Chest
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A 72-year-old woman, nonsmoker, presented with approximately 2 months of nonproductive cough. The cough was initially intermittent, occurred more regularly during bedtime, but gradually became more frequent throughout the day with no reported triggering factors. The remaining review of associated symptoms was negative; she did not complain of shortness of breath, fever, chest pain, muscle weakness, weight loss, night sweats, or fatigue. ⋯ Patient was free of disease on follow up from her endocrinologist, to optimize levothyroxine treatment. Her regular prescription included statins. Her professional occupation was not related to special exposure, and she reported no alcohol consumption, illicit drug use, or any recent travel.
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Survivors of critical care may demonstrate mental health disorders in the months after discharge. ⋯ The network of potential risk factors for mental illness among patients discharged from an ICU is complex and involves multiple factors (age, premorbid mental health, acute emotional stress, and physical impairment after ICU stay). The negative impact of the burden of mental illness on HRQoL among critical care survivors is of concern.
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Hormone replacement therapy (HRT) is prescribed to millions of women worldwide. Previous studies have suggested that HRT has both protective and harmful effects in asthma. ⋯ HRT seems to play a role in the development of asthma in mature women. Clinicians prescribing HRT and women receiving HRT should be aware that new airway symptoms can develop, and discontinuation of HRT should be considered.
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Although estimates of suboptimal adherence to oral corticosteroids in asthma range from 30% to 50%, no ideal method for measurement exists; the impact of poor adherence in severe asthma is likely to be particularly high. ⋯ Low adherence is a common problem in severe asthma, whether measured directly or self-reported. We report poor agreement between the two methods, suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.
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A 34-year-old man presented to a community hospital with fever and fatigue for 3 days and was found to be febrile and tachycardic with a cavitary pulmonary lesion and paratracheal adenopathy on CT imaging. One month before, he had presented to his primary care provider with a palmar rash; he had been diagnosed and treated for syphilis and was also diagnosed with HIV. He had a CD4 count of 106 cells/μL and an HIV viral load of 1,290,000 copies/mL. Pneumocystis prophylaxis with trimethoprim-sulfamethoxazole and antiretroviral treatment with only tenofovir and emtricitabine therapy were started 2 weeks before presentation.