Predicting Health Access During Critical Public Health Crises: An Analysis of Medical Office Responses to the COVID-19 Pandemic.

Objectives: This study explores how ambulatory medical practices adapted their policies in response to the global COVID-19 crisis. Practice and provider characteristics were used to build an artificial intelligence model that predicts future medical practice closures during critical events.

Methods: We surveyed 261 outpatient medical practices and collected information on clinician age, gender, the protective measures implemented, closure status, and utilization of telemedicine services.

Gross Hematuria and Lower Urinary Tract Symptoms Associated With Military Burn Pits Exposures in US Veterans Deployed to Iraq and Afghanistan.

Objective: The aim of the study is to describe rates of hematuria and other lower urinary tract symptoms, including self-reported cancer rates, among veterans postburn pits emissions exposure during deployment to Iraq and Afghanistan.

Methods: US post-9/11 veterans with burn pits emissions exposure confirmed via DD214 forms in the Burn Pits360.org Registry were sent a modified survey.

Iraq/Afghanistan war lung injury reflects burn pits exposure.

This descriptive case series retrospectively reviewed medical records from thirty-one previously healthy, war-fighting veterans who self-reported exposure to airborne hazards while serving in Iraq and Afghanistan between 2003 and the present. They all noted new-onset dyspnea, which began during deployment or as a military contractor. Twenty-one subjects underwent non-invasive pulmonary diagnostic testing, including maximum expiratory pressure (MEP) and impulse oscillometry (IOS).

Plausible Role of Asthma Biological Modifiers in the Treatment of Eosinophilic Esophagitis.

Eosinophilic esophagitis (EoE) is a T-helper type-2 (Th2/T2) cell-mediated disease characterized by 15 or more eosinophils per high-powered esophageal biopsy microscopy field (eos/hpf), excluding other causes. EoE is often clinically characterized by symptoms such as dysphagia, nausea, food impaction, and chest pain that do not respond to antacids. Two-thirds of patients are unresponsive to proton pump inhibitors (PPIs).

Clinical use of the abiomed BVS 5000 as a pulsatile extracorporeal membrane oxygenation unit.

The traditional extracorporeal membrane oxygenation circuit uses a centrifugal pump. These pumps require close monitoring and are subject to complications. In addition, they do not take advantage of the potential benefits of pulsatile flow.

Pulmonary embolism after insertion of a Greenfield filter.

This report describes a case in which a patient had a Greenfield filter placed at the time of diagnosis of deep vein thrombosis (DVT) when he was asymptomatic for pulmonary embolism. Later in the patient's hospital course, a typical clincal picture of pulmonary embolism developed. The issues examined in this report include: (1) the incidence of asymptomatic pulmonary embolism; (2) the value of the baseline ventilation perfusion (VQ) lung scan for the diagnosis of DVT; and (3) the value of an echocardiogram in diagnosing pulmonary embolism.

Proximal diabetic neuropathy presenting with respiratory weakness.

A patient is described with proximal diabetic neuropathy presenting with respiratory weakness. A 50 year old man developed progressive shortness of breath over 2 months. He also had weakness of hip flexion.

Coronary artery bypass grafting in patients with COPD.

Objective: To more fully define the influence of COPD in patients undergoing coronary artery bypass grafting (CABG).

Methods: One hundred ninety-one patients with COPD underwent CABG from March 1, 1995, to June 21, 1996. There were 129 male and 62 female patients.

Superior vena cava syndrome caused by a benign retrosternal multinodular goiter.

Retrosternal thyroid accounts for a significant percentage of anterior mediastinal masses, but has been described very rarely as the cause of superior vena cava (SVC) syndrome. Most cases of SVC syndrome occur as a complication of malignancy. The authors report the case of a patient with few respiratory symptoms, mild upper airway obstruction, and SVC syndrome caused by a benign retrosternal multinodular goiter.

Chylothorax: the result of previous radiation therapy?

A patient with a remote history of Hodgkin's lymphoma was seen with recurring bilateral pleural effusions, finally diagnosed as chylothorax after many thoracenteses. The patient also had a previous history consistent with chylous ascites. The only plausible etiology of the chylous effusions (and ascites) was previous radiation therapy to the chest and abdomen.

Pneumothorax complicating small-bore feeding tube placement.

Small-bore Silastic feeding tubes are being used with increasing frequency for short- and long-term enteral hyperalimentation. We present three cases where these flexible tubes were passed into the tracheobronchial tree and then out into the pleural space. The result in each case was a pneumothorax or hydropneumothorax.

Pulmonary infiltrates associated with Vibrio vulnificus septicemia.

In the case described, fatal Vibrio vulnificus primary septicemia was complicated by development of diffuse pulmonary infiltrates. Clinical features of this recently discovered infectious disease are discussed. Various aspects of diagnoses of pulmonary infiltrates in patients with V vulnificus septicemia are also presented.

Reactive airway dysfunction syndrome in three police officers following a roadside chemical spill.

The reactive airway dysfunction syndrome (RADS) is a recently described syndrome in which bronchial hyperreactivity and asthmatic symptoms develop in previously healthy individuals after a single large exposure to an irritating gas, fume, or vapor. We report a cluster of three Philadelphia police officers who developed RADS after a common exposure to toxic fumes from a roadside truck accident. Results of initial pulmonary function testing were normal in all three, and methacholine challenge was required for diagnosis in two out of the three.

Cholecystopleural fistula with cholelithiasis presenting as a right pleural effusion.

At autopsy, multiple gallstones were recovered from the right pleural space of an elderly patient who presented with a massive right pleural effusion and septic shock. The mechanisms of gallstone migration and fistula formation between the gallbladder and right pleural space are described. Despite atypical presentations, gallbladder disease remains an important differential consideration of right pleural effusion in the elderly.

Mismatch between 99mTc-DTPA aerosol and 81mKr lung ventilation scintigraphy: a pitfall of radionuclide imaging.

Pulmonary ventilation and perfusion scintigraphies were performed using 99mTc-MAA, 81mKr, and 99mTc-DTPA aerosol in a patient with asthma. Lung perfusion scintigraphy and 99mTc-DTPA aerosol scintigraphy showed multiple matching defects, however, 81mKr ventilation scintigraphy showed mismatch with lung perfusion scintigraphy. A pitfall of this examination was discussed.

Treatment of tracheobronchial granular cell myoblastomas with endoscopic bipolar cautery.

Granular cell myoblastomas of the trachea and right upper lobe bronchus were discovered incidentally during therapeutic bronchoscopy. Because of their propensity to cause airway compromise and distal atelectasis, ablation of both lesions was undertaken. This is the first reported case of bipolar cautery of GCM through a flexible fiberoptic bronchoscope.

Angiosarcoma presenting as diffuse alveolar hemorrhage.

Angiosarcoma has been reported as occurring in both postirradiation and postradical mastectomy patients. Described is a patient, postmastectomy and irradiation, with alveolar hemorrhage secondary to angiosarcoma. Angiosarcoma, primary or metastatic to lung, should be included in the differential diagnosis of diffuse alveolar hemorrhage in this patient population.

Sarcoma of the pulmonary artery.

A patient is described in whom clinical presentation, V/Q scan, and pulmonary angiogram were consistent with pulmonary embolus. No improvement occurred despite therapy with heparin. When sent for surgical embolectomy, sarcoma of the pulmonary artery was diagnosed.