Chest
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Bacterial pulmonary infection is a common life-threatening complication in immunocompromised patients. The results of BAL cultures are not immediately available, and their microbiological yield might be limited by empiric antibiotic prescriptions. We evaluated clinical signs and symptoms, leukocyte counts, C-reactive protein (CRP) levels, procalcitonin levels, and BAL fluid neutrophil percentages as potential markers for bacterial infection in a cohort of immunocompromised patients with pulmonary complications. ⋯ Neutrophil percentage in BAL fluid, procalcitonin level, and CRP level might be potentially useful to differentiate bacterial infection from nonbacterial conditions in immunocompromised hosts with pulmonary complications.
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COPD is a significant cause of morbidity and mortality. Guidelines recommend the confirmation of a COPD diagnosis with spirometry. Limited evidence exists, however, documenting the frequency of spirometry use in clinical practice. ⋯ Our study suggests that approximately 32% of a broad range of patients with a new COPD diagnosis had undergone spirometry within the previous 2 years to 6 months following diagnosis. In addition, spirometric testing appeared to decrease with increasing age. As opposed to a prior report, women were not less likely to have undergone spirometry. This study shows that spirometry is infrequently used in clinical practice for diagnosis of COPD and suggests opportunities for practice improvement.
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To produce an improved, COPD-specific version of the St. George respiratory questionnaire (SGRQ-C). ⋯ The SGRQ-C contains the best of the original items, no longer specifies a recall period, and produces scores equivalent to the original.
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Cardiac resynchronization therapy (CRT) has been shown to improve cardiac function and reduce Cheyne-Stokes respiration but has not been evaluated in patients with obstructive sleep apnea (OSA). In this pilot study, we investigated the impact of both CRT and CRT plus increased rate pacing in heart failure (ie, congestive heart failure [CHF]) patients with OSA. We hypothesized that through increased cardiac output CRT/pacing would reduce obstructive events and daytime symptoms of sleepiness. ⋯ CRT improved cardiac function and reduced the AHI. Reduced circulatory delay likely stabilized ventilatory control systems and may represent a new therapeutic target in OSA.
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Pneumonia viruses such as influenza may potentially spread by airborne transmission. We studied the dispersion of exhaled air through a simple oxygen mask applied to a human patient simulator (HPS) during the delivery of different oxygen flow in a room free of air currents. ⋯ Substantial exposure to exhaled air occurs generally within 0.4 m from patients receiving supplemental oxygen via a simple mask. Health-care workers should take precautions when managing patients with community-acquired pneumonia of unknown etiology that is complicated by respiratory failure.