Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine最新文献

{"title":"Histological Transformation to Small Cell Carcinoma of an Adenosquamous Carcinoma of the Lung With Epidermal Growth Factor Receptor Mutation in Exons 20 and 21 After Treatment With Erlotinib: Case Report","authors":"L. Fernández-Trujillo, Laura Tapia, Marcela Vallejo, M. Aguirre, J. Lores, L. Sua","doi":"10.1177/1179548419872993","DOIUrl":"https://doi.org/10.1177/1179548419872993","url":null,"abstract":"Lung carcinoma currently represents 1 of the leading causes of death from cancer worldwide and regionally. The molecular identification of sensitive mutations of targeted treatment have changed the strategies of pharmacologic management in non-small cell lung carcinoma. However, mechanisms of resistance have been described, among them the change of histological type to small cell carcinoma. We present the case of a 46-year-old male patient, non-smoker, with a clinical history of a mass in the upper lobe of the right lung and an initial histological diagnosis of adenosquamous carcinoma of the lung, with the presence of mutations for epidermal growth factor receptor (EGFR) in exons 20 (S768I) and 21 (L858R). He received treatment with tyrosine kinase inhibitor (Erlotinib) with good clinical and radiological response. However, 1 year after the start of the medication, he consulted for a progressive onset of constitutional symptoms and respiratory symptoms, with radiographic worsening and new biopsy with a diagnosis of adenosquamous carcinoma with the adenocarcinoma component transformed to small cell carcinoma, with persistence of EGFR mutation. We describe the clinical, radiological, and laboratory characteristics as well as the outcome of this case. To conclude, among the mechanisms of resistance described to the treatment with tyrosine kinase inhibitors in patients with carcinomas with mutated EGFR, the transformation to small cell carcinoma besides being infrequent is particular, requiring a different diagnostic and therapeutic approach.","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"1 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89891055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Streptococcus pneumoniae</i> as a Cause of Community-Acquired Pneumonia in Indian Adolescents and Adults: A Systematic Review and Meta-Analysis.","authors":"Canna J Ghia, Raja Dhar, Parvaiz A Koul, Gautam Rambhad, Mark A Fletcher","doi":"10.1177/1179548419862790","DOIUrl":"10.1177/1179548419862790","url":null,"abstract":"<p><strong>Background: </strong><i>Streptococcus pneumoniae</i> is one of the primary cause of community-acquired pneumonia (CAP) worldwide. However, scant data are available on the prevalence of etiological organisms for CAP in adolescent and adult Indian population.</p><p><strong>Objective: </strong>We performed a systematic review and meta-analysis to determine the contribution of <i>S. pneumoniae</i> in the causation of CAP in Indian patients aged 12 years or above.</p><p><strong>Methodology: </strong>We performed a systematic search of both indexed and non-indexed publications using PubMed, databases of National Institute of Science Communication and Information Resources (NISCAIR), Annotated Bibliography of Indian Medicine (ABIM), Google Scholar, and hand search including cross-references using key terms 'community acquired pneumonia AND India'. All studies, published between January 1990 and January 2017, that evaluated Indian patients aged above 12 years with a confirmed diagnosis of CAP were eligible for inclusion. Our search retrieved a total of 182 studies, of which only 17 and 12 qualified for inclusion in the systematic review of all etiological organisms, and meta-analysis of <i>S. pneumonia</i>, respectively.</p><p><strong>Results: </strong>A total of 1435 patients met the inclusion criteria. The pooled proportion of patients with <i>S. pneumoniae</i> infection was 19% (95% confidence interval [CI]: 12%-26%; I² = 94.5% where I² represents heterogeneity, <i>P</i> < .01). Other major etiological agents are <i>Mycoplasma pneumoniae</i> (15.5% [1.1%-35.5%]), <i>Klebsiella pneumoniae</i> (10.5% [1.6%-24.0%]), and <i>Legionella pneumophila</i> (7.3% [2.5%-23.8%]).</p><p><strong>Conclusions: </strong>Analysis found approximately a one-fifth proportion of adult Indian patients of CAP with <i>S. pneumoniae</i> infection, suggesting it as a leading organism for causing CAP compared with other etiological organisms.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"13 ","pages":"1179548419862790"},"PeriodicalIF":1.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Deleterious Rare Alleles for Acute-Onset Diffuse Interstitial Lung Disease in Collagen Diseases","authors":"H. Furukawa, S. Oka, K. Shimada, A. Hashimoto, A. Komiya, T. Matsui, S. Tohma","doi":"10.1177/1179548419866443","DOIUrl":"https://doi.org/10.1177/1179548419866443","url":null,"abstract":"Objective: Acute-onset diffuse interstitial lung disease (AoDILD) includes acute exacerbation of interstitial lung disease (ILD), drug-induced ILD, and Pneumocystis pneumonia in collagen diseases patients. As AoDILD causes a poor prognosis in collagen disease patients, the pathogenesis of AoDILD should be investigated. Exome sequencing studies revealed that rare variants were detected to be causative in some diseases. Recently reported upregulated genes in acute exacerbation of idiopathic pulmonary fibrosis could provide candidate genes for restricted exome analysis of AoDILD in collagen disease. Here, we investigated rare variants in the coding and boundary regions of these candidate genes in AoDILD. Methods: Deleterious rare variants in the coding and boundary regions of the candidate genes were analyzed by exome sequencing and the deleterious rare allele frequencies in AoDILD were compared with those of controls. Results: A significant association was detected for deleterious rare alleles in NPL (P = .0044, Pc = .0399, odds ratio [OR] = 10.05, 95% confidence interval [CI] = 3.01-33.55). A deleterious rare allele frequency in the 9 candidate genes (P = .0011, OR = 7.17, 95% CI = 2.80-18.33) was also increased in AoDILD in multigene panel analysis. The Krebs von den Lungen–6 (KL-6) levels in AoDILD patients with deleterious rare alleles were tended to be lower than those without (P = .0168, Pc = .1509). Conclusions: The deleterious rare alleles in NPL were associated with AoDILD. In addition, the deleterious rare allele frequency in the 9 candidate genes was also increased in AoDILD. The deleterious rare alleles might contribute to the pathogenesis of AoDILD.","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"191 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83458494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of a Newly Established Multidisciplinary Team on the Interventional Treatment of Patients With Emphysema.","authors":"Vasileios Kouritas,&nbsp;Richard Milton,&nbsp;Emmanouel Kefaloyannis,&nbsp;Kostas Papagiannopoulos,&nbsp;Allesandro Brunelli,&nbsp;Doytchin Dimov,&nbsp;Sishik Karthik,&nbsp;Andrew Hardy,&nbsp;Peter Tcherveniakov,&nbsp;Nilanjan Chaudhuri","doi":"10.1177/1179548419852063","DOIUrl":"https://doi.org/10.1177/1179548419852063","url":null,"abstract":"<p><strong>Background: </strong>The emphysema interventional treatment involves mainly lung volume reduction surgery (LVRS) and endobronchial valve (EBV) implantation. Few institutes discuss these cases at a dedicated emphysema multidisciplinary team (MDT) meeting.</p><p><strong>Objectives: </strong>To investigate the impact of a newly established dedicated emphysema MDT meeting on the interventional treatment of such patients.</p><p><strong>Methods: </strong>During a study period of 4 years, the outcome of 44 patients who underwent intervention according to the proposal of the emphysema MDT (group A) was compared with the outcome of 44 propensity score matched patients (group B) treated without the emphysema MDT proposal.</p><p><strong>Results: </strong>More LVRS and less EBV insertions were performed in group A (<i>P </i>=<i> </i>.009). In group B, the interventions were performed sooner than in group A (<i>P </i>=<i> </i>.003). Postoperative overall morbidity and length of in-hospital stay were similar in the 2 groups (<i>P </i>=<i> </i>.918 and .758, respectively). Improvement of breathing ability was reported in more patients from group A (<i>P </i>=<i> </i>.012). In group B, the total number of re-interventions was higher (<i>P </i>=<i> </i>.001) and the time to re-intervention had the tendency to be less (<i>P </i>=<i> </i>.069). Survival was similar between the 2 groups (<i>P </i>=<i> </i>.884). Intervention without discussion at the MDT and EBV as initial intervention was an independent predictor of re-intervention.</p><p><strong>Conclusions: </strong>Interventional treatment for patients with chronic obstructive pulmonary disease (COPD) after discussion at a dedicated MDT involved more LVRS performed, required fewer interventions for their disease, and had longer re-intervention-free intervals and better breathing improvement.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"13 ","pages":"1179548419852063"},"PeriodicalIF":2.0,"publicationDate":"2019-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548419852063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37385320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Exploration Into Knowledge, Attitudes, and Beliefs Towards Risky Health Behaviours in a Paediatric Cystic Fibrosis Population.","authors":"Rebecca Keyte,&nbsp;Helen Egan,&nbsp;Michail Mantzios","doi":"10.1177/1179548419849427","DOIUrl":"10.1177/1179548419849427","url":null,"abstract":"<p><p>Risky behaviours are prevalent within the cystic fibrosis (CF) population; however, there is a lack of research which has investigated risky behaviour engagement among adolescents with CF, with reasons for initiation currently being unknown, as no qualitative studies have been conducted. This research therefore examines knowledge, attitudes, and beliefs towards risky behaviours at an age commonly associated with initiation. Ten paediatric participants were recruited. Thematic analysis illustrated several psychological factors associated with risky behaviours. A desire for normalcy was evident, with this been associated with a desire to engage in normalised risky behaviours. Evidence of a life-orientated illness perspective was also prevalent, with participants believing that many individuals engage in risky behaviours for fun. Overall, there was a reported lack of knowledge on consequences of risky behaviours, with many participants not being informed of these by health care professionals (HCPs). This research provides insight into an area of CF paediatric care which could be improved on, with the provision of awareness regarding risky behaviours not being embedded within paediatric CF care. Consequently, this research demonstrates the need for interventions to be integrated into paediatric CF care for the prevention and reduction of risky behaviours.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"13 ","pages":"1179548419849427"},"PeriodicalIF":2.0,"publicationDate":"2019-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548419849427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37338553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory Fungal Diseases in Adult Patients With Cystic Fibrosis.","authors":"Emanuele Delfino,&nbsp;Filippo Del Puente,&nbsp;Federica Briano,&nbsp;Chiara Sepulcri,&nbsp;Daniele Roberto Giacobbe","doi":"10.1177/1179548419849939","DOIUrl":"https://doi.org/10.1177/1179548419849939","url":null,"abstract":"<p><p>Clinical manifestations of respiratory fungal diseases in adult cystic fibrosis (CF) patients are very heterogeneous, ranging from asymptomatic colonization to chronic infections, allergic disorders, or invasive diseases in immunosuppressed CF patients after lung transplantation. In this narrative review, mainly addressed to clinicians without expertise in CF who may nonetheless encounter adult CF patients presenting with acute and chronic respiratory syndromes, we briefly summarize the most representative clinical aspects of respiratory fungal diseases in adult CF patients.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"13 ","pages":"1179548419849939"},"PeriodicalIF":2.0,"publicationDate":"2019-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548419849939","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37339184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aztreonam Lysine Inhalation Solution in Cystic Fibrosis.","authors":"Elizabeth Claire Elson,&nbsp;Joel Mermis,&nbsp;Deepika Polineni,&nbsp;Christopher M Oermann","doi":"10.1177/1179548419842822","DOIUrl":"https://doi.org/10.1177/1179548419842822","url":null,"abstract":"<p><p>Patients with cystic fibrosis (CF) develop pulmonary disease secondary to airway infection and dysregulated inflammation. Therapeutic innovations such as nebulized antimicrobial therapy targeting specific pathogens have resulted in improvements in quality of life and life expectancy. Aztreonam lysine for inhalation (AZLI) solution was initially approved to improve respiratory symptoms in CF patients with <i>Pseudomonas aeruginosa</i> (PA) in 2010 by the Food and Drug Administration. Since then, research broadening labeling and clinical application has been developed. In this review, we analyze published and ongoing research regarding AZLI therapy in CF. A search of the Cochrane Database of Systematic Reviews and the PubMed and ClinicalTrials.gov databases was conducted to identify publications about AZLI. Three pre-approval studies were identified and assessed. Two are Phase 3, placebo-controlled trials, assessing a variety of safety and efficacy endpoints, leading to FDA approval. The third is an open-label extension of the two previous trials. An additional seven post-approval, completed trials were identified and are included in this review. They represent a variety of study designs including safety and efficacy in patients with mild lung disease and young patients, an active comparator trial vs inhaled tobramycin, an eradication study, a study among patients with <i>Burkholderia cepacia</i>, and a study assessing continuous alternating antibiotic therapy. Finally, five ongoing clinical trials are discussed. Overall, studies demonstrated that inhaled aztreonam is a safe and effective antimicrobial treatment for the eradication of newly acquired <i>P. aeruginosa</i> and long-term suppressive therapy of chronic endobronchial infection among people with cystic fibrosis.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"13 ","pages":"1179548419842822"},"PeriodicalIF":2.0,"publicationDate":"2019-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548419842822","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37180429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic Fibrosis Transmembrane Conductance Regulator Genotype, Not Circulating Catecholamines, Influences Cardiovascular Function in Patients with Cystic Fibrosis.","authors":"Alexander L Bisch,&nbsp;Courtney M Wheatley,&nbsp;Sarah E Baker,&nbsp;Elizabeth R Peitzman,&nbsp;Erik H Van Iterson,&nbsp;Theresa A Laguna,&nbsp;Wayne J Morgan,&nbsp;Eric M Snyder","doi":"10.1177/1179548419835788","DOIUrl":"https://doi.org/10.1177/1179548419835788","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cystic fibrosis (CF) is a genetic disease affecting multiple organ systems of the body and is characterized by mutation in the gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR). Previous work has shown that a single dose of aβ-agonist increases cardiac output (Q) and stroke volume (SV) and decreases systemic vascular resistance (SVR) in healthy subjects. This effect is attenuated in patients with CF; however, the mechanism is unknown. Potential explanations for this decreased cardiovascular response to a β-agonist in CF include inherent cardiovascular deficits secondary to the CFTR mutation, receptor desensitization from prolonged β-agonist use as part of clinical care, or inhibited drug delivery to the bloodstream due to mucus buildup in the lungs. This study sought to determine the effects of endogenous epinephrine (EPI) and norepinephrine (NE) on cardiovascular function in CF and to evaluate the relationship between cardiovascular function and CFTR F508del mutation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 19 patients with CF and 31 healthy control subjects completed an assessment of Q (C&lt;sub&gt;2&lt;/sub&gt;H&lt;sub&gt;2&lt;/sub&gt; rebreathing), SV (calculated from Q and heart rate [HR]), Q and SV indexed to body surface area (BSA, QI, and SVI, respectively), SVR (through assessment of Q and mean arterial blood pressure [MAP]), and HR (from 12-lead electrocardiogram [ECG]) at rest along with plasma measures of EPI and NE. We compared subjects by variables of cardiovascular function relative to EPI and NE, and also based on genetic variants of the F508del mutation (homozygous deletion for F508del, heterozygous deletion for F508del, or no deletion of F508del).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Cystic fibrosis patients demonstrated significantly lower BSA (CF = 1.71 ± 0.05 m&lt;sup&gt;2&lt;/sup&gt; vs healthy = 1.84 ± 0.04 m&lt;sup&gt;2&lt;/sup&gt;, &lt;i&gt;P&lt;/i&gt; = .03) and SVI (CF = 30.6 ± 2.5 mL/beat/m&lt;sup&gt;2&lt;/sup&gt; vs healthy = 39.9 ± 2.5 mL/beat/m&lt;sup&gt;2&lt;/sup&gt;, &lt;i&gt;P&lt;/i&gt; = .02) when compared with healthy subjects. Cystic fibrosis patients also demonstrated lower Q (CF = 4.58 ± 0.36 L/min vs healthy = 5.71 ± 0.32 L/min, &lt;i&gt;P&lt;/i&gt; = .03) and SV (CF = 54 ± 5.5 mL/beat vs healthy = 73.3 ± 4.5 mL/beat, &lt;i&gt;P&lt;/i&gt; = .01), and a higher HR (CF = 93.2 ± 3.9 bpm vs healthy = 80.5 ± 2.7 bpm, &lt;i&gt;P&lt;/i&gt; &lt; .01) and SVR (CF = 2082 ± 156 dynes*s/cm&lt;sup&gt;-5&lt;/sup&gt; vs healthy = 1616 ± 74 dynes*s/cm&lt;sup&gt;-5&lt;/sup&gt;, &lt;i&gt;P&lt;/i&gt; = .01) compared with healthy subjects. Furthermore, CF patients demonstrated a lower SV (&lt;i&gt;P&lt;/i&gt; &lt; .01) corrected for NE when compared with healthy subjects. No significant differences were seen in HR or Q relative to NE, or SVR relative to EPI. Differences were seen in SV (F&lt;sub&gt;(2,14)&lt;/sub&gt; = 7.982, &lt;i&gt;P&lt;/i&gt; &lt; .01) and SV index (F&lt;sub&gt;(2,14)&lt;/sub&gt; = 2.913, &lt;i&gt;P&lt;/i&gt; = .08) when patients with CF were stratified according to F508del mutation (number of deletions).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Individuals with CF have lower cardiac an","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"13 ","pages":"1179548419835788"},"PeriodicalIF":2.0,"publicationDate":"2019-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548419835788","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37291239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of Medication Utilization and Clinical Outcomes in Patients With Idiopathic Pulmonary Fibrosis Treated With Nintedanib or Pirfenidone.","authors":"Anastasia Y Ipatova,&nbsp;Pamela H Koerner,&nbsp;Richard T Miller,&nbsp;Francis Staskon,&nbsp;Melanie Radi","doi":"10.1177/1179548419834922","DOIUrl":"https://doi.org/10.1177/1179548419834922","url":null,"abstract":"<p><p>Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease which results in thickening and scarring of the interstitial tissue. As the only 2 Food and Drug Administration (FDA)-approved medications on the market, it is valuable to compare the impact of nintedanib and pirfenidone on clinical outcomes. Records of patients who started nintedanib or pirfenidone between calendar years 2015 and 2016 at a national specialty pharmacy were retrospectively reviewed. Data collection was derived from patient management applications and statistical data analysis was completed in SAS (SAS Institute Inc^®). The nintedanib population contained 2605 patients and of the population completing clinical assessment surveys (n = 1343), 46% of respondents (n = 612) reported no adverse events, with the remaining 54% reporting at least 1 adverse event. Average proportion of days covered (PDC) was 84.2% (SD = 17.0). Average final monthly copay for this group was $235. The pirfenidone population had 1322 patients, and of the surveyed population (n = 764), 58% of respondents (n = 445) reported no adverse events, with the remaining 42% reporting at least 1 adverse event. Average PDC was 83.4% (SD = 17.3). Average final monthly copay for this group was $339. Outcomes in the studied IPF population were similar for nintedanib and pirfenidone.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"13 ","pages":"1179548419834922"},"PeriodicalIF":2.0,"publicationDate":"2019-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548419834922","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37071812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Mass of Posterior Mediastinum: A Case of Retrotracheal Parathyroid Adenoma Presenting With Primary Hyperparathyroidism.","authors":"Sani Rabiou,&nbsp;Boubacar Efared,&nbsp;Sani Aminou,&nbsp;Hicham Harmouchi,&nbsp;Kassim Sidibé,&nbsp;Marouane Lakranbi,&nbsp;Yassine Ouadnouni,&nbsp;Mohamed Smahi","doi":"10.1177/1179548418811840","DOIUrl":"https://doi.org/10.1177/1179548418811840","url":null,"abstract":"<p><p>Although parathyroid ectopy in the mediastinum has been the subject of several publications, its location in the posterior mediastinum is very rarely reported. We report a case of a 69-year-old patient who presented with clinical symptoms of malignant hypercalcemia due to a retrotracheal mediastinal parathyroid adenoma. The surgical excision leads to a quick normalisation of the phosphocalcic balance with improvement of the clinical symptoms. Ectopic hypersecreting parathyroid adenoma with life-threatening hypercalcemia should prompt radiological assessment and appropriate surgical management to prevent further clinical complications.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":"12 ","pages":"1179548418811840"},"PeriodicalIF":2.0,"publicationDate":"2018-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548418811840","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36719677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}