We present the case of a female in her 20s with a history of obesity and obstructive sleep apnea (OSA) on continuous positive airway pressure (CPAP) therapy, who developed silent microaspiration pneumonitis and organising pneumonia (OP) following the recent initiation of Semaglutide for weight loss. She initially presented with shortness of breath, a non‐productive cough and subjective fevers of 1‐week duration. On admission, she was hypoxic, requiring 6 L of oxygen via nasal cannula and chest imaging revealed right lung infiltrates concerning for community‐acquired pneumonia. Despite completing antibiotics, her symptoms and imaging progressively worsened. An extensive infectious and autoimmune workup was conducted, but no clear aetiology was identified. Diagnostic bronchoscopy revealed severe gastroesophageal reflux disease (GERD) with evidence of microaspiration, leading to the diagnosis of organising pneumonia (OP) secondary to silent aspiration. Although long‐acting glucagon‐like peptide‐1 (GLP‐1) agonists like Semaglutide do not typically cause reflux, they are known to delay gastric emptying, which can increase intragastric pressure. In this patient, the combination of delayed gastric emptying from Semaglutide, obesity and CPAP therapy likely contributed to reflux and silent aspiration. The patient was successfully treated with corticosteroids and proton pump inhibitors, resulting in clinical and radiographic improvement. This case highlights the potential for silent aspiration in patients on GLP‐1 receptor agonists, especially those on CPAP therapy, and underscores the importance of monitoring for reflux‐related complications in these patients.

Background: Pulmonary Arterial Hypertension (PAH) is a significant comorbidity that can complicate the care of patients in the Intensive Care Unit (ICU). PAH's hemodynamic burden and systemic effects add complexity to managing fluid balance, ventilatory support, and other critical care interventions. This study aims to investigate the impact of fluid balance in ICU patients with PAH. Methods: We conducted a retrospective cohort study using the MIMIC-IV v3.1 database. Patients with diagnosed PAH (ICD-9: 4160; ICD-10: I270) and complete ICU records were included. Exclusions were applied for missing data, duplicate ICU stays, and secondary causes of pulmonary hypertension. An initial cohort of 178 patients was identified. Further data validation led to a final cohort comprising 102 patients. Analyses were conducted in Google BigQuery and Python-based tools (Google Colab). Results: Among 102 patients, 77 (75.4%) had a positive fluid balance, and 25 (24.5%) had a negative balance. Positive fluid balance was associated with higher ICU mortality (14.49% vs . 5.88%), shorter ICU stays (2.29 vs . 3.06 days), and a 74% increase in ICU mortality odds (OR: 1.74, 95% CI: 1.10–2.85). The lowest ICU mortality was seen in patients with net fluid balance between -2000 mL and +2000 mL. Severely positive balance (>+5000 mL) was associated with the highest ICU mortality (19%) and longest ICU LOS (6.16 days). Discussion: This study highlights the critical importance of fluid balance in PAH patients, a population uniquely susceptible to right ventricular failure. The findings suggest that even modest positive fluid balance may worsen outcomes, supporting prior physiologic models linking volume overload to RV dysfunction. While limited by retrospective design and lack of hemodynamic data, the results underscore the potential benefit of individualized fluid strategies and the selective use of advanced monitoring. Further prospective research is needed to define safe fluid thresholds and guide therapy in this high-risk group. Conclusion: Our findings suggest that both excessive positive and severe negative fluid balance may be detrimental in ICU patients with PAH. A moderate fluid balance range (-2000 mL to +2000 mL) showed the most favorable outcomes.

The integration of AI into healthcare has marked a transformative era, with machine learning (ML) playing a pivotal role in reshaping the landscape of interstitial lung disease (ILD) management. ML models excel in analysing complex datasets, such as medical imaging and electronic health records, offering unprecedented advancements in the diagnosis, prognosis, and treatment of ILDs. These models have demonstrated superior accuracy compared to traditional methods, particularly in diagnosing idiopathic pulmonary fibrosis, where delays in diagnosis significantly impact patient outcomes. Early and precise diagnosis through ML-driven tools allows for the timely initiation of therapy, which is crucial for improving prognosis and extending patients’ quality of life. Despite the challenges in data quality and model interpretability, the future of ML in pulmonary healthcare is promising, with continued advancements poised to enhance patient management and outcomes. This article aims to examine the transformative potential of ML in the management of ILD.

Introduction: Tight glycemic control is essential for optimal outcomes after coronary artery bypass graft (CABG) surgery, regardless of pre-operative diabetes status. The ideal timing for transitioning from intravenous (IV) to subcutaneous (SC) insulin remains unclear. This study addresses this knowledge gap by comparing the effects of early transition (postoperative day 1, POD1) versus delayed transition on glycemic control and patient outcomes after CABG surgery. Methods: We analyzed data from a single tertiary medical center focusing on patients receiving insulin during their CABG hospitalization between 1 and 31 October 2022. We divided patients into two groups based on their transition timing: (1) Delayed Transition Group, patients transitioned from IV insulin infusion to SC insulin after POD1; and (2) Early Transition Group, patients transitioned on POD1. The primary outcome was the incidence of euglycemia on POD1. Secondary outcomes included rates of maintaining euglycemia from POD1 until POD10 or hospital discharge, hospital length of stay (LOS), ICU LOS, mean glucose levels, rates of hyperglycemia (blood glucose > 180 mg/dL) and hypoglycemia (blood glucose < 70 mg/dL), and rate of restarting IV insulin. Statistical analysis adjusted for BMI and diabetes diagnosis. Results: A total of 394 patients were enrolled, with 68 patients (17.3%) in the delayed-transition group and 326 patients (82.7%) in the early-transition group. Majority of the patients were males (74%), with an average age of 67 ± 9 years. Mean HbA1C and creatinine levels were comparable between the two groups. Patients in the early-transition group experienced a shorter ICU and hospital length of stay compared to the delayed-transition group, without a higher risk of restarting IV insulin. Conclusions: Early transition from IV insulin drip to SC insulin on POD1 of CABG surgery reduces ICU and hospital LOS without increasing the risk of transitioning back to IV insulin.

Background: Peripheral artery disease (PAD) is a progressive atherosclerotic condition associated with significant morbidity and mortality. While PAD prevalence is comparable between sexes, women tend to have worse clinical outcomes, higher rates of disability, and are underdiagnosed and undertreated compared to men. This study examines sex differences in PAD presentation, diagnosis, and treatment outcomes using the Medical Information Mart for Intensive Care (MIMIC)-IV v3.1 database. Methods: A retrospective cohort study was conducted using electronic health records from the MIMIC-IV v3.1 database, identifying patients diagnosed with PAD between 2008 and 2022. Patient selection was based on International Classification of Diseases (ICD)-9 and ICD-10 codes. The following two datasets were constructed: an admission-level dataset (6468 admissions, 3913 unique patients) and a patient-level dataset aggregating multiple admissions per individual. Key variables included demographics, hospitalization details, procedure rates, and clinical outcomes. Sex-based comparisons were performed to assess disparities in disease burden, intervention rates, and mortality. Results: The study cohort comprised 3913 PAD patients. Women were significantly older than men at time of admission (mean 70.78 vs. 68.97 years, p < 0.05) and had lower rates of procedural intervention across all categories, including angioplasty (12.85% vs. 15.39%) and bypass grafting (14.74% vs. 16.98%). Despite similar Intensive Care Unit (ICU) admission rates (30.56% in females vs. 31.73% in males), women experienced greater delays in PAD diagnosis and treatment initiation. The in-hospital mortality rate was comparable between sexes (6.62% vs. 6.92%). Women presented more frequently with atypical or asymptomatic PAD, leading to delays in diagnosis and specialist referrals. Conclusions: This study highlights significant sex disparities in PAD diagnosis and management. Women with PAD are older at diagnosis, receive fewer procedural interventions, and experience delayed clinical recognition, contributing to a higher cumulative disease burden. These findings underscore the need for sex-specific diagnostic criteria, improved clinical awareness, and equitable treatment strategies to optimize PAD outcomes in women.