Chest
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Interstitial lung disease (ILD) is associated with increased morbidity and mortality in rheumatoid arthritis (RA). Moreover, acute exacerbation (AE) is a devastating complication of RA plus ILD. However, few data on AE in RA-associated ILD are available. ⋯ Our findings suggest that approximately one-third of patients with RA-associated ILD experience AE and that ever smoker status, and lower lung function and exercise capacity predispose patients to AE. AE significantly affects the overall survival of patients with RA-associated ILD.
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Pulmonary rehabilitation programs (PRP) are important for people with symptomatic COPD. ⋯ Among people with COPD who were suitable for a PRP, referral from the tertiary hospital setting was suboptimal. Suitable participants who were not referred showed lower interest in attending a PRP. There were novel complex individual barriers that reduced one's interest in participating in a PRP.
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Case Reports
A 51-Year-Old Woman With Interstitial Lung Disease and Subsequent COVID-19 Presenting With Worsening Dyspnea.
A 51-year-old Puerto Rican woman, with a known but inconclusive diagnosis of interstitial lung disease (ILD) since 2002 and recent moderate COVID-19, is now presenting with subacute worsening dyspnea on exertion. The patient had sporadic medical care over the years for her ILD (Table 1). Prior workup included chest CT imaging with a "crazy-paving" pattern of lung disease, as defined by ground-glass opacity with superimposed interlobular septal thickening and visible intralobular lines. ⋯ She had lived with mild yet nonprogressive functional impairment and stable exercise intolerance over these years. She was then hospitalized for COVID-19 in August 2020 and for recurrent shortness of breath in September 2020. She now presented 4 months following her September 2020 hospitalization.
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A 28-year-old man with a history of congenital HIV sought treatment at the ED with a chief symptom of generalized malaise and confusion of 3 days' duration. He had mild dyspnea, but no respiratory distress, and he reported no fever, chest pain, or headache. We were unable to obtain past medical, family, or social history because of encephalopathy and we had no available contact person. ⋯ He was prescribed Stribild (elvitegravir-cobicistat-emtricitabine-tenofovir disoproxil fumarate) and darunavir; however, pharmacy records revealed he did not fill the prescriptions. He underwent no further clinic follow-up examinations. He grew up in California and moved to upstate New York 5 years previously.