Early or delayed bronchoscopy in patients admitted to the emergency department for mild-to-moderate hemoptysis?

BACKGROUND: The correct timing for bronchoscopy in massive hemoptysis is well established, whereas in mild-to-moderate hemoptysis there still is uncertainty. The aim of our study was to evaluate if performing a fibrobronchoscopy (FBS) within 48 hours after the onset of mild-to-moderate hemoptysis was related to a higher possibility to identify the site and the cause of bleeding, compared to a delayed one. METHODS: We conducted a retrospective study over one-year period from March 2015, in which consecutive patients admitted to the emergency department underwent FBS for spontaneous mild-to-moderate hemoptysis in our medium-size teaching hospital. RESULTS: We included 69 patients. Definitive diagnosis was achieved in 52 cases (75%) combining clinical, imaging and endoscopic data (neoplastic diseases 22%, infections 20%, alveolar hemorrhage 13%). FBS was performed within 48 hours of symptoms onset in 41 patients (59%). The site of bleeding was identified in 28 cases (41%), 64% of which underwent FBS within 48 hours. Endoscopic diagnosis was reached in 45 patients (65%), 60% of which underwent FBS within 48 hours. No statistical association with localization (P=0.62) or diagnosis (P=1.00) was found with early FBS. Despite a high prevalence in our cohort of patients treated with anticoagulant or antiplatelet drugs (39%), we found no statistical association with bronchoscopy localization (P=0.12) and diagnosis (P=0.21). CONCLUSIONS: In conclusion, in case of mild to moderate hemoptysis, an early bronchoscopy in the emergency department setting does not seem to improve the possibility to find neither the cause nor the localization of the bleeding source.

Foot and Soccer Referees': A Pilot Study Searching "Performance" Throughout Prevention.

Soccer refereeing is a "not-conventional" sport in which aerobic workload is prevalent. Along the years, several studies have attempted to define best markers of referees' performance. Many studies focused their attention on field tests and their relationship with aerobic power. Instead, in this study, starting by a medical assessment satisfying the FIFA 11+ criteria for injuries prevention, we have investigated the foot of soccer referees and we have also wanted to find possible and/or unexpected improvements in performance. As performance marker, we have used the referral field test for soccer referees that is internationally validated and known as Yo-Yo test (YYiR1). While standardized foot posture index (FPI) questionnaire was used for screening foot referees conditions (40 young, all men by sex, with mean age 23.47 ± 4.36). Analyzing collected data, we have demonstrated by means of Read-Cressie Chi square test that neutral FPI is an important favor item affecting YYiR1 results. Further studies will be necessary in order to confirm our pilot investigation.

Evaluating health-related quality of life, work ability, and disability in pulmonary arterial hypertension: an unmet need.

To our knowledge, there are no specific and validated measures of quality of life (QoL) or degree of disability for pulmonary arterial hypertension (PAH). A review of the literature shows that, with the exception of one recently designed specifically for pulmonary hypertension, QoL questionnaires used in PAH studies are generic measures. These are selected because of shared symptoms that do not necessarily correlate well with functional or physiologic measures and have not been validated for applicability in PAH. In this review, we present the available QoL tools for pulmonary artery hypertension and describe the need for more specific instruments that consider the physical and emotional implications of the diseases associated with PAH and the impact of various treatment options. We also discuss the impact of PAH on work ability and the need for provisions to address medical disability status and Social Security benefit status.