Case Reports
Idiopathic pleuroparenchymal fibroelastosis: description of a novel clinicopathologic entity.
Between 1996 and 2001, we identified five cases of a unique idiopathic pleuroparenchymal lung disease characterized by a clinical presentation suggestive of a chronic idiopathic interstitial pneumonia, marked pleural and parenchymal radiographic involvement with an upper lobe predominance, and surgical lung biopsy findings that did not fit with any of the currently defined interstitial pneumonias. The pathologic findings included the following: (1) intense fibrosis of the visceral pleura; (2) prominent, homogenous, subpleural fibroelastosis; (3) sparing of the parenchyma distant from the pleura; (4) mild, patchy lymphoplasmacytic infiltrates; and (5) small numbers of fibroblastic foci present at the leading edge of the fibrosis. In this report, we characterize the clinical, radiographic, physiologic, and pathologic findings of this entity, which we term idiopathic pleuroparenchymal fibroelastosis.