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Al Qurayn, Egypt

Nitu M.,Section of Pediatric Pulmonology | Montgomery G.,Section of Pulmonology | Montgomery G.,Pediatric Bronchoscopy Laboratory
Pediatrics in Review | Year: 2011

• A wide array of conditions ultimately can lead to acid-base imbalance, and interpretation of acid-base disorders always involves a mix of art, knowledge, and clinical experience. • Solving the puzzle of acid-base disorders begins with accurate diagnosis, a process requiring two tasks. First, acid-base variables in the blood must be reliably measured to determine the effect of multiple ions and buffers. Second, the data must be interpreted in relation to human disease to define the patient's acid-base status. • History, physical examination, and additional laboratory testing and imaging help the clinician to identify the specific cause of the acid-base isturbance and to undertake appropriate intervention. Source

Bosch D.,Section of Pulmonology
Clinical Pulmonary Medicine | Year: 2011

Pleural effusion resulting from pleuroperitoneal communication is a rare complication in patients undergoing continuous ambulatory peritoneal dialysis. We report a 50-year-old patient presenting with dyspnea due to hydrothorax that resulted from peritoneal dialysate transuding through the diaphragm. Typically, a transudative pleural effusion in patients undergoing CAPD is a manifestation of a positive fluid balance. The approach for identifying pleuroperitoneal communications is reviewed, with attention to the anatomic derangements underlying this process, and the various therapeutic options are illustrated. © 2011 by Lippincott Williams & Wilkins. Source

Man A.,Section of Rheumatology | Davidyock T.,Section of Pulmonology | Ferguson L.T.,Section of Rheumatology | Ieong M.,Section of Pulmonology | And 2 more authors.
Rheumatology (Oxford, England) | Year: 2015

OBJECTIVE: An accelerated rate of decline in forced vital capacity (FVC) affects >50% of patients with SSc but data on the variability and determinants of this change are scarce. We sought to identify trajectories of FVC and their associated variables in SSc patients over a 12-year period.METHODS: Clinical and pulmonary function data were retrospectively collected. SSc patients with three or more FVC values were included. Group-based modelling was used to cluster similar FVC patterns into trajectories. Baseline variables were associated with the trajectories using multinomial logistic regression. The effect of CYC on FVC was examined with each trajectory as a time-varying covariate.RESULTS: In 254 SSc patients we identified seven distinct FVC trajectories: very low slow decline (5.5%), very low improve (13.8%), low fast decline (9.5%), low stable (19.7%), low-normal improve (31.1%), normal improve (16.1%) and normal stable (4.3%). Younger age and the presence of pulmonary hypertension, Interstitial lung disease and shortness of breath at baseline significantly increased the odds of declining trajectories vs the reference trajectory (low-normal improve). CYC was associated with FVC improvement in the low fast decline trajectory.CONCLUSION: The course of FVC in SSc was highly variable, with improvement and stability experienced even by those with low baseline FVC. Trajectory modelling was able to identify SSc patients who were most likely to experience FVC decline and thus could be a useful tool for patient management as well as clinical trial design. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com. Source

Bohm M.,Section of Pulmonology | Malik Z.,Section of Pulmonology | Sebastiano C.,Section of Pulmonology | Thomas R.,Section of Pulmonology | And 3 more authors.
Journal of Clinical Gastroenterology | Year: 2012

BACKGROUND: Eosinophilic esophagitis is a chronic inflammatory disease with mucosal accumulation of eosinophils. There is a paucity of data among racial/ethnic groups other than white patients. AIM: To determine if racial/ethnic differences exist in clinical presentation, endoscopic appearance, and biopsy results in adult patients (age ≥18 y) with mucosal eosinophilia and examine the prevalence of mucosal eosinophilia at an urban hospital over a 10-year period. METHODS: Pathology reports searched at Temple University Hospital 2000 to 2009; key words: "eosinophils", "esophagus" , and "biopsy". Clinical and endoscopic records reviewed on patients with ≥15 eosinophils/high power field. RESULTS: A total of 64 adults (average age, 41 y; 62% male patients; 81% white, 12% black, and 6% Hispanic). White patients were significantly younger (P=0.03). Adult mucosal eosinophilia diagnosis increased by 833% (3 in 2000 to 25 in 2009); black/Hispanic diagnosis increased by 500% (1 in 2000 to 5 in 2009). Solid food dysphagia was more common among white patients (72% vs. 0.33%, P=0.02). Reflux symptoms were more common in black/Hispanic patients (42% vs. 22%, P=0.16). Normal endoscopy (42% vs. 13%, P=0.04) and reflux changes (41% vs. 21%, P=0.16) were more common in black/Hispanic patients. Furrows (42% vs. 8%, P=0.04) and rings (46% vs. 0%, P=0.002) were more common in white patients. Average eosinophil counts did not vary between groups. CONCLUSIONS: Mucosal eosinophilia presents with significant differences between racial/ethnic groups in age at onset, symptoms at presentation, and endoscopic features. Differences may reflect different phenotypes of the same disease or separate disease entities. Copyright © 2012 by Lippincott Williams & Wilkins. Source

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