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A Systematic Review of Pulmonary Embolism in Patients With Lung Cancer.

Pulmonary embolism (PE) is increasingly recognized as causing significant morbidity and mortality in modern societies; however, little is known about PE in patients with lung cancer.

We systematically reviewed Medline, Web of Science, and the Cochrane Library databases and selected 26 studies, including 2 randomized controlled trials, and 4 prospective, 18 retrospective cohort, and 2 case-control studies. Overall incidence of PE was 3.6%. Pulmonary embolism abbreviated survival in 2 studies when the diagnosis was synchronous with lung cancer.

Venous thromboembolism prophylaxis, treatment, and surveillance are inconsistently reported. Clinical outcome data pertaining to this topic are limited and of overall poor methodologic quality.

Multidetector computed tomography for acute pulmonary embolism: embolic burden and clinical outcome.

In patients with acute pulmonary embolism (PE) the correlation between the embolic burden assessed at multidetector computed tomography (MDCT) and clinical outcome remains unclear.

Patients with symptomatic acute PE diagnosed by MDCT were included in a multicenter study aimed at assessing the prognostic role of the embolic burden evaluated at MDCT.

Methods : Embolic burden was assessed as i) localization of the emboli: central (saddle or at least one main pulmonary artery), lobar or distal (segmental or sub-segmental arteries) and ii) the obstruction index (OI) by the scoring system of Qanadli. The primary outcome was 30-day all-cause-death and/or clinical deterioration. Predictors of all-cause-death and/or clinical deterioration were identified by Cox regression statistics.

Results : Overall 579 patients were included in the study; 60 (10.4%) died or had clinical deterioration at 30 days. Central localization of emboli was not associated with all-cause-death and/or clinical deterioration (hazard ratio [HR] 2.42; 95% CI 0.77-7.59, p=0.13). However, in the 516 hemodynamically stable patients, central localization of emboli (HR 8.3, 95% CI 1.0-67, p=0.047) was an independent predictor of all-cause-death and/or clinical deterioration while distal emboli were inversely associated with these outcome events (HR 0.12, 95% CI 0.015-0.97, p=0.047). No correlation was found between OI (evaluated in 448 patients) and all-cause-death and/or clinical deterioration in the overall study population and in hemodynamically stable patients.

Conclusions : In hemodynamically stable patients with acute PE, central emboli are associated with an increased risk for all-cause-death and/or clinical deterioration; this risk is low in patients with segmental or subsegmental PE

COPD Complications

COPD complications include cor pulmonale, COPD exacerbation, pneumonia, pneumothorax, pulmonary hypertension, secondary polycythemia and respiratory failure. (Source: About.com Eating Disorders)

Randomized controlled trial of high concentration oxygen in suspected community-acquired pneumonia

Conclusions We conclude that high concentration oxygen therapy increases the PtCO2 in patients presenting with suspected community-acquired pneumonia. This suggests that the potential increase in PaCO2 with high concentration oxygen therapy is not limited to COPD, but may also occur in other respiratory disorders with abnormal gas exchange. (Source: JRSM)

Risk Factors for Drug‐resistant Streptococcus pneumoniae and Antibiotic Prescribing Practices in Outpatient Community‐acquired Pneumonia

Conclusions:  DRSP risk factors were present in approximately half of outpatient CAP cases treated in the acute care setting; however, guideline‐concordant antibiotic therapy was infrequent. Strict adherence to current guidelines would substantially increase use of fluoroquinolones or combination therapy. Whether the potential risks associated with these broad‐spectrum regimens are justified by improved clinical outcomes requires further study. (Source: Academic Emergency Medicine)

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