Chest
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Patients with autoimmune and/or inflammatory diseases (AIIDs) are prone to serious infectious complications such as Pneumocystis jirovecii pneumonia (PJP). In non-HIV patients, the prognosis is poorer, and diagnostic tests are of lower sensitivity. Given the low incidence of PJP in AIIDs, with the exception of granulomatosis with polyangiitis, and the non-negligible side effects of chemoprophylaxis, routine prescription of primary prophylaxis is still debated. ⋯ Effective alternative drugs such as atovaquone or aerosolized pentamidine could be used when trimethoprim-sulfamethoxazole is not tolerated or contraindicated. No standard guidelines are available to guide PJP prophylaxis in patients with AIIDs. This review covers the epidemiology, risk factors, and prevention of pneumocystis in the context of AIIDs.
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Multicenter Study
Association between nocturnal hypoxemia and cancer incidence in patients investigated for obstructive sleep apnea. Data from a large multicenter French cohort.
Previous studies have yielded inconsistent findings regarding the association between OSA and cancer in humans. ⋯ Nocturnal hypoxemia was associated with all-cancer incidence in patients investigated for OSA. Whether OSA therapy might reduce the risk of cancer needs further evaluation.
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Palliative care is associated with improved survival and quality of life among patients with lung cancer; however, its influence on health-care utilization and quality of care is unclear. ⋯ Palliative care (particularly in outpatient settings) is associated with reduced health-care utilization at the end of life and may improve the quality of care among patients with advanced lung cancer. These findings support the role of palliative care as an important component of comprehensive cancer care and highlight the potential benefits of outpatient palliative care services.
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Randomized Controlled Trial
Low prognostic value of novel nocturnal oxygen saturation metrics in patients with obstructive sleep apnea and high cardiovascular event risk: post-hoc analyses of the SAVE study.
Traditional methods for the quantification of OSA severity may not encapsulate potential relationships between hypoxemia in OSA and cardiovascular risk. ⋯ Apnea-hypopnea index and oxygen desaturation index were not associated with cardiovascular outcomes. In contrast, the pattern of oxygen desaturation was associated with heart failure and myocardial infarction. However, concomitant risk factors remained the predominant determinants for secondary cardiovascular events and thus deserve the most intensive management.
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Review
How I Do It: Ultrasound-guided Internal Jugular and Femoral Central Venous Catheter Insertion.
Central venous catheterization is routinely performed in the ICU to obtain venous access for hemodynamic monitoring, parenteral nutritional support, hemodialysis, and delivery of fluids and vasoactive medications. Although central venous catheters can be lifesaving, their insertion is not without risk. ⋯ The purpose of this article is to review the basic principles of real-time ultrasound-guided internal jugular and femoral catheter placement. An approach for incorporating these tools into clinical practice is presented, along with illustrative figures and video.