scholarly journals Bronchoscopy in COVID19 ARDS patients on mechanical ventilation – a prospective study

2021 ◽  
Author(s):  
Ravindra Mehta ◽  
Sameer Bansal ◽  
Ashwin Kumar ◽  
Anmol Thorbole ◽  
L Chakravarthi ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Laboratory Findings ◽  
Pneumocystis Jiroveci ◽  
Mechanically Ventilated ◽  
Aerosol Generation ◽  
Culture Positivity ◽  
Co Morbidity ◽  
A Prospective Study ◽  
Viral Inclusions ◽  
Bacterial Superinfection

AbstractBackgroundBronchoscopy has been done sparingly in COVID19 patients due to the risk of aerosol generation, with few reports describing its clinical utility. We describe a study on bronchoscopy in mechanically ventilated (MV) COVID-19 patients outlining the procedural, clinical, utilitarian and safety aspects.MethodsBedside bronchoscopy was performed in suspected or confirmed COVID-19 cases on MV; only positive cases were included in the study. Demographic, clinical, bronchoscopic and laboratory findings were noted and analysed.Results98 procedures were performed on 61 patients, mean age of 62.1 years, 51 (83.6%) males. 42 patients (69%) had at least 1 co-morbidity. Major indications for bronchoscopy were new radiographic infiltrates with clinical deterioration, increased endotracheal tube (ETT) secretions and haemorrhagic secretions/hemoptysis. Common findings were copious secretions in 87 (88.8%), purulent in 61%, mucoid in 18%, haemorrhagic in 7% and frothy in 14% cases. Morphologically, hyperaemic airways were seen in 85 (86.7%) cases, ranging from mild (61%) to moderate-severe (39%). On the management front, antibiotics were changed in 31 (31.6%) cases based on bronchoscopic findings. Other significant changes included reduction or stopping of steroids and anticoagulation, fluid, and diuretic adjustment and ETT repositioning. The incidence of bacterial superinfection was also high (54% culture positivity for various bacteria), a significant number (94%) with multi-drug resistant organisms. Fungi were seen in 7 cases (7.1%). Pneumocystis jiroveci was not seen and cytology did not show any viral inclusions. Therapeutic mucus plug removal was done in 30 cases (30.6%), and hemoptysis control in 4% cases. The procedures were safe with no complications, and none of the HCW developed any COVID19 infection.ConclusionBronchoscopy in critically ill MV COVID-19 patients contributes on both diagnostic and therapeutic fronts and can significantly influence management decisions. With adequate precautions and standard protocols, it is safe for both HCW and patients.

scholarly journals Standardized grey scale ultrasonography in Graves' disease: correlation to autoimmune activity

1999 ◽  
pp. 332-336 ◽  
Author(s):  
U Schiemann ◽  
R Gellner ◽  
B Riemann ◽  
G Schierbaum ◽  
J Menzel ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Antithyroid Drug ◽  
Thyroid Volume ◽  
Control Group ◽  
Graves Disease ◽  
Laboratory Findings ◽  
Grey Scale ◽  
Antithyroid Drug Treatment ◽  
Student’S T ◽  
A Prospective Study

OBJECTIVE: Graves' disease leads to thyroid enlargement and to reduction of tissue echogenicity. Our purpose was to correlate grey scale ultrasonography of the thyroid gland with clinical and laboratory findings in patients with Graves' disease. DESIGN: Fifty-three patients with Graves'disease were included in our study, 100 euthyroid volunteers served as control group. Free thyroxine (FT(4)), TSH and TRAb (TSH receptor antibodies) values were measured and correlated with sonographic echogenicity of the thyroid gland. METHODS: All patients and control persons underwent ultrasonographical histogram analyses under standardized conditions. Mean densities of the thyroid tissues were determined in grey scales (GWE). RESULTS: Compared with controls with homogeneous thyroid lobes of normal size (25.6 +/- 2.0GWE, mean +/- S.D.) echogenicity in patients with Graves' disease was significantly lower (21.3 +/- 3. 3GWE, mean +/- S.D., P < 0.0001). Among the patients with Graves' disease significant differences of thyroid echo levels were revealed for patients with suppressed (20.4 +/- 3.1 GWE, mean +/- S.D., n=34) and normalized TSH values (22.5 +/- 3.6GWE, mean +/- S.D., n=19, P < 0.02). Significantly lower echogenicities were also measured in cases of persistent elevated TRAb levels (19.9 +/- 2.9GWE, mean +/- S.D., n=31) in comparison with normal TRAb levels (22.9 +/- 3.5 GWE, mean +/- S.D., n=22, P < 0.0015). No correlation could be verified between echogenicity and either still elevated or already normalized FT(4) values or the thyroid volume. In coincidence of hyperthyroidism and Graves' ophthalmopathy (19.7 +/- 3.5GWE, mean +/- S.D., n=23) significantly lower echogenicity was measured than in the absence of ophthalmological symptoms (22.3 +/- 3.3GWE, mean +/- S.D., n=30, P < 0.016). Patients needing active antithyroid drug treatment revealed significantly lower thyroid echogenicity (20.3 +/- 3.1 GWE, mean +/- S.D., n=40) than patients in remission (23.7 +/- 3.4 GWE, mean +/- S.D., n=13, P < 0.001). Statistical evaluation was carried out using Student's t-test. CONCLUSIONS: Standardized grey scale histogram analysis allows for supplementary judgements of thyroid function and degree of autoimmune activity in Graves' disease. Whether these values help to estimate the risk of recurrence of hyperthyroidism after withdrawal of antithyroid medication should be evaluated in a prospective study.

A prospective study of the clinical utility of ApoE genotype in the prediction of outcome in patients with memory impairment

Neurology ◽  
1996 ◽  
Vol 46 (1) ◽  
pp. 149-154 ◽  
Author(s):  
M. C. Tierney ◽  
J. P. Szalai ◽  
W. G. Snow ◽  
R. H. Fisher ◽  
T. Tsuda ◽  
...  
Keyword(s):  
Prospective Study ◽  
Memory Impairment ◽  
Clinical Utility ◽  
Apoe Genotype ◽  
Prediction Of Outcome ◽  
A Prospective Study ◽  
With Memory

Predictive Value of Early Continuous Electroencephalogram Monitoring in Ventilated Preterm Infants With Intraventricular Hemorrhage

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 337-343
Author(s):  
J. Connell ◽  
L. de Vries ◽  
R. Oozeer ◽  
R. Regev ◽  
L. M.S. Dubowitz ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Eeg Monitoring ◽  
Mechanically Ventilated ◽  
Functional Correlation ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
A Prospective Study ◽  
Ultrasound Evidence ◽  
Significant Data

The contribution of early continuous fourchannel EEG monitoring to the evaluation of intraventricular hemorrhage in acutely ill preterm infants mechanically ventilated for acute respiratory distress was assessed in a prospective study of 54 infants of less than 34 weeks' gestation. Early abnormal EEG results correlated significantly with later outcome. They often preceded ultrasound evidence of hemorrhage and provided prognostically significant functional correlation with the grade of hemorrhage. Continuous EEG monitoring allows collection of significant data with minimal interference and could contribute to clinical management of high-risk preterm infants.

Impact of obesity in mechanically ventilated patients: a prospective study

2008 ◽  
Vol 34 (11) ◽  
pp. 1991-1998 ◽  
Author(s):  
Jean-Pierre Frat ◽  
◽  
Valérie Gissot ◽  
Stéphanie Ragot ◽  
Arnaud Desachy ◽  
...  
Keyword(s):  
Prospective Study ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
A Prospective Study ◽  
Ventilated Patients

Extramedullary myeloma in ectopic parathyroid adenoma: a case report

2020 ◽  
pp. 1-10
Author(s):  
Nagehan Ozdemir Barisik ◽  
Ozge Hande Gunes ◽  
Guven Yilmaz ◽  
Sevinc Hallac Keser ◽  
Aylin Ege Gul ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Parathyroid Adenoma ◽  
Plasma Cells ◽  
Rare Condition ◽  
Mass Effect ◽  
Laboratory Findings ◽  
Ectopic Parathyroid Adenoma ◽  
Co Morbidity ◽  
Ectopic Parathyroid

Abstract Extramedullary myeloma, a subgroup of multiple myeloma, is a rare condition characterised by extra-skeletal infiltration of clonal plasma cells. Although parathyroid adenoma’s co-morbidity with multiple myeloma is common, extramedullary myeloma, an ectopic parathyroid adenoma has not been reported in the literature. This is the first study in literature that presents extramedullary myeloma that infiltrated ectopic parathyroid adenoma in the mediastinum after multiple myeloma treatment. In its course of relapse, the extramedullary myeloma created mass effect and no laboratory findings were present due to its non-secretory nature. Keywords: myeloma, metastasis, adenoma, parathyroid Continuous....

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