ABSTRACT
Complete lung collapse associated with sarcoidosis is exceedingly rare. Although lymphoma should be ruled out when patients with mediastinal lymphadenopathy develop lung collapse, sarcoidosis should be considered in the differential, especially when associated with fibrosing mediastinitis.
ABSTRACT
BACKGROUND: CPAP is considered to be the cornerstone of therapy for obstructive sleep apnea. However, adherence to this treatment is frequently poor, which may lead to ongoing symptoms, including daytime sleepiness and poor cognitive function. We aimed to determine the efficacy of showing patients their raw graphic polysomnography (PSG) data in increasing their CPAP adherence. METHODS: The subjects were patients with obstructive sleep apnea (n = 37, diagnosed on prior PSG), who were prospectively randomized into an experimental arm or a control arm. The patients in the experimental arm (n = 18) were shown detailed PSG data, including graphic data from PSG prior to prescription of CPAP. The patients in the control arm (n = 19) were shown the non-graphic paper report of the PSG. Adherence data, collected using CPAP devices with internal microprocessors (adherence cards), was read at 4 weeks after treatment initiation. RESULTS: There was no difference in age (57.3 ± 11.8 y vs 55.5 ± 11.6 y, P = .64), body mass index (BMI) (32.7 ± 6.3 kg/m(2) vs 32.3 ± 6.6 kg/m(2), P = .85), and apnea-hypopnea index (36.0 ± 27.8 events/h vs 30.5 ± 19.1 events/h, P = .48) between the experimental and control arms. There was no difference in percent of days CPAP was used (58% vs 64%, P = .59) and average number of hours each night CPAP was used (3.9 ± 2.1 h vs 4.1 ± 2.5 h, P = .76) between the experimental and control arms, respectively. In multi logistic regression models, which included age, BMI > 30 kg/m(2), apnea-hypopnea index, and experimental intervention, only BMI was found to increase likelihood of improved adherence (odds ratio = 13.3, P = .007). CONCLUSIONS: Showing patients raw graphic PSG data does not seem to improve adherence to CPAP. BMI is a very strong predictor of CPAP adherence.
Subject(s)
Computer Graphics , Continuous Positive Airway Pressure , Feedback, Sensory , Patient Compliance , Polysomnography , Sleep Apnea, Obstructive/therapy , Aged , Audiovisual Aids , Female , Humans , Male , Middle Aged , Prospective Studies , Sleep Apnea, Obstructive/psychology , Treatment OutcomeABSTRACT
We report a case of pulmonary strongyloidiasis in a patient with large granular lymphocytosis. He was on short-term high dose immunosuppressant therapy. A 77-year-old white male presented to the emergency room with fever and shortness of breath for 10 days. The patient had been diagnosed about 3 months prior to this presentation with "large granular lymphocytosis" (LGL) after a workup for pancytopenia. Methotrexate and prednisone had been started 1 month ago for the treatment of LGL. Five days prior to the current presentation, he had been started on moxifloxacin as an outpatient but got progressively worse and came to an emergency room. Bronchial washings (bronchoalveolar lavage) demonstrated numerous filariform larvae of Strongyloides stercoralis. The patient was treated with ivermectin and improved. Pulmonary strongyloidiasis should be considered in the differential if X-ray findings show a interstitial or alveolar pattern and if the patient has visited the endemic areas, even in the remote past.
