Targeting Lipopolysaccharides in Gram-negative Sepsis: Therapeutic Advances and Challenges.

Gram-negative bacterial sepsis remains a major global health threat, exacerbated by rising antimicrobial resistance and limited efficacy of current therapies. Central to its pathogenesis is lipopolysaccharide (LPS), a potent endotoxin that triggers overwhelming inflammation and organ dysfunction. This review critically evaluates emerging therapies targeting LPS in sepsis.

Beneath the Label - Evaluating the FDA Approval of Copenhagen Classic Snuff as a Modified Risk Tobacco Product.

Description In this review, we critically evaluate the Food and Drug Administration's modified risk tobacco product (MRTP) status granted to a smokeless tobacco product (March 2023), Copenhagen Classic Snuff (CCS). This new status necessitates an assessment of the product CCS use and its public health impacts. We assess the impact of CCS as it relates to the reduction of lung cancer risk and the potential increased risk for nasopharyngeal cancer, chronic rhinitis, nicotine dependence, and other health hazards.

From Molars to Bronchus; The Tale of an Aspirated Dental Instrument.

Background: Aspiration of dental instruments is a rare event that carries potentially serious complications when it occurs, especially in older patients, where protective reflexes are diminished. Clinical management may be difficult because of the risk of granulation tissue and different retrieval strategies according to the object's characteristics. In this report, we describe the case of an 84-year-old man who aspirated a dental bur during a routine dental procedure, necessitating immediate intervention.

Delaying disease progression in COPD with early escalation to triple therapy: a modelling study (DEPICT-2).

Introduction: In patients with COPD, dual bronchodilator (long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA)) and triple therapy (inhaled corticosteroid/LAMA/LABA) reduce the risk of exacerbations and lung function decline in the short-mid-term, but their long-term impact is unknown. This modelling study explores long-term impact of these therapies on lung function decline, quality of life (QoL) and all-cause mortality.

Methods: This modelling approach used a longitudinal nonparametric superposition model using published data regarding exacerbations, QoL (assessed by St George's Respiratory Questionnaire (SGRQ)) and mortality.

Teratoma to Angiosarcoma: A Metamorphosis in the Mediastinum.

We describe a rare and remarkable transformation of an immature mediastinal teratoma into high-grade angiosarcoma in a 21-year-old male. Mediastinal teratomas, particularly immature ones, are exceedingly rare, representing a small fraction of germ cell tumors (GCTs). Our case describes the clinical journey of the patient, who initially presented with acute chest pain and was subsequently diagnosed with an immature teratoma following imaging studies and elevated tumor markers.

A Review of Endobronchial-Ultrasound-Guided Transbronchial Intranodal Forceps Biopsy and Cryobiopsy.

Benign and malignant mediastinal lesions are not infrequently encountered in clinical practice. Mediastinoscopy has long been considered the gold standard in evaluating mediastinal pathology. Since its introduction into clinical practice, endobronchial-ultrasonography-guided transbronchial fine needle aspiration (EBUS-TBNA) has replaced mediastinoscopy as the initial procedure of choice to evaluate mediastinal lesions and to stage lung cancer.

Hungatella hathewayi bacteremia due to acute appendicitis: A case report and a narrative review.

Hungatella species, including Hungatella hathewayi and Hungatella effluvii, previously identified as part of the Clostridium genus, are anaerobic bacteria primarily residing in the gut microbiome, with infrequent implications in human infections. This article presents the case of an 87-year-old Asian male admitted for a hyperosmolar hyperglycemic state with septic shock secondary to Hungatella hathewayi bacteremia originating from acute appendicitis. Remarkably, the bacterium was detected in the blood 48 hours before the emergence of clinical and radiographic evidence of acute appendicitis.

Understanding the Gaps in the Reporting of COPD Exacerbations by Patients: A Review.

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function, poor quality of life, loss of exercise capacity, risk of serious cardiovascular events, hospitalization, and death. However, patients underreport exacerbations, and evidence suggests that unreported exacerbations have similar negative health implications for patients as those that are reported. Whilst there is guidance for physicians to identify patients who are at risk of exacerbations, they do not help patients recognise and report them.

Breathless Revelation: Unmasking Acute Myeloid Leukemia Through Acute Respiratory Failure.

Establishing a diagnosis of acute myeloid leukemia (AML) in a patient presenting with acute respiratory failure is rare. Here, we present a case of AML initially appearing as hypoxemic respiratory failure linked to presumed community-acquired pneumonia. This case report unravels the intricate diagnostic odyssey of an atypical AML presentation masquerading as an acute respiratory failure, accentuating the multifaceted challenges clinicians encounter in discerning the actual underlying pathology amidst the haze of mimicry.

Delphi Consensus on Clinical Applications of GOLD 2023 Recommendations in COPD Management: How Aligned are Recommendations with Clinical Practice?

Introduction: The objective of this Delphi study was to understand and assess the level of consensus among respiratory experts on the clinical application of GOLD 2023 recommendations in management of patients with chronic obstructive pulmonary disease (COPD).

Methods: The study comprised two online surveys and a participant meeting with 34 respiratory experts from 16 countries. Responses of 73 questions were recorded using a Likert scale ranging from 0 (disagreement) to 9 (agreement).

Exemestane-Everolimus-Induced Angioedema in a Woman With Metastatic Breast Cancer: A Case Report and Review.

Dual exemestane-everolimus therapy has been shown to confer a progression-free survival benefit in women with refractory advanced hormone-receptor-positive breast cancer. Patients with breast cancer may experience several other comorbidities, including hypertension, for which angiotensin-converting enzyme inhibitors (ACE-I) are a first-line therapy for hypertension of cardiovascular and/or renal etiology. One rare but feared side effect of ACE-I is severe angioedema due to decreased bradykinin degradation, which can lead to respiratory collapse.

Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica.

Total hip arthroplasty (THA) is the preferred treatment for patients with hip joint disorders refractory to conservative management. While original implants were designed to articulate a metallic femoral head onto a polyethylene liner, the popularity of "metal-on-metal" (MoM) hip implants surged in the early 21st century due to their perceived superior long-term durability and lower revision rates. However, subsequent follow-up studies showed high failure rates due to inflammatory responses to periprosthetic metallic debris leading to lymphocytic proliferation, soft tissue necrosis or fibrosis, systemic metal toxicity, and/or the development of cystic pseudotumors.

Clinical Concepts for Triple Therapy Use in Patients with COPD: A Delphi Consensus.

Purpose: Role of triple therapy in chronic obstructive pulmonary disease (COPD) management is supported by growing evidence, but consensus is lacking on various aspects. We conducted a Delphi survey in respiratory experts on the effects of triple therapy on exacerbation reduction, early optimization, pneumonia risk, and mortality benefits in COPD management.

Methods: The study comprised 2-round online surveys and a participant meeting with 21 respiratory experts from 10 countries.

Achalasia and Cricopharyngeal Sphincter Dysfunction in a Patient With Myasthenia Gravis: A Case Report.

This case report describes an 82-year-old female patient with myasthenia gravis (MG) who presented with worsening dysphagia. The patient was found to have cricopharyngeal sphincter and esophageal achalasia, and a percutaneous endoscopic gastrostomy (PEG) tube was placed due to severe pharyngeal dysphagia and cricopharyngeal dysfunction. The patient had class IVb myasthenia gravis and was treated with intravenous immunoglobulin (IVIG), prednisone, and pyridostigmine.

DElaying Disease Progression In COPD with Early Initiation of Dual Bronchodilator or Triple Inhaled PharmacoTherapy (DEPICT): A Predictive Modelling Approach.

Introduction: Clinical studies demonstrate an accelerated decline in lung function in patients with moderate chronic obstructive pulmonary disease (COPD) (Global Initiative for Chronic Obstructive Lung Disease [GOLD] grade 2) versus severe and very severe COPD (GOLD grades 3 and 4). This predictive modelling study assessed the impact of initiating pharmacotherapy earlier versus later on long-term disease progression in COPD.

Methods: The modelling approach used data on decline in forced expiratory volume in 1 s (FEV) extracted from published studies to develop a longitudinal non-parametric superposition model of lung function decline with progressive impact of exacerbations from 0 per year to 3 per year and no ongoing pharmacotherapy.

Brain Abscesses by Nocardia: An Interesting Case.

The successful management of disseminated infection is not well described in medical literature. Immunocompetent individuals presenting with complicated and widespread infection is an uncommon phenomenon. We describe an interesting case of a large abscess in the brain in an immunocompetent patient that was aspirated.

Pulmonary Glomus Tumor.

Glomus tumors, which account for less than 2% of soft tissue tumors, are a rare benign soft tissue neoplasm. They originated from neuro-myo-arterial glomus tissue whose primary function is regulation of the body temperature. This tissue is commonly located in the dermis or subcutis in the subungual region; however, it can be extracutaneous such as in bones, the genitourinary tract, the gastrointestinal tract, and the respiratory tract.

A Case of Left-Sided Infective Endocarditis of Multiple Native Valves Complicated by Valve Leaflet Perforation, Multiple Septic Emboli, Thromboembolic Events, and Cardiac Arrhythmias.

Coagulase-negative staphylococci (CoNS) can uncommonly cause native valve endocarditis. We present a case of left-sided infective endocarditis of native valves presenting with splenic, lung, and brain infarcts along with aortic and significant mitral valve involvement with mitral valve perforation. The patient was also found to be in atrial flutter and atrial fibrillation.

Randomized Open Investigation Determining Steroid Dose in Severe COVID-19: The ROIDS-Dose Clinical Trial.

Introduction Treatment with dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19) pneumonia requiring supplemental oxygen, but the optimal dose has not been determined. Objective To determine whether weight-based dexamethasone of 0.2 mg/kg is superior to 6 mg daily in reducing 28-day mortality in patients with COVID-19 and hypoxemia.

Mycobacterium abscessus Pneumonia in Severe Alcoholism.

Non-tuberculous mycobacterial infections (mycobacterium other than and ) are organisms that are commonly found in the environment such as water, soil, and dust. They may form difficult to eliminate biofilms and have been reported to cause significant infections in humans, especially in immunocompromised hosts. This article describes an interesting case of in the lung.

Indwelling Pleural Catheter (IPC) for the Management of Hepatic Hydrothorax: The Known and the Unknown.

Background: Hepatic hydrothorax (HH) is described as pleural effusion secondary to liver cirrhosis after ruling out other etiologies. We aim to assess the efficacy of an indwelling pleural catheter (IPC) placement in refractory HH in this systematic review and meta-analysis.

Methods: A comprehensive search of literature was performed from inception to December 2020.

Asystole in COVID-19 Infection: A Case Report.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has been associated with a broad spectrum of cardiac manifestations ranging from myocardial injury and heart failure to cardiac arrhythmias. In this report, we present a rare case of sinus node dysfunction/asystole in a young patient without any known history of coronary artery disease or cardiac arrhythmias, which necessitated pacemaker placement.

Delayed anaphylaxis due to gadolinium- A rare clinical scenario.

Acute respiratory distress syndrome is a sudden in onset, diffuse inflammatory form of lung injury which may be associated with a variety of etiologies such as pneumonia, sepsis, aspiration, and severe trauma. Prompt recognition and treatment of acute respiratory distress syndrome is critical to reduce the associated high mortality. Severe lung injury presenting as acute respiratory distress syndrome secondary to gadolinium contrast media (gadobutrol) is rarely reported.