Chest
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A 45-year-old man with a medical history that included asthma and chronic nasal congestion presented for an evaluation of possible OSA. He reported loud snoring, witnessed apneas in sleep, and daytime sleepiness. The patient's score on the Epworth Sleepiness Scale was 12 of 24, indicating excessive sleepiness. His nasal congestion had been treated with frequent use of an over-the-counter nasal decongestant.
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Review Meta Analysis
Stroke, Major Bleeding and Mortality Outcomes in Warfarin Users with Atrial Fibrillation and Chronic Kidney Disease: A Meta-analysis of Observational Studies.
The use of warfarin in patients with atrial fibrillation (AF) and chronic kidney disease (CKD) can be problematic because of increased bleeding risk. We performed a systematic review and meta-analysis of observational studies that evaluated the use of warfarin in patients with AF and CKD to evaluate the risks of ischemic stroke/thromboembolism, major bleeding, and mortality. ⋯ Based on this meta-analysis, the use of warfarin for AF may have an unfavorable risk/benefit ratio in patients with end-stage CKD but not in those with non-end-stage CKD.
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Letter Randomized Controlled Trial Comparative Study
A Prospective, Randomized, Double-Blind Trial Comparing the Diagnostic Yield of 21- and 22-Gauge Aspiration Needles for Performing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Sarcoidosis.
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A white woman in her 80s presented to the ED with nonproductive cough, fever, and 2 weeks of progressive generalized weakness. Previously ambulatory, she now was so weak she required assistance out of bed.