Management of an infant with epidermolysis bullosa on invasive mechanical ventilation

ABSTRACT Objective: To describe, for the first time in the pediatric population, the use of an effective technique to mobilize secretion in a patient whose disease imposes many care limitations. Case description: 2-year-old infant with Epidermolysis Bullosa, dependent on mechanical ventilation after cardiorespiratory arrest. Infant evolved with atelectasis in the right upper lobe with restriction to all manual secretion mobilization techniques due to the risk of worsening skin lesions. We opted for tracheal aspiration in a closed system combined with expiratory pause, a technique only described in adult patients so far. Comments: This case report is the first to use this technique in a pediatric patient. The use of expiratory pause combined with tracheal aspiration not only optimized the mobilization of secretion, but it was also a safe tool for reversing atelectasis. Our case report brings an important result because it increases the possibilities of managing pediatric patients admitted to intensive care units, especially in situations of absolute contraindication for chest maneuvers.

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Relationship between availability of physiotherapy services and ICU costs

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562017000000196 ◽

2018 ◽

Vol 44 (3) ◽

pp. 184-189 ◽

Cited By ~ 4

Author(s):

Bruna Peruzzo Rotta ◽

Janete Maria da Silva ◽

Carolina Fu ◽

Juliana Barbosa Goulardins ◽

Ruy de Camargo Pires-Neto ◽

...

Keyword(s):

Mechanical Ventilation ◽

Length Of Stay ◽

Invasive Mechanical Ventilation ◽

Severity Of Illness ◽

Apache Ii Score ◽

Health Evaluation ◽

Icu Length Of Stay ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital ◽

First Time

ABSTRACT Objective: To determine whether 24-h availability of physiotherapy services decreases ICU costs in comparison with the standard 12 h/day availability among patients admitted to the ICU for the first time. Methods: This was an observational prevalence study involving 815 patients ≥ 18 years of age who had been on invasive mechanical ventilation (IMV) for ≥ 24 h and were discharged from an ICU to a ward at a tertiary teaching hospital in Brazil. The patients were divided into two groups according to h/day availability of physiotherapy services in the ICU: 24 h (PT-24; n = 332); and 12 h (PT-12; n = 483). The data collected included the reasons for hospital and ICU admissions; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; IMV duration, ICU length of stay (ICU-LOS); and Omega score. Results: The severity of illness was similar in both groups. Round-the-clock availability of physiotherapy services was associated with shorter IMV durations and ICU-LOS, as well as with lower total, medical, and staff costs, in comparison with the standard 12 h/day availability. Conclusions: In the population studied, total costs and staff costs were lower in the PT-24 group than in the PT-12 group. The h/day availability of physiotherapy services was found to be a significant predictor of ICU costs.

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Apicotomy as Treatment for Failure of Orthodontic Traction

Case Reports in Dentistry ◽

10.1155/2013/168232 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Leandro Berni Osório ◽

Vilmar Antonio Ferrazzo ◽

Geraldo Serpa ◽

Kívia Linhares Ferrazzo

Keyword(s):

Case Report ◽

Maxillary Sinus ◽

Dentigerous Cyst ◽

Dental Arch ◽

Effective Technique ◽

Presumptive Diagnosis ◽

Tooth Position ◽

Sinus Infection ◽

Vitality Test ◽

The Right

Objective.The purpose of this study was to present a case report that demonstrated primary failure in a tooth traction that was subsequently treated with apicotomy technique.Case Report.A 10-year-old girl had an impacted upper right canine with increased pericoronal space, which was apparent on a radiographic image. The right maxillary sinus showed an opacity suggesting sinusitis. The presumptive diagnosis was dentigerous cyst associated with maxillary sinus infection. The plan for treatment included treatment of the sinus infection and cystic lesion and orthodontic traction of the canine after surgical exposure and bonding of an orthodontic appliance. The surgical procedure, canine position, root dilaceration, and probably apical ankylosis acted in the primary failure of the orthodontic traction. Surgical apical cut of the displaced teeth was performed, and tooth position in the dental arch was possible, with a positive response to the pulp vitality test.Conclusion.Apicotomy is an effective technique to treat severe canine displacement and primary orthodontic traction failure of palatally displaced canines.

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Case Report of Necrotizing Fasciitis Associated withStreptococcus pneumoniae

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2016/6872739 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Lei Jiao ◽

Zain Chagla ◽

Reham Mohammedsaeed Kaki ◽

Gabriela Gohla ◽

Marek Smieja

Keyword(s):

Case Report ◽

Streptococcus Pneumoniae ◽

Necrotizing Fasciitis ◽

Neutrophil Infiltration ◽

Skin Lesions ◽

Blood Samples ◽

Surgical Exploration ◽

Lower Back ◽

Life Threatening ◽

The Right

Necrotizing fasciitis, caused byStreptococcus pneumoniae, is an extremely rare and life-threatening bacterial soft tissue infection. We report a case of early necrotizing fasciitis associated withStreptococcus pneumoniaeinfection in a 26-year-old man who was immunocompromised with mixed connective tissue disease. The patient presented with acute, painful, erythematous, and edematous skin lesions of his right lower back, which rapidly progressed to the right knee. The patient underwent surgical exploration, and a diagnosis of necrotizing fasciitis was confirmed by pathological evidence of necrosis of the fascia and neutrophil infiltration in tissue biopsies. Cultures of fascial tissue biopsies and blood samples were positive forStreptococcus pneumoniae. To our knowledge, this is the first report of necrotizing fasciitis resulting fromStreptococcus pneumoniaediagnosed at early phase; the patient recovered well without surgical debridement.

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Negative Pressure Pulmonary Edema and APRV Mode in Invasive Mechanical Ventilation: A Case Report

Respiratory Case Reports ◽

10.5505/respircase.2020.04557 ◽

2020 ◽

Vol 9 (2) ◽

pp. 91-95

Author(s):

Esra Aktiz Bıçak ◽

Zeki Korhan ◽

Mustafa Bıçak ◽

Osman Uzundere ◽

Cem Kıvılcım Kaçar ◽

...

Keyword(s):

Mechanical Ventilation ◽

Case Report ◽

Pulmonary Edema ◽

Negative Pressure ◽

Invasive Mechanical Ventilation ◽

Negative Pressure Pulmonary Edema

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Huge peripapillary staphyloma with craniofacial clefts: A case report

European Journal of Ophthalmology ◽

10.1177/1120672120946292 ◽

2020 ◽

pp. 112067212094629

Author(s):

Fei Yu ◽

Yao Fu

Keyword(s):

Case Report ◽

Deep Excavation ◽

Resonance Imaging ◽

Large Defect ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

First Time ◽

Left Eyelid ◽

Peripapillary Staphyloma

Purpose: We reported the occurrence of a congenital unilateral huge peripapillary staphyloma in association with craniofacial clefts for the first time. Case report: A 1-year-old boy presented with a large defect on his left eyelid, a wide oblique columella nasi and an atypical wedge-shaped extension of the unilateral anterior hairline. Magnetic resonance imaging (MRI) examinations revealed there were cracks on his nasal septum, palate, and superior alveolar midline. Moreover, we surprisingly uncovered a gourd-shaped eyeball with the compressed optic nerve on the right side, while the right eye seemed normal from appearance. Under anaesthesia, fundus examination of the right eye showed a 15 mm-deep excavation surrounding the optic disc with defective choroid and dysplastic optic papilla. We reconstructed the left eyelid of the patient to protect his cornea and would make other solutions according to the results of follow-up. Conclusion: Peripapillary staphyloma and craniofacial clefts are two dissimilar rare congenital anomalies. In this patient, we firstly observed the co-existence of the two defects, which may provide the experience to the diagnosis and treatment of peripapillary staphyloma and craniofacial clefts. This case also gives us the pathogenic inspiration for further studies of peripapillary staphyloma and craniofacial clefts.

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Flexible bronchoscopy and mechanical ventilation in managing Mounier-Kuhn syndrome: a case report

Sao Paulo Medical Journal ◽

10.1590/1516-3180.20160336270117 ◽

2017 ◽

Vol 136 (3) ◽

pp. 266-269

Author(s):

Aslihan Gürün Kaya ◽

Aydin Çiledağ ◽

Çetin Atasoy ◽

Demet Karnak

Keyword(s):

Mechanical Ventilation ◽

Case Report ◽

Invasive Mechanical Ventilation ◽

Respiratory Acidosis ◽

Flexible Bronchoscopy ◽

Positive Pressure ◽

Laboratory Findings ◽

Non Invasive ◽

Arterial Blood ◽

Congenital Condition

ABSTRACT CONTEXT: Mounier-Kuhn syndrome is a rare congenital condition with distinct dilatation and diverticulation of the tracheal wall. The symptoms may vary and the treatment usually consists of support. CASE REPORT: The patient was a 60-year-old male with recurrent hospital admission. He was admitted in this case due to dyspnea, cough and sputum production. An arterial blood sample revealed decompensated respiratory acidosis with moderate hypoxemia. A chest computed tomography (CT) scan showed dilatation of the trachea and bronchi, tracheal diverticula and bronchiectasis. Flexible bronchoscopy was performed, which revealed enlarged airways with expiratory collapse. Furthermore, orifices of tracheal diverticulosis were also detected. Non-invasive positive pressure ventilation (NPPV) was added, along with long-term oxygen therapy. At control visits, the patient’s clinical and laboratory findings were found to have improved. CONCLUSION: Flexible bronchoscopy can be advocated for establishing the diagnosis and non-invasive mechanical ventilation can be used with a high success rate, for clinical wellbeing in Mounier-Kuhn syndrome.

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Utility of Endobronchial Valves in a Patient with Bronchopleural Fistula in the Setting of COVID-19 Infection: A Case Report and Brief Review

Southwest Journal of Pulmonary and Critical Care ◽

10.13175/swjpcc046-21 ◽

2021 ◽

Vol 23 (4) ◽

pp. 109-114

Author(s):

Nazanin Sheikhan ◽

◽

Elizabeth Benge ◽

Amanpreet Kaur ◽

Jerome Hruska ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Case Report ◽

Distress Syndrome ◽

Bronchopleural Fistula ◽

Invasive Mechanical Ventilation ◽

Air Leak ◽

Mechanically Ventilated ◽

Growing Body ◽

Endobronchial Valve

Patients with COVID-19 pneumonia frequently develop acute respiratory distress syndrome (ARDS), and in severe cases, require invasive mechanical ventilation. One complication that can develop in patients with ARDS who are mechanically ventilated is a bronchopleural fistula (BPF). Although rare, the frequency of BPF in patients with COVID-19 pneumonia is increasingly recognized. Here, we present a 48-year old man with BPF associated with COVID-19 pneumonia. Treatment with a commercial endobronchial valve (EBV) system resulted in reduced air leak allowing for tracheostomy placement. Our case adds to a growing body of evidence suggesting that the presence of COVID-19 pneumonia does not hinder the utility of EBV’s in the treatment of BPF’s.

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Differentiating stroke, transient ischemic attack, or hemiplegic migraine in a teenager: a case report

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0015.0631 ◽

2021 ◽

Vol 15 (2) ◽

pp. 1-5

Author(s):

Monika Ciechanowska ◽

Jan Stachurski

Keyword(s):

Emergency Department ◽

Case Report ◽

Transient Ischemic Attack ◽

Pediatric Population ◽

Young Patients ◽

Diagnostic Process ◽

First Episode ◽

Hemiplegic Migraine ◽

Ischemic Attack ◽

The Right

Background: The symptoms of stroke in the pediatric population are less evaluated than in adults. Although certain indicators are characteristic of stroke – acute drooping of the mouth corners, hemiparesis, and headache – they are not pathognomonic. Other diseases may manifest with similar symptoms, such as the first episode of hemiplegic migraine, and should be differentiated from stroke at an emergency department. Aim of the study: We present the differential diagnosis between stroke, transient ischemic attack, and first episode of hemiplegic migraine in a teenager with alarming focal symptoms. Case report: We present a case of 15-year-old patient with acute headache, drooping of the right mouth corners, and hemiparesis of the right upper and lower limb. He was brought by ambulance to the emergency department under suspicion of a stroke. A series of diagnostic tests performed at the Emergency Department did not reveal any vascular incident. Further diagnosis was performed at the Neurology Department. The patient was discharged from the hospital with a suspicion of first attack of hemiplegic migraine or transient ischemic attack. Conclusions: Differentiating stroke from other conditions in young patients is a significant challenge. The stroke diagnostic process in children requires further research to support accurate diagnosis and, if necessary, treatment as rapidly as possible.

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Diffuse Cutaneous Mastocytosis in a Child - a Case Report

Serbian Journal of Dermatology and Venerology ◽

10.1515/sjdv-2017-0013 ◽

2017 ◽

Vol 9 (3) ◽

pp. 124-128

Author(s):

Svetlana Popadić ◽

Mirjana Gajić-Veljić ◽

Biljana Marenović ◽

Miloš Nikolić

Keyword(s):

Case Report ◽

Systemic Mastocytosis ◽

Pediatric Population ◽

Skin Lesions ◽

Clinical Findings ◽

Topical Steroids ◽

Systemic Involvement ◽

Clonal Proliferation ◽

Cutaneous Mastocytosis

Abstract Mastocytosis refers to a group of diseases characterized by a clonal proliferation and accumulation of mast cells in one or more tissues/organs with different clinical presentations. In children, limited cutaneous forms of mastocytosis are rather frequent, while systemic mastocytosis is rare. The diagnosis of cutaneous mastocytosis is based on clinical findings and histopathology. We present a patient who developed skin lesions at the age of 18 months. Clinical findings, confirmed by histopathology, were consistent with diffuse cutaneous mastocytosis. The follow-up period was 7 years. The treatment included oral antihistamines in combination with mast cell stabilizers, mild topical steroids and avoidance of friction. During the follow-up period, there were no signs of systemic involvement, and the quality of life was preserved, despite the large surface of affected skin. This case report should increase the awareness and knowledge of clinicians about this rare form of cutaneous mastocytosis in the pediatric population.

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Intravenous Administration of Umbilical Cord Mesenchymal Stromal Cells in Advanced-stage Critical COVID-19: a Case Report

10.21203/rs.3.rs-132721/v1 ◽

2020 ◽

Author(s):

Katia Nunes Silva ◽

Priscila Pinheiro ◽

Andre Gobatto ◽

Rogerio Passos ◽

Bruno Paredes ◽

...

Keyword(s):

Mechanical Ventilation ◽

Case Report ◽

Umbilical Cord ◽

Mesenchymal Stromal Cells ◽

Stromal Cells ◽

Prolonged Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Disease Patient ◽

Human Umbilical Cord ◽

Advanced Stage

Abstract Background: Coronavirus disease 2019 (COVID-19) associated- severe acute respiratory distress syndrome (ARDS) patients may require prolonged mechanical ventilation, thus resulting in lung fibrosis and high fatality rates. Several therapies have been developed in patients with pneumonia requiring oxygen therapy as well as during the early course of invasive mechanical ventilation. Mesenchymal stromal cells (MSCs) may have a role in controlling the hyperinflammatory response seen in such cases and prevent aggravation or increase/accelerate recovery. While MSC-based therapies have been studied mostly in patients that did not require invasive ventilation or during the first hours of tracheal intubation, to date the potential of MSC therapy to treat advanced-stage of severe/critical COVID-19 cases has not been extensively studied. Methods: This is a case report of a 30-year-old male patient who presented progressive clinical deterioration of COVID-19 in ICU after 21-day admission and 14 days with invasive mechanical ventilation. The first symptom onset was 35 days before MSC therapy. The patient was treated with allogenic human umbilical cord-derived MSCs [5 x 107 (2 doses 2 days interval)].Results: No serious adverse events attributed to MSC administration were observed during and after the procedure. Oxygenation (PaO2/FiO2 ratio) and the need for vasoactive drugs improved. Chest CT scan imaging, which showed signs of bilateral and peripheral ground-glass, consolidation as well as fibrosis, improved significantly during the time course of the disease. Patient was discharged 13 days after cell therapy. Cytokine analysis demonstrated modulation of different mediators accompanied by modulation of different cell populations in peripheral blood, including a reduction in inflammatory monocytes, increased frequency of patrolling monocytes, CD4+ lymphocytes and type 2 classical dendritic cells (cDC2). Conclusion: This study described for the first time the effects of MSC therapy in a patient at late stage COVID-19 associated severe lung injury and fibrosis. Therefore, further clinical trials should be design assessing the efficacy of MSC therapy in ARDS patients undergoing prolonged mechanical ventilation due to COVID-19.

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