Fatal Allergic Reaction to Gadolinium Contrast.

Gadolinium-based contrast agents (GBCA) have been used to enhance the sensitivity and specificity of disease diagnoses. They have excellent safety profiles. However, rare adverse events may happen. We present a case of severe fatal allergic reaction to GBCA in a 35-year-old patient.

Heat Stroke Leading to a Fatal Outcome.

Heat stroke (HS) can cause several physiological changes in the body. In its most severe form, it can cause multi-organ failure including encephalopathy, circulatory shock, liver failure, renal failure, disseminated intravascular coagulation, and rhabdomyolysis among others. HS is a preventable condition; however, it can be life-threatening in severe forms. We present a case of HS in a 54-year-old male, with rapidly progressive multi-organ failure and a fatal outcome along with a brief literature review.

Methylene Blue in Refractory Shock.

Many patients suffer shock in intensive care units (ICU). The majority of the patients with shock respond to standard treatment with vasopressors in addition to the treatment of underlying etiology. Some may not respond to vasopressors and have high mortality. To those patients who do not respond, methylene blue has been used in the past with some success. We present a case report on the use of methylene blue along with a brief literature review.

Pulmonary Rehabilitation: A Retrospective Study in Eastern North Carolina.

BACKGROUND: Pulmonary rehabilitation (PR) is an evidence-based measure to benefit chronic obstructive pulmonary disease (COPD) patients. Many patients have benefitted from our robust university hospital-based PR program. We have objectively assessed the benefit of our PR program for COPD patients in Eastern North Carolina. METHODS: We used retrospective chart review to collect data from all the patients who completed PR from January 1, 2012 through December 31, 2013. Data collection included quality-of-life scores using short-form 36 (SF-36) and 6-minute walk distance (6MWD) to measure exercise capacity before and after PR. We also collected data on COPD exacerbation frequency 1 year before and 1 year after PR. The data were analyzed using the statistical software Statistical Package for the Social Sciences version 22.0. RESULTS: We analyzed data from 51 patients with 4 categories of COPD: mild (n = 2), moderate (n = 12), severe (n = 23), and very severe (n = 14). The PR program resulted in improvement in 6MWD of an average of 263.8 feet (P < .01) and a decrease in COPD exacerbation frequency by 0.3 events per year (P < .05). There were mixed results for quality-of-life scores. LIMITATIONS: Our study was conducted at 1 center and thus involved a single COPD patient population with limited sample size. We did not follow patients long term to see whether the benefits were sustained. CONCLUSIONS: Our PR program resulted in a positive impact on exercise capacity, COPD exacerbation rate, and some aspects of quality of life.