Chest
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A 68-year-old woman presented to a subspecialty complex-airways-disease clinic with chronic cough. She had a 10-pack-year history of smoking, quit over 35 years ago, and had mild atopy (dust mite) and mild rhinitis. She did not have any relevant occupational exposure or comorbidities. ⋯ It had been present for years, though it changed in nature over time. She also reported one to two episodes of streaky hemoptysis. She had not noticed significant benefit with nasal or inhaled corticosteroids, but short bursts of prednisone had temporarily modestly improved her cough.
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During the COVID-19 pandemic, the University of Virginia adult cystic fibrosis (CF) center transitioned from in-person clinical encounters to a model that included interdisciplinary telemedicine. The pandemic presented an unprecedented opportunity to assess the impact of the interdisciplinary telemedicine model on clinical CF outcomes. ⋯ This CF care model, which includes IDC-TM, successfully monitored lung function and BMI, identified exacerbations, and followed guidelines-based care during the pandemic. A significant decrease in antibiotic use suggests that social mitigation strategies were protective.
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A 16-year-old girl presented to the ED with complaints of loose stools, abdominal pain, and rash over her legs for the last 7 days. There was no history of fever, vomiting, oral ulcers, or mucosal bleeds. ⋯ There was a history of significant but undocumented weight loss. On day 3 of hospital admission, she developed numbness over her right foot.
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A 16-year-old boy presented with 6 days of left iliac fossa pain. He had a medical history of right subtalar dislocation and appendicitis requiring laparotomy 3 years earlier, complicated by wound dehiscence. His family history was significant for his brother's sudden death 3 weeks prior after a 12-month illness with intermittent epigastric pain, weight loss, and hemoptysis. Travel history was significant for travel to the Philippines 3 years prior, in which he spent time in the hospital for appendicitis.
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Congenital tracheoesophageal fistula is usually diagnosed at an early age, but may remain undetected into adulthood if atresia is absent and if the fistula is small. A tracheoesophageal fistula should be suspected in patients with unexplained episodes of respiratory distress or pneumonia; however, more subtle signs can be an important symptom for early recognition of the disease. ⋯ In the present case, air movement between the esophagus and the trachea through the fistula caused a high-pitched sound, which the patient described as a "catlike cry." The high-pitched sound ceased after surgical closure of the fistula. We report here the symptom of "catlike cry" as one manifestation of tracheoesophageal fistula.