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CHEST 2011: Embargoed studies highlight new lung health research

Bath Salts Emerging as New Recreational Drugs
(#1120069, Wednesday, October 26, 1:15 PM Eastern)

The use of bath salts as recreational drugs has greatly escalated in recent years. Researchers from the University of Oklahoma Health Sciences Center in Oklahoma City, Oklahoma describe an incident of a man experiencing significant agitation, paranoia, and hallucinations who also exhibited violent behavior upon his emergency department arrival. His case is not unique. Despite disclaimers of "not for human consumption" package warnings, according to the American Association of Poison Control Centers, calls for bath salt poisoning incidents have skyrocketed, with 1,782 since January 2011 compared with 302 in all of 2010. The inexpensive powdery substances with benign names contain stimulants not detectable through drug screens. However, they can produce a "high" along with increased blood pressure, increased heart rate, agitation, hallucinations, extreme paranoia, and delusions, not unlike the Oklahoma patient. Treatment for ingesting these bath salts is sedation until the side effects wear off, along with supportive care. Although currently federally unregulated, 26 states have made these substances illegal.

Caffeinated Alcoholic Beverages May Harm Patients With Chronic Medical Conditions
(#1114467, Sunday, October 23, 7:30 PM Eastern)

The use of caffeinated alcoholic beverages and other nonalcoholic energy drinks has been increasing since their introduction 20 years ago. Researchers from the University of Kansas Medical Center in Kansas City noted that the effects of caffeinated alcoholic beverages, such as 4 Loko, on patients with chronic medical conditions are not documented and may be more pronounced in these patients. Their patient experienced a high glucose load, and caffeine intake allowed for excessive alcohol consumption, which induced loss of consciousness, prolonged time without insulin, and diabetic coma. The alcohol content in some of these beverages can range from 11% to 12%, with 60 grams of sugar. Since being evaluated by the US Food and Drug Administration, 4 Loko maker Phusion Products has removed caffeine, taurine, and guarana from their drinks. Even so, the product has been banned in Michigan, New York, Oklahoma, Utah, and Washington. Still, no studies currently evaluate the side effects of these beverages on people with chronic illnesses, adolescents, or young adults.

Silicone Injections May Prove Deadly According to Several Research Studies
(#1119731, Sunday, October 23, 3:00 PM Eastern)
(#1119840, Sunday, October 23, 7:30 PM Eastern)
(#1119859, Monday, October 24, 1:15 PM Eastern)

Reports of adverse events, including death, from silicone injections for cosmetic purposes have been increasing in both medical and consumer literature. Researchers from Louisiana State University Health Sciences Center in New Orleans, Louisiana; Henry Ford Hospital in Detroit, Michigan; and Olive View-UCLA Medical Center in Sylmar, California all reported cases of near-lethal and lethal silicone use. Legitimate use of liquid silicone injections during plastic surgery is rare; however, illegal use in quasi-sterile conditions is rampant. Despite silicone being considered chemically inert and used in implantable medical devices, injectable liquid silicone has demonstrated potentially deadly results. In one of these three studies, the patient died, while two patients were hospitalized and experienced respiratory and nerve damage caused by receiving injections of liquid silicone. Furthermore, death from silicone embolism syndrome has been reported to be as high as 33%. Soft tissue injection for cosmetic purposes is especially dangerous and frequently deadly, at the very least resulting in a number of complications throughout the body. Considering the potential outcomes of respiratory distress and potential death, people should be informed about the potential deadly consequences of their choices.

Cryotherapy Proves Invaluable Tool in Aspirating Foreign Bodies from Airways
(#1106385, Wednesday, October 26, 1:15 PM Eastern)

Foreign bodies (FB) often enter the body through oral cavities, and their retrieval can sometimes be difficult. However, novel technologies now provide unique ways by which to remove these objects. Researchers from Louisiana State University in Shreveport, Louisiana demonstrated a flexible cryoprobe in the case of woman who had a sharp metallic FB, specifically, a pushpin, in her lung. After conventional means failed, the researchers used a cryoprobe, positioning it so the tip contacted the FB, and then lifted it out of position and extracted it with forceps without damaging any tissues. In cryotherapy, a coolant is delivered under pressure to the tip of a probe that passes through the working channel of a flexible bronchoscope. When placed in contact with the FB, the cryoprobe can be iced and made to adhere to the FB. Additional advantages include vasoconstriction (narrowing the blood vessel cavity), analgesia (pain relief), and slowed blood flow. Cryotherapy also causes shrinkage in organic objects. The patient in this case benefitted from this advancement and survived.

Pulmonologists Experience Pain While Performing Bronchoscopy
(#1119403, Wednesday, October 26, 3:00 PM Eastern)

Although a significant amount of attention being paid to ergonomics and overuse injury in the gastroenterologic and surgical medical settings, little attention is focused on other medical specialty areas such as bronchoscopy. Over a 3-month period in 2011, researchers from Winthrop-University Hospital in Mineola, New York studied the responses of 132 pulmonologists to an online questionnaire. Of the 132 respondents, 50 (39.1%) experienced pain while operating a bronchoscope. Seventy-six percent of these pulmonologists indicated the pain occurred once or only a few times, while 22% experienced recurring pain, mainly in the shoulder, back, wrist, neck, and thumb. The pain appeared to be associated with overuse injury and height less than 5'7". Of those feeling pain, 80% sought no treatment and only 38% attempted to modify their workspace. Measures may be necessary to prevent musculoskeletal injuries for bronchoscopists.

Combination Therapy Shows Promise for PAH Treatment
(#1080799, Wednesday, October 26, 3:00 PM Eastern)

Current treatments for pulmonary arterial hypertension (PAH) often entail observing patient deterioration when using a single medication and seeing its effects before starting a second medication. Researchers from Calgary, AB, Canada conducted clinical trials on high-risk patients with a mean age of 60 years who had idiopathic and connective tissue disease-associated PAH. The researchers administered a first-line oral combination therapy of bosentan and sildenafil, which yielded improvements in 6-min walk test, symptoms, and blood flow and cardiac function parameters. This strategy appears to be relatively safe and well tolerated by the patients in this study. However, the magnitude and durability of clinical improvements along with the risks of early drug-induced liver damage remain unclear and warrant further study.

Catheter-Related Bloodstream Infections Significantly Decreased After Guideline Implementation
(#1108555, Tuesday, October 25, 3:00 PM Eastern)

Evidence-based guidelines have been shown to improve health-care outcomes. In 2006, a guideline called the Institute of Health Improvement Bundle was created to help hospitals reduce the rate of catheter-related bloodstream infection (CRBSI), the most frequently occurring nosocomial infection. Researchers from the Spinal Cord Injury Center (SCI) at the James A. Haley Veterans Hospital and the University of South Florida, both in Tampa, retrospectively reviewed the charts of 895 patients admitted to the SCI who required the placement of a central venous catheter (CVC) between 2007 and 2010. Catheter-related infections were recorded along with the number of CVC line days on each SCI unit and the CRBSI rates during this time. The CRBSI rate at the SCI was reduced from 4.38 infections per 1,000 line days in 2007 to 0.32 infections per 1,000 line days during 2010. This CRBSI rate demonstrated a statistically significant decrease and confirmed that the implementation of evidence-based practice guidelines in the care of CVCs may reduce CRBSI rates, especially when the components are bundled and executed simultaneously.

Hospitalizations for Stomach Bacterial Infection Growing at Epidemic Rates
(#1117461, Tuesday, October 25, 3:00 PM Eastern)

A recent study by researchers from the University of Massachusetts; Barnes-Jewish Hospital in St. Louis, Missouri; and Washington Hospital Center in Washington, DC, emphasizes the increasing frequency and severity of Clostridium difficile infection (CDI), a stomach infection caused by bacteria. In the United States, age-adjusted CDI hospital fatalities nearly doubled between 2000 and 2005. From 2000 to 2008, the total number of adults discharged with CDI increased from 134,361 to 340,352, equaling an approximate increase of 19.2% per year. Overall, the US incidence of CDI among adults rose from 4.47 in 2000 to 10.16 in 2008, per 1,000 adult hospitalizations. In proportion to all CDI hospitalizations, this diagnosis rose from 23.4% in 2000 to 32.6% in 2008, and associated death rates rose from 3.4% in 2000 to 4.1% in 2008. The growth of CDI hospitalizations continues to rise in this country, and their growth far outpaces the rate of general hospitalizations. Increased focus needs to be spent on prevention.

Beware of Toxins in Household Products
(#1089817, Tuesday, October 24, 3:00 PM Eastern)

Approximately 60 deaths per year occur due to ethylene glycol (EG) exposure, a water soluble solvent used in a variety of products including printing links, leather finishers, antifreeze, plumbing fluids, and cleaning solutions. In 1999, 6,281 cases of EG exposure were reported, with 23 deaths from toxic exposure. As little as 100 mL of EG can be poisonous to a human being. Researchers from East Tennessee State University in Johnson City, Tennessee experienced a 49-year-old man with bipolar and other disorders admitted to an inpatient psychiatry ward for confusion and hallucinations. Although his examination and vital signs were normal upon admittance, 18 h later, as his mental state worsened, the ICU team was consulted. Family members told the medical team he had been cleaning the floors of his home, and his clothes had become soaked with the cleaning solution, which contained EG as a portion of its major contents. Researchers note that, unrecognized and untreated, renal failure may develop between 24 and 48 hours after ingestion; however, subacute poisoning can result from skin exposure. This can include multiorgan injury, central nervous system injury, psychiatric symptoms, and personality changes. This demonstrates that a single massive exposure to the skin can be toxic.


Contact: Sue Roberts
American College of Chest Physicians

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