Chest
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Although previous studies suggested that rituximab increases the risk of Pneumocystis jirovecii pneumonia (PJP), it is uncertain whether its primary prophylaxis for PJP is justified. ⋯ TMP-SMX prophylaxis significantly reduces PJP incidence with a tolerable safety profile in patients receiving rituximab treatment.
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Initial waves of the COVID-19 pandemic have largely spared children. With the advent of vaccination in many older age groups and the spread of the highly contagious Delta variant, however, children now represent a growing percentage of COVID-19 cases. PICU capacity is far less than that of adult ICUs. ⋯ Critically ill children selected for care in adult settings should be at least 12 years of age and ideally have conditions common in children and adults alike (eg, community-acquired sepsis, trauma). Children with complex, pediatric-specific disorders are best served in PICUs and are not recommended for transfer. The goal of such transfers is to maintain critical capacity for those children in greatest need of the PICU's unique abilities, therefore preserving systems of care for all children.
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Multicenter Study Observational Study
Association of Body Mass Index and Change in Weight with Mortality in Patients with Fibrotic Interstitial Lung Disease.
Mortality risk assessment in interstitial lung disease (ILD) is challenging. Our objective was to determine the prognostic significance of BMI and change in weight in the most common fibrotic ILD subtypes. ⋯ Both BMI and weight loss are independently associated with 1-year mortality in fibrotic ILD. BMI and weight loss may be clinically useful prognostic indicators in fibrotic ILD.
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Nontuberculous mycobacterial (NTM) infections are difficult to diagnose and treat. Biomarkers to identify patients with active infection or at risk of disease progression would have clinical utility. Sputum is the most frequently used matrix for the diagnosis of NTM lung disease. ⋯ Sputum proteomics identified candidate biomarkers of NTM severity and treatment response. However, underlying lung disease and typical bacterial pathogens such as P aeruginosa are also key determinants of the sputum proteomic profile.
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A 31-year-old Asian male never-smoker living in the upper Midwest with a past medical history of congenital bilateral hearing loss sought treatment with a 1-week history of fever, fatigue, right-sided pleuritic chest pain, shortness of breath, productive cough with mild intermittent hemoptysis, night sweats, and unintentional 10-lb weight loss over 4 weeks. He was adopted from South Korea as an infant, and thus the family history was unknown. ⋯ He travelled to South Korea and New Hampshire approximately 9 months previously. He did not take any medication.