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Background: Air pollution is increasingly recognized as a risk factor for acute exacerbation of chronic obstructive pulmonary disease (COPD). Changing climate and weather patterns can modify the levels and types of air pollutants. For example, dust outbreaks increase particulate air pollution. Objective: This paper examines the effect of Saharan dust storms on the concentration of coarse particulate matter in Miami, and its association with the risk of acute exacerbation of COPD (AECOPD). Methods: In this prospective cohort study, 296 COPD patients (with 313 events) were followed between 2013 and 2016. We used Light Detection and Ranging (LIDAR) and satellite-based Aerosol Optical Depth (AOD) to identify dust events and quantify particulate matter (PM) exposure, respectively. Exacerbation events were modeled with respect to location- and time-lagged dust and PM exposures, using multivariate logistic regressions. Measurements and main results: Dust duration and intensity increased yearly during the study period. During dust events, AOD increased by 51% and particulate matter &le, 2.5 &micro, m in aerodynamic diameter (PM2.5) increased by 25%. Adjusting for confounders, ambient temperature and local PM2.5 exposure, one-day lagged dust exposure was associated with 4.9 times higher odds of two or more (2+ hereto after) AECOPD events (odds ratio = 4.9, 95% CI = 1.8&ndash, 13.4, p &lt, 0.001). Ambient temperature exposure also showed a significant association with 2+ and 3+ AECOPD events. The risk of AECOPD lasted up to 15 days after dust exposure, declining from 10&times, higher on day 0 to 20% higher on day 15. Conclusions: Saharan dust outbreaks observed in Miami elevate the concentration of PM and increase the risk of AECOPD in COPD patients with recurring exacerbations.

Introduction: Cardiac involvement affects clinically around 5% of patients with sarcoidosis. There is limited information on the timing of cardiac sarcoidosis. Aim: To determine the timing of cardiac involvement in patients with sarcoidosis. Methods: In a cross-sectional study, we enrolled all cardiac sarcoidosis subjects registered in the University of Miami Sarcoidosis Program registry from Jan. 2016 to Jan. 2017. These patients had annual assessment of cardiac involvement with screening ECG, followed by imaging studies if required. Cardiac sarcoidosis was grouped as at least probable, or possible per World Association for Sarcoidosis and other Granulomatous Disorders guidelines. The Kaplan-Meir estimate curve was used to determine the cumulative probability of diagnosing cardiac involvement. Results: Among 85 subjects in our registry, 10(11.7%) subjects met the criteria for at least probable cardiac sarcoidosis. They had age mean (SD) 56.6 (8.1), and sarcoidosis diagnosis age of 49.6 (11.3) years. Cardiac sarcoidosis was diagnosed at a mean age of 50.6 (8.7) years. In 8(80%) subjects, cardiac sarcoidosis was the presenting feature2(20%) of subjects were diagnosed 5 or more years after sarcoidosis was diagnosed. (Figure 1). Conclusion: Our pilot study suggests that cardiac involvement in sarcoidosis usually occurs in the early phase of disease and the risk decreases over time. Therefore, we recommend that screening for cardiac sarcoidosis should be a part of the initial evaluation of every patient with sarcoidosis.

We report a case of a patient with septic shock who underwent central venous catheter placement in the left internal jugular vein, and a bedside ultrasound 'bubble study' revealed venous cannulation. A chest X-ray postprocedure revealed concern for arterial system catheterisation. However, the possibility of a persistent left superior vena cava was discussed and confirmed with a formal transthoracic echocardiogram and CT. This case demonstrates the importance of ultrasound-guided visualisation of anatomical structures in real time during central venous catheterisation. Other similar cases from the literature are briefly described.

This is the case of a 33-year-old man with Behçet’s disease who presented with recurrent haemoptysis and a rapidly expanding right pulmonary artery pseudoaneurysm. Due to the significant risk of major bleeding and death, he was promptly treated with an Amplatzer vascular plug.