Chest
-
The interaction between obesity and OSA is complex. Although it is often assumed that obesity is the major cause of OSA, and that treatment of the OSA might mitigate further weight gain, new evidence is emerging that suggests this may not be the case. Obesity explains about 60% of the variance of the apnea-hypopnea index (AHI) definition of OSA, mainly in those < 50 years and less so in the elderly. ⋯ The slight fall in the overall AHI with weight loss, however, may be associated with a larger drop in the nonsupine AHI, thus converting some patients from nonpositional to positional (ie, supine only) OSA. Importantly, patients undergoing surgical weight loss need close monitoring to prevent complications. Finally, in patients with moderate to severe obesity-related OSA, the combination of weight loss with CPAP appears more beneficial than either treatment in isolation.
-
There is growing interest in the re-emerging interaction between type 2 diabetes (DM) and TB, but the underlying biologic mechanisms are poorly understood despite their possible implications in clinical management. Experts in epidemiologic, public health, basic science, and clinical studies recently convened and identified research priorities for elucidating the underlying mechanisms for the co-occurrence of TB and DM. We identified gaps in current knowledge of altered immunity in patients with DM during TB, where most studies suggest an underperforming innate immunity, but exaggerated adaptive immunity to Mycobacterium tuberculosis. ⋯ Studies in humans at different stages of DM (no DM, pre-DM, and DM) or TB (latent or active TB) should be complemented with findings in animal models, which provide the unique opportunity to study early events in the host-pathogen interaction. Such studies could also help identify biomarkers that will complement clinical studies in order to tailor the prevention of TB-DM, or to avoid the adverse TB treatment outcomes that are more likely in these patients. Such studies will also inform new approaches to host-directed therapies.
-
Multicenter Study Observational Study
Direct oral anticoagulant- or warfarin-related major bleeding: characteristics, reversal strategies and outcomes from a multi-center observational study.
Direct oral anticoagulants (DOACs) have expanded the armamentarium for antithrombotic therapy. Although DOAC-related major bleeding was associated with favorable outcomes compared with warfarin in clinical trials, warfarin effects were reversed in < 40% of cases, raising concerns about the generalizability of this finding. ⋯ In this unselected cohort of patients with oral anticoagulant-related hemorrhage with high rates of warfarin reversal, in-hospital mortality was lower among DOAC-associated bleeding events. These findings support the safety of DOACs in routine care and present useful baseline measures for evaluations of DOAC-specific reversal agents.
-
Single-point measurements of maximal inspiratory pressure (MIP) are frequently used to suggest muscle weakness in clinical practice. Although there is a large variability in "mean" predicted MIP depending on the chosen reference values, it remains unclear whether those discrepancies actually impact on the prevalence of weakness, that is, MIP below the lower limit of normal. ⋯ The choice of MIP reference values strongly impacts on the prevalence of weakness. Some specific equations relate better to clinical and physiologic indicators of weakness, suggesting that they might be particularly useful to screen subjects for advanced respiratory neuromuscular assessment.