Nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, obesity, and other features of metabolic syndrome and is known to be the most common cause for abnormal liver enzymes. The recent surge in the number of patients with NAFLD has been accompanied by an increase in research on potential treatment options, particularly weight loss and dietary interventions. Given the growing interest on the role of carbohydrates in the prevention and treatment of NAFLD, this review discusses the relationship between the amount of carbohydrates in the diet and effects on NAFLD, with special emphasis on a low-carbohydrate diet. We discuss the role of insulin resistance in the pathophysiology of NAFLD and provide an overview of various popular diets and their role as a treatment option for NAFLD. Additional large, longer-duration trials studying the efficacy of a low-carbohydrate diet in the treatment and prevention of NAFLD are eagerly awaited.

Asthma and obstructive sleep apnea (OSA) are among the most prevalent chronic human diseases of the 21st century. They share several risk and aggravating factors such as obesity, smoking, gastroesophageal reflux, sinonasal disease or upper airway involvement, systemic inflammation, etc. Although the association between OSA and chronic obstructive pulmonary disease or "overlap syndrome" is better known and characterized, the association of asthma and OSA or "alternative overlap syndrome" is less clearly defined and understood. Nevertheless, their coexistence has synergistic effects on patient symptoms, response to therapy, and general outcomes. Taxonomically, asthma and OSA are syndromically defined entities that are quite heterogeneous, being characterized by a plethora of clinical phenotypes. The complex interactions between these conditions should take into account more specific etiopathogenic mechanisms or distinct disease endotypes. The potential clinical, pathogenic, and therapeutic significance of the disease endotypes is still emerging and needs further evaluation. We present here a review on the bidirectional relationships between asthma and OSA, including their clinical, pathophysiologic, and therapeutic connections. Furthermore, we propose here to look at these interactions beyond the development of comprehensive inventories of genotypes, clinical and pathophysiologic phenotypes, but in the larger context of obstructive lung and airway disorders, with the goal to reassess meaningful syndromes based on natural history and predictable patient outcomes, which will help us better stratify therapy in an era of personalized medicine.

Purpose: The aim of this survey was to gather data about the incidence of various sleep disorders, particularly sleep apnea, in subjects with IPF who participated in a regional patient-oriented seminar on this condition. We hypothesized that the frequency of Obstructive Sleep Apnea (OSA) and psychiatric sleep disorders would be disproportionately high in the IPF population. Methods:The project was a one-time survey administered to stable patients with IPF and their family members from the South eastern USA who participated in the "Living with IPF" public seminar at the Emory University campus. The survey used a validated questionnaire, i.e., Sleep Disorders Questionnaire (SDQ), to detect presence of Sleep Apnea (SA) and selected sleep disorders -Restless Legs Syndrome (RLS), Psychiatric Sleep Disorders (PSY) and narcolepsy (NAR). The questionnaire was administered to all participants (with and without IPF), in a confidential manner. The findings were used to determine if there were differences in the incidence of SA and other sleep disorders between individuals with IPF and those without the disease.Results: A total of 52 people agreed to participate in the study. One subject was excluded due to unclear IPF status. The median SDQ raw scores in IPF patients for SA, RLS, PSY and NAR were 28.7, 27.1, 26.2 and 26.5, respectively; overall, they were not statistically different in IPF patients versus control subjects. However, as validated in other studies, patients with history of OSA had significantly higher SDQ-SA scores. Conclusions:The present study aimed to investigate cross-sectionally the incidence of self-reported sleep conditions in patients with IPF versus healthy family member controls. Overall, we did not find a disproportionately higher incidence of sleep disorders in the IPF population. This may be explained by inherent methodological limitations and the small sample size.

Poorly differentiated non-small cell lung carcinoma with a component of sarcoma-like (spindle and/or giant cells) or sarcoma (malignant bone, cartilage, or skeletal muscle) cells are called pleomorphic carcinoma. These carcinoma represent one of the 5 subtypes of rare pulmonary malignancies collectively classified as sarcomatoid carcinoma by the World Health Organization histologic classification of lung tumors. The pathogenesis of sarcomatoid carcinoma remains unclear, and treatment of this malignant tumor is less defined. Very few cases of sarcomatoid carcinoma involving the upper respiratory tract have been reported in the literature. We report here an atypical presentation and location of this tumor (in the trachea), causing obstruction with a positional ball-valve effect, in a patient with tracheobronchomegaly (Mounier-Kuhn syndrome). In addition, we discuss the recurrent nature of the disease and the potential therapeutic difficulties.

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