Rationale Idiopathic pulmonary fibrosis (IPF) is a parenchymal lung disease with limited therapeutic choices. IPF is prevalent among elderly patients, in whom cardiometabolic comorbidities are common. Glucagon-like peptide 1 (GLP-1) agonists are a novel group of medications used to treat type II diabetes mellitus (T2DM) and obesity, particularly those with atherosclerosis, heart failure, or chronic kidney disease. GLP-1 agonists have demonstrated a reduction in pulmonary fibrosis progression in animal models. We aim to explore the impact of GLP-1 agonists on all-cause mortality among IPF patients. Methods Data from 94 healthcare organizations in the TriNetX database were analyzed from January 1st, 2014, to October 14th, 2024. We included patients older than 18 years with a diagnosis of IPF (ICD-10 J84.112) and stratified the data according to GLP-1 agonist use, including liraglutide, lixisenatide, tirzepatide, dulaglutide, exenatide, and semaglutide. We performed propensity score matching accounting for demographics, comorbidities, and medications to evaluate the impact of GLP-1 agonists on all-cause mortality at three-years after the index event. The index event was defined as the first day meeting all criteria, including diagnosis of IPF and initiation of GLP-1 agonist for cohort 1 and diagnosis of IPF only for cohort 2. We present the data using hazard ratios (HR) with log-rank tests and 95% confidence intervals (CI). A two-sided P-value of <0.05 was considered statistically significant. Results Cohort 1 included 1,307 patients using GLP-1 agonists and Cohort 2 included 26,130 IPF patients with no GLP-1 agonists use. After propensity matching, 1,166 patients in each group were compared.Hypertension and T2DM were prevalent in approximately two-thirds of patients. Notably, less than 7.5% of these patients were on antifibrotics, including pirfenidone or nintedanib. Between these two cohorts, there were no statistically significant differences in demographics, comorbidties, and medications except for body mass index (33.4 vs. 29.5 m/kg2) and hemoglobin A1C concentration (7.2 vs. 6.7), Cohort 1 and 2, respectively. Regarding outcomes, all-cause mortality at three-years (HR: 0.62; CI 0.53 – 0.74, p<0.01) was significantly reduced among IPF patients taking GLP-1 agonists. Additionally, Cohort 1 had a survival probability 69.11% compared to 58.85% of Cohort 2 within 3 years of follow up. Conclusion The use of GLP-1 agonists may be associated with reduced mortality among IPF patients with cardiometabolic comorbidities. However, the infrequent use of antifibrotics in this analysis raises questions about their underutilization. Further prospective research is needed to better understand GLP-1 agosnists role in patients with IPF.

Background: In prior studies, central pulmonary embolism (PE) was associated with high clot burden and was considered an independent predictor for thrombolysis. Further information about predictors of adverse outcomes in these patients is needed for better risk stratification. The objective is to describe independent predictors of adverse clinical outcomes in patients with central PE. Methods: Large retrospective, observational, and single-center study of hospitalized patients with central PE. Data were gathered on demographics, comorbidities, clinical features on admission, imaging, treatments, and out-comes. Multivariable standard and Least Absolute Shrinkage and Selection Operator (LASSO) machine learning logistic regressions and sensitivity analyses were used to analyze factors associated with a composite of adverse clinical outcomes, including vasopressor use, mechanical ventilation, and inpatient mortality. Results: A total of 654 patients had central PE. The mean age was 63.1 years, 59% were women, and 82% were African American. The composite adverse outcome was observed in 18% (n = 115) of patients. Serum creatinine elevation (odds ratio [OR] = 1.37, 95% CI = 1.20-1.57; p = 0.0001), white blood cell (WBC) count elevation (OR = 1.10, 95% CI = 1.05-1.15; p < 0.001), higher simplified pulmonary embolism severity index (sPESI) score (OR = 1.47, 95% CI = 1.18-1.84; p = 0.001), serum troponin elevation (OR = 1.26, 95% CI 1.02-1.56; p = 0.03), and respiratory rate increase (OR = 1.03, 95% CI = 1.0-1.05; p = 0.02) were independent predictors of adverse clinical outcomes. yyuuConclusion: Among patients with central PE, higher sPESI score, WBC count elevation, serum creatinine eleva-tion, serum troponin elevation, and respiratory rate increase were independent predictors of adverse clinical outcomes. Right ventricular dysfunction on imaging and saddle PE location did not predict adverse outcomes.

Methods: We evaluated a deep learning algorithm (DL), for classifying HRCT based on ATS/ERS/JRS/ALAT IPF guideline criteria (SOFIA), among an international group of radiologists and pulmonologists. Participants evaluated HRCTs from 203 suspected IPF patients, assigning a likelihood score for each of the guideline-based HRCT categories (each 0-100%, summing to 100%). SOFIA scores were then provided, and participants were given the opportunity to revise their scores. Agreement on (weighted kappa) and prognostic accuracy (Cox regression and C-index) of 1) UIP scores, 2) guideline-based diagnosis and 3) INBUILD categorisation (UIP/probable UIP vs indeterminate/alternative diagnosis – i.e., trial screening mode) were evaluated. Results: 116 participants completed the study, including 20 ILD trained radiologists. The majority opinion of ILD radiologists on each HRCT was used as a diagnostic reference standard. SOFIA improved agreement for UIP probability scores among all participants, excluding the ILD radiologists, (0.67 [IQR 0.57-0.73] vs 0.71 [IQR, 0.65-0.76], p=2.1x10-5) and guideline-based diagnoses (0.50 [IQR 0.43-0.54] vs 0.61 [IQR, 0.56-0.66], p=2.8x10-16) and INBUILD categorisation (0.42 [IQR 0.35-0.47] vs 0.56 [IQR, 0.49-0.62], p=7.1x10-19). Prognostic accuracy for UIP probability scores (mortality) were good for radiologist scoring (n=116, C-index=0.60 [IQR 0.58-0.62]), and these improved with the addition of SOFIA (C-index=0.63 [IQR 0.61-0.65], p=3.6x10-12). Conclusion: In pulmonary fibrosis, DL support may improve accuracy of HRCT diagnoses, provide prognostic information and faciliate screening in clinical trials.

ABSTRACT Background Coronavirus disease 2019 (COVID-19) may result in rapid onset of hypoxemic respiratory failure. This study aimed to characterize the factors and outcomes associated with prolonged hypoxia in patients with COVID-19. Prolonged severe hypoxia (PSH) was defined as hypoxia requiring ≥6 L/min of oxygen by nasal cannula or equivalent for more than 10 days. Research design and methods This study was designed as a single-center retrospective analysis. Multivariable logistic regression was utilized to assess factors associated with PSH. Results The sample included 554 patients with 117 (21%) having PSH. Median length of stay of patients with PSH was significantly longer (median IQR: 18 days vs 6 days, p < 0.0001). Patients with PSH had significantly higher rates of venous thromboembolism (p < 0.0001) and major bleeding (p < 0.004). The presence of cirrhosis (OR 3.32, 95% CI [1.02 to 10.83]) and hypertension (OR 1.99, 95% CI [1.12 to 3.53]) were independently associated with PSH, while outpatient use of anti-platelet agents had an inverse association (OR 0.57, 95% CI [0.36 to 0.91]). Conclusion PSH is associated with increased length of stay, morbidity, and mortality. Hypertension and liver cirrhosis were significantly associated with higher odds of PSH, while use of anti-platelet therapy had a protective effect.

In this systematic review, we seek to clarify the impact of treatment of hyperthyroidism on pulmonary hypertension in patients with both these conditions. We included 39 of 709 articles retrieved, that studied patients with hyperthyroidism and pulmonary hypertension (PH). From these, those with a documented pre-treatment Pulmonary Artery Systolic Pressure (PASP) > 35 mmHg and complete follow up were analyzed, yielding 3 case series and 22 case reports with a total of 81 cases. A significant improvement in PASP was noted with achieving euthyroidism in the 3 case series. The case reports showed a significant reduction in mean PASP from 60.5 ± 13.2 mmHg to 37.5 ± 10.1 mmHg (p < 0.001) in patients with Grave's disease with achieving euthyroidism. No deaths were reported during the follow up period. Achievement of a euthyroid state in patients with hyperthyroidism is associated with statistically significant reductions in PASP.

CASE PRESENTATION: A 65-year-old woman with a history of chronic persistent atrial fibrillation, tobacco use, and COPD was admitted to the hospital 2 months after catheter ablation for persistent atrial fibrillation and dyspnea. Her dyspnea was present at rest and worsened by exertion with limitation to ambulating less than two blocks. She also endorsed a 1-month history of cough with minimally productive whitish sputum with frequent nocturnal exacerbations and orthopnea. She denied any fevers, chest pain, or hemoptysis.

Exogenous diamines and polyamines added to rat hepatoma (HTC) cells in culture rapidly decrease ornithine decarboxylase (ODC) activity. Previous evidence has suggested that these amines act either at the level of blocking new enzyme synthesis or by the induction of a non‐competitive protein inhibitor, termed antizyme, which complexes with ODC to form an inactive complex. With the use of HMO A cells, a recently cloned rat hepatoma cell line that has a greatly stabilized ODC, it has been possible to demonstrate that 10 −5 M of exogenous putrescine blocks the increase in ODC activity, but unlike in the parent HTC cell line, without induction of the antizyme or formation of any inactive ODC‐antizyme complex. However, complete blockade of ODC at 10 −2 M putrescine is effected by induction of antizyme and formation of the ODC‐antizyme complex, as now evidenced by the isolation of the active enzyme and antizyme components after Sephadex column chromatography in the presence of 250 mM NaCl. These findings indicate clearly that two polyamine‐regulatory mechanisms for ODC exist and are separable in this cell line.

Background: Given the heterogeneity of etiologies, pathophysiology, and presentation of angioedema, variations in clinical outcomes, such as intubation and hospital readmissions, need further clarification. Objective: To determine the factors associated with intubation and hospital readmissions in patients with angioedema. Methods: Retrospective study of patients evaluated with a diagnosis of angioedema in a 6-year period. Demographic and clinical data, such as medication use, family history, comorbidities, and symptoms, were recorded. Multivariable logistic regression was used to analyze factors associated with intubation, whereas Cox regression was used to analyze readmissions. Results: Of 636 patients, the most common cause of angioedema was that induced by angiotensin-converting enzyme inhibitor (ACEI) at 58%. The overall mortality was 0.5%. After adjusting for sex, race, comorbidities, and type of angioedema, smoking (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.10-2.93; P = .02), calcium channel blocker therapy (OR, 1.91; 95% CI, 1.18-3.10; P = .009), histaminergic symptoms (OR, 3.21; 95% CI, 1.935.33; P < .001), and age (OR, 1.02; 95% CI, 1.00-1.04; P = .02) were independently associated with increased odds of intubation. Involvement of either the pharynx, larynx, or tongue was associated with higher odds of intubation (OR, 20.96; 95% CI, 10.63-41.33; P < .001). A total of 10% of the patients had a readmission for angioedema within 90 days, and 75% occurred within 30 days. After multivariable Cox regression analysis, only chronic obstructive pulmonary disease and asthma (OR, 2.13; 95% CI, 1.12-4.07; P = .02) and ACEI-related angioedema (OR, 2.93; 95% CI, 1.33-6.47; P = .008) were significantly associated with readmissions. Conclusion: Smoking, calcium channel blocker use, histaminergic symptoms, age, and upper airway involvement were markedly associated with intubation. The presence of chronic obstructive pulmonary disease, asthma and ACEI-related angioedema were independently associated with increased odds of readmission. (C) 2021 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Cognitive bias plays a significant role in medical errors. In the pandemic of corona virus disease-19 (COVID-19), recognizing and creating strategies to minimize these biases is crucial to optimize medical care for our patients. In this article we present a case of a 68-year-old male with decreased appetite, subjective fears, dry cough, and confusion. The report illustrates the concept of cognitive bias during a pandemic and discusses strategies to ameliorate them.

We report a case of a 59-year-old male with a one-month history of pleuritic chest pain who was diagnosed with tracheobronchopathia osteochondroplastica (TO). TO is a rare benign condition characterized by protruding submucosal nodules into the tracheobronchial lumen. The disease is generally asymptomatic, with rare cases of progressive nodularity, cough, dyspnoea, and haemoptysis. Diagnosis can be made via bronchoscopic visualization of bony and cartilaginous nodules on tracheal walls. Although generally benign, the rarity of this condition makes diagnosis difficult even for trained pulmonologists and frequently predisposes patients to unnecessary invasive diagnostic testing and improper management of symptoms and contributing co-morbid conditions. We present this case to increase physician and patient awareness about this disease to help improve diagnostic strategy and knowledge of disease manifestations and potential complications.

In this Letter to the Editor, Agrawal et al. debate the conflicts that can arise regarding the authorship of case reports. Like all other medical journals, EJCRIM has zero tolerance for the willful undisclosed re-submission of papers that have already been published elsewhere. However, this may occasionally happen by accident, especially in large healthcare institutions in which multiple teams of physicians may care for a patient throughout their illness. EJCRIM endorses and recommends to all potential authors the very sensible suggestions made by Agrawal et al. to avoid such an error occurring. EJCRIM would also encourage authors to consider the following: The first author should ensure that no one else involved in the case has reported it or plans to report it. This is especially important for physicians working in large healthcare centres, and/or for case reports of patients who have been under investigation or treatment for prolonged periods.On rare occasions EJCRIM will consider a case that has already been published, provided that this is fully and explicitly disclosed, and there is a clear reason why re-publication is justified. An example might be where new information has come to light that significantly changes the conclusions of the original report. As in all reports published by EJCRIM the decision to publish will depend on the educational value, or learning points, of the case.

Cardiopulmonary resuscitation (CPR) has been shown to increase survival after cardiac arrest, but is associated with the risk of acquired injuries to the patient. While traumatic chest wall injuries are most common, other injuries include upper airway, pulmonary and intra-abdominal injuries. This review discusses the risk factors and prevalence of CPR-related injuries.

Inferior vena cava filter (IVCF) placement appears to be expanding over time despite absence of clear directing evidence.Two populations were studied. The first population included patients who received an IVCF between January 2005 and August 2013 at our community hospital center. Demographic information, indications for placement, and retrieval rate was recorded among other variables. The second population comprised of patients receiving an IVCF from 2005 to 2012 according to the Nationwide Inpatient Sample (NIS) using ICD-9CM coding. Patients were divided into 2 groups based on the year of admission for comparison, that is, first group from 2005 to 2008 and the second from 2009 to 2012. In addition, we analyzed annual trends in filter placement, acute venothromboembolic events (VTE) and several underlying comorbidities within this population.At our center, 802 IVCFs were placed (55.2% retrievable); 34% for absolute, 61% for relative, and 5% for prophylactic indications. Major bleeding (27.5%), minor self- limited bleeding (13.7%), and fall history (11.2%) were the commonest indications. Periprocedural complication rate was 0.7%, and filter retrieval rate was 7%. The NIS population (811,487 filters) saw a decline in IVCF placement after year 2009, following an initial uptrend (Ptrend< 0.01). IVCF use among patients with neither acute VTE nor bleeding among prior VTE saw a 3-fold absolute reduction from 2005 to 2012 (33,075-11,655; Ptrend< 0.01). Patients from 2009 to 2012 were more likely to be male and had higher rates of acute VTE, thrombolytic use, cancer, bleeding, hypotension, acute cardiorespiratory failure, shock, prior falls, blood product transfusion, hospital mortality including higher Charlson comorbidity scores. The patients were younger, had shorter length of stay, and were less likely to be associated with strokes including hemorrhagic or require ventilator support. Prior falls (adjusted odds ratio-aOR 2.8), thrombolytic use (aOR 1.76), and shock (aOR 1.45) were most predictive of IVCF placement between 2009 and 2012 on regression analysis.Recent trends suggest that a higher proportion of patients receive temporary IVCF, for predominantly relative indications. Nationally, the number of filters being placed is decreasing, especially among those who did not experience acute VTE or bleeding events. Prior falls, thrombolytic therapy, and shock were most predictive of IVCF placement in latter half of the study period.