Is it just an infection?

Is it just an infection or something more? http://ow.ly/HEcH30lSO6a.

Α 78-year-old female who presents with a non-resolving pneumonia: what is your diagnosis?

Non-resolving pneumonia with a mass-like radiological appearance raises clinical suspicion of many causes, with malignancy the most prominent. Infectious causes should be investigated thoroughly as they carry a better prognosis. http://ow.ly/QEPL30mLIk4.

Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic.

BACKGROUND: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a major cause of morbidity and mortality. Different clinical models and questionnaires have been used to evaluate patients with the highest OSAHS probability. OBJECTIVES: To evaluate the clinical utility of five different questionnaires--STOP, STOPBang (SB), Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS), and 4-Variable Screening Tool (4-V) - in a sleep clinic in order to identify patients at risk for OSAHS and to assess the best possible combination of these tools. METHODS: 1853 (74.4% males) patients (mean age 52±14 years; mean body mass index 32.8±7 kg/m2) visiting a sleep clinic were studied retrospectively. RESULTS: SB had the highest sensitivity (97.6%), the largest area under the receiver operating characteristics curve (AUC) (0.73; 95% CI, 0.7-0.76) and best OR (5.9; 95% CI, 3.6-9.5), but the lowest specificity (12.7%) for AHI > or =15. The 4-V > or = 14 had the highest specificity (74.4%) followed by ESS (67%). BQ had good sensitivity (87%), worse specificity (33%) than 4-V and ESS but better than STOP (13%) and SB (12.7%). The combination of questionnaires did not improve their predictive value. CONCLUSIONS: SB had the highest sensitivity, OR, and AUC, but rather low specificity, and 4-V the highest specificity. The combination of different questionnaires did not improve their predictive value.

The financial crisis has an impact in sleep medicine: experience of a sleep clinic in Greece.

OBJECTIVE: Greece has entered a long period of economic crisis with adverse effects in daily life. The aim of our study was to evaluate the impact of the economic crisis on the population visiting a sleep clinic between years 2008 and 2011. METHODS: Comparison of the number of patients, anthropometric data, symptoms, and treatment between 2008 (beginning of crisis) to 2011(great impact of crisis) was conducted. RESULTS: The number of patients significantly reduced in 2011(n = 127) compared with that in 2008 (n = 463) and 2009 (n = 465). The mean age, body mass index, and Epworth Sleepiness Scale did not differ between the years (52.2 ± 13.7 years, 33 ± 7.4 kg/m(2), and 11.4 ± 5.4, respectively). The main symptom of the patients was daytime sleepiness, and the symptoms that worsened in 2011 compared with 2008 were headaches (32.4 vs. 49.6 %, p < 0.001) and nightmares (44 vs. 75.9 %, p < 0.001). In 2008, 69.1 % of patients required treatment for obstructive sleep apnea syndrome with continuous positive airway pressure (CPAP), and 81.6 % of them received CPAP. In 2011, 67.7 % required treatment, but only 52.3 % received CPAP. CONCLUSIONS: The economic crisis can be reflected in the number of patients, their symptoms and their treatment options.