Invasive pulmonary aspergillosis in COVID-19. A case series at Gregorio Maranon University General Hospital

Purpose: Patients with acute respiratory distress syndrome (ARDS) due to viral infection admitted at ICU are at risk for secondary complications like invasive pulmonary aspergillosis. Our study evaluates severe ARDS due to COVID-19 associated invasive pulmonary aspergillosis at a single center in Madrid, Spain. Materials and Methods: A retrospective chart review of patients with COVID-19 associated ARDS admitted to two of the five ICUs that were available at the Gregorio Maranon University General Hospital, Madrid, Spain. Results: COVID-19 associated invasive pulmonary aspergillosis was found in 4 of 79 critically ill patients with severe ARDS. Conclusion: Patients with ARDS triggered by COVID-19 seem to be at risk of developing invasive pulmonary aspergillosis, being necessary the early diagnosis and treatment in order to improve their prognosis.

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P.138 Minimally invasive treatment of syringomyelia using tubular retractors

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.240 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S53-S53

Author(s):

K Yang ◽

M Sourour ◽

N Zagzoog ◽

K Reddy

Keyword(s):

Minimally Invasive ◽

Chart Review ◽

Case Series ◽

Retrospective Chart Review ◽

Senior Author ◽

Invasive Technique ◽

Single Center ◽

Invasive Treatment ◽

Multiple Modalities ◽

Subarachnoid Spaces

Background: Multiple modalities have been used in the treatment of syringomyelia, including direct drainage, shunting into peritoneal, pleural and subarachnoid spaces. The authors report their experience of surgical treatment of syringomyelia in a minimally invasive fashion. Methods: We conducted a single-center retrospective chart review on our syringomyelia cases treated with minimally invasively using Metrx Quadrant retractor system since January 2011. Lateral fluoroscopy was used to guide the placement of the retractor onto the lamina of the corresponding level. This was followed by laminectomy and a small durotomy. Once the syrinx cavity was identified and the proximal end of the tubing was inserted into the syrinx cavity, the tubing was tunneled into the pleural incision subcutaneously. Insertion of the pleural end of the shunt was performed under the microscope, with removal of a small amount of the rib at its upper edge. Results: 10 procedures were performed in 7 patients by the senior author. Etiologies of syringomyelia included Chiari malformation, trauma, diastematomyelia and kyphoscoliosis. All patients improved neurologically. No patients had immediate postoperative complications. One patient underwent two revisions of syringopleural shunts due to multilobulated nature of syringomyelia. Conclusions: Our case series presents a novel, minimally invasive technique for shunting of syringomyelia with results comparable to open procedures.

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COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital

Journal of Fungi ◽

10.3390/jof7100881 ◽

2021 ◽

Vol 7 (10) ◽

pp. 881

Author(s):

David Ranhel ◽

Ana Ribeiro ◽

Judite Batista ◽

Maria Pessanha ◽

Elisabete Cristovam ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Distress Syndrome ◽

Invasive Pulmonary Aspergillosis ◽

Case Series ◽

Invasive Disease ◽

Sensu Stricto ◽

Pulmonary Aspergillosis ◽

Strict Interpretation ◽

Low Threshold

Invasive pulmonary aspergillosis (IPA) has become a recognizable complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in facilitating fungal invasion in COVID-19 patients, leading to a COVID-19-associated pulmonary aspergillosis (CAPA) phenomenon. From November 2020 to 15 February 2021, 248 COVID-19 patients were admitted to our ICUs, of whom ten patients (4% incidence) were classified as either probable (six) or possible (four) CAPA cases. Seven patients had positive cultural results: Aspergillus fumigatus sensu stricto (five), A. terreus sensu stricto (one), and A. welwitschiae (one). Five patients had positive bronchoalveolar lavage (BAL) and galactomannan (GM), and two patients had both positive cultural and GM criteria. All but two patients received voriconazole. Mortality rate was 30%. Strict interpretation of classic IPA definition would have resulted in eight overlooked CAPA cases. Broader diagnostic criteria are essential in this context, even though differentiation between Aspergillus colonization and invasive disease might be more challenging. Herein, we aim to raise awareness of CAPA in view of its potential detrimental outcome, emphasizing the relevance of a low threshold for screening and early antifungal treatment in ARDS patients.

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COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series

Mycoses ◽

10.1111/myc.13254 ◽

2021 ◽

Vol 64 (4) ◽

pp. 457-464 ◽

Cited By ~ 1

Author(s):

Eelco F. J. Meijer ◽

Anton S. M. Dofferhoff ◽

Oscar Hoiting ◽

Jacques F. Meis

Keyword(s):

Case Series ◽

Single Center ◽

Pulmonary Aspergillosis ◽

Dual Case

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Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab040 ◽

2021 ◽

Author(s):

Jonathan P Scoville ◽

Evan Joyce ◽

Joshua Hunsaker ◽

Jared Reese ◽

Herschel Wilde ◽

...

Keyword(s):

Hospital Stay ◽

Chart Review ◽

Statistical Tests ◽

Case Series ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Opioid Use ◽

Pain Scores ◽

Surgical Methods ◽

Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

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Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

Journal of Anesthesia ◽

10.1007/s00540-021-02960-6 ◽

2021 ◽

Author(s):

Azzeddine Kermad ◽

Jacques Speltz ◽

Guy Danziger ◽

Thilo Mertke ◽

Robert Bals ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Retrospective Study ◽

Linear Regression ◽

Chart Review ◽

Distress Syndrome ◽

Minute Ventilation ◽

Retrospective Chart Review ◽

University Hospital ◽

High Doses ◽

End Tidal

Abstract Purpose In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). Methods Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded. Results Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h−1; p < 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour−1∙kg−1ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%; p < 0.05), as were co-sedatives (7% versus 31%, p < 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents, p < 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5]; p < 0.01). Conclusion Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.

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Penile Prosthesis Placement with Immediate Buried Penis Correction: A Retrospective Chart Review

Surgical Case Reports ◽

10.31487/j.scr.2021.02.11 ◽

2021 ◽

pp. 1-3

Author(s):

Christopher J. Salgado ◽

Genesis Navas ◽

Lalama Maria ◽

Lindsay M. Tanner ◽

...

Keyword(s):

Erectile Dysfunction ◽

Chart Review ◽

Functional Performance ◽

Case Series ◽

Penile Prosthesis ◽

Retrospective Chart Review ◽

Combined Approach ◽

Suspensory Ligament ◽

Cosmetic Appearance ◽

Buried Penis

Introduction: We present a case report on six patients who underwent a combined approach to improve the cosmetic appearance and functional performance of their buried penis. Aim: To report our combined approach to improve both buried penis and erectile dysfunction. Methods: In one surgery, we performed: a malleable penile prosthesis, ventral phalloplasty, and penile suspensory ligament release followed by a suprapubic lipectomy. Results: Postoperatively, all patients had an increase in penile length and were able to achieve successful penetrative intercourse. The average difference between the pre-operational and post-operational flaccid length of our six patients was 3.5 cm ± 1.38 (range, 1.9 to 5.08 cm). Conclusion: This case series serves as successful examples of using a combined approach in one stage to not only improve the cosmetic appearance of a buried penis but also address erectile dysfunction.

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Low-Dose Aminophylline for the Treatment of Neonatal Non-Oliguric Renal Failure—Case Series and Review of the Literature

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-13.2.80 ◽

2008 ◽

Vol 13 (2) ◽

pp. 80-87

Author(s):

Bethany A. Lynch ◽

Peter Gal ◽

J. Laurence Ransom ◽

Rita Q. Carlos ◽

Mary Ann V.T. Dimaguila ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Chart Review ◽

Low Dose ◽

Case Series ◽

Retrospective Chart Review ◽

Review Of The Literature ◽

Oliguric Renal Failure ◽

The Impact

OBJECTIVE Aminophylline is a methylxanthine with multiple physiologic actions. At low doses, aminophylline can antagonize adenosine and improve renal function via increased glomerular filtration rate. Despite its clinical use, little data exists in neonates for this indication. Therefore, the objective of this report is to describe the impact of aminophylline on renal function indices in a series of neonates with acute renal failure. MATERIALS AND METHODS This was a retrospective chart review of 13 neonates with acute renal failure who received aminophylline during a 15-month study period. Aminophylline was administered at 1 mg/kg intravenously or orally every twelve hours. Forty-six percent (n = 6) of the patients received a 5 mg/kg loading dose before initiation of maintenance therapy. Most patients had already received other treatments for renal failure, including diuretics and dopamine. RESULTS Resolution of acute renal failure (with normalization of serum creatinine and blood urea nitrogen) was documented in 10 patients (77%). Four of the thirteen patients died from complications due to their prematurity. Failure of low-dose aminophylline was observed in 3 of the 4 patients who died. CONCLUSIONS Low-dose aminophylline in neonates with acute renal failure is associated with an improvement in renal function indices.

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Risks Of Ventilator-Associated Pneumonia And Invasive Pulmonary Aspergillosis In Patients With Viral Acute Respiratory Distress Syndrome Related or Not To Coronavirus 19 Disease

10.21203/rs.3.rs-44275/v1 ◽

2020 ◽

Author(s):

Keyvan Razazi ◽

Romain ARRESTIER ◽

Anne-Fleur Haudebourg ◽

Brice Benelli ◽

Guillaume Carteaux ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Invasive Aspergillosis ◽

Distress Syndrome ◽

Invasive Pulmonary Aspergillosis ◽

Resistant Bacteria ◽

Ventilator Associated Pneumonia ◽

Retrospective Case ◽

Pulmonary Aspergillosis

Abstract Background The goal of this study was to assess risk factors of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with SARS-CoV-2 infection.Methods. We conducted a monocenter retrospective study comparing the prevalence of VAP and invasive aspergillosis between patients with COVID-19 related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS).Results. We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 hours. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS: 14 (16%) vs 38 (48%), p<0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS : 58 (64%) vs. 36 (44%), p=0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14-2.52), p<0.01].The prevalence of multi-drug resistant bacteria (MDR) related VAP was significantly higher in C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p=0.03. Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p<0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p=0.003], but there was no difference in Aspergillus colonization.Conclusions. In this retrospective case-control study, we evidenced a higher prevalence of VAP and MDR-VAP in C-ARDS than in NC-ARDS, and a lower risk for invasive aspergillosis in the former group.

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