Chest
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The COVID-19 pandemic has presented new challenges surrounding end-of-life planning and has been associated with increased online discussion about life support. ⋯ The observed increase in tweets regarding LSIs and ACP suggests that Twitter was consistently used to discuss treatment modalities and preferences related to intensive care during the pandemic. Future interventions to increase online engagement with ACP may consider leveraging influencers and personal stories. Finally, we identified do-not-resuscitate-related discrimination as a commonly held public fear, which should be further explored as a barrier to ACP completion and can be proactively addressed by clinicians during bedside goals-of-care discussions.
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Case Reports
A 44-Year-Old Man With Right Limb Convulsion and Cavitary Lung Lesion With Diffuse Interstitial Abnormalities.
A 44-year-old man with a history of asthma presented with intermittent convulsion of the right limb, fever in the late afternoon, and decreased exercise tolerance over 2 months. Occasional productive cough, no hemoptysis, and weight loss of nearly 6 kg were observed during this period. Neither chemotherapy nor oral immunosuppressive drugs had been administered, and no exposure to toxic substances was known. ⋯ Bronchoscopy with BAL and transbronchial biopsy were nondiagnostic. While preparing for another diagnostic procedure, the patient gradually developed increasing dyspnea and more frequent convulsions with the progression of lesions on the follow-up chest CT scan. The patient was transferred to our hospital.
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A 34-year-old man presented to our institution with lightheadedness and dyspnea on exertion. His medical history included chronic pancreatitis, juvenile rheumatoid arthritis (JRA), gastroesophageal reflux disease, hypertension, lumbar degenerative disc disease, seizure disorder, anterior uveitis, and multiple vertebral fractures. In addition, he was a cigarette smoker with a 10-pack-year smoking history.
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A 79-year-old woman was admitted to the hospital for progressive dyspnea and severe hypoxemia, requiring oxygen supplementation. The dyspnea started approximately 3 to 4 weeks before presentation and was slowly progressive throughout the following weeks. ⋯ In the months leading up to her current presentation there were no changes in medication and no use of antibiotics. She had no known exposure to toxic fumes or substances, she was a nonsmoker, and her family history was unremarkable for autoimmune disorders or interstitial lung disease (ILD).