Diagnosis and management of combined post- and precapillary pulmonary hypertension in a patient with multiple comorbidities

Diagnosis of pulmonary hypertension requires a laborious investigation that must be performed in accordance with international guidelines. Right-heart catheterization is the gold standard examination to assess the degree of hemodynamic impairment of  post- or precapillary origin, guiding management. The presence of comorbidities is becoming rather frequent in real-life pulmonary hypertension cases, thus creating diagnostic and therapeutic complexity. We present a case of combined post- and precapillary pulmonary hypertension in a patient with ischemic heart disease and combined pulmonary fibrosis and emphysema, in order to describe the diagnostic algorithm for pulmonary hypertension and elucidate the problematic aspects of managing this debilitating disease in a patient with several comorbidities. Current guidelines do not support the use of specific vasodilator treatment in group II — due to heart disease and group III-due to lung disease pulmonary hypertension, unless the patient presents with severe pulmonary hypertension (mean pulmonary artery pressure > 35 mm Hg or cardiac index < 2.0 L/min) with right ventricular dysfunction and is treated in an expert center and preferably in the context of a randomized control trial. In the case presented, therapeutic management focused, firstly, on treatment of the underlying heart and lung disease and, subsequently, on specific vasoactive therapy, due to severe hemodynamic deterioration

Longitudinal changes in exercise capacity among adult cystic fibrosis patients

Introduction: Longitudinal data regarding changes in exercise capacity among adult cystic fibrosis (CF) patients are currently scarce. The aim of this brief report was to assess changes in exercise capacity among adult CF patients with stable and mild-to-moderate disease eight years after their initial evaluation.Material and methods: Maximum cardiopulmonary exercise testing (CPET) was utilized. Other assessments included Doppler echocardiography, the 6-minute walking test, spirometry, and lung volume evaluation. Results: Eleven (6 male, 5 female) patients completed both evaluations (initial and after eight years). During follow-up, indices of ventilatory impairment (such as ventilatory reserve; p=0.019, and ventilatory equivalent for carbon dioxide; p = 0.047) deterio-rated significantly following a decline in respiratory function measurements. Peak oxygen uptake (VO2), both as an absolute (26.6 ± 8.46 vs 23.89 ± 6.16 mL/kg/min; p = 0.098) and as a % of predicted value (71.21 ± 16.54 vs 70.60 ± 15.45; p = 0.872), did not deteriorate. This is also true for oxygen pulse (p = 0.743), left heart ejection fraction (p = 0.574), and pulmonary artery systolic pressure (p = 0.441). However, the anaerobic threshold, both as an absolute (p = 0.009) and as a % of predicted value (p = 0.047), was significantly lower during follow-up. Conclusion: In adult CF patients with stable, mild-to-moderate disease, a peak VO2 may be preserved for several years. However, even in these patients, deconditioning is present

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Acute Respiratory Failure as Primary Manifestation of Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis

The systemic vasculitides are multifocal diseases characterized by the presence of blood vessel inflammation in multiple organ systems. Their clinical presentation is variable extending from self-limited illness to critical complications including diffuse alveolar hemorrhage and glomerulonephritis. Alveolar hemorrhage is a lifethreatening manifestation of pulmonary vasculitis that can rapidly progress into acute respiratory failure requiring ventilatory support. We present the case of a 74-year-old patient admitted to the Intensive Care Unit with severe hypoxic respiratory failure and diffuse alveolar infiltrates in chest imaging that was later diagnosed as antineutrophil cytoplasmic antibodies-associated vasculitis. The report highlights the importance of differentiate between alveolar hemorrhage and acute respiratory distress syndrome of other etiology because alveolar hemorrhage is reversible with prompt initiation of treatment

Συγκριτική μελέτη των συστημάτων Τριτοβάθμιας εκπαίδευσης της Ελλάδας, της Γαλλίας και της Δανίας: Οι δημόσιες δαπάνες, ως το ποσοστό του ΑΕΠ, και η παγκόσμια κατάταξη των Πανεπιστημίων τους.

Σκοπός της παρούσας διπλωματικής εργασίας είναι να καταδείξει τα οφέλη που έχει η επένδυση στην Τριτοβάθμια εκπαίδευση από τα κράτη μέσω των δημοσίων δαπανών, αλλά και αντιστρόφως, πώς η χρηματοδότηση που παρέχουν, μέσω του κρατικού προϋπολογισμού, συμβάλει στην ανάπτυξη των Πανεπιστημίων τους και τη είσοδο τους στις σημαντικότερες κατατάξεις καλύτερων Πανεπιστημίων παγκοσμίως. Στη Δεύτερη ενότητα θα μελετήσουμε τη σύνδεση που υπάρχει μεταξύ της Τριτοβάθμιας εκπαίδευσης και της οικονομικής ανάπτυξη μιας χώρας καθώς και το πώς συνδέεται με την ανεργία και την οικονομική ανάπτυξη της. Τα στοιχεία που θα χρησιμοποιηθούν παρέχονται από τον Οργανισμό Οικονομικής Συνεργασίας και Ανάπτυξης (ΟΟΣΑ), από το Κέντρο Ανάπτυξης Εκπαιδευτικής Πολιτικής της ΓΣΕΕ αλλά και την Ευρωπαϊκή Στατιστική Υπηρεσία (EUROSTAT). Προκειμένου, λοιπόν, να εξετάσουμε κατά πόσο η χρηματοδότηση των Πανεπιστημίων συνδέεται με τον αριθμό των ανώτατων ιδρυμάτων που έχουν στις παγκόσμιες κατατάξεις Πανεπιστημίων, θα χρησιμοποιήσουμε τα παραδείγματα της Ελλάδας, της Γαλλίας και της Δανίας. Στην Τρίτη ενότητα θα εξηγήσουμε γιατί επιλέξαμε τις χώρες αυτές. Όπως θα διαπιστώσουμε αποτελούν παραδείγματα χωρών όπου η Τριτοβάθμια εκπαίδευση χρηματοδοτείται σε μεγάλο βαθμό από τον κρατικό προϋπολογισμό. Αρχικά θα μελετήσουμε το εκπαιδευτικό σύστημα, ως προς την Τριτοβάθμια εκπαίδευση, ενώ όπου χρειάζεται θα προχωρήσουμε παραθέτοντας κάποιες επιπλέον πληροφορίες για την Δευτεροβάθμια εκπαίδευση τους. Στη συνέχεια, στην Τέταρτη Ενότητα θα προχωρήσουμε σε συγκριτική μελέτη αυτών, προκειμένου να συνδέσουμε την χρηματοδότηση που λαμβάνουν τα Πανεπιστήμιά τους με τον αριθμό των Πανεπιστημίων που έχουν στις λίστες με τα 500 καλύτερα Πανεπιστήμια παγκοσμίως. Πρώτα θα δούμε πως χρηματοδοτεί κάθε χώρα την Ανώτατη εκπαίδευση της, και ύστερα, μελετώντας τις παγκόσμιες λίστες κατάταξης Πανεπιστημίων θα επιχειρήσουμε να δούμε κατά πόσο συνδέονται. Οι κατατάξεις που θα μελετήσουμε είναι οι Quacquarelli Symonds World University Rankings (QS), Times Higher Education World University Rankings (TIMES), και Academic Ranking of World Universities (Shanghai/ ARWU ) του 2017. Επιλέξαμε τις συγκεκριμένες κατατάξεις Πανεπιστημίων καθώς αποτελούν από τις πιο διαδεδομένες και αξιόπιστες παγκοσμίως. Τέλος, θα προσπαθήσουμε να συνδέσουμε το ποσοστό του ΑΕΠ που δίνεται σε κάθε μια από τις τρεις χώρες με τον αριθμό των Πανεπιστημίων που έχουν σε κάθε μια από τις τρεις λίστες, προκειμένου να επιβεβαιώσουμε την υπόθεση μας, πως η οικονομική ανάπτυξη μιας χώρας και η Τριτοβάθμια εκπαίδευση της συνδέονται. Επομένως η χρηματοδότηση, με τη μορφή δημοσίων δαπανών για την Ανώτατη εκπαίδευση μιας χώρας, αποτελεί επένδυση τόσο στο ανθρώπινο δυναμικό της, όσο και στην οικονομία και την οικονομική της ανάπτυξη.The aim of this diploma thesis is to demonstrate the benefits of investing in tertiary education by the state through public spending and, vice versa, how the funding provided through the state budget contributes to the development of their Universities and their entry into the most important rankings of the best Universities worldwide. In Chapter Two, we will study the link between higher education and the economic development of a country, and how it is linked to unemployment and economic growth. The data to be used are provided by the Organization for Economic Cooperation and Development (OECD), the Center for the Development of Educational Policy of the GSEE and the European Statistical Office (EUROSTAT). In order to study whether University funding is linked to the number of top universities in the world ranking of Universities, we will use the examples of Greece, France and Denmark. In Section Three we will explain why we chose these countries. As we will see, they are examples of countries where Tertiary Education is largely funded by the state budget. Initially, we will study the education system with regard to Tertiary Education, and wherever is necessary, we will proceed by providing some additional information on their secondary education. Then on the Fourth Chapter, we will proceed to a comparative study of these in order to link the funding received by their Universities to the number of Universities that they have enlisted to the 500 Best Universities in the world. First, we will examine how each country finances its higher education, and then we will proceed look at the world class universities lists and we will try to see how they are connected. The rankings to be studied are Quacquarelli Symonds (QS) World Universities, World University Higher Education Awards (TIMES), and World University Academic Rankings (Shanghai / ARWU) in 2017. We chose these Universities due to them being widespread and reliable worldwide. Finally, we will try to link the percentage of GDP given to each of the three countries by the number of Universities each of them have into the three lists in order to confirm our hypothesis that a country's economic development and Tertiary Education its associated. Therefore, in the form of public spending for higher education in a state, is an investment effort on its human capital, its economic development, and their economy in general

A case of pulmonary veno-occlusive disease: diagnostic dilemmas and therapeutic challenges

Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary hypertension (PH). Misdiagnosis of the disease is common since PVOD presents with clinical and radiographic features mimicking idiopathic pulmonary arterial hypertension or even PH due to interstitial lung disease. Vasodilators may not be efficacious in PVOD and may in fact worsen hemodynamic status with the development of pulmonary edema. Lung transplantation represents the best treatment option. In the present report we describe the challenging diagnosis of PVOD in a patient with PH referred to our department. Final diagnosis was established by surgical lung biopsy. The patient was offered sequential combination therapy under close monitoring and maintained remarkable clinical stabilization while being on the waiting list for lung transplantation