Chest
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A 27-year-old man was hospitalized in the burn unit after sustaining an acute inhalational injury and facial burns after an accidental occupational exposure to an industrial disinfectant consisting of a mixture of hydrogen peroxide (15%-30%), acetic acid (5%-15%), and peracetic acid (5%-15%). He demonstrated cough, shortness of breath, and hoarseness of voice at presentation that had developed 6 h after exposure. In addition to the inhalational injury of the vocal cords and lower airways on bronchoscopy (Fig 1), the patient also was diagnosed with acute inhalational pneumonitis based on the findings of hypoxemic respiratory failure and bilateral perihilar airspace opacities on chest radiography (Fig 2). ⋯ However, symptoms of productive cough and shortness of breath on exertion persisted, and he was rehospitalized 27 days after exposure. He was a nonsmoker with no prior history of atopy, asthma, or lung disease. His medical history was remarkable for hypertension and severe obesity with a BMI of 34.7 kg/m2.
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Worldwide, health-care professionals are experiencing unprecedented stress related to the coronavirus disease 2019 pandemic. Responding to a new virus for which there is no effective treatment yet and no vaccine is beyond challenging. ⋯ We explore here, guided by evidence, the concept and features of moral distress and individual resilience. Mitigation strategies involve individual and institutional responsibilities; the importance of solidarity, peer support, psychological first aid, and gratitude are highlighted.
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Systematic endobronchial ultrasound (EBUS)-guided lung cancer staging starts with hilar N3 nodes, proceeding sequentially to mediastinal N3, N2, and N1 nodes, with sampling of all enlarged nodes (size, ≥ 5 mm) by EBUS. However, procedure time is limited by patient comfort when moderate sedation is used. It is unclear if EBUS staging should start with hilar N3 nodes or whether starting with mediastinal N3 nodes suffices. Knowing the probability of hilar N3 nodes with PET-CT scan negative findings harboring occult metastasis can inform this decision. ⋯ When using moderate sedation, because time is limited, it is reasonable to start with the mediastinal N3 nodes if the hilar and mediastinal N3 nodes show negative PET scan results. Patients with positive PET scan findings of the mediastinal N3 nodes probably should undergo hilar N3 node sampling.
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Randomized Controlled Trial Multicenter Study
Obstructive Sleep Apnea patients adhering to Continuous positive Airway Pressure: A randomized trial.
Excessive daytime sleepiness (EDS) in individuals with OSA syndrome persisting despite good adherence to CPAP is a disabling condition. Pitolisant is a selective histamine H3-receptor antagonist with wake-promoting effects. ⋯ Pitolisant used as adjunct to CPAP therapy for OSA with residual sleepiness despite good CPAP adherence significantly reduced subjective and objective sleepiness and improved participant-reported outcomes and physician-reported disease severity.
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Multicenter Study
Prolonged Circulation Time is Associated with Mortality Among Older Men with Sleep Disordered Breathing.
Conventional metrics to evaluate sleep-disordered breathing (SDB) have many limitations, including their inability to identify subclinical markers of cardiovascular (CV) dysfunction. ⋯ LFCt is associated with both CV and all-cause mortality in older men, independent of baseline CV burden and SDB metrics. LFCt may be a novel physiologic marker for subclinical CVD and adverse outcomes in patients with SDB.