News briefs from the June issue of CHEST

PULMONARY HYPERTENSION: A CASE OF MISTAKEN IDENTITY?

New research shows that patients who are diagnosed with pulmonary arterial hypertension (PAH) but fail to respond to targeted therapies may actually have a condition known as pulmonary veno-occlusive disease (PVOD), a subtype of PAH. Australian researchers reviewed 14 cases of clinically diagnosed PAH who had failed medical therapy and found that 12 patients (86 percent) had PVOD and 2 patients (14 percent) had PAH only. Although there were no significant differences in clinical presentations between patients with PVOD and PAH only, there were considerable differences in the vessel pathologic findings and pathophysiology between the two conditions. Researchers speculate that these differences may be the reason why some patients with PAH do not respond to standard PAH therapy. The researchers conclude that further research is needed to determine if PVOD should be considered an individual type of PAH or remain a PAH subtype. The study is published in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

OVERCOMING BARRIERS TO PAIN MANAGEMENT IN THE ICU

A new article underscores the many complexities and challenges associated with managing pain in the critically ill patient. Although the complex conditions presented by the critically ill patient provide significant obstacles, the authors discuss additional barriers to optimal pain management, including outdated clinical practices and faulty systems. The authors also present a number of structured approaches that have been shown to be successful in improving pain treatment in the critically ill patient, as well as future directions for pain management in the ICU. The article is published in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

URINALYSIS MAY REVEAL SEVERITY OF BREATHING DISORDER IN CHILDREN

New research suggests that the urine concentration of lipid mediators may determine the severity of sleep-disordered breathing (SDB) in children. Cysteinyl leukotrienes (CysLTs), lipid mediators associated with inflammatory conditions such as asthma, have been found in high concentrations in the tonsil tissue of children with SDB. Researchers from Greece speculated that high CysLTs concentrations found in urine also could indicate severity of SDB in children. The team measured morning urine concentrations in 19 children with moderate-to-severe SDB, 29 children with mild SDB, 26 children with primary snoring, and 18 control subjects. Results showed that children with moderate-to-severe SDB had higher CysLTs levels than the other groups. Results also showed that urine levels of CysLTs, tonsillar size, and BMI were significant predictors of obstructive apnea-hypopnea index. The report is published in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.


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