Southwest journal of pulmonary, critical care & sleep最新文献

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Healthcare Labor Unions-Has the Time Come? 医疗行业工会——时机到了吗?

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2023-11-03 DOI: 10.13175/swjpcc2047-23

Richard Robbins

No abstract available. Article truncated after 150 words. Labor unions in America look like they are making a comeback. Employees at Starbucks stores, Amazon warehouses, Trader Joe's, and REI, grad students, Uber and Lyft drivers and employees at the Medieval Times have voted to unionize. Hollywood actor and writers, the United Auto Workers, and Kaiser Permanente employees have been on strike (1). Headline writers began declaring things like, "Employees everywhere are organizing" and that the United States was seeing a "union boom” (2). In September, the White House asserted "Organized labor appears to be having a moment" (2). However, the Bureau of Labor Statistics recently released its union data for 2022 and the data shows that the share of American workers in a union has continued to decline (2). Last year, the union membership rate fell by 0.2 percentage points to 10.1% — the lowest on record. Despite an increase in union efforts since the pandemic, healthcare workers — particularly …

没有摘要。文章在150字后被删节。美国的工会似乎正在东山再起。星巴克、亚马逊仓库、Trader Joe's和REI的员工、研究生、优步和Lyft司机以及中世纪时代的员工都投票成立了工会。好莱坞演员和作家、美国汽车工人联合会(United Auto Workers)和凯撒医疗机构(Kaiser Permanente)的员工一直在罢工(1)。头条新闻的作者开始宣称，“各地的员工都在组织起来”，美国正在经历“工会热潮”(2)。9月，白宫宣称“有组织的劳工似乎正在经历一个时刻”(2)。美国劳工统计局(Bureau of Labor Statistics)最近公布了2022年的工会数据，数据显示，美国工人参加工会的比例继续下降(2)。去年，工会会员率下降了0.2个百分点，降至10.1%，创历史新低。尽管自疫情以来工会的努力有所增加，但医疗工作者——尤其是……

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November 2023 Medical Image of the Month: Obstructive Uropathy Extremis 2023年11月医学影像:梗阻性尿路极端症

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2023-11-02 DOI: 10.13175/swjpccs043-23

Nathan Walton, Elizabeth Mata, Max Hart, Matthew Borchart, Adnan Abbasi

No abstract available. Manuscript truncated after 150 words. A 71-year-old veteran presented to the emergency department with two-weeks of progressive back pain radiating to the abdomen associated low-grade fever, nausea, and new lower extremity edema. The family reported confusion. His medical history was significant for chronic prostatitis and low-grade prostate cancer on biopsy that was lost to follow-up eleven years ago. His only reported medications were aspirin 81 mg daily and naproxen 500mg up to four times a day for his pain. Vitals were significant for a temperature of 36.1 C, initial blood pressure of 201/74, heart rate of 128/min, respirations at 18/min with a saturation of 97% on 2L NC. Physical exam demonstrated no difference in blood pressures between arms. No abnormal heart sounds. Clear breath sounds to auscultation bilaterally. Flank tenderness to percussion and significant abdominal tenderness over the epigastric and suprapubic region with 3+ pitting edema of the bilateral lower extremities. Screening labs were notable …

没有摘要。手稿在150字后被删节。一位71岁的退伍军人以两周的进行性背部疼痛向腹部放射，伴有低烧、恶心和新的下肢水肿就诊于急诊科。这家人表示很困惑。他的病史有慢性前列腺炎和低级别前列腺癌，11年前随访时丢失。他唯一报告的药物是阿司匹林，每天81毫克，萘普生500毫克，每天4次，以缓解疼痛。体温36.1℃，初始血压201/74，心率128/min，呼吸18/min, 2L NC饱和度97%，生命体征显著。身体检查显示两臂之间的血压没有差异。无异常心音。双侧听诊呼吸音清晰。腹部叩击痛，腹部上腹部和耻骨上明显压痛，双侧下肢伴有3+点状水肿。筛选实验室是值得注意的……

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November 2023 Imaging Case of the Month: A Crazy Association 2023年11月月度影像病例:一个疯狂的协会

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2023-11-01 DOI: 10.13175/swjpccs046-23

Parker Brown, Prasad Panse, Michael Gotway

No abstract available. Manuscript truncated after 150 words. HPI: A 55-year-old man presents with a history of cough, poor appetite, low energy, and weight loss over the previous 6-10 months following COVID-19 infection 2 months earlier. PMH, SH, FH: The patient’s past medical history was positive for CVOID-19 infection 2 months earlier as well as pneumonia, not specified, in the previous year. The patient’s past medical history was also remarkable for a 7-unit gastrointestinal hemorrhage approximately one year earlier following polypectomy for benign lesions in the transverse colon. During that hospital admission a complete blood count showed 1% blasts which prompted hematology consultation. The consulting oncologist felt the peripheral blasts were the result of a leukemoid reaction secondary to increased bone marrow stimulation owing to the patient’s acute anemia caused by the gastrointestinal hemorrhage. Macrocytosis and reticulocytosis was also noted and attributed to the same. Repeat complete blood count showed no blasts although some myelocytes, metamyelocytes, and polychromasia …

没有摘要。手稿在150字后被删节。HPI:一名55岁男性，在2个月前感染COVID-19后，在过去6-10个月内出现咳嗽、食欲不振、精力不足和体重减轻的病史。PMH、SH、FH:患者既往病史2个月前为CVOID-19感染阳性，前一年未明确为肺炎。患者的既往病史也值得注意的是，大约一年前，在横结肠良性病变息肉切除术后发生了7个单位的胃肠道出血。在住院期间，全血细胞计数显示1%的细胞，这促使血液学咨询。咨询肿瘤学家认为外周细胞是由于患者胃肠道出血引起的急性贫血导致骨髓刺激增加而继发的白血病反应的结果。巨噬细胞增多症和网状细胞增多症也被认为是由同样的原因引起的。重复全血细胞计数显示未见母细胞，但有髓细胞、化髓细胞和多色变…

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October 2023 Medical Image of the Month: Swyer-James-MacLeod Syndrome 2023年10月月度医学图像:斯威尔-詹姆斯-麦克劳德综合征

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2023-10-02 DOI: 10.13175/swjpccs042-23

Samantha Moore, Clinton Jokerst

No abstract available. Article truncated after 150 words. Pathological slides from a right upper lobectomy specimen obtained at an outside institution were submitted to our Department of Pathology for review. A pre-operative noncontrast chest CT from the outside institution was submitted along with the path slides. The patient was a 27 y/o man who presented to the outside institution with exercise intolerance and increasing shortness of breath following a bout of COVID in early 2023. The patient also related a history of possible chronic myocarditis. A review of the CT demonstrated 2 distinct right-sided areas of hyperinflated, emphysematous lung with a relatively normal appearing left lung (Figure 1). Although congenital lobar emphysema was considered, the multifocal nature of the findings suggested against this, and a diagnosis of Swyer-James-MacLeod Syndrome was entertained. Histopathological analysis (Figure 2) confirmed this suspicion. When questioned further, the patient related a history of neonatal RSV infection requiring 3 weeks of hospitalization. The constellation of …

没有摘要。文章在150字后被删节。从外部机构获得的右上肺叶切除标本的病理切片提交给我们的病理科进行审查。外部机构的术前胸部CT与路径片一起提交。患者是一名27岁的男性，在2023年初的一次COVID发作后，他向外部机构提出了运动无耐力和呼吸急促的症状。患者还可能有慢性心肌炎病史。CT复查显示2个明显的右侧过度充气肺气肿区，左侧肺看起来相对正常(图1)。虽然考虑先天性叶性肺气肿，但多灶性的表现表明并非如此，并考虑了Swyer-James-MacLeod综合征的诊断。组织病理学分析(图2)证实了这一怀疑。进一步询问时，患者有新生儿呼吸道合胞病毒感染史，住院3周。星座…

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October 2023 Critical Care Case of the Month: Multi-Drug Resistant K. pneumoniae 2023年10月重症监护病例:多重耐药肺炎克雷伯菌

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2023-10-01 DOI: 10.13175/swjpccs040-23

Robert Raschke

No abstract available. Article truncated after 150 words. History of Present Illness: A 75-year-old man presented from a skilled nursing facility with altered mental status and hypotension. He had a seven-year-long history of steroid-dependent myasthenia gravis, but had previously declined Covid vaccination, and subsequently experienced a severe case of COVID-19 pneumonia five months prior to admission. This resulted in chronic respiratory failure and renal failure for which he subsequently underwent tracheostomy, tunneled subclavian vein dialysis catheter placement and percutaneous endoscopic gastrostomy (PEG). He had resided in a skilled nursing facility since then, requiring four subsequent hospital readmissions for complications. These sequentially included septic shock due to a catheter associated blood stream infection, an intra-abdominal abscess due to PEG migration into the peritoneum resulting in fungal blood stream infection, recurrent intra-abdominal infection with multiple organisms, and bacterial pneumonia. Treatment of these infectious complications included replacement of the tunneled dialysis catheter and exploratory laparotomy with debridement of multiple abscesses. The …

没有摘要。文章在150字后被删节。病史:75岁男性，从专业护理机构就诊，精神状态改变，低血压。他有7年的类固醇依赖性重症肌无力病史，但此前拒绝接种Covid -19疫苗，随后在入院前5个月出现了严重的Covid -19肺炎病例。这导致慢性呼吸衰竭和肾功能衰竭，随后他接受了气管切开术，锁骨下静脉透析导管置入和经皮内镜胃造口术(PEG)。从那时起，他一直住在一家专业护理机构，随后因并发症再次住院四次。这些依次包括由于导管相关血流感染引起的脓毒性休克，由于PEG迁移到腹膜导致的真菌血流感染引起的腹内脓肿，复发性腹内多种生物感染和细菌性肺炎。这些感染性并发症的治疗包括更换隧道透析导管和剖腹探查术并对多发脓肿进行清创。…

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Infectious Diseases Telemedicine to the Arizona Department of Corrections During SARS-CoV-2 Pandemic. A Short Report. 在SARS-CoV-2大流行期间对亚利桑那州惩教部门的远程医疗。简短的报告。

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2023-09-23 DOI: 10.13175/swjpccs038-23

Stephen Klotz, Krystal Fimbres, Lawrence York

The University of Arizona infectious diseases provides telemedicine clinics to the Arizona Department of Corrections (DOC) and Pima County Jail. Beginning in January 2020 there was a sharp drop in the number of monthly consultations following the public health emergency regarding the SARS-CoV-2 pandemic. Only since ending the emergency have the number of consults risen each month to pre-pandemic numbers. However, the nature of consult requests has changed. In this report we document the change from predominately human immunodeficiency virus (HIV) consults to a broader spectrum of infectious-related issues, most noteworthy being infective endocarditis, osteomyelitis, and chronic hepatitis B and C infection, the majority of cases due to intravenous drug injection. Although the DOC and jail underwent major upheavals intramurally due to the pandemic, medical outcomes with the diseases listed above, were excellent. The telemedicine infectious diseases clinics continued to provide timely, effective care for inmates.

亚利桑那大学传染病科为亚利桑那州惩教局和皮马县监狱提供远程医疗诊所。从2020年1月开始，在SARS-CoV-2大流行的突发公共卫生事件之后，每月的咨询次数急剧下降。直到紧急状态结束后，每个月的咨询人数才上升到大流行前的数字。但是，咨询请求的性质发生了变化。在本报告中，我们记录了从主要的人类免疫缺陷病毒(HIV)到更广泛的感染相关问题的变化，最值得注意的是感染性心内膜炎、骨髓炎和慢性乙型和丙型肝炎感染，大多数病例是由于静脉注射药物引起的。虽然DOC和监狱内部因大流行而经历了重大动荡，但上述疾病的医疗结果非常好。远程医疗传染病诊所继续为囚犯提供及时、有效的护理。

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March 2023 Critical Care Case of the Month: A Bad Egg 2023年3月每月重症监护病例:一个坏蛋

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2023-03-01 DOI: 10.13175/swjpccs009-23

Richard Robbins

No abstract available. Article truncated after 150 words. History of Present Illness: You are asked to see a 35-year-old man who was admitted to the ICU from the ER the previous night with an exacerbation of his chronic obstructive pulmonary disease (COPD). He has a long history of COPD and came to the ER for COVID-19 testing because he was at a party where a friend was later found to COVID-19. He denies any change in his chronic respiratory symptoms but his spirometry was significantly worse than his baseline in the ER and despite his protests he was admitted. He was treated with empiric antibiotics (amoxicillin and clavulanic acid), corticosteroids (methylprednisolone 125 mg every 6 hours), bronchodilators (albuterol/ipratropium every 4 hours) and oxygen. He says his breathing has not improved and he wants to go home. He has had gradually increasing shortness of breath for the past 8-10 years. He has minimal cough but denied any fevers, systemic …

没有摘要。文章在150字后被删节。目前病史:你被要求看一名35岁的男性，他在前一天晚上因慢性阻塞性肺疾病(COPD)的恶化而被急诊室收治到ICU。他有长期的慢性阻塞性肺病病史，因为他参加了一个朋友后来被发现患有COVID-19的聚会，所以他来到急诊室进行COVID-19检测。他否认他的慢性呼吸道症状有任何改变，但他的肺活量明显低于他在急诊室的基线，尽管他提出抗议，他还是入院了。给予经用性抗生素(阿莫西林和克拉维酸)、皮质类固醇(甲基强的松龙125mg / 6小时)、支气管扩张剂(沙丁胺醇/异丙托品/ 4小时)和氧气治疗。他说他的呼吸没有改善，他想回家。在过去的8-10年里，他的气短逐渐加重。他轻微咳嗽，但否认发烧，全身…

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Associations Between Insomnia and Obstructive Sleep Apnea with Nutritional Intake After Involuntary Job Loss. 失眠症和阻塞性睡眠呼吸暂停与非自愿失业后营养摄入的关系。

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2023-01-01 DOI: 10.13175/swjpccs001-23

Salma Batool-Anwar, Patricia L Haynes, Aria Panchal, Stuart F Quan

Objectives: Involuntary job loss is a stressful life event that can result in changes in nutritional intake. Both insomnia and obstructive sleep apnea (OSA) also are associated with alterations in dietary intake, but the extent to which this occurs in those who have experienced involuntary job loss is unclear. This study assessed nutritional intake in recently unemployed persons with insomnia and obstructive sleep apnea in comparison to those without a sleep disorder.

Methods: Participants from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study were screened for sleep disorders using the Duke Structured Interview for Sleep Disorders. They were classified as having OSA, acute or chronic insomnia or no sleep disorder. Dietary data was collected using United States Department of Agriculture Multipass Dietary recall methodology.

Results: A total of 113 participants had evaluable data and were included in this study. The cohort was comprised mainly of women (62%) and 24% were non-Hispanic white. Participants with OSA had a higher BMI compared with no sleep disorder (30.6 ± 9.1 vs 27.4 ± 7.1 kg/m², p≤0.001). Those with acute insomnia had significantly decreased consumption of total protein (61.5 ± 4.7 vs. 77.9 ± 4.9 g, p≤0.05) and total fat (60.0 ± 4.4 vs. 80.5 ± 4.6 g, p≤0.05). Among the participants with chronic insomnia, there was little overall difference in nutrient consumption compared to the no sleep disorder group although there were several gender specific differences. There were no overall differences between participants with OSA in comparison to no sleep disorder, but women consumed less total fat (89.0 ± 6.7 vs. 57.5 ± 8.0 g, p≤0.01). The Healthy Eating Index of all groups was below the average value of Americans.

Conclusion: Unemployed persons compared to those with sleep disorders differ in their consumption of major nutrients; the dietary composition of those with acute insomnia exhibited the greatest divergence. Additionally, the overall nutritional intake of recently unemployed persons is poor.

目的:非自愿失业是一种压力生活事件，可导致营养摄入的变化。失眠和阻塞性睡眠呼吸暂停(OSA)也与饮食摄入的改变有关，但这种情况在那些经历过非自愿失业的人身上发生的程度尚不清楚。这项研究评估了最近失业的失眠和阻塞性睡眠呼吸暂停的人与没有睡眠障碍的人的营养摄入量。方法:通过职业转换评估日常活动模式(ADAPT)研究的参与者使用杜克睡眠障碍结构化访谈筛选睡眠障碍。他们被分为阻塞性睡眠呼吸暂停、急性或慢性失眠或无睡眠障碍。膳食数据采用美国农业部多通道膳食召回方法收集。结果:共有113名具有可评估数据的参与者被纳入本研究。该队列主要由女性组成(62%)，24%为非西班牙裔白人。与无睡眠障碍的受试者相比，OSA患者的BMI更高(30.6±9.1 vs 27.4±7.1 kg/m2, p≤0.001)。急性失眠症患者总蛋白(61.5±4.7比77.9±4.9 g, p≤0.05)和总脂肪(60.0±4.4比80.5±4.6 g, p≤0.05)的消耗明显减少。在患有慢性失眠症的参与者中，与没有睡眠障碍的一组相比，营养消耗的总体差异不大，尽管存在一些性别差异。与无睡眠障碍的受试者相比，OSA患者之间没有总体差异，但女性消耗的总脂肪较少(89.0±6.7 g vs. 57.5±8.0 g, p≤0.01)。所有人群的健康饮食指数都低于美国人的平均值。结论:无业人员与睡眠障碍者在主要营养素的摄取上存在差异;急性失眠症患者的饮食构成差异最大。此外，最近失业人员的总体营养摄入量很差。

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引用次数: 0

Assessing Depression and Suicidality Among Recently Unemployed Persons with Obstructive Sleep Apnea and Socioeconomic Inequality 评估新近失业的阻塞性睡眠呼吸暂停患者的抑郁和自杀倾向与社会经济不平等

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2022-04-21 DOI: 10.1101/2022.04.20.22274101

Vijay Singh, Patricia L Haynes, Stuart F. Quan

Background: Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder that often is associated with several psychiatric conditions. Job loss is a stressful life event that can also affect mental health and socioeconomic status (SES). We investigated whether there was an association between the prevalence of OSA and several psychiatric conditions within a cohort of persons who recently became unemployed and whether SES was a contributing factor. Methods: Data from 292 participants who completed the screening evaluation of the Assessing Daily Activity Patterns through occupational Transitions (ADAPT) Study were used to assess the association between the prevalence of OSA, and current and past depression, and past suicidality. A type III sleep home sleep monitor was used to identify the presence of OSA and assess its severity. Depression and suicidality were ascertained using the Mini-international neuropsychiatric interview. Years of education was used as a proxy for SES. Results: There were no significant associations between severity of OSA, SES and current depression, past depression, and suicidality. Past suicidality was noted to be more common among those who were single/widowed (17.4%) or those who were divorced or separated (11.1%) (p=0.027). Current depression was more common among Hispanics in comparison to non-Hispanics. Furthermore, prevalence rates of both depression and past suicidality were higher than previous reports in general populations. Conclusions: Within a cohort of individuals who experienced recent job loss, there was no association between OSA and depression or past suicidality. Prevalence rates of both depression and past suicidality were higher than previous reports in the general population.

背景:阻塞性睡眠呼吸暂停(OSA)是一种常见的睡眠相关呼吸障碍，通常与几种精神疾病有关。失业是一个有压力的生活事件，也会影响心理健康和社会经济地位(SES)。我们调查了在一组最近失业的人群中，阻塞性睡眠呼吸暂停的患病率与几种精神疾病之间是否存在关联，以及社会经济状况是否是一个促成因素。方法:通过职业转换评估日常活动模式(ADAPT)研究筛选评估的292名参与者的数据用于评估OSA患病率、当前和过去的抑郁以及过去的自杀行为之间的关系。使用III型睡眠家庭睡眠监测仪来确定OSA的存在并评估其严重程度。使用迷你国际神经精神病学访谈确定抑郁和自杀倾向。受教育年限被用作社会经济地位的代表。结果:OSA、SES的严重程度与当前抑郁、既往抑郁和自杀倾向之间无显著相关性。单身/丧偶人士(17.4%)或离婚或分居人士(11.1%)有自杀倾向的人数较多(p=0.027)。当前的抑郁症在西班牙裔人群中比非西班牙裔人群更为常见。此外，在一般人群中，抑郁症和过去自杀的患病率都高于之前的报道。结论:在最近经历失业的个体队列中，OSA与抑郁症或过去的自杀倾向之间没有关联。在一般人群中，抑郁症和过去自杀的流行率都高于之前的报道。

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引用次数: 1

Diagnostic Challenges of Acute Eosinophilic Pneumonia Post Naltrexone Injection Presenting During The COVID-19 Pandemic COVID-19大流行期间纳曲酮注射后急性嗜酸性肺炎的诊断挑战

Southwest journal of pulmonary, critical care & sleep

Pub Date : 2022-02-14 DOI: 10.13175/swjpccs002-22

Michelle A. W. Breuer, Abdulmonam Ali

No abstract available. Article truncated after 150 words. Introduction Acute eosinophilic pneumonia (AEP) is a rare respiratory illness that may present with nonspecific symptoms ranging in severity from cough and dyspnea to potentially fatal acute respiratory distress syndrome. Although the exact etiology of AEP is unknown, it is thought to be a hypersensitivity reaction that can be idiopathic or caused by various infections, inhalation exposures, and medications (1). Here we present a rare case of AEP secondary to injectable naltrexone. Case Presentation A 45-year-old Caucasian male with a history of alcohol use disorder presented to the emergency room with a 3-day history of progressively worsening dyspnea and dry cough. The patient was a lifelong non-smoker with an unremarkable past medical history aside from alcohol abuse and obesity (BMI 41.64 kg/m²). He denied fever or chills, orthopnea, chest pain, or symptoms suggestive of paroxysmal nocturnal dyspnea. He also denied any recent sick contacts, including exposure to COVID-19. Relevant history …

没有摘要。文章在150字后被删节。急性嗜酸性粒细胞性肺炎(AEP)是一种罕见的呼吸系统疾病，可能出现非特异性症状，严重程度从咳嗽和呼吸困难到可能致命的急性呼吸窘迫综合征。虽然AEP的确切病因尚不清楚，但它被认为是一种过敏性反应，可能是特发性的，也可能是由各种感染、吸入性暴露和药物引起的(1)。在这里，我们报告了一例罕见的AEP继发于注射纳曲酮的病例。病例介绍一名45岁白人男性，有酒精使用障碍史，因3天的呼吸困难和干咳进行性加重史而被送往急诊室。患者终生不吸烟，除酗酒和肥胖(BMI 41.64 kg/m²)外，既往无明显病史。他否认有发热或发冷、直喘气、胸痛或提示阵发性夜间呼吸困难的症状。他还否认最近有任何患病接触，包括接触COVID-19。相关历史…

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