Chest
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ABSTRACT BACKGROUND Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community acquired pneumonia. MR-proADM when measured during AECOPD has also been shown to be a predictor for mortality, we hypothesized that MR-proADM levels measured in a stable state could also predict mortality. METHODS We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during stable state and at hospitalization for AECOPD when they also produced sputum. ⋯ The corrected Odds Ratio for one year mortality was 8.90 (95% CI 1.94 - 44.6) in patients with high MR-proADM levels measured in stable state, compared to patients with low levels. CONCLUSIONS MR-proADM measured in stable state showed to be a strong predictor for mortality in COPD patients. MR-proADM is far more convenient to measure than other predictors for mortality in COPD such as the BODE score.
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American Thoracic Society guidelines support using fractional exhaled nitric oxide (FENO) measurements in patients with asthma and highlight gaps in the evidence base. Little is known about the use of FENO levels to predict asthma exacerbations among high-risk, urban, minority populations receiving usual care. ⋯ FENO level may not be a clinically useful predictor of health-care use for asthma exacerbations in urban minority children with asthma.
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Rhabdomyolysis is a well-known clinical syndrome of muscle injury associated with myoglobinuria, electrolyte abnormalities, and often acute kidney injury (AKI). The pathophysiology involves injury to the myocyte membrane and/or altered energy production that results in increased intracellular calcium concentrations and initiation of destructive processes. Myoglobin has been identified as the primary muscle constituent contributing to renal damage in rhabdomyolysis. ⋯ There is little evidence other than from animal studies, retrospective observational studies, and case series to support the routine use of bicarbonate-containing fluids, mannitol, and loop diuretics. Hyperkalemia and compartment syndrome are additional complications of rhabdomyolysis that must be treated effectively. A definite need exists for well-designed prospective studies to determine the optimal management of rhabdomyolysis.
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Investigations on breath analysis have provided preliminary data on its potential in the noninvasive diagnosis of lung diseases. Although the conventional comparisons of exhaled breath in study populations (ie, diseased vs healthy) may help to identify patients with various lung diseases, we believe that the analysis of exhaled breath holds promise beyond this scenario. On the basis of preliminary findings, we hypothesize that breath analysis (1) could be applied not only to identify patients with lung disease but also to better phenotype healthy subjects at risk and patients with a particular disease, which is in-line with current efforts toward individualized medicine; (2) could be useful in estimating internal body time to determine the optimal time of drug administration, thereby maximizing drug activity and reducing toxicity (chronopharmacology); and (3) could be applied to monitor drugs or drug metabolites, thus, enhancing adherence to prescribed medications and enabling studies on pharmacokinetics.
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The fraud and abuse laws that govern conduct related to the federal health-care programs, such as Medicare and Medicaid, impose broad and complex limitations on billing practices and financial relationships among providers. Given the potential consequences of engaging in fraudulent behavior, it is crucial that physicians appreciate the types of activities that may run afoul of these laws. This article summarizes the major aspects of the fraud laws that are most likely to have a daily impact on physician practice: the Civil False Claims Act, the Medicare and Medicaid Anti-Kickback Statute, and the so-called Stark Law prohibition on physician self-referrals.