Chest
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There is no standardized system to grade pleural effusion size on CT scans. A validated, systematic grading system would improve communication of findings and may help determine the need for imaging guidance for thoracentesis. ⋯ A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels.
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Thromboembolic diseases are common. Heparins and the vitamin K antagonists have been the mainstay of therapy for > 60 years, but both classes of agents have limitations. The "ideal" anticoagulant should be as effective and safe as heparin and vitamin K antagonists but should also be available in both a parenteral and an oral formulation, have predictable pharmacokinetics, and lack significant toxicities unrelated to the anticoagulant activity. ⋯ Rivaroxaban is approved in the United States for VTE prevention after major orthopedic surgery and for stroke prevention in atrial fibrillation and is approved in Europe and Canada for secondary prevention of VTE. Apixaban is currently under review by the US Food and Drug Administration for stroke prevention and is approved in Europe for VTE prevention following major orthopedic surgery. Dabigatran is approved in the United States for stroke prevention in nonvalvular atrial fibrillation and is being reviewed for secondary prevention of VTE.
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Paracentesis has been considered a relatively safe procedure; however, hemorrhagic complications do occur and can be fatal, especially in the context of coagulopathy. We describe the case of a 47-year-old man with coagulopathy secondary to end-stage liver disease, whose hospital course was complicated by paracentesis-related hemoperitoneum leading to abdominal compartment syndrome. ⋯ Understanding key anatomic structures is essential for patient safety in the setting of paracentesis. While recognizing the lack of clinical studies demonstrating the effectiveness of ultrasonography use in paracentesis, we discuss the benefit of bedside abdominal ultrasonography to locate ascites and avoid intraabdominal structures, as well as vascular ultrasonography, during needle insertion to avoid abdominal wall vessels.
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Presently, there is insufficient information to compare the value of daily diaries vs retrospective questionnaires for assessing symptoms in relationship to asthma control in clinical trials. Daily symptom diaries are often burdensome to gather, incomplete, susceptible to fabrication, and of questionable reliability. There is also concern that retrospective symptom questionnaires may be subject to poor recall and may be insensitive. ⋯ The results of this study indicate that daily diaries used to determine ACDs can be a more sensitive tool than ACT for assessing differential treatment responses with respect to asthma control.
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Comparative Study
Systemic inflammatory pattern of patients with community-acquired pneumonia with and without COPD.
Several clinical studies have evaluated the role of COPD in patients with community acquired pneumonia (CAP). We investigated the systemic inflammatory response of patients with CAP (CAP 1 COPD) and patients without associated COPD (CAP only). ⋯ Our prospective study demonstrates a different, disease-specific, early inflammatory pattern between patients with CAP with and without associated COPD. These findings are not completely corticosteroid mediated.