Clinics in chest medicine
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This article focuses on recent advances in the identification of genes and genetic polymorphisms that have been implicated in the development of human interstitial lung diseases. It focuses on the inherited mendelian diseases in which pulmonary fibrosis is part of the clinical phenotype and the genetics of familial idiopathic pulmonary fibrosis and other rare inherited interstitial lung diseases. The article also reviews the association studies that have been published to date regarding the genetics of sporadic idiopathic pulmonary fibrosis. The reader is directed to recent reviews on human genetic predisposition of sarcoidosis, environmental-related, drug-related, connective tissue related pulmonary fibrosis, and genetic predisposition of fibrosis in animal models.
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Pulmonary sarcoidosis is one of the most common causes of idiopathic interstitial lung disease. Clinical presentation can range from asymptomatic to respiratory failure. ⋯ Treatment options include corticosteroids. In the past few years, alternatives to corticosteroids have been developed,especially for patients with a chronic condition.
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At least 250,000 episodes of VTE leading to hospitalization or death are estimated to occur in the United States each year. A number of clinical and demographic risk factors for VTE are recognized,with the latter including both age and race. Overall,the incidence of VTE does not appear to vary significantly by sex, as evidenced by a lack of consistency in the magnitude and even direction of effect of sex in a variety of epidemiologic studies of varying design. ⋯ Approaches to diagnosis of VTE in the pregnant woman are largely the same as in the nonpregnant patient, but special treatment considerations do apply. Warfarin is embryopathic, particularly between the 6th and 12th weeks of pregnancy, and should be avoided in favor or heparin or low-molecular weight heparin when treatment of the pregnant woman is necessary. Guidelines have been published to assist the clinician in decision making about prophylaxis of pregnant women at increased risk or pregnancy-related or post-partum VTE.
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Clinics in chest medicine · Jun 2004
ReviewGender differences in sleep and sleep-disordered breathing.
Sleep and sleep disorders are different in several important ways between men and women. Because of pregnancy and menopause, women experience changes in sleep that may present as clinical problems. In clinical populations, women are more likely to present with insomnia than are men, although their sleep may be better preserved. ⋯ There are little data on the effects of different treatments for OSA between men and women. OHS is a syndrome that may be as common in women as in men. The role of hormones in its pathophysiology is not well-defined.
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Clinics in chest medicine · Jun 2004
ReviewChronic obstructive pulmonary disease: are women more susceptible than men?
Current data show that women now suffer from COPD at least as commonly as men. They seem to be more predisposed to suffer the adverse respiratory consequences of tobacco smoking with the development of COPD at an earlier age and with a greater degree of lung function impairment for a given amount of tobacco exposure. This may be explained, in part, by women's greater airway responsiveness to exogenous stimuli--an increased responsiveness that is explained largely by differences in lung size and geometry. ⋯ This gender bias in diagnosis is not likely to be remedied until physicians begin to use spirometric testing to screen for this common disease. Women who smoke may have greater difficulty quitting than men. There are documented differences in health care use between men and women who have COPD, but too few studies have been done to allow conclusions to be drawn about the impact of sex and gender on the prognosis of the disease.