Evidence-Based Approach of Biologic Therapy in Bronchial Asthma.

The emergence of biologic agents in the treatment of bronchial asthma has a wide impact on improving quality of life, reducing morbidity, and overall health care utilization. These therapies usually work by targeting specific inflammatory pathways involving type 2 inflammation and are particularly effective in severe eosinophilic asthma. Various randomized controlled trials have shown their effectiveness by reducing exacerbation rates and decreasing required glucocorticoid dosages. One of the relatively newer agents, tezepelumab, targets thymic stromal lymphoprotein and has proven its efficacy in patients independent of asthma phenotype and serum biomarker levels. This article reviews the pathophysiologic mechanism behind biologic therapy and offers an evidence-based discussion related to the indication, benefits, and adverse effects of such therapies.

Temporal Trends for Patients Hospitalized With Atrial Fibrillation in the United States: An Analysis From the National Inpatient Sample (NIS) Database 2011-2018.

BACKGROUND: Atrial fibrillation (AF) has historically been a growing burden on the global public health system. Previously, literature on the trends associated with AF-related hospitalizations has been published. However, there seems to be a gap in up-to-date information, notably within the last decade. PURPOSE: This study aims to investigate the trends, outcomes, and factors associated with AF hospitalization and the continued impact of AF on the United States health system. METHODS: Patient data were collected from the years 2011 to 2018 from the National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-9 and ICD-10 codes. We selected patients hospitalized with a diagnosis of AF. Descriptive statistics, statistical analysis, and Mann-Whitney U testing were employed to compare continuous dichotomous variables. After respective adjustments, multivariate hierarchical logistic regression was used to establish mortality rates, length of stay (LOS), and hospital charges. RESULTS: The study included 509,305 patients hospitalized with a primary diagnosis of unspecified AF. The mean age of patients hospitalized with AF was 71 years. AF hospitalizations were slightly higher in women as compared to men (51.7% vs. 48.2%). The predominant race involved was Caucasians at 77.9% followed by African Americans and Hispanics at 7.4% and 5.4%, respectively. The three most frequent coexisting conditions noted were hypertension (69.9%), diabetes mellitus (24.3%), and chronic obstructive pulmonary disease (16.4%). Medicare/Medicaid was the primary payer associated with the majority of AF hospitalizations at 72.6%. Overall in-hospital mortality associated with AF hospitalizations was 0.96%. Comorbid conditions conferring the highest mortality risks included coagulopathies (644%) and cerebral vascular accidents (597%). Mean LOS was found to be 3.35 days. Hospitalization charges increased year-over-year and correlated with an increase in the national burden of cost for these patients of $3.6 billion. CONCLUSIONS: Our study investigates the national trends surrounding AF hospitalizations. Overall in-hospital mortality rates appear to be stable as compared to prior years and past literature. Comorbid conditions conferring significantly higher mortality rates included coagulopathies, cerebral vascular accidents, acute kidney injury, and end-stage renal disease. Additionally, suboptimal insurance status was also associated with increased mortality risk. The cost of hospitalization in AF patients has increased steadily, conferring a $3.6 billion burden on the US healthcare system.

Evidence-Based Mechanical Ventilatory Strategies in ARDS.

Acute respiratory distress syndrome (ARDS) remains one of the leading causes of morbidity and mortality in critically ill patients despite advancements in the field. Mechanical ventilatory strategies are a vital component of ARDS management to prevent secondary lung injury and improve patient outcomes. Multiple strategies including utilization of low tidal volumes, targeting low plateau pressures to minimize barotrauma, using low FiO2 (fraction of inspired oxygen) to prevent injury related to oxygen free radicals, optimization of positive end expiratory pressure (PEEP) to maintain or improve lung recruitment, and utilization of prone ventilation have been shown to decrease morbidity and mortality. The role of other mechanical ventilatory strategies like non-invasive ventilation, recruitment maneuvers, esophageal pressure monitoring, determination of optimal PEEP, and appropriate patient selection for extracorporeal support is not clear. In this article, we review evidence-based mechanical ventilatory strategies and ventilatory adjuncts for ARDS.

A Rare Case of 15q11.2 Microdeletion Syndrome with Atypical Features: Diagnostic Dilemma.

Burnside Butler syndrome or 15q11.2 microdeletion syndrome is a relatively rare chromosomal abnormality that is recently being recognized. Current diagnostic techniques like chromosomal microarray analysis (CMA) have profoundly contributed to currently reported cases. The diagnostic dilemma is that prenatal screening and karyotype analysis typically yield unclear results. We would like to emphasize the importance of taking a detailed family history, knowing the classic clinical features, and using CMA to help diagnose this syndrome. We present an eight-year-old Caucasian female with a past medical history of intrauterine growth restriction, microcephaly, a high arched palate, speech delay, and a learning disability with recurrent bleeding from the eyes and oral cavity. The bleeding co-occurs whenever she develops the common cold.