Pub Date : 2024-07-16DOI: 10.12746/swrccc.v12i52.1181
Tasmea Haque, Pragati Basera, Tushi Singh, Dauod Arif
This patient has a complex medical history that includes intellectual disability, blindness, deafness, seizure disorder, tracheomalacia, and recurrent aspiration. He had a percutaneous endoscopic gastrostomy in place for tube feeding. He again presented with acute respiratory distress, hypoxemia, fever, and leukocytosis. Chest computed tomography (CT) revealed bilateral infiltrates and nodular densities. A previous chest CT done 6 years prior to admission revealed multiple micronodules scattered throughout both lung fields. The patient had had a previous lung biopsy 20 years prior to admission which revealed lentil starch material in bronchioles and multifocal foreign body giant cell reactions. The patient was treated with an empiric antibiotic regimen and improved. This case demonstrates the radiographic and histologic changes associated with lentil pneumonia which is an unusual type of aspiration pneumonia. Keywords: Lentil pneumonia, granulomas, aspiration, nodules
{"title":"Lentil aspiration pneumonitis","authors":"Tasmea Haque, Pragati Basera, Tushi Singh, Dauod Arif","doi":"10.12746/swrccc.v12i52.1181","DOIUrl":"https://doi.org/10.12746/swrccc.v12i52.1181","url":null,"abstract":"This patient has a complex medical history that includes intellectual disability, blindness, deafness, seizure disorder, tracheomalacia, and recurrent aspiration. He had a percutaneous endoscopic gastrostomy in place for tube feeding. He again presented with acute respiratory distress, hypoxemia, fever, and leukocytosis. Chest computed tomography (CT) revealed bilateral infiltrates and nodular densities. A previous chest CT done 6 years prior to admission revealed multiple micronodules scattered throughout both lung fields. The patient had had a previous lung biopsy 20 years prior to admission which revealed lentil starch material in bronchioles and multifocal foreign body giant cell reactions. The patient was treated with an empiric antibiotic regimen and improved. This case demonstrates the radiographic and histologic changes associated with lentil pneumonia which is an unusual type of aspiration pneumonia. \u0000Keywords: Lentil pneumonia, granulomas, aspiration, nodules","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141832849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients on long-term immunosuppression, including corticosteroids or immunomodulatory drugs, are susceptible to opportunistic infections, such as like Pneumocystis jirovecii pneumonia (PJP). Corticosteroid use can increase the frequency of fungal infection, mask symptoms, and delay the diagnosis, and thus warrant preventive measures. Maintaining a high index of suspicion is important, and prophylactic antibiotics, particularly trimethoprim-sulfamethoxazole, should be considered for high-risk patients. This case underscores the diagnosis of PJP in a patient with interstitial lung disease receiving prolonged steroid therapy, despite lacking HIV and conventional risk factors for this infection. Notably, PJP can present as a more severe infection in non-HIV patients, leading to higher mortality rates and stressing the need for swift and effective diagnosis and treatment by healthcare providers. Keywords: Pneumocystis jirovecii; pneumonia; chronic corticosteroid treatment use; fungal pneumonia; interstitial lung disease
长期使用皮质类固醇或免疫调节药物等免疫抑制剂的患者很容易发生机会性感染，如肺孢子菌肺炎（PJP）。使用皮质类固醇会增加真菌感染的频率，掩盖症状，延误诊断，因此需要采取预防措施。保持高度怀疑非常重要，高危患者应考虑使用预防性抗生素，尤其是三甲双胍-磺胺甲噁唑。本病例强调了对长期接受类固醇治疗的间质性肺病患者的 PJP 诊断，尽管该患者缺乏 HIV 感染和常规感染风险因素。值得注意的是，PJP 在非 HIV 患者中可能表现为更严重的感染，从而导致更高的死亡率，这也强调了医护人员迅速有效诊断和治疗的必要性。关键词肺孢子菌；肺炎；长期使用皮质类固醇治疗；真菌性肺炎；间质性肺病
{"title":"Pneumocystis jirovecii pneumonia secondary to chronic steroid use: An uncommon cause of pneumocystis pneumonia","authors":"Mandvi Pandey, Nithila Sivakumar, Anunaya Aashish, Dhruvangkumar Modi","doi":"10.12746/swrccc.v12i52.1321","DOIUrl":"https://doi.org/10.12746/swrccc.v12i52.1321","url":null,"abstract":"Patients on long-term immunosuppression, including corticosteroids or immunomodulatory drugs, are susceptible to opportunistic infections, such as like Pneumocystis jirovecii pneumonia (PJP). Corticosteroid use can increase the frequency of fungal infection, mask symptoms, and delay the diagnosis, and thus warrant preventive measures. Maintaining a high index of suspicion is important, and prophylactic antibiotics, particularly trimethoprim-sulfamethoxazole, should be considered for high-risk patients. This case underscores the diagnosis of PJP in a patient with interstitial lung disease receiving prolonged steroid therapy, despite lacking HIV and conventional risk factors for this infection. Notably, PJP can present as a more severe infection in non-HIV patients, leading to higher mortality rates and stressing the need for swift and effective diagnosis and treatment by healthcare providers. \u0000Keywords: Pneumocystis jirovecii; pneumonia; chronic corticosteroid treatment use; fungal pneumonia; interstitial lung disease","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.12746/swrccc.v12i52.1327
A. Motes, Tushi Singh, Myrian N VINAN VEGA, Divya Vangipuram-Wyatt, Joscilin Mathew, Kenneth Nugent
Diabetes is a chronic, metabolic disease characterized by hyperglycemia which eventually can cause serious organ damage. The prevalence of diabetes has steadily increased over the past few decades, and approximately 1.4 million Americans are diagnosed with diabetes every year. Diabetes was the seventh leading cause of death in the United States in 2019. Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. It occurs more frequently in the patients with type 1 diabetes but can also develop in people with type 2 diabetes. It was determined that the average cost per DKA episode was $6,444, and that the annual cost of medical treatment in a diabetic patient with a prior episode of DKA was 2.67 times higher than a diabetic patient with no history of DKA. The criteria for DKA resolution at University Medical Center (UMC) in Lubbock, Texas, are different from current American Diabetes Association (ADA) guidelines. At UMC, a plasma bicarbonate ≥18 mEq/L, a venous pH > 7.3, and anion gap ≤12 mEq/L must be recorded twice (4 hours apart) before bridging to subcutaneous long-acting insulin administration. This time requirement could contribute to a longer time for DKA resolution and longer intensive care unit and hospital stays.Keywords: Diabetic ketoacidosis, DKA resolution
{"title":"Diabetic ketoacidosis resolution: From the traditional way to guideline-based management in the MICU at University Medical Center, Lubbock, Texas","authors":"A. Motes, Tushi Singh, Myrian N VINAN VEGA, Divya Vangipuram-Wyatt, Joscilin Mathew, Kenneth Nugent","doi":"10.12746/swrccc.v12i52.1327","DOIUrl":"https://doi.org/10.12746/swrccc.v12i52.1327","url":null,"abstract":"Diabetes is a chronic, metabolic disease characterized by hyperglycemia which eventually can cause serious organ damage. The prevalence of diabetes has steadily increased over the past few decades, and approximately 1.4 million Americans are diagnosed with diabetes every year. Diabetes was the seventh leading cause of death in the United States in 2019. Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. It occurs more frequently in the patients with type 1 diabetes but can also develop in people with type 2 diabetes. It was determined that the average cost per DKA episode was $6,444, and that the annual cost of medical treatment in a diabetic patient with a prior episode of DKA was 2.67 times higher than a diabetic patient with no history of DKA. The criteria for DKA resolution at University Medical Center (UMC) in Lubbock, Texas, are different from current American Diabetes Association (ADA) guidelines. At UMC, a plasma bicarbonate ≥18 mEq/L, a venous pH > 7.3, and anion gap ≤12 mEq/L must be recorded twice (4 hours apart) before bridging to subcutaneous long-acting insulin administration. This time requirement could contribute to a longer time for DKA resolution and longer intensive care unit and hospital stays.Keywords: Diabetic ketoacidosis, DKA resolution","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":" 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141832022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.12746/swrccc.v12i52.1329
Kenneth Nugent
Abstract Patients with prior COVID-19 infection can have residual symptoms and significant disability. In particular, some patients have abnormal lung function with reduced volumes and diffusion capacities. However, some patients have relatively normal lung function and chest x-rays but have significant dyspnea. These patients have been evaluated using cardiopulmonary exercise testing (CPET) to determine their peak O2 consumption and their cardiac and respiratory responses during standardized testing. In general, these studies demonstrate that the level of impairment correlates with the severity of the initial infection. In addition, some patients have little or no improvement in their VO2 over time. This test can provide some insight as to exact system limitations resulting in impairment. Six-minute walk tests provide alternative approaches for evaluating patients when CPET testing is not available. Most patients who have had prior COVID infection improve with standard pulmonary rehabilitation. Keywords: COVID-19 infection, dyspnea, cardiopulmonary exercise testing, rehabilitation
{"title":"Cardiopulmonary exercise testing in post-COVID-19 patients","authors":"Kenneth Nugent","doi":"10.12746/swrccc.v12i52.1329","DOIUrl":"https://doi.org/10.12746/swrccc.v12i52.1329","url":null,"abstract":"Abstract \u0000Patients with prior COVID-19 infection can have residual symptoms and significant disability. In particular, some patients have abnormal lung function with reduced volumes and diffusion capacities. However, some patients have relatively normal lung function and chest x-rays but have significant dyspnea. These patients have been evaluated using cardiopulmonary exercise testing (CPET) to determine their peak O2 consumption and their cardiac and respiratory responses during standardized testing. In general, these studies demonstrate that the level of impairment correlates with the severity of the initial infection. In addition, some patients have little or no improvement in their VO2 over time. This test can provide some insight as to exact system limitations resulting in impairment. Six-minute walk tests provide alternative approaches for evaluating patients when CPET testing is not available. Most patients who have had prior COVID infection improve with standard pulmonary rehabilitation. \u0000Keywords: COVID-19 infection, dyspnea, cardiopulmonary exercise testing, rehabilitation","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.12746/swrccc.v12i52.1305
Zain Amar, Muneeb Rehman, Alfredo Iardino, Yasir Ahmed
Drug-induced thrombocytopenia is a challenging clinical dilemma that is often overlooked. Nafcillin is a beta-lactam anti-staphylococcal penicillin antibiotic used as a first-line treatment for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and severe infections. Nafcillin has been associated with a higher rate of premature antibiotic discontinuation than cefazolin. Here we report a 58-year-old woman with multiple comorbid conditions who presented with a prosthetic right hip joint infection due to MSSA and was treated with nafcillin but developed profound thrombocytopenia due to a possible nafcillin side effect on the 14th day of therapy. Thrombocytopenia resolved after discontinuation of nafcillin, and the patient was treated successfully with cefazolin. Keywords: Nafcillin-induced thrombocytopenia, drug-induced thrombocytopenia, thrombocytopenia
{"title":"Nafcillin-induced thrombocytopenia: An uncommon complication","authors":"Zain Amar, Muneeb Rehman, Alfredo Iardino, Yasir Ahmed","doi":"10.12746/swrccc.v12i52.1305","DOIUrl":"https://doi.org/10.12746/swrccc.v12i52.1305","url":null,"abstract":"Drug-induced thrombocytopenia is a challenging clinical dilemma that is often overlooked. Nafcillin is a beta-lactam anti-staphylococcal penicillin antibiotic used as a first-line treatment for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and severe infections. Nafcillin has been associated with a higher rate of premature antibiotic discontinuation than cefazolin. Here we report a 58-year-old woman with multiple comorbid conditions who presented with a prosthetic right hip joint infection due to MSSA and was treated with nafcillin but developed profound thrombocytopenia due to a possible nafcillin side effect on the 14th day of therapy. Thrombocytopenia resolved after discontinuation of nafcillin, and the patient was treated successfully with cefazolin. \u0000Keywords: Nafcillin-induced thrombocytopenia, drug-induced thrombocytopenia, thrombocytopenia","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.12746/swrccc.v12i52.1323
Letisha Mirembe, Abhijit Gutal
This case report describes a rare instance of Candida albicans liver abscess in a 46-year-old immunocompetent male with extensive medical history. The report underscores the diagnostic challenges in such atypical presentations and emphasizes the critical role of a multidisciplinary approach for effective management, highlighting the unusual nature of the case in the context of the patient's immune competence.
{"title":"Uncharted Territory Navigating a Rare Candida Albicans Liver Abscess Case","authors":"Letisha Mirembe, Abhijit Gutal","doi":"10.12746/swrccc.v12i52.1323","DOIUrl":"https://doi.org/10.12746/swrccc.v12i52.1323","url":null,"abstract":"This case report describes a rare instance of Candida albicans liver abscess in a 46-year-old immunocompetent male with extensive medical history. The report underscores the diagnostic challenges in such atypical presentations and emphasizes the critical role of a multidisciplinary approach for effective management, highlighting the unusual nature of the case in the context of the patient's immune competence. \u0000 ","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141832397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.12746/swrccc.v12i52.1269
Vaibhav Oberoi, A. Sekhon, Ashish Sarangi
Post-extubation anxiety causes significant distress in intensive care unit patients. This review provides treatment recommendations for managing anxiety during weaning and extubation from mechanical ventilation. Factors predisposing to anxiety include cerebral vascular disease, endocrine disorders, cardiopulmonary decompensation, disrupted sleep-wake cycles, and the stressful ICU environment. This review analyzed 21 articles sourced from Google Scholar and PubMed, focusing on case reports, case series, systematic reviews, and meta-analyses. These studies reported that dexmedetomidine effectively reduces extubation time and ICU length of stay through its anxiolytic properties. Antipsychotics, like quetiapine, showed potential in managing anxiety during ventilator weaning, but high-dose haloperidol posed risks. Benzodiazepines were linked to paradoxical agitation and respiratory suppression. Non-pharmacological treatments, such as aromatherapy, music therapy, and massage therapy, appeared to reduce anxiety and improve sleep quality. Caregiver approaches, including parental presence and psychological training, also reduced anxiety. In conclusion, non-pharmacological approaches should be prioritized, and pharmacological treatments considered when necessary. More research is essential to identify optimal treatments for post-extubation anxiety with minimal patient risk and effective symptom control. Keywords: Anxiety, ICU patients, critically ill patients, post-extubation
{"title":"Management of post-extubation anxiety in the intensive care unit","authors":"Vaibhav Oberoi, A. Sekhon, Ashish Sarangi","doi":"10.12746/swrccc.v12i52.1269","DOIUrl":"https://doi.org/10.12746/swrccc.v12i52.1269","url":null,"abstract":"Post-extubation anxiety causes significant distress in intensive care unit patients. This review provides treatment recommendations for managing anxiety during weaning and extubation from mechanical ventilation. Factors predisposing to anxiety include cerebral vascular disease, endocrine disorders, cardiopulmonary decompensation, disrupted sleep-wake cycles, and the stressful ICU environment. This review analyzed 21 articles sourced from Google Scholar and PubMed, focusing on case reports, case series, systematic reviews, and meta-analyses. These studies reported that dexmedetomidine effectively reduces extubation time and ICU length of stay through its anxiolytic properties. Antipsychotics, like quetiapine, showed potential in managing anxiety during ventilator weaning, but high-dose haloperidol posed risks. Benzodiazepines were linked to paradoxical agitation and respiratory suppression. Non-pharmacological treatments, such as aromatherapy, music therapy, and massage therapy, appeared to reduce anxiety and improve sleep quality. Caregiver approaches, including parental presence and psychological training, also reduced anxiety. In conclusion, non-pharmacological approaches should be prioritized, and pharmacological treatments considered when necessary. More research is essential to identify optimal treatments for post-extubation anxiety with minimal patient risk and effective symptom control. \u0000Keywords: Anxiety, ICU patients, critically ill patients, post-extubation","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.12746/swrccc.v12i52.1325
Thomas E. Gill, Estrella Herrera-Molina, G. Ibarra-Mejía, Soyoung Jeon, Karin Ardon-Dryer
in dust-associated diseases, more consistent monitoring of dust levels should be implemented across the western USA, not just in the major cities where detailed measurements are now available. Our research team is currently investigating the health effects of dust in other West Texas cities, including Amarillo and Midland, and evaluating the potential health effects of thunderstorms, which have been shown to impact other cities in the USA and across the globe. We are also determining the incidence of coccidioido-mycosis (Valley fever), caused by the soil-dwelling fungus Coccidioides and potentially associated with dust and wind in West Texas. We actively welcome collaborations with other researchers and students.
{"title":"Update-Exposure to dust events and hospitalizations in West Texas cities: The human health consequences of dust","authors":"Thomas E. Gill, Estrella Herrera-Molina, G. Ibarra-Mejía, Soyoung Jeon, Karin Ardon-Dryer","doi":"10.12746/swrccc.v12i52.1325","DOIUrl":"https://doi.org/10.12746/swrccc.v12i52.1325","url":null,"abstract":"in dust-associated diseases, more consistent monitoring of dust levels should be implemented across the western USA, not just in the major cities where detailed measurements are now available. Our research team is currently investigating the health effects of dust in other West Texas cities, including Amarillo and Midland, and evaluating the potential health effects of thunderstorms, which have been shown to impact other cities in the USA and across the globe. We are also determining the incidence of coccidioido-mycosis (Valley fever), caused by the soil-dwelling fungus Coccidioides and potentially associated with dust and wind in West Texas. We actively welcome collaborations with other researchers and students.","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thrombosis of the inferior vena cava is an uncommon condition and may not be recognized until the affected patient develops severe symptoms. It is associated with a higher risk of complications than other locations of deep venous thrombosis. Here we present a case of a 72-year-old man with bilateral occlusion of the external iliac veins and inferior vena cava. Keywords: Inferior vena cava, thrombosis, managemen
{"title":"Subacute inferior vena cava occlusion after treatment for advanced colorectal cancer: presentation and management","authors":"Letisha Mirembe, Devin Bird, Robyn Tapp, Bailey Gutierrez, Haven Ward, I. Obokhare","doi":"10.12746/swrccc.v12i52.1287","DOIUrl":"https://doi.org/10.12746/swrccc.v12i52.1287","url":null,"abstract":"Thrombosis of the inferior vena cava is an uncommon condition and may not be recognized until the affected patient develops severe symptoms. It is associated with a higher risk of complications than other locations of deep venous thrombosis. Here we present a case of a 72-year-old man with bilateral occlusion of the external iliac veins and inferior vena cava. \u0000Keywords: Inferior vena cava, thrombosis, managemen","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：