The Diagnostic Value of the Pleural Fluid C-Reactive Protein in Parapneumonic Effusions

properly cited. Purpose. The aim of this study was to evaluate the sensitivity of pleural C-reactive protein (CRP) biomarker levels in identifying parapneumonic effusions. Methods. A single-center, retrospective review of 244 patients diagnosed with pleural effusions was initiated among patients at the Rabin Medical Center, Petah Tikva, Israel, between January 2011 and December 2013. The patients were categorized into 4 groups according to their type of pleural effusion as follows: heart failure, malignant, postlung transplantation, and parapneumonic effusion. Results. The pleural CRP levels significantly differentiated the four groups ( < 0.001) with the following means: parapneumonic effusion, 5.38 ± 4.85 mg/dL; lung transplant, 2.77 ± 2.66 mg/dL; malignancy, 1.19±1.51 mg/dL; and heart failure, 0.57±0.81 mg/dL. The pleural fluid CRP cut-off value for differentiating among parapneumonic effusions and the other 3 groups was 1.38 mg/dL. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.2%, 71.5%, 37%, and 95%, respectively. A backward logistic regression model selected CRP as the single predictor of parapneumonic effusion (OR = 1.59, 95% CI = 1.37-1.89). Conclusions. Pleural fluid CRP levels can be used to distinguish between parapneumonic effusions and other types of exudative effusions. CRP levels < 0.64 mg/dL are likely to indicate a pleural effusion from congestive heart failure, whereas levels ≥ 1.38 mg/dL are suggestive of an infectious etiology

Prognostic Significance of the N-Terminal Pro-B-Type Natriuretic Peptide in Lung Transplant Candidates on the Waiting List

We investigated the prognostic significance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in lung transplant candidates, in a retrospective single-center study. Data regarding various baseline characteristics and all-cause mortality were collected for 205 lung transplant candidates placed on waitlist for transplantation from November 2017 to December 2019. Associations of NT-proBNP levels with baseline characteristics and mortality were analyzed. Results showed NT-proBNP values correlated positively with age, forced vital capacity, mean pulmonary artery pressure (MPAP), and pulmonary capillary wedge pressure; and negatively with diffusing lung capacity for carbon monoxide and cardiac index. The optimal cut-off of NT-proBNP for predicting MPAP levels > 35 mmHg was 251 pg/mL; with 58.1% sensitivity, 85.7% specificity, 45.0% positive predictive value, and 91.0% negative predictive value. During a median follow-up period of 2.2 years, 97 patients underwent lung transplantation, 42 died waiting for donation, and 66 were alive and still waiting for transplantations. On multivariate analysis, higher NT-proBNP levels were strongly associated with increased mortality among waitlisted lung transplant candidates (HR 1.49, 95% CI 1.10–2.03, p = 0.01). In conclusion NT-proBNP can predict mortality among waitlisted lung transplant candidates. Lower levels of NT-proBNP can preclude severe pulmonary artery hypertension. Assessment of NT-proBNP may improve risk stratification among lung transplant candidates

Orthostatic hypotension: definition, classification and evaluation

Purpose: Orthostatic hypotension (OH) is a common and clinically important disorder. Published papers vary regarding the definitions of OH and methodologies of evaluation. Moreover, substantial gaps in the skills and knowledge required for assessment of OH have been reported by clinicians. We aimed to provide current information regarding the definition, classification and evaluation of OH. Methods: We performed a comprehensive search of medical databases, using the following keywords: “postural hypotension” or “orthostatic hypotension”, combined with: “definition”, “classification”, “diagnosis”, “evaluation” or “meaning”. We selected for this review the most relevant recent publications and key papers in the field, published in the English language. Results: Current data regarding definitions, classification and the evaluation of OH are reviewed. The various aspects of OH assessment are extensively discussed. Considerable discrepancies exist between the published guidelines regarding the methodology of OH diagnosing. We propose an algorithm for OH evaluation and a standardized protocol for bedside determination of OH by healthcare providers. Conclusions: Correct assessment of OH is essential for its accurate diagnosis. The methodology of OH evaluation has not been sufficiently standardized. We emphasize the clinical importance of the uniform investigation of OH, according to the current guidelines for OH definition and meaning

Physical Activity and Exertional Desaturation Are Associated with Mortality in Idiopathic Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease that manifests in hypoxemia, inactivity, and poor prognosis. This study aimed to assess the prognostic role of physical activity (PA) and exertional desaturation (ED) with mortality in IPF. At baseline, 34 IPF patients (68 (50–81) years) were interviewed using the International Physical Activity Questionnaire (IPAQ), and SpO2 was assessed pre to post 6-min walking test (∆SpO2). Patients were prospectively followed up for 40 months. Receiver operating characteristics curve analysis determined cut-off points associated with mortality, and Cox proportional hazard ratio (HR) were conducted. Thresholds for increased mortality risk in IPF patients were determined as IPAQ ≤ 417 metabolic equivalent task (METS)-min/week, p = 0.004 (HR; 9.7, CI 95% (1.3–71.9), p = 0.027), and ∆SpO2 ≥ 10%, p = 0.002, (HR; 23.3, CI 95% (1.5–365), p = 0.025). This study demonstrated a significant association of PA and ED with mortality in IPF patients. The findings emphasize the clinical importance of PA and ED assessments to aid in IPF risk stratification, prognosis prediction, and in providing early appropriate treatments, such as pulmonary rehabilitation, PA consultation, oxygen supplementation, and lung transplantation referral. These results underscore that even low levels of PA corresponding to 100–105 min/week were associated with a reduced mortality risk and better survival in IPF

The Diagnostic Value of the Pleural Fluid C-Reactive Protein in Parapneumonic Effusions

Purpose. The aim of this study was to evaluate the sensitivity of pleural C-reactive protein (CRP) biomarker levels in identifying parapneumonic effusions. Methods. A single-center, retrospective review of 244 patients diagnosed with pleural effusions was initiated among patients at the Rabin Medical Center, Petah Tikva, Israel, between January 2011 and December 2013. The patients were categorized into 4 groups according to their type of pleural effusion as follows: heart failure, malignant, post-lung transplantation, and parapneumonic effusion. Results. The pleural CRP levels significantly differentiated the four groups (p<0.001) with the following means: parapneumonic effusion, 5.38±4.85 mg/dL; lung transplant, 2.77±2.66 mg/dL; malignancy, 1.19±1.51 mg/dL; and heart failure, 0.57±0.81 mg/dL. The pleural fluid CRP cut-off value for differentiating among parapneumonic effusions and the other 3 groups was 1.38 mg/dL. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.2%, 71.5%, 37%, and 95%, respectively. A backward logistic regression model selected CRP as the single predictor of parapneumonic effusion (OR = 1.59, 95% CI = 1.37–1.89). Conclusions. Pleural fluid CRP levels can be used to distinguish between parapneumonic effusions and other types of exudative effusions. CRP levels < 0.64 mg/dL are likely to indicate a pleural effusion from congestive heart failure, whereas levels ≥ 1.38 mg/dL are suggestive of an infectious etiology

Erratum to “Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient”

Lan istripuek eraginiko heriotzen trataera, euskal prentsaren aldetik, aztergai dugu artikulu honetan. Horretarako 2001. eta 2009. urteetan Bizkaian izandako heriotzak aintzat hartu dira. Abiapuntuko hipotesia zera da: beste heriotza bortitz batzuetan ez bezala "esate baterako ETAk burututako atentatuetan edo Genero Indarkeriagaitik sortutakoetan, non hedabideen jarreretan izandako bilakaera azken urteotan nabarmena den" lan istripuen kasuan gertaerako kazetaritzatik oso hurbil dagoen beste ikuspegi bat mantentzen da. Gure azterketa osatzeko hainbat elkarrizketa egin zaie Euskal Herriko sindikatu nagusietako ordezkariei. Testu hau Zientzi eta Berrikuntzarako Ministerioak fintzatutako Ikerkerta Proiektu batean oinarrituta dago (CSO2010-19866, erreferiantziaduana, hain zuzen).; This article explores the evolution of the Basque print media"s approach to reporting labour fatalities, beginning with an analysis of press coverage of workplacerelated deaths in the Province of Biscay during the period 2001-2009. Our initial hypothesis held that the regional press policy of treating certain types of violent death (such as deaths related to violence perpetrated by Basque separatists and gender violence) as key social issues has been in sharp contrast to its perception and handling of labour-related fatalities, which have generally been treated as undifferentiated local news events and lumped together with items such as traffic accidents. This paper is part of a wider research project financed by the Ministry of Science and Innovation titled "The evolution of newspaper coverage of violent deaths in the Basque Country" (reference CSO2010-19866).; En este artículo se analiza la evolución en el tratamiento de los accidentes laborales mortales por parte de la prensa vasca, tomando como referencia los fallecimientos ocurridos en Bizkaia en los años 2001 y 2009. Como hipótesis de partida se considera que, al contrario de lo que ha ocurrido con otras muertes violentas, como las provocadas por los atentados de ETA o por la violencia de género, en donde se puede observar una toma de postura por parte de los medios en los últimos años, en el caso de la siniestralidad laboral nos encontramos con un enfoque mucho más cercano al periodismo de sucesos, en el que los fallecimientos en el puesto de trabajo se equiparan a los accidentes de tráfico. Este texto forma parte de un proyecto de investigación más amplio sobre "La evolución en el tratamiento de las muertes violentas en la prensa del País Vasco", financiado por el Ministerio de Ciencia e Innovación (referencia CSO2010-19866)