Idiopathic pulmonary fibrosis (IPF) is a type of interstitial lung disease (ILD) classified under idiopathic fibrotic disorders of the lung. It is the most common type of ILD presenting clinically in the seventh decade of life, almost always at the later stage of illness, attributed to its earlier nonspecific presentation. The term IPF is used when no specific cause for pulmonary fibrosis is identified. Initially described in 1944, recent advances in lung biopsy and pathology have described the disease in detail. This led to further classification of ILD. Also, there have been multiple recent studies indicative of an increased incidence. However, accurate epidemiological data for IPF is minimal, with some being contradictory. Inconsistency in the case definition criteria and methodology has resulted in epidemiological inaccuracy when used to detect patients in the study population. To avoid inaccuracy American Thoracic Society collaborated with the European, Japanese, and Latin American Thoracic Society to arrive at a consensus resulting in 2010 IPF evidence-based guidelines. Notable epidemiological differences are observed in the European, American, and Asian countries. Some countries have set up national registries to collect essential patient data for future studies and comparison with other countries. In this topic, we try to glean over the epidemiology of IPF.
Part of the book: Idiopathic Pulmonary Fibrosis
Of all the medications available to physicians worldwide, antibiotics play an essential role in inpatient and outpatient settings. Discovered in the early nineteenth century by Alexander Fleming, penicillin was the first antibiotic isolated from a mold. Dr. Gerhard Domagk developed synthetic sulfa drugs by altering the red dye used in chemical industries. Since then, multiple antibiotic classes have been discovered with varying antimicrobial effects enabling their use empirically or in specific clinical scenarios. Antibiotics with different mechanisms of action could be either bactericidal or bacteriostatic. However, no clinical significance has been observed between cidal and static antibiotics in multiple trials. Their presence has led to safer deep invasive surgeries, advanced chemotherapy in cancer, and organ transplantation. Indiscriminate usage of antibiotics has resulted in severe hospital-acquired infections, including nosocomial pneumonia, Clostridioides difficile infection, multidrug-resistant invasive bacterial infections, allergic reactions, and other significant side effects. Antibiotic stewardship is an essential process in the modern era to advocate judicial use of antibiotics for an appropriate duration. They play a vital role in medical and surgical intensive care units to address the various complications seen in these patients. Antibiotics are crucial in severe acute infections to improve overall mortality and morbidity.
Part of the book: Infections and Sepsis Development
The average potassium intake in the United States population ranges from 90 to 120 mEq/day. About 98% of the total body’s potassium is intracellular, and only 2% is present in the extracellular compartment. This distributional proportion is essential for cellular metabolic reactions and maintaining a gradient for resting membrane potential. A loss of this gradient results in hyper- or hypopolarization of the cell membrane, especially in cardiac muscles leading to life-threatening arrhythmias. Multiple mechanisms in human maintain homeostasis. Transient initial changes are due to transcellular shifts activating sodium-potassium ATPase pumps on the cell membrane. The kidneys essentially take part in excess potassium excretion, maintaining total body stores constant within normal range. Gastrointestinal secretion of potassium is insignificant in individuals with normal renal function, however plays an essential role in individuals with compromised renal function. So far, a classic feedback mechanism was thought to maintain potassium homeostasis; however, a recently recognized feedforward mechanism acting independently also helps preserve potassium homeostasis. Hence, potassium homeostasis is vital for humans to function at a normal level.
Part of the book: Potassium in Human Health
Pulmonary embolism is an acute emergency due to the occlusion of the pulmonary arteries by a venous blood clot. The pathophysiology of pulmonary embolism follows Virchow\'s triad, which encompasses stasis in veins, increased coagulation, and vessel wall trauma. Pregnancy, major trauma or surgery, prolonged immobilization, obesity, medication, and inherited risks are important risks. It is an essential rule-out diagnosis in chest pain and dyspnea patients in the emergency room. It is also responsible for significant mortality if not diagnosed and treated promptly. Physicians utilize multiple algorithmic scores and calculators to supplement diagnosis along with a high degree of clinical suspicion at initial presentation. Clinical diagnosis involves utilizing multiple modalities, including D-dimer, troponin, arterial blood gas analysis, electrocardiogram, bedside echocardiogram, and imaging modalities such as venous duplex, chest computed tomography, ventilation-perfusion scans, and pulmonary angiogram. Some imaging modalities carry the risk of radiation and being invasive. The treatment can itself be short-term or lifelong based on the causative factor. Anticoagulants used in the therapy can itself cause devastating complications if not monitored appropriately. Despite adequate treatment, some of these patients progress to chronic disease resulting in secondary pulmonary hypertension.
Part of the book: New Knowledge about Pulmonary Thromoboembolism
Pneumonia acquired during hospitalization is called nosocomial pneumonia (NP). Nosocomial pneumonia is divided into two types. Hospital-acquired pneumonia (HAP) refers to hospital-acquired pneumonia, whereas ventilator-associated pneumonia (VAP) refers to ventilator-associated pneumonia. Most clinical literature stresses VAP’s importance and associated mortality and morbidity, whereas HAP is not given enough attention even while being the most common cause of NP. HAP, like VAP, carries a high mortality and morbidity. HAP is the commonest cause of mortality from hospital-acquired infections. HAP is a common determinant for intensive care unit (ICU) admits with respiratory failure. Recent research has identified definite risk factors responsible for HAP. If these are prevented or modified, the HAP incidence can be significantly decreased with improved clinical outcomes and lesser utilization of the health care resources. The prevention approach will need multiple strategies to address the issues. Precise epidemiological data on HAP is deficient due to limitations of the commonly used diagnostic measures. The diagnostic modalities available in HAP are less invasive than VAP. Recent infectious disease society guidelines have stressed the importance of HAP by removing healthcare-associated pneumonia as a diagnosis. Specific differences exist between HAP and VAP, which are gleaned over in this chapter.
Part of the book: Pneumonia