The American journal of medicine
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Multicenter Study
Benefit of appropriate empirical antibiotic treatment: thirty-day mortality and duration of hospital stay.
We evaluated the effect of inappropriate antibiotic treatment on mortality and duration of hospital stay in medical inpatients with bacterial infections. ⋯ Appropriate empirical antibiotic treatment is associated with a better survival and shortened duration of hospital stay in medical patients with bacterial infections.
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Review Case Reports
Coccidioidomycosis in pregnancy: case report and review of the literature.
Coccidioidomycosis is an uncommon fungal infection during pregnancy. We report a case and review the literature on coccidioidomycosis in pregnancy. ⋯ Mortality rates have improved over time in association with the timely administration of antifungal therapy. Disseminated coccidioidomycosis may occur during pregnancy, especially during the third trimester. Improved maternal and fetal survival is associated with early disease recognition and administration of amphotericin B.
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Forced expiratory volume in 1 second (FEV1) declines normally with aging by approximately 30 mL/yr, but in susceptible smokers, the decline is greater (about 60 mL/yr), resulting in the development of chronic obstructive pulmonary disease (COPD). Smoking cessation usually restores the normal or near-normal rate of FEV1 decline, whereas intermittent quitting provides less benefit. Thus, smoking cessation is a critical component for the prevention of COPD progression. ⋯ Genetic components of the decline in FEV1 are being actively explored, but none has been extensively validated other than alpha1-antitrypsin deficiency. To date, only smoking cessation has been definitively shown to be effective in reducing the rate of FEV1 decline, but other therapeutic strategies are under active research. Consequently, FEV1 and its change over time are important outcomes in COPD and valuable measures for the assessment of disease progression.
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Comparative Study
Deep venous thrombosis and pulmonary embolism in hospitalized patients with sickle cell disease.
As would be expected with a hypercoagulable state, pulmonary embolism (PE) occurs in sickle cell disease (SCD). Its frequency, however, is undetermined, largely because of difficulties in distinguishing it from thrombosis in situ. The prevalence of deep venous thrombosis (DVT) is also undetermined in patients with SCD. Knowing the prevalence of DVT would be an important step in the overall assessment of the risk of PE in these patients. ⋯ The high prevalence of apparent PE in patients with SCD, compared with non-SCD African-American patients of the same age and the comparable prevalence of DVT in both groups are compatible with the concept that thrombosis in situ might be present in many. On the other hand, the data suggest that PE is not rare in patients with SCD. This suggests that PE might be an etiologic factor in patients with SCD who develop respiratory symptoms. In such patients, an imaging procedure might be appropriate.