Demographic and geographical trends in chronic lower respiratory diseases mortality in the United States, 1999 to 2020.

Chronic lower respiratory disease (CLRD) related mortality has decreased in the United States due to increasing awareness in the general population and advancing preventative efforts, diagnostic measures, and treatment. However, demographic and regional differences still persist throughout the United States. In this study, we analyzed the temporal trends of demographic and geographical differences in CLRD-related mortality. Data was extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Using this data, age-adjusted mortality rates per 100,000 people (AAMR), annual percentage change (APC), and average annual percentage changes with 95% confidence intervals (CIs) were assessed. The Joinpoint Regression Program was used to determine mortality trends between 1999 and 2020 based on demographic and regional groups.During this study period, there were 3,064,049 CLRD-related deaths, with most demographics and regional areas showing an overall decreasing trend. However, higher mortality rates were seen in the non-Hispanic White population and rural areas. Interestingly, mortality rates witnessed a decreasing trend for males throughout the study duration compared to females, who only began to show decreases in mortality during the latter half of the 2010s. Using these results, one can target efforts and build policies to improve CLRD-related mortality and reduce disparities in the coming decades.

A new dawn in internal medicine education curriculum-a project by the residents, with the residents, for the residents.

The academic half-day (AHD) curriculum is an alternative to the noon conference (NC) approach. To date, there is little literature evaluating the transition from NC to AHD in internal medicine residency programs. We investigated the effectiveness of AHD by comparing in-training exam (ITE) and American Board of Internal Medicine (ABIM) certifying exam scores of residents before and after implementation of AHD. In 2019, we transitioned to the AHD curriculum. Averages of three consecutive years of NC (2016-2018) and AHD (2019-2021) were used for statistical testing to determine ITE and ABIM score changes. The class of 2018 experienced both approaches. Cohen's d effect sizes were calculated to assess the magnitude of change in ITE and ABIM scores between NC (2016-2018) and AHD (2019-2021) cohorts. Residents' performance significantly improved (P < 0.05) on ABIM scores (513.80 ± 48.34) on average from 2019 to 2021 compared to ABIM scores (452.42 ± 49.72) on average from 2016 to 2018 with a large effect size of 1.27. Similarly, a significant (P = 0.005) improvement in ITE scores was observed from 2019 to 2021 with implementation of AHD compared to preceding NC scores (2016-2018) with a moderate effect size of 0.52. Participating residents in AHD sessions had higher ITE and ABIM scores compared to those in hourly NC didactic sessions with significantly improved resident attendance and overall satisfaction.

The Association of Hypophosphatemia With Resistant Lactic Acidosis in Critical Care Illness.

Critically ill patients are known to have a variety of electrolyte abnormalities. Lactic acidosis can frequently be seen secondary to shock states and is usually treated with aggressive volume resuscitation. Interestingly, hypophosphatemia is a potential cause of resistant lactic acidosis, which may not be as commonly identified or considered. We present a case of a 42-year-old man admitted twice over a span of 6 months with an elevated lactate level that did not resolve with volume resuscitation. It was ultimately determined that his lactic acidosis was due to hypophosphatemia after ruling out other potential causes. Phosphate replacement therapy resulted in the normalization of his lactate. In the literature, multiple theories have indicated the association of hypophosphatemia with lactic acidosis though no prior cases exist supporting a direct relationship. In this case, we set forth to evaluate the complicated relationship between all of these factors and to highlight the importance of early detection and treatment of hypophosphatemia, which may be beneficial in treating lactic acidosis.

Cardiac tamponade as a complication of bronchogenic cyst.

Bronchogenic cysts are rare incidental findings, but they can have life-threatening complications. Herein, we report a case of a 44-year-old man who presented with complaints of left-sided chest pain, intermittent dyspnea, and pink-tinged sputum. Computed tomography angiography of the chest revealed a large cystic mediastinal mass in the subcarinal location. During his hospital stay, the patient became hypotensive with jugular venous distention and muffled heart sounds on auscultation. A stat echocardiogram depicted a large pericardial effusion with early diastolic collapse of the right ventricle. Pericardiocentesis was performed for cardiac tamponade, followed by thoracotomy with removal of bronchogenic cyst. Herein, we highlight the relation between bronchogenic cysts and cardiac tamponade and review the surgical treatment options.