Chest
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Devastating cases of sepsis in previously healthy patients have received widespread attention and have helped to catalyze state and national mandates to improve sepsis detection and care. However, it is unclear what proportion of patients hospitalized with sepsis previously were healthy and how their outcomes compare with those of patients with comorbidities. ⋯ The vast majority of patients hospitalized with community-onset sepsis harbor pre-existing comorbidities. However, previously healthy patients may be more likely to die when they seek treatment at the hospital with sepsis compared with patients with comorbidities. These findings underscore the importance of early sepsis recognition and treatment for all patients.
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As outcomes have improved across the hematologic malignancy population, candidacy for ICU admission has increased. This complex population may develop a variety of complications related to their treatment or underlying disease that can result in critical illness necessitating ICU support. This review highlights common causes of critical illness associated with hematologic malignancies, including the following: (1) neutropenic sepsis; (2) hyperleukocytosis and leukostasis across patients with acute myeloid leukemia; (3) complications of acute promyelocytic leukemia; (4) tumor lysis syndrome; and (5) critical care complications that can arise following hematopoietic stem cell transplantation.
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The outbreak of COVID-19 has brought renewed attention to past narratives of disease outbreaks. What do the Black Death and COVID-19 have in common? How we tell outbreak stories is shaped by political, cultural, social, and historical contexts. It is deeply rhetorical. ⋯ Similarly, modern outbreak narratives also tend to use militarized language, which results in othering peoples and cultures where a disease might have originated. Given the contemporary political tensions between China and the United States, narratives about the origin of the SARS-CoV-2 virus and its transmission have led to a transnational infodemic of misinformation as well as discrimination and violence against people of Asian descent. In light of this long-running pattern, we argue for more interdisciplinary collaborations between the experts whose work is used to build outbreak narratives to adopt more critical rhetorical approaches in communicating with the public.
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Severe pulmonary hypertension (PH) is prognostically highly relevant in patients with COPD. The criteria for severe PH have been defined based on hemodynamic thresholds in right heart catheterization. ⋯ In patients with COPD, the combination of echocardiography, NT-proBNP level, and PA to Ao diameter ratio predicts severe PH with high sensitivity and specificity. The contribution of severe PH and severe airflow limitation to impaired survival is comparable.