To compare the efficacy and safety of four home-based pulmonary rehabilitation models-traditional home-based pulmonary rehabilitation, telerehabilitation, hybrid pulmonary rehabilitation, and self-management pulmonary rehabilitation-in patients with COPD. We sought to generate comparative evidence against usual care and center-based pulmonary rehabilitation to guide model selection in clinical practice. We systematically searched PubMed, Embase, CINAHL, Scopus, and the Cochrane Library from inception to May 1, 2025 for randomized controlled trials involving adults with COPD. A frequentist random-effects network meta-analysis was conducted using Stata 15.0 to synthesize direct and indirect evidence across prespecified outcomes: the six-minute walk test (6MWT), St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnea scale, Chronic Respiratory Disease Questionnaire (CRQ) domains, Hospital Anxiety and Depression Scale (HADS), and adverse events (AEs). Global and local consistency were assessed and rankings were summarized using the surface under the cumulative ranking curve (SUCRA). The risk of bias was evaluated with RoB 2.0 tool, and the protocol was registered on PROSPERO (CRD420251038495). A total of 39 RCTs involving 3610 patients were included. For exercise capacity, telerehabilitation, traditional home-based pulmonary rehabilitation, and hybrid pulmonary rehabilitation significantly improved 6MWT compared with usual care, and no statistically significant differences were observed between any home-based model and center-based pulmonary rehabilitation for the 6MWT. For health-related quality of life, telerehabilitation, traditional home-based pulmonary rehabilitation, and hybrid pulmonary rehabilitation significantly reduced SGRQ total scores versus usual care. For health status, telerehabilitation significantly improved CAT scores compared with usual care [MD = -2.49, 95% CI (-4.76, -0.22)]. For dyspnea-related outcomes, self-management pulmonary rehabilitation, hybrid pulmonary rehabilitation and traditional home-based pulmonary rehabilitation improved the mMRC dyspnea scale versus usual care. Telerehabilitation also improved HADS-Anxiety scores versus usual care [MD = -1.40, 95% CI (-2.79, -0.01)] and depression scores versus both self-management pulmonary rehabilitation [MD = -1.31, 95% CI (-2.53, -0.09)] and usual care[MD = -1.34, 95% CI (-2.51, -0.18)]. Ranking probabilities suggested that traditional home-based pulmonary rehabilitation had the lowest likelihood of adverse events among home-based models. Home-based pulmonary rehabilitation models yield clinically meaningful improvements in COPD and may provide exercise-capacity benefits comparable to center-based pulmonary rehabilitation. As effects and rankings vary across outcomes, no single model is optimal for all patients. Model selection should consider patient needs, digital access, and available resources.

The acetazolamide challenge test is frequently performed to evaluate cerebral blood flow and reserve capacity in cerebrovascular disease. Most of its side effects are mild and transient. Acute pulmonary edema (PE) has never been reported to occur after acetazolamide challenge tests. Here, we present a case of acute noncardiogenic PE triggered by an acetazolamide challenge test. A 62-year-old man with carotid artery stenosis underwent an acetazolamide challenge test during an arterial spin labeling (ASL) magnetic resonance (MR) imaging study. The patient showed stable vital signs and no neurologic abnormalities. The patient had no pulmonary or cardiac problems that could induce acute PE. Routine laboratory findings, electrocardiography, and chest X-ray also produced normal findings. An acetazolamide challenge ASL MR study was performed with intravenous administration of 1 g of acetazolamide. Two hours after acetazolamide administration, sudden dyspnea and hypoxemia developed, and chest X-ray and computed tomography revealed diffuse PE. Immediately, the oxygen supply and furosemide treatment were initiated. The following day, the dyspnea and PE improved and the patient recovered completely. To the best of our knowledge, this is the first case report of acute noncardiogenic PE triggered by intravenous acetazolamide administration in an acetazolamide challenge test.

Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between an artery and a vein without an intervening capillary component. Most PAVMs are congenital, caused by hereditary hemorrhagic telangiectasia, but around 20% are acquired. The most common presenting symptom is dyspnoea on exertion, but patients can be completely asymptomatic. Furthermore, Gestational trophoblastic neoplasia (GTN) is a group of rare tumors that arise from abnormal growth of trophoblastic tissue which includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor can progress, invade, metastasize, and lead to death if left untreated. In the majority of GTNs, the disease is limited to the uterus where the abnormal trophoblast proliferation and localized hCG production may lead to focal vascular changes, including the formation of AVMs. Most patients with GTN present with abnormal vaginal bleeding but they can also present with bleeding from metastatic sites. Symptoms of pulmonary metastasis from GTN often include cough, hemoptysis, and chest pain. However, PAVMs are not typically listed as a direct consequence of this metastatic spread. Here, we report a rare case of metastatic GTN initially presented with pulmonary vascular malformation.

We present the case of a 22-year-old female with a history of systemic lupus erythematosus and antiphospholipid syndrome, complicated by recurrent deep vein thrombosis of the lower extremities and pulmonary embolism, who subsequently developed chronic thromboembolic pulmonary hypertension. The patient presented with progressive dyspnea, ultimately limiting daily activities, and was managed with long-term anticoagulation and pulmonary vasodilator therapy. Diagnostic workup, including imaging and hemodynamic assessment, revealed multiple bilateral segmental perfusion defects, right heart dilation, and significantly elevated pulmonary pressures with increased pulmonary vascular resistance, consistent with operable chronic thromboembolic disease. The patient underwent pulmonary endarterectomy via median sternotomy under cardiopulmonary bypass with deep hypothermia and intermittent total circulatory arrest. Two periods of circulatory arrest, of 19 and 18 minutes, were utilized during the procedure. Organized thromboembolic material was successfully removed from both pulmonary arteries, achieving adequate endarterectomy planes without major intraoperative complications. In the immediate postoperative period, the patient remained hemodynamically stable, with expected improvement in right ventricular afterload and pulmonary hemodynamics. This case highlights the importance of recognizing chronic thromboembolic pulmonary hypertension in young patients with autoimmune disease and recurrent thrombotic events, as well as the role of pulmonary endarterectomy as a potentially curative treatment when performed in specialized centers.

Giant goiters can lead to tracheal compression with acute respiratory failure. We present a case with a giant goiter as well as acute respiratory failure, which required urgent surgery. We report the case of a 36-year-old female patient who presented to the emergency room with a giant goiter, which had been present for 12 years and had become compressive for one month, as well as laryngeal dyspnea. For this compressive goiter, she benefited from an emergency thyroidectomy. After histological analysis of the specimen, it was found to be cancerous. Giant goiters can cause compression of the critical structures of the neck. In cases of compressive goiter, dyspnea is the most common sign of compression and can constitute a life-threatening emergency requiring emergency thyroidectomy. Multi-nodular goiter and thyroid cancers are the two main etiologies found in the literature to be responsible for acute dyspnea due to tracheal compression. Emergency thyroidectomy is the appropriate treatment for asphyxial goiter.

Libman-Sacks endocarditis (LSE), characterized by sterile valvular vegetations, is a recognized complication of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). However, its occurrence as the initial manifestation of previously undiagnosed autoimmune disease is uncommon and may create significant diagnostic uncertainty. A 27-year-old female presented to the emergency department with acute-onset exertional dyspnea, cough, and severe anemia, with a history of three consecutive first-trimester miscarriages. Initial evaluation revealed severe mitral regurgitation with valvular masses, raising suspicion for infective endocarditis. Further workup demonstrated elevated inflammatory markers, autoimmune hemolytic anemia, nephrotic-range proteinuria, and positive autoimmune serology, including antinuclear antibodies, anti-double-stranded DNA, anticardiolipin IgG, anti-β2-glycoprotein I IgG, and lupus anticoagulant. Transthoracic echocardiography showed severe mitral regurgitation with valvular masses and reduced left ventricular ejection fraction, while transesophageal echocardiography confirmed Libman-Sacks vegetations. Computed tomography of the chest revealed diffuse alveolar hemorrhage. The patient was diagnosed with new-onset SLE and APS, presenting with LSE and multisystem involvement. Management included pulse methylprednisolone therapy, hydroxychloroquine, cyclophosphamide, therapeutic anticoagulation, and plasma exchange for alveolar hemorrhage, resulting in clinical improvement with resolution of hemoptysis and improvement in cardiac function. This case is particularly notable because severe valvular disease led to the initial recognition of previously undiagnosed SLE and APS in the setting of simultaneous pulmonary, hematologic, renal, and obstetric manifestations. It highlights the importance of considering autoimmune etiologies in young patients with unexplained valvular heart disease, particularly in the presence of suggestive systemic features.

Emergencies cause disruption to the normal flow of the working day in a busy veterinary practice, requiring diversion of resources from routine cases to assist with the medical priority. Assessments and decisions have to be made rapidly, which can be challenging if the particular medical condition is not dealt with on a regular basis.

Emergencies cause disruption to the normal flow of the working day in a busy veterinary practice, requiring diversion of resources from routine cases to assist with the medical priority. Assessments and decisions have to be made rapidly, which can be challenging if the particular condition is not dealt with on a regular basis.