Interstitial Lung Disease as an Emerging Contributor to Mortality in Patients With Inflammatory Bowel Disease: A Population-Based Epidemiological Study.

INTRODUCTION: We aim to investigate the contribution of interstitial lung disease (ILD) to mortality in patients with inflammatory bowel disease (IBD). METHODS: We performed a comprehensive retrospective, population-based epidemiological study across the United States from 2001 to 2020, using the Wide-ranging Online Data for Epidemiologic Research database. Mortality data were classified according to the International Classification of Diseases, Tenth Revision , with the codes J84 for ILD, K50 for Crohn's disease, and K51 for ulcerative colitis. To discern patterns, age-adjusted mortality rates (AMR) were computed, stratified by sex, geographic census region, and racial/ethnic demographics. RESULTS: From 2001 to 2020, there were 57,967 reported deaths among patients with IBD with an AMR per million significantly rising from 10.989 in 2001-2005 to 11.443 in 2016-2020 ( P < 0.0001). ILD was a contributor to death in 1.19% (692/57,967) of these cases, with AMR rising from 0.092 to 0.143 per million ( P = 0.010). The percentage of ILD-related deaths in the IBD population increased from 1.02% to 1.30% over 2 decades. ILD was a more common cause of death in patients with Crohn's disease than with ulcerative colitis (54.6% vs 45.4%), with a significant increase for both conditions from 2001 to 2020 ( P < 0.05). An upward trend in ILD-related mortality was observed in both sexes ( P < 0.05) and within the White population ( P = 0.010). DISCUSSION: The observed increase in mortality rates due to ILD among patients with IBD is concerning and highlights a critical need for systematic ILD screening protocols within the IBD patient population to facilitate early detection and management.

Role of COPD in a case of fatal Aspergillus niger tracheobronchitis.

A man with chronic obstructive pulmonary disease (COPD) in his mid-60s was admitted for respiratory failure due to multifocal, necrotising pneumonia. Despite initial improvement with antimicrobial therapy, the patient developed hemoptysis and progressive infiltrates. Subsequent fungal cultures from his bronchoalveolar lavage were positive for Aspergillus niger and treatment with voriconazole was added for suspected invasive pulmonary aspergillosis (IPA). A repeat bronchoscopy revealed cobblestone lesions with mucosal friability throughout the lower trachea and bilateral mainstem bronchi. Endobronchial biopsy showed septated hyphae confirming the diagnosis of IPA. Despite appropriate therapy, the patient declined further and passed away on hospital day 11. Invasive infections with A. niger are infrequent, with a paucity of data on clinical course and outcomes. Our case adds to the current body of literature regarding the potential virulence of this species in patients with COPD.

Bacterial pneumonia infection in pregnancy.

Bacterial pneumonia in pregnancy is the most common fatal non-obstetrical infection and is associated with poorer maternal and fetal outcomes. Risk factors include normal physiological and anatomic changes that occur during pregnancy. In this review, we will discuss the etiological pathogens of bacterial pneumonias in pregnancy and its common complications, including both maternal and fetal outcomes. We will also review the diagnosis and management of bacterial pneumonia in the outpatient and inpatient setting and highlight the major pregnancy and lactation considerations when choosing antibiotic therapies.

Congenital Pulmonary Airway Malformation in an Adult Male Presenting With Hemoptysis.

Congenital pulmonary airway malformations (CPAMs) are rarely encountered in the adult population. Although they are typically diagnosed in the prenatal period, some may not cause symptoms and go unnoticed until adulthood. Patients with CPAM are at risk of developing pneumonia, hemorrhage, pneumothorax, and malignancy. There is a paucity of evidence regarding the management and prognostication of adults with CPAM. Patients often need to undergo surgical resection to prevent further episodes of infection, bleeding, or malignant transformation. Here, we present the case of an adult male with a CPAM who presented with frank hemoptysis. Computed tomography scan and bronchoscopy localized the lesion to the lingula. The patient underwent elective surgical resection of the lesion by video-assisted thoracoscopy and did not suffer any adverse outcomes. Surgical resection is generally recommended and appears to be a safe and effective approach to treating patients with symptomatic CPAMs. Inhaled tranexamic acid and bronchial artery embolization are valuable interventions in our armamentarium for managing hemoptysis but should not replace a definite surgical intervention due to the risk of recurrence.

Patient-related factors may influence nursing perception of sleep in the Intensive Care Unit.

OBJECTIVE: There exist conflicting data regarding the accuracy of ICU nurses accurately assessing patient sleep using validated questionnaires. Using the Richards-Campbell Sleep Questionnaire (RSQ), we hypothesize that patient factors might influence nursing perception of their sleep. METHODS: Patients in the ICU who met the inclusion criteria were asked to complete the sleep questionnaire, as were their nurses and intraclass correlation analysis was done. RESULTS: 38 paired patient-nurse surveys were included for analysis. The mean difference in total average score of the RSQ was not significantly different between patients and nurses. There was fair intraclass correlation by patient age, black race, and admission for respiratory illnesses. A good intraclass correlation existed for non-blacks and admission for non-respiratory reasons. Most striking was the intraclass correlation by sex, with poor intraclass correlation for women compared to an excellent correlation for men. CONCLUSION: The results of our study confirm that patients in our ICU have poor sleep with a fair intraclass correlation. When examined by patient related factor, the greatest divergence between patient and nursing perception of sleep in the ICU using the RCSQ was patient female sex. More research is needed in this area to better understand the divergence and improve sleep in the ICU.