Chest
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Air pollution and OSA are independently associated with systemic inflammation, but it is unknown if these exposures interact to influence systemic inflammation. ⋯ Long-term residential PM2.5 exposure was associated with increased IL-6 and IL-10 concentrations in patients evaluated for suspected OSA. BC exposure was also associated with increased IL-6 but only in the subgroup of patients with moderate to severe OSA. These data suggest the potential for joint effects of moderate to severe OSA and air pollution on systemic inflammation.
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Case Reports
Severe Coronavirus Disease 2019 Infection in an Adolescent Patient After Hematopoietic Stem Cell Transplantation.
Infection with the severe acute respiratory syndrome coronavirus 2 causes severe acute lung injury in approximately 5% of infected adults, but few reports have been made of severe pediatric disease. We present an adolescent patient who contracted severe acute respiratory syndrome coronavirus 2 one week after a paternal haplo-identical hematopoietic stem cell transplant, with development of severe hyperferritinemic acute lung injury and macrophage activation-like syndrome. We present her case and a comparison of her laboratory data with those of a cohort of pediatric patients with coronavirus disease 2019 without severe disease.
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Observational Study
Integrating the STOP-BANG score and clinical data to predict cardiovascular events after infarction: A machine learning study.
OSA conveys worse clinical outcomes in patients with coronary artery disease. The STOP-BANG score is a simple tool that evaluates the risk of OSA and can be added to the large number of clinical variables and scores that are obtained during the management of patients with myocardial infarction (MI). Currently, machine learning (ML) is able to select and integrate numerous variables to optimize prediction tasks. ⋯ The integration of the STOP-BANG score into clinical evaluation (considering Killip class, GRACE score, and simple laboratory values) of subjects who were admitted for an acute MI because of ML can significantly optimize the identification of patients who will experience an in-hospital cardiovascular event.
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A 21-year-old man presented to the ED of The George Washington University Hospital complaining of chills, shortness of breath, hemoptysis, and a generalized rash. Three days before admission, he noticed a productive cough, severe sore throat, and subjective fever. He also experienced extreme fatigue, generalized sweating, and chest pain with coughing. ⋯ Occasionally, he smokes cannabis and e-cigarettes. He is sexually active with men, and his last unprotected sexual encounter was a month earlier. He denied photophobia, rhinorrhea, ear pain, nasal congestion, abdominal pain, nausea, vomiting, diarrhea, or dysuria.
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A 33-year-old man with ulcerative colitis (UC) and primary sclerosing cholangitis presented with worsening shortness of breath, nonproductive cough, and intermittent fevers after he was found to have a WBC count of 27,000 cells/μL on an outpatient laboratory evaluation. He reported feeling progressively unwell with intermittent right upper quadrant pain and shortness of breath since a hospital admission for a UC flare 6 months prior, during which he was first diagnosed with primary sclerosing cholangitis. He noted that prior to that admission 6 months ago, his UC had been in remission for > 10 years. ⋯ He had a cough but denied sputum production. He reported no recent travels and denied sick contacts. His medications included mesalamine, ursodiol, montelukast, and an albuterol inhaler.