Diffuse pulmonary calcifications: A case series and review of literature.

Pulmonary calcifications are usually incidental asymptomatic findings discovered on x-rays or computed tomography scans that can be easily overlooked, and their significance undermined, especially in a seemingly asymptomatic person. Calcifications can be a marker of chronicity or disease severity, and thus have diagnostic value. Rarely, calcification can be the direct cause of morbidity. Calcifications can be either localized or diffuse. Many diseases, in particular infectious diseases, can cause localized calcifications. Diffuse calcifications are less common and usually secondary to a handful of conditions such as dystrophic pulmonary calcifications, metastatic pulmonary calcifications, disseminated pulmonary ossifications and pulmonary alveolar microlithiasis. We describe three cases of diffuse pulmonary calcifications, review the different causes of diffuse pulmonary calcifications and provide some indicators on how to differentiate between them. Differentiating between the different types of pulmonary calcifications has significant implications on the management and prognosis of the patients, and thus it is important to distinguish between them.

Availability, timeliness, documentation and quality of consultations among hospital departments: a prospective, comparative study.

BACKGROUND: Many in-patients require care from practitioners in various disciplines. Consultations most probably have significant implications for hospitalization outcomes. PURPOSE: To determine key aspects of consultations provided by various departments to formulate an optimal policy. METHODS: This study comprised two methods: first, a questionnaire was completed in 2019 by 127 physicians interns, residents and senior doctors) from the medical and surgical departments (64 from the surgical wards, 43 from the medical wards and 22 from the emergency room and General ICU) regarding the availability, timeliness and documentation rate of the consultations they received from different disciplines. The investigators rounded through the various departments that were included in the study and they accosted a sample of interns, residents and attending physicians, who were then asked to fill the questionnaire. Overall compliance of filling the questionnaire was 95%. Residents accounted for 72% of the filled questionnaires, seniors and interns accounted for 15 and 13% respectively. Second, a convenience sample of 300 electronic records of hospitalized patients (135 from the surgical wards, 129 from the Medical wards and 36 from the emergency room and General ICU) of actually carried out consultations was reviewed for validated indicators of quality for both the consultation request and response. We used a 5-point Likert scale, ranging from poor (1) to superb (5), to grade the measured parameters. RESULTS: The availability, timeliness and documentation rate for medical consultations were 4 ± 0.9, 4.1 ± 0.9 and 4.3 ± 0.9 respectively, as compared with surgical consultations 3.2 ± 1.1, 3.4 ± 1.2 and 3.6 ± 1.2 respectively (P < 0.001). The mean time (in hours) from the consultation request till documentation (of the requested consultation) by consultants in the medical and surgical departments was 3.9 ± 5.9 and 10.0 ± 15.6, respectively (P < 0.001). The quality of requests of consultations from the medical and surgical departments was 3.4 ± 1.1 and 2.8 ± 1.2, respectively (P < 0.001). Two different models of consultations are employed: while each medical department adopts several departments for medical consultations, each day's on-call surgeon provides all the hospital's surgical consultations. CONCLUSION: We detected significant differences in key aspects of consultations provided by the departments. The medical model of consultations, in which each medical department adopts several other wards to which it provides consulting services upon request, should probably be adopted as a major policy decision by hospitals directors to enhance inter-departmental consultations.

Medical Cannabis in Asthmatic Patients.

BACKGROUND: With the increased use of cannabis in the medicinal and recreational domains, it is becoming more important for physicians to better understand its harmful and beneficial effects. Although medical cannabis comes in several forms, the preferred route of administration is smoking or inhalation. After caring for three asthmatic patients who were treated with medical cannabis and who reported improvement in their symptoms, we decided to review the available data on the effects of medical cannabis on asthmatic patients. OBJECTIVES: To review the known effects of medical cannabis on asthmatic patients. METHODS: A thorough search was conducted of the MEDLINE and PubMed databases as well as the internet for publications about the effects of medical cannabis on asthmatic patients. RESULTS: Cannabis has a bronchodilator effect on the airways and might have an anti-inflammatory effect on asthmatic patients. However, harmful effects on the lungs are mainly attributed to smoking and include airway irritation and the development of chronic bronchitis symptoms. CONCLUSIONS: Cannabis has some benefit, yet there are many harmful effects on the lungs. Additional research is needed to determine the harmful effects of vaporizers as well as inhalers.