Using the gli spirographic prediction equations to revisit the allometric relationships between lung volumes, height and age in adults.

The determination the forced vital capacity (FVC) and the forced expiratory volume in 1 second (FEV1) during spirometry studies, is at the core of the evaluation of the pulmonary function of patients with respiratory diseases. The Global Lung Function Initiative (GLI) offers the most extensive data set of normal lung functions available, which is currently used to determine the average expected/predicted FEV1 and FVC (predV), and their lower limit of normal (LLN, 5th percentile) at any given height and age for women and men. These prediction equations are currently expressed in a rather complex form: predV = exp [p+ (a x Ln (height) + (n x Ln (age)) + spline] and LLN = exp(Ln (predV) + Ln (1 - 1.645 x S x CV)/S); and are currently used to generate interpretations in commercialized spinographic system. However, as shown in this paper, these equations contain physiological and fundamental allometric information on lung volumes that become obvious when rewriting mean predicted values as a "simple" power function of height and LLN as a percentage of the mean predicted values. We therefore propose to present the equations of prediction obtained from the GLI data using simplified expressions in adults (18-95 years old) to reveal some of their physiological and allometric meaning. Indeed, when predicted FEV1 and FVC (predV) were expressed under the form predV= αx heightax b(age), the resulting exponent (a) ranges between 2 and 3, transforming the one dimension of a length (size) into a volume, akin to the third-order power (cubic) function of height historically used to predict lung volumes. Only one function, b (age), is necessary to replace all the factors related to age, including the tables of discrete data of spline functions original equations. Similarly, LLN can be expressed as LLN = c (age) xpredV to become a simple percentage of the predicted values, as a function of age. The equations with their respective new polynomial functions were validated in 52,764 consecutive spirometry tests performed in 2022 in 22,612 men and 30,152 women at the Cleveland Clinic. Using these equations, it become obvious that for both women and men, FEV1/FVC ratio decreases with the size as the exponent of the power function of height is lower for FEV1 than FVC. We conclude that rewriting the GLI predicted equations with simpler formulations restitutes to the GLI data some of their original allometric meaning, without altering the accuracy of their prediction.

A nationwide retrospective analysis of ventilator-associated pneumonia in the US.

Ventilator-associated pneumonia (VAP) is a major cause of healthcare-associated mortality and morbidity in critically ill patients who are mechanically ventilated. The purpose of this study was to describe the various primary discharge diagnoses of hospitalizations with VAP, to identify their demographic characteristics, and to identify risk factors for mortality in hospitalizations with VAP. Hospitalizations with a diagnosis of VAP with mechanical ventilation for over 24 hours were selected from the National Inpatient Sample in 2016 and 2017. In total, 33,140 hospitalizations with VAP were analyzed. The leading principal discharge diagnoses for hospitalizations leading to VAP were sepsis due to an unspecified organism (16.92%), respiratory failure (8.09%), and VAP (6.38%). Mortality among hospitalizations with VAP was 20.9%. Independent risk factors for mortality in hospitalizations with VAP were uninsured status (adjusted odds ratio [aOR] 2.13, 95% confidence interval [CI] 1.49-3.06, P < 0.001), acute renal failure (aOR 2.00, 95% CI 1.75-2.30, P < 0.001), and liver disease (aOR 1.82, 95% CI 1.52-2.18, P < 0.001). In conclusion, VAP is associated with significant mortality. Infective, traumatic, cardiovascular, and respiratory conditions accounted for over 85% of hospitalizations with VAP. Acute renal failure, the presence of liver disease, and lack of insurance are associated with higher mortality in hospitalizations with VAP.

A perplexing cause of upper GI Bleed.

Valleculae is one of a potential source of GI bleed. The lesions in the valleculae may potentially be missed during the routine endoscopies and due diligence is required especially among patients with GI bleed where no source of bleed could be identified.

Intracranial thrombosis associated with MSSA bacteraemia in the setting of influenza A.

The authors present a case of a 42-year-old previously healthy man who presented in sepsis, with right lateral gaze palsy. He was found to have bilateral cavernous sinus thrombosis (CST) and bilateral internal jugular thrombosis in the setting of Staphylococcus aureus bacteraemia. The patient was successfully treated and recovered from his illness after a protracted stay in the medical intensive care unit. We go over the treatment course and follow-up of this patient and discuss the need to have a high degree of clinical suspicion for CST and suppurative thrombophlebitis of the internal jugular veins. We also discuss the possible role of the Panton-Valentine leukocidin in causing thrombotic complications of S. aureus bacteraemia.

Imaging in Vaping-associated Lung Injury: Beyond the Haze.

E-cigarette or vaping, product associated lung injury is a rampant public health issue with a total of 2807 reported hospitalized patients in the United States as of February 18, 2020. Limited data, non-specific symptoms, non-responsiveness to antibiotics, and the lack of a specific biomarker, make it a diagnosis of exclusion. Overlap of clinical and imaging findings with other ongoing respiratory illness (MERS, SARS and COVID-19) poses a challenge in accurate diagnosis. We compiled 3 cases of patients hospitalized with confirmed vaping-associated lung injury and analyzed their imaging patterns, which revealed bilateral consolidation, ground-glass opacities and pleural effusions. We also reviewed the available literature on pathophysiology, imaging findings of EVALI and other respiratory illness.

Predicting COVID-19 Using Retrospective Data: Impact of Obesity on Outcomes of Adult Patients With Viral Pneumonia.

Background Community-acquired pneumonia due to viral pathogens is an under-recognized cause of healthcare-associated mortality and morbidity worldwide. We aimed to compare mortality rates and outcome measures of disease severity in obese vs non-obese patients admitted with viral pneumonia. Methods Adult patients admitted with viral pneumonia were selected from the Nationwide Inpatient Sample of 2016 and 2017. The arms were stratified based on the presence of a secondary discharge diagnosis of obesity. The primary outcome was inpatient mortality. Secondary outcomes included sepsis, acute respiratory failure, acute respiratory distress syndrome, acute kidney injury, and pulmonary embolism. Results and interpretation In total, 89,650 patients admitted with viral pneumonia were analyzed, and 17% had obesity. There was no significant difference in mortality between obese and non-obese patients (aOR: 0.98, 95% CI: 0.705 - 1.362, p < 0.001). Compared to non-obese patients, obese patients had higher adjusted odds of developing acute hypoxic respiratory failure (aOR: 1.37, 95% CI: 1.255 - 1.513, p < 0.001), acute respiratory distress syndrome (aOR: 2.29, 95% CI: 1.554 - 3.381, p < 0.001), need for mechanical ventilation (aOR: 1.50, 95% CI: 1.236 - 1.819, p < 0.001), and pulmonary embolism (aOR: 1.69, 95% CI: 1.024 - 2.788, p = 0.040). Conclusions Obesity was not found to be an independent predictor of inpatient mortality in patients admitted with viral pneumonia. However, obesity is associated with worse clinical outcomes and disease severity as defined by the presence of complications, greater incidence of acute respiratory failure (ARF), acute respiratory distress syndrome (ARDS), need for mechanical ventilation, acute kidney injury (AKI), pulmonary embolism (PE), stroke, and sepsis.

Impact of Protein Energy Malnutrition on Outcomes of Adults With Viral Pneumonia: A Nationwide Retrospective Analysis.

Background Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality. Viral organisms have been identified as the causal pathogen in approximately 20% of CAP. Nutritional status plays an important role in the response to pneumonia. This study aims to identify whether protein energy malnutrition (PEM) is an independent risk factor for mortality and morbidity in viral CAP. Materials and methods This was a retrospective cohort study involving adult hospitalizations for viral CAP in the United States using the Nationwide Inpatient Sample (NIS) database. This cohort was further divided based on the presence or absence of a secondary discharge diagnosis of PEM. The primary outcome was inpatient mortality. Secondary outcomes included the rate of mechanical ventilation among other complications. Results The in-hospital mortality for viral CAP was 2.22%. Patients with PEM had over two-fold high adjusted odds of inpatient mortality (aOR: 2.42, 95% CI: 1.746-3.351, p < 0.001) compared with patients without PEM. Patients with PEM had higher adjusted odds of having septic shock (aOR: 3.34, 95% CI: 2.158-5.160, p < 0.001). NSTEMI (aOR: 1.75, 95% CI: 1.163-2.621, p = 0.007), need for mechanical ventilation (aOR: 3.13, 95% CI: 2.448-4.006, p < 0.001), CVA (aOR: 3.49, 95% CI: 1.687-7.220, p = 0.001), DVT (aOR: 2.19, 95% CI: 1.453-3.295, p < 0.001), and PE (aOR: 2.24, 95% CI: 1.152-4.357, p = 0.017) relative to patients without PEM. Conclusion In conclusion, coexisting PEM is associated with a higher rate of in-hospital morbidity and mortality in patients with viral CAP. Early identification and treatment of nutritional deficiencies can lead to improved outcomes and reduced costs.

Racial Disparities in Outcomes of Adults Hospitalized for Viral Pneumonia.

Background Viral pneumonia is an important cause of respiratory morbidity and mortality. Cases of viral pneumonia are becoming increasingly more common as at-risk populations increase globally. We sought to highlight the racial distribution of hospitalized patients with viral pneumonia and compare their outcomes. Materials and methods Data were obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study involved adults who had a principal discharge diagnosis of viral pneumonia. The primary outcome analyzed was inpatient mortality. Secondary outcomes included the development of sepsis, septic shock, acute respiratory failure, acute respiratory distress syndrome, non-ST segment elevation myocardial infarction (NSTEMI), acute kidney failure, deep vein thrombosis, pulmonary embolism, cerebrovascular accident, need for mechanical ventilation, and use of vasopressors as well as mean length of hospitalization and mean total hospital charges. Results Blacks and Hispanics had lower inpatient mortality adjusted odds (aOR: 0.39, 95% CI = 0.229 - 0.662, p<0.001 and aOR: 0.55, 95% CI = 0.347 - 0.858, p=0.009, respectively) compared to Whites. Black and Hispanic patients were also found to have lower adjusted odds ratio of having acute respiratory failure (aOR: 0.54, 95% CI = 0.471 - 0.614, p<0.001, and 0.66, 95% CI = 0.576 - 0.753, p<0.001, respectively). Conclusion Black and Hispanic patients are at lower risk of adverse outcomes when compared to White patients with viral pneumonia.

Severe Hypercalcemia as the Initial Presentation of a Neuroendocrine Carcinoma of Unknown Primary Site: A Case Report.

Hypercalcemia is a common paraneoplastic syndrome that is associated with many malignancies. Hypercalcemia develops in malignancies through various mechanisms. Parathyroid hormone-related protein (PTHrP) is secreted by malignancy involving the lungs, breast, colorectum, bladder, and, rarely, neuroendocrine tumors. This is a rare case of severe hypercalcemia as the initial presentation of a high-grade metastatic neuroendocrine tumor of an unknown primary site.

Elizabethkingia meningoseptica: emerging multidrug resistance in a nosocomial pathogen.

A 46-year-old male patient presented with complaints of burning micturition for 2 days. Initial history, physical examination and laboratory investigations were consistent with the diagnosis of congestive cardiac failure (CCF) and concomitant urinary tract infection. CCF was treated with diuretics and a urine culture/sensitivity (C/S) was sent which returned growing Elizabethkingia meningoseptica resistant to all tested drugs. Intravenous cefotaxime which had been started empirically 3 days earlier was withheld at this point, and a repeat urine C/S was sent revealing resistance to all tested drugs (including reserved drugs) barring minocycline. The patient was treated with oral minocycline for 14 days after which he was symptomatically better with sterile urine. The patient was subsequently discharged.