Fidaa Shaib

Incidence, Etiology, Timing, and Risk Factors for Clinical Failure in Hospitalized Patients With Community-Acquired Pneumonia

BACKGROUND The etiology of clinical failure in hospitalized patients with community-acquired pneumonia (CAP) may be related or unrelated to pulmonary infection. The objective of this study was to define the incidence, etiology, timing, and risk factors associated with clinical failures related to CAP vs those unrelated to CAP. METHODS Observational retrospective study of consecutive CAP patients. All patients who experienced clinical failure were identified. Cases were presented to a review committee that defined, by consensus, etiology, timing, and risk factors for clinical failures related to CAP. RESULTS Among 500 patients who were enrolled in the study, clinical failure was identified in 67 (13%). Clinical failure was related to CAP in 54 patients (81%). The most common etiologies for clinical failure related to CAP were severe sepsis (33%), acute myocardial infarction (28%), and progressive pneumonia (19%). All cases of severe sepsis occurred in the first 72 h of hospitalization. The most common etiology for clinical failure unrelated to CAP was the development of hospital-acquired pneumonia (45%). At the time of hospital admission, factors associated with clinical failure related to CAP were advanced age, congestive heart failure, hypotension, abnormal gas exchange, acidosis, hypothermia, thrombocytopenia, and pleural effusion. CONCLUSIONS The development of severe sepsis early during hospitalization is the primary etiology for clinical failure related to CAP. To achieve early treatment intervention, physicians should maintain a high index of suspicion for severe sepsis in hospitalized patients with CAP. To decrease the number of clinical failures unrelated to CAP, interventions need to be developed at the local level to improve the processes of care for patients with pneumonia.

Prevention of Low Back Pain in Sedentary Healthy Workers: A Pilot Study

Introduction: Low back pain (LBP) is the second most frequent neuromuscular ailment among Americans and third reason for physician visits by older people. Although remedies have been reported to palliate LBP, there is no effective prevention. We performed this one-year pilot study to determine if daily intervention of mild home exercises, focused on conditioning muscles maintaining upright 2-legged balance, prevented LBP. Methods: University of Louisville hospital and research lab volunteer employees with no history of chronic back pain were randomized after informed consent. Subjects were divided into 2 statistically similar groups, control and intervention. LBP episodes were recorded and compared over the 1-year period. Medical, blood chemistry, spirometric and clinical examinations were done on all volunteers twice, at beginning and end of the trial period. A set of 6 calisthenics, focusing on balance-control, low-back-connected musculature, was taught to the intervention group over 2 months. A matched control group was observed and examined only. Exercises, performed daily, required 15 minutes. Results: In this pilot study, LBP was completely prevented in intervention group (0 of 13), whereas nearly 60% of controls (10 of 17) experienced back pain in 1 year. Intervention group showed significant improvement in strengths of balance-controlling muscles; control group showed no change. Exercises yielded an unexpected fitness benefit ofraising automatic respiratory exchange. Conclusions: This pilot study suggests that LBP can be prevented in 50-year-old healthy working persons by daily, mild home calisthenics that improve balance-muscle strength. We hypothesize that improved respiratory function may be related to improved posture.

Pulmonary Vein Stenosis Due to a Compressive Malignant Tumor Detected by Transesophageal Echocardiography

A 72-year-old man presented to the emergency department with a history suggestive of a transient ischemic attack. On physical examination, he had bilateral expiratory rhonchi and no residual neurological deficit. A chest radiograph, obtained on admission, did not reveal any obvious lung mass or nodule. As part of the evaluation protocol, a transesophageal echocardiogram (TEE) was performed to rule out a possible cardioembolic etiology. The TEE showed normal left ventricular systolic function, mildly dilated right ventricle with moderately elevated right ventricular systolic pressure, and a patent foramen ovale with a right-to-left …