BACKGROUND:Obstructive sleep apnea is common, but its long-term association with site-specific cancers remains unclear. In this study, we examined 15-year risks of site-specific cancers in people with obstructive sleep apnea compared with the general population and to people with overweight or obesity. METHODS:We conducted a nationwide population-based cohort study using Danish registries, 1995-2021. People diagnosed with obstructive sleep apnea were compared with the general population and to people with overweight or obesity. Adjusted (weighted) 15-year risks, risk differences, and risk ratios (RRs) were estimated using the Aalen-Johansen estimator. Confounding was addressed using standardized morbidity ratio weighting. RESULTS:The study included 114,264 people with obstructive sleep apnea, 115,497 members of the general population, and 113,034 with overweight or obesity. After weighting, the distributions of sex (74% male), age (median 53 years), and comorbidities were comparable across the three cohorts. Obstructive sleep apnea was associated with an increased risk of cancers of the brain (adjusted 15-year risk: 5.78 vs. 3.61 per 1,000 persons; aRR 1.60 [95% CI 1.43-1.78]) and spinal cord (1.65 vs. 1.17 per 1,000 persons; aRR 1.41 [95% CI 1.16-1.72]) compared with the general population. Associations persisted when the obstructive sleep apnea cohort was compared with those with overweight or obesity. No associations were observed for other site-specific cancers. CONCLUSION:Obstructive sleep apnea was associated with an increased risk of brain and spinal cord cancers. These findings highlight the importance of effective prevention of obstructive sleep apnea and the need for further research on treatment.
Delirium is highly prevalent, harmful and often lethal. Missed or delayed diagnosis of delirium occurs with extreme frequency, particularly in the hypoactive variant, and worsens outcome still further. The absence of effective pharmacotherapy further exacerbates adverse outcomes. Several means to improve recognition of this condition at bedside are delineated, including two little-known but valuable signs, namely picking at the bedclothes (carphology) and at the air (floccillation).
BACKGROUND:The impact of pneumonia on pulmonary hemodynamics may be underestimated by available risk scores, such as CURB-65 and the Pneumonia Severity Index (PSI). We evaluated the prognostic utility of pulmonary artery diameter (PAD) in pneumonia. METHODS:We retrospectively screened 1,887 CT pulmonary angiography scans. Pneumonia was defined as a pulmonary infiltrate accompanied by clinical or laboratory evidence of infection. Patients' characteristics and outcomes were extracted from medical records. PAD was measured using three methods (PAD1-3) and tested for association with mortality. RESULTS:A total of 243 pneumonia cases were included. PAD1-3 showed strong inter-method agreement (ICC=0.88, P<0.0001). PAD1 showed the most consistent association with mortality and was widely applicable. PAD1 was larger in non-survivors at 30 days (29.6 vs. 26.4 mm, P=0.0003), 90 days (28.5 vs. 26.4 mm, P=0.002), and one year (28.0 vs. 26.4 mm, P=0.01). Thirty-day mortality increased stepwise across PAD1 tertiles (3.8%, 13.9%, and 22.8%, P=0.001), as did 90-day and one-year mortality. PAD1 was an independent predictor of 30-day mortality (HR 1.11 per mm, 95% CI 1.02-1.22, P = 0.02). PAD1, CURB-65, and PSI showed comparable performance in predicting 30-day mortality (ROC-AUC=0.70-0.73). CONCLUSIONS:PAD is independently associated with mortality in pneumonia and demonstrates comparable predictive performance to CURB-65 and PSI for 30-day mortality. These findings support incorporating vascular imaging markers into risk stratification scores.
BACKGROUND:The safety of performing thoracentesis without interrupting direct oral anticoagulant (DOAC) therapy remains unknown. This study evaluated the safety of ultrasound-guided thoracentesis during uninterrupted DOAC treatment. METHODS:In this single-center, retrospective cohort study, adult patients undergoing ultrasound-guided thoracentesis while receiving therapeutic-dose DOACs between 2019 and 2025 were evaluated. Thoracentesis was performed 2-24 hours after the last DOAC dose (or within 48 hours for patients with eGFR <60 mL/min/1.73 m²). The primary endpoint was International Society on Thrombosis and Haemostasis (ISTH)-defined major bleeding attributed to the procedure. RESULTS:Overall, 137 patients were included (mean age 85.1 ± 9.2 years; 74% with eGFR <60 mL/min/1.73 m²). Apixaban was the predominant DOAC (88%). The median time from the last DOAC dose to thoracentesis was 13 hours. No major post-procedural bleeding, puncture-site hematomas, or clinically significant hemoglobin drops (>2 g/dL) occurred. Non-hemorrhagic complications included pneumothorax in 9 patients (7%). There was no procedure-related mortality. CONCLUSIONS:Ultrasound-guided thoracentesis during uninterrupted DOAC therapy was not associated with major bleeding, even in elderly patients with impaired renal function. These findings suggest routine DOAC interruption before thoracentesis may be unnecessary.
BACKGROUND:Electrocardiographic (ECG) limb-lead reversals are common and can simulate myocardial infarction, ischemia, and axis deviation, yet they can be challenging to recognize. METHODS:All incoming first year cardiology fellows (n=6) at a single academic medical center were first assessed at baseline for their ability to identify limb-lead reversal patterns on 12-lead ECGs. The fellows were then taught a mnemonic "Blips and Flips" which was used to organize the six limb-lead reversal patterns into two visually intuitive categories. Blips represents low-amplitude patterns from bilateral arm-leg, RA-RL, and LA-RL reversals, while Flips represents inverted-lead patterns from LA-RA, RA-LL, and LA-LL reversals and the clockwise and counter-clockwise limb-cable rotations. Reminders using interactive and humorous repetition were administered two times per month for six months. RESULTS:At baseline, 2 of the 6 fellows were able to identify the most obvious Flips sign of isolated inversion of Lead I indicating LA-RA reversal. None were able to detect the more nuanced Blips patterns or other Flips with Lead III inversion LA-LL reversal. After six months, all fellows could consistently identify all forms of Blips with remaining difficulty in lead III inversion (Flips) being occasionally called "ischemia" incorrectly. CONCLUSIONS:This humor-integrated memorable mnemonic for a challenging concept helped to reduce trainee anxiety and improve long-term retention and accurate recall. This framework of limb-lead reversal can be extended to anyone who reads ECGs to improve diagnostic accuracy in ECG pattern recognition.
