The aim of this study is to assess the various clinical features, risk factors, and electrocardiographic (EKG) findings associated with acute pulmonary embolism (PE). Knowledge gained from the study may enable health care providers in diagnosis of PE, thus allowing them to carry out appropriate diagnostic testing and treatment after recognition of this potentially lethal disease. PE is common but frequently under-diagnosed clinical problem, associated with potentially fatal outcomes. Clinical presentation is highly variable, non-specific and most patients have an underlying identifiable risk factor. The presentation of PE can easily be confused with other cardio-pulmonary or systemic disorders. Prompt diagnosis of this potentially deadly disease is of utmost importance. Knowledge of salient features associated with PE may enable health care providers in diagnosis of PE, thus allowing them to carry out appropriate diagnostic testing and treatment after its recognition. We performed a single-center, cross-sectional descriptive study including all inpatient and emergency department encounters ≥18 years of age diagnosed with PE at our institution, a 300-bed inner city community hospital, during the dates January 2007 to December 2010. All patients were diagnosed with multi-detector 64-slice spiral computed tomography angiography. Using a standardized form, we performed simultaneous retrospective chart review to collect the necessary data required for the study. PE was confirmed in 334 patients during the 4 years study period. Mean age of subjects was 65.8 years (±16.4, range 22-98). Females represented 54 % of study subjects. Dyspnea, chest pain, and cough were present in 72, 38, and 19 % of the patients, respectively. Dyspnea was the only presenting symptom in 29 %. Tachypnea, hypoxia, tachycardia, and signs of DVT were present in 39, 35, 33, and 29 %, respectively. Cancer was most common risk factor present in 27 %, followed by prior history of venous thromboembolism (DVT or PE), immobilization, and surgery in 19, 15, and 15, respectively. EKG interpretation revealed normal sinus rhythm in 53 %, sinus tachycardia in 31 %, S1Q3T3 pattern in 6 %, and atrial fibrillation (AF) in 6 %.We also noted that 8 % of elderly patients had new onset AF at the time of diagnosis of PE. Diagnosis of PE remains a challenging task due to its variable presentation. Many of the classical features associated with this potentially fatal disease are often missing. This data re-emphasizes a wide spectrum of clinical presentation and non-specificity of symptoms of PE. Clinical suspicion of PE is a critical step and of paramount importance for further objective investigations, which would assist in the diagnosis and appropriate timely management of PE.

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Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory process. It is increasingly recognized as a major public health problem, affecting more than 20 million adults in the US. It is also recognized as a leading cause of hospitalizations and is the fourth leading cause of death in the US. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) operates to promote evidence-based management of COPD, increase awareness and encourage research. In 2011, GOLD published a consensus report detailing evidence-based management strategies for COPD, which were last updated in 2015. In recent years, newer strategies and a growing number of new pharmacologic agents to treat symptoms of COPD have also been introduced and show promise in improving the management of COPD. We aim to provide an evidence-based review of the available and upcoming pharmacologic and non-pharmacologic treatment options for stable COPD, with continued emphasis on evidence-based management.

In the last 2 decades, chronic obstructive pulmonary disease (COPD) has been increasingly recognized as a major public health problem. Since the introduction of the Global Initiative for Chronic Obstructive Lung Disease in 1998, growing interest in the pathogenesis and management of patients with COPD has led to notable improvements in patient care and quality of life. Despite greater awareness of this common preventable disease and major therapeutic advances during this period, the global impact of COPD remains strikingly large. We provide an evidence-based clinical review on COPD, with a focus on internists as the target audience.

In the last decade, greater focus has been directed toward venous thromboembolism (VTE) prophylaxis in hospitalized, non-surgical patients. Both deep venous thrombosis and pulmonary embolism are potentially preventable causes of patient morbidity and mortality related to hospitalization. Despite the availability of high-quality, evidence-based guidelines for VTE prevention, there is compelling evidence that many hospitalized patients do not receive appropriate VTE prevention measures. Hospitalists play an important role in the implementation of appropriate VTE prophylaxis measures for this patient population; thus, knowledge of updated recommendations is vital to their practice, as well as patient safety. We provide a comprehensive evidence-based clinical review of VTE prophylaxis for nonsurgical hospitalized patients, including risk factors and risk assessment, indications for prophylaxis, recommended therapeutic options, and updates from recently released practice guidelines by the American College of Physicians and the American College of Chest Physicians, published in 2011 and 2012, respectively.