BACKGROUND This study investigates the impact of type 2 diabetes mellitus(T2DM)on the risk of interstitial lung disease(ILD)and its subtypes in patients with rheumatoid arthritis(RA).RA is often complicated by ILD.T2D...BACKGROUND This study investigates the impact of type 2 diabetes mellitus(T2DM)on the risk of interstitial lung disease(ILD)and its subtypes in patients with rheumatoid arthritis(RA).RA is often complicated by ILD.T2DM has systemic proinflam-matory effects,but its impact on RA-related ILD is unclear.This research aims to elucidate the interplay between these conditions to inform clinical management and patient care strategies.AIM To determine if RA patients with T2DM have a higher occurrence of ILD compar-ed to RA patients without T2DM.METHODS We conducted a retrospective cohort study using the 2019-2020 National Inpa-tient Sample.Adult RA patients with and without T2DM were identified via International Classification of Diseases,10th Revision(ICD-10)codes.Propensity score matching(1:1)balanced 15+confounders.Logistic regression assessed the association of T2DM with ILD(overall and by subtype)and secondary outcomes(acute respiratory distress syndrome,pneumothorax,pleural effusion,pulmonary hypertension).Missing data were excluded.ILD subtypes were included based on ICD-10 codes and case count.RESULTS Among 199380 RA inpatients,ILD was more common in those with T2DM(2.25%)vs without(1.11%).After matching(n=121046),ILD remained higher in RA+T2DM[odds ratio(OR)=2.02,95%CI:1.84-2.22,P<0.001],with an absolute risk increase of about 1.14%.T2DM was associated with higher odds of ILD subtypes including usual interstitial pneumonia(OR=3.20)and non-specific interstitial pneumonia(OR=3.50).Other subtypes showed elevated ORs;eosinophilic pneumonia showed an inverse association(OR=0.23).PAH and pneumo-thorax were also more common in RA+T2DM(OR=1.40 and 1.85,respectively).Acute respiratory distress syn-drome and pleural effusion rates did not differ by T2DM status.Rare subtype findings should be interpreted cautiously.CONCLUSION T2DM increases ILD risk in RA and is linked to higher rates of pulmonary hypertension and pneumothorax,suggesting a role in exacerbating RA-related lung complications.展开更多
Airway management is a skill necessary for healthcare providers who manage patients. Intubation is a skill that both anesthesiologists and intensivists use daily. We present a case of a neonate that developed signific...Airway management is a skill necessary for healthcare providers who manage patients. Intubation is a skill that both anesthesiologists and intensivists use daily. We present a case of a neonate that developed significant worsening stridor after a successful intubation for a hernia repair. After 4 intubation attempts, with easy visualization of the vocal cords and unsuccessful placement of the endotracheal tube, the patient was emergently brought to the operating room for evaluation.展开更多
The use of SponTaneous Respiration using IntraVEnous anesthesia and High-flow nasal oxygen (STRIVE-Hi) in laryngeal surgery has become more widely reported. This method eliminates the endotracheal tube as a fuel for a...The use of SponTaneous Respiration using IntraVEnous anesthesia and High-flow nasal oxygen (STRIVE-Hi) in laryngeal surgery has become more widely reported. This method eliminates the endotracheal tube as a fuel for a potential fire. However, little has been published on its use in the pediatric population. Our case report describes its use in a 2-year-old undergoing micro-direct laryngoscopy with CO<sub>2</sub> assisted supraglottoplasty and rigid bronchoscopy for airway obstruction from congenital laryngomalacia. The STRIVE-Hi technique was modified for the pediatric patient by using a lower flow through the nasal cannula (4 L). No major changes in SpO<sub>2</sub> were detected during the 30-minute procedure. With back up airway safety equipment in place, STRIVE is proving to be a safe technique with major advantages when used in this unique scenario.展开更多
文摘BACKGROUND This study investigates the impact of type 2 diabetes mellitus(T2DM)on the risk of interstitial lung disease(ILD)and its subtypes in patients with rheumatoid arthritis(RA).RA is often complicated by ILD.T2DM has systemic proinflam-matory effects,but its impact on RA-related ILD is unclear.This research aims to elucidate the interplay between these conditions to inform clinical management and patient care strategies.AIM To determine if RA patients with T2DM have a higher occurrence of ILD compar-ed to RA patients without T2DM.METHODS We conducted a retrospective cohort study using the 2019-2020 National Inpa-tient Sample.Adult RA patients with and without T2DM were identified via International Classification of Diseases,10th Revision(ICD-10)codes.Propensity score matching(1:1)balanced 15+confounders.Logistic regression assessed the association of T2DM with ILD(overall and by subtype)and secondary outcomes(acute respiratory distress syndrome,pneumothorax,pleural effusion,pulmonary hypertension).Missing data were excluded.ILD subtypes were included based on ICD-10 codes and case count.RESULTS Among 199380 RA inpatients,ILD was more common in those with T2DM(2.25%)vs without(1.11%).After matching(n=121046),ILD remained higher in RA+T2DM[odds ratio(OR)=2.02,95%CI:1.84-2.22,P<0.001],with an absolute risk increase of about 1.14%.T2DM was associated with higher odds of ILD subtypes including usual interstitial pneumonia(OR=3.20)and non-specific interstitial pneumonia(OR=3.50).Other subtypes showed elevated ORs;eosinophilic pneumonia showed an inverse association(OR=0.23).PAH and pneumo-thorax were also more common in RA+T2DM(OR=1.40 and 1.85,respectively).Acute respiratory distress syn-drome and pleural effusion rates did not differ by T2DM status.Rare subtype findings should be interpreted cautiously.CONCLUSION T2DM increases ILD risk in RA and is linked to higher rates of pulmonary hypertension and pneumothorax,suggesting a role in exacerbating RA-related lung complications.
文摘Airway management is a skill necessary for healthcare providers who manage patients. Intubation is a skill that both anesthesiologists and intensivists use daily. We present a case of a neonate that developed significant worsening stridor after a successful intubation for a hernia repair. After 4 intubation attempts, with easy visualization of the vocal cords and unsuccessful placement of the endotracheal tube, the patient was emergently brought to the operating room for evaluation.
文摘The use of SponTaneous Respiration using IntraVEnous anesthesia and High-flow nasal oxygen (STRIVE-Hi) in laryngeal surgery has become more widely reported. This method eliminates the endotracheal tube as a fuel for a potential fire. However, little has been published on its use in the pediatric population. Our case report describes its use in a 2-year-old undergoing micro-direct laryngoscopy with CO<sub>2</sub> assisted supraglottoplasty and rigid bronchoscopy for airway obstruction from congenital laryngomalacia. The STRIVE-Hi technique was modified for the pediatric patient by using a lower flow through the nasal cannula (4 L). No major changes in SpO<sub>2</sub> were detected during the 30-minute procedure. With back up airway safety equipment in place, STRIVE is proving to be a safe technique with major advantages when used in this unique scenario.
