An unusual spirometric shape that you must not forget.

An anomalous spirometric pattern can initiate a diagnostic path leading to the finding of a congenital vascular malformation. The flow-volume curve may hide a nonrespiratory pathology. Spirometry is not just asthma or COPD. http://bit.ly/30iHRCp.

Prevalence of gastrointestinal disorders having an impact on tablet levothyroxine absorption: should this formulation still be considered as the first-line therapy?

PURPOSE: In patients with hypothyroidism, levothyroxine (LT4) is the treatment of choice, and tablets are the most commonly prescribed formulation. Despite multiple scenarios being reported in the literature with impaired tablet absorption and likely missed TSH targets, it is yet unclear what the implications are for clinical practice and the role of liquid solution (LS) and soft gel (SG) formulations. We have thus conducted a narrative review evaluating the prevalence within the general population of gastrointestinal disorders impacting tablet LT4 absorption. METHODS: PubMed and Google Scholar were searched until December 2019 for systematic reviews and meta-analyses on the topic. If they could not be retrieved, other types of manuscripts were searched. RESULTS: Lactose malabsorption and Helicobacter pylori infection represented the most common disorders, with a global prevalence of 68% and 48%, respectively. The prevalence of other conditions, including autoimmune gastritis, bariatric surgery, celiac disease, gastroparesis, giardiasis, liver cirrhosis, or ulcerative colitis, was lower than 20%. Data at regional and country levels were found to be heterogeneous, but at least one in five patients was diagnosed with one disorder. CONCLUSIONS: The worldwide prevalence of gastrointestinal disorders associated with tablet LT4 malabsorption, including lactose malabsorption and Helicobacter pylori infection, is high. Interactions with drugs or food can further increase this risk. Considering that all studies investigating the impact of switching patients from tablet to LS or SG found an improved thyroid balance, the latter formulations should be considered as first-line therapy for managing hypothyroidism.

Performance of Five Ultrasound Risk Stratification Systems in Selecting Thyroid Nodules for FNA.

CONTEXT: Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine-needle aspiration procedures (FNA) in patients with thyroid nodules. OBJECTIVE: We conducted a systematic review and meta-analysis evaluating the ability of the 5 most common US RSSs for the appropriate selection of thyroid nodules for FNA. DATA SOURCES: This systematic review and meta-analysis was registered on PROSPERO (CRD42019131771). PubMed, CENTRAL, Scopus, and Web of Science were searched until March 2019. STUDY SELECTION: Original articles reporting data on the performance of AACE/ACE/AME, ACR TI-RADS, ATA, EU-TIRADS, and K-TIRADS were included. DATA EXTRACTION: The number of nodules classified as true negative, true positive, false negative, and false positive was extracted. Summary operating points were estimated using a random-effects model. Interobserver agreement was also assessed. DATA SYNTHESIS: Twelve studies evaluating 18 750 thyroid nodules were included. Participants were adult outpatients with thyroid nodules submitted to either FNA or core-needle biopsy or surgery and with available US images. The final diagnosis for malignant nodules was generally based on histology, while cytology was used for benign nodules. Diagnostic odds ratio (DOR) ranged from 2.2 to 4.9. A head-to-head comparison showed a higher relative DOR for ACR-TIRADS versus ATA (P = .002) or K-TIRADS (P = .002), due to a higher relative likelihood ratio for positive results. CONCLUSIONS: The present meta-analysis found a higher performance of ACR TI-RADS in selecting thyroid nodules for FNA. However, the comparison across the most common US RSSs was limited by the data available. Further studies are needed to confirm this finding.

Inhaled Corticosteroids And Risk Of Tuberculosis In Patients With Obstructive Lung Diseases: A Systematic Review And Meta-Analysis Of Non-randomized Studies.

Background: An association between systemic corticosteroids and tuberculosis (TB) is reported in the literature. Here within, we conducted a systematic review and meta-analysis to evaluate the effects of inhaled corticosteroids (ICS) on the risk of TB in patients with obstructive lung diseases. Methods: The review was registered on PROSPERO (CRD42018095874). PubMed, CENTRAL, Scopus and Web of Science were searched from inception to September 2018. Papers reporting cases of incident TB in patients with obstructive lung diseases were included; studies without data on ICS use were excluded. Simultaneous use of oral corticosteroids (OCS) and population attributable fraction (PAF) for TB from ICS exposure were also assessed. Data were analyzed using a generic inverse variance method with a random-effects model. ORs with 95% CI were estimated. Results: Out of 4044 retrieved papers, 9 articles evaluating adult patients only were included in the review. 36,351 patients were prescribed ICS, while 147,171 were not. Any ICS use was associated with an increased risk of TB versus no ICS use (OR=1.46; 95% CI 1.06 to 2.01; p=0.02; I2=96%). A similar result was also found for current ICS use versus prior/no ICS use, as well as for high, moderate and low ICS dose versus no ICS. When simultaneous OCS use was evaluated, the independent contribution of ICS was confirmed only in patients not on OCS (OR=1.63; 95% CI 1.05 to 2.52; p=0.03; I2=94%). Only 0.49% of all TB cases could be attributable to ICS exposure. Conclusions: Despite the association between ICS and TB, the contribution of this risk factor to the epidemiology of TB seems to be limited. As a consequence, no population-based interventions are warranted. Rather, this risk should be taken into account on an individual basis, particularly in those patients with a high risk of progression from LTBI to TB.

The future of PACS in healthcare enterprises.

Picture Archiving and Communication System (PACS), which was originally designed as a tool for facilitating radiologists in interpreting images more efficiently, is evolving into a hospital-integrated system storing diagnostic imaging information that often reaches far beyond Radiology. The continuous evolution of PACS technology has led to a gradual broadening of its applications, ranging from teleradiology to CAD (Computer-Assisted Diagnosis) and multidimensional imaging, and is moving into the direction of providing access to image data outside the Radiology department, so to reach all the branches of the healthcare enterprise. New perspectives have been created thanks to new technologies (such as holographic media and GRID computing) that are likely due to expand PACS-based applications even further, improving patient care and enhancing overall productivity.

Cooling electrons by magnetic-field tuning of Andreev reflection.

A solid-state cooling principle based on magnetic-field-driven tunable suppression of Andreev reflection in superconductor/two-dimensional electron gas nanostructures is proposed. This cooling mechanism can lead to very large heat fluxes per channel up to 10;{4} times greater than currently achieved with superconducting tunnel junctions. This efficacy and its availability in a two-dimensional electron system make this method of particular relevance for the implementation of quantum nanostructures operating at cryogenic temperatures.