Acute gastrointestinal bleeding (GIB) is a frequently encountered medical emergency and it can be lifethreatening depending on the etiology and the clinical condition of the patient. The most common causes of GIB are peptic ulcer disease, aspirin-induced gastritis, variceal hemorrhage, esophagitis, neoplasms like gastric cancer. Acquired hemophilia causing acute gastrointestinal bleed is extremely rare and only a few cases are reported worldwide. Acquired hemophilia A (AHA) is a rare disorder caused by the production of autoantibodies that inactivates clotting factor VIII. We present a case of upper gastrointestinal bleed due to AHA which was undiagnosed for two years. A 74-year-old patient with a history of myasthenia gravis, presented with anemia, and GIB. She underwent multiple endoscopies without a clear bleeding source. Coagulation studies showed isolated activated partial thromboplastin time prolongation which was not corrected by mixing study. Factor VIII activity was low and Bethesda titer showed elevated inhibitor levels. Factor Eight Bypassing Agent, recombinant factor VIIa, and steroids were given to control bleeding. Her clinical condition worsened, and she passed away. Elderly patients presenting with an undiagnosed source of GIBs, inconclusive endoscopic studies should be evaluated for acquired coagulopathies, especially in those with a history of autoimmune diseases and malignancies. Prompt diagnosis and treatment are warranted as it carries a high mortality.
Purpose of review Over the last decade, vaping has emerged into an epidemic of alarming proportions among US teens. This review evaluates the factors leading to the rise of vaping, reasons for its striking popularity among US teens, health consequences of vaping, and measures to mitigate the vaping epidemic. Recent findings Contemporary research highlights the continued rise of vaping amongst US teens and explains the reasons for its popularity, such as the variety of devices, a wide range of available flavors, youth-targeted advertisements, and lack of awareness of adverse consequences from vaping. This publication highlights current research findings of health consequences of vaping, including a discussion of EVALI (e-cigarette or vaping product use-associated lung injury) and provides an update on strategies to curtail the vaping epidemic. Summary Vaping has risen to epidemic proportions amongst US teens. This poses a clear and present danger to teens’ health with adverse effects ranging from acute lung injury to long-term addiction. This article summarizes key research findings that explain the reasons for the epidemic, health consequences of vaping, and provides an overview of efforts to mitigate the vaping threat to US teens.
Purpose of review Asthma and chronic obstructive pulmonary disease are both commonly encountered respiratory conditions. The term asthma--COPD overlap (ACO) has been used to identify patients presenting with features of both conditions. Controversy exists regarding its definition, approach to diagnosis and management. In this publication, recent evidence has been reviewed that provides insight into diagnosis and management of this condition. Recent findings Previously, multiple criteria were used to define Asthma--COPD overlap. In this publication, the most recent guidelines to identify this condition have been reviewed. This publication provides a summary of the recent evidence with regard to the role of various diagnostic modalities including the use of biomarkers, such as exhaled nitric oxide, serum IgE and provides updated evidence on available treatment choices for this condition. Summary ACO is a commonly encountered clinical condition with patients experiencing frequent exacerbations and resulting in increased healthcare resource utilization. Recent interest in ACO has led to development of a framework towards diagnosis and management of this condition. Therapeutic choices for ACO range from bronchodilator therapy to immunomodulatory therapy, highlighting the heterogeneity of this condition. Additional research is required to improve understanding of pathogenesis and improve outcomes in ACO.
We were unable to demonstrate a relationship between depressive symptoms and directly measured physical activity level in patients with COPD.
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