scholarly journals Unexpected complications of pulmonary edema

2015 ◽  
Vol 4 (3S) ◽  
pp. 25-30
Author(s):  
Laura Perazzolo ◽  
Claudio Marengo
Keyword(s):  
Pulmonary Edema ◽  
Elderly Woman ◽  
State Of The Art ◽  
Clinical Status ◽  
Decubitus Ulcer ◽  
Proper Treatment ◽  
Ed Overcrowding ◽  
Therapeutic Protocols ◽  
Poor Outcomes ◽  
Full Occupancy

The article illustrates the case report of a patient, an elderly woman, admitted in the Emergency Department (ED) with acute pulmonary edema, which was quickly solved through a well-timed application of the therapeutic protocols. At first, the course of the treatment was positive, but some complications developed because of the long stay in the hospital, specifically a decubitus ulcer; this condition quickly evolved regardless of the proper treatment, and caused a progressive fall of the general clinical status of the patient. Within the ER, some state-of-the-art clinical apparatus (protocols, unintrusive ventilation) are available for even the treatment of the worst conditions. ED overcrowding – with full occupancy of beds and long waits of patients – is related to greater risk of poor outcomes. One of the risks is to expose the patient to serious complications, that are note related to the reason of admission in hospital, but, paradoxically, are caused by the prolonged hospitalization in ED.

Abstract 3490: Perfusion Defect Is Associated With Poor Prognosis Of Lacunar Infarction.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jeong Jin Park ◽  
Na-Young Ryoo ◽  
Joung-Ho Rha ◽  
Hee-Kwon Park
Keyword(s):  
Regression Analysis ◽  
Propensity Score ◽  
Perfusion Defect ◽  
Poor Prognosis ◽  
Small Vessel Disease ◽  
Clinical Status ◽  
Current Smoker ◽  
Parent Artery ◽  
Poor Outcomes

Backgrounds: Small subcortical infarctions are caused by lipohyalinosis and also by microatheroma and microembolism. However, it remained still unknown which clinical or radiological findings could be useful for prediction of long-term prognosis. We sought to find whether perfusion images are associated with long-term poor clinical status. Methods: We reviewed 197 patients who admitted from January, 2009 to January, 2011, and who had the lacunae(≤20mm) in the perforator territory of the middle cerebral artery on diffusion-weight MRI(DWI) within 3 days of onset. T2 weighted imaging and perfusion-weighted MRI(PWI) were evaluated in all participants. We divided the patients according to the existence of perfusion defect and analyzed the association between perfusion defect and poor outcomes, defined as modified Rankin score(mRS)≥3 at 3 months Results: Among a total 197 patients(69 Men; 63.8±11.2y), 78 subjects(52 Men; 62.4±12.1y) had the perfusion defect on PWI. The subject with perfusion defect had the higher frequency of current smoker(P=0.03) and poor outcomes at 3 months (P=0.002), compared to those without. There was no difference in other risk factors, infarct size or parent artery stenosis between two groups. Multivariate binary regression analysis showed that the perfusion defect was strongly associated with poor outcomes at 3 months(P=0.002;adjusted OR 4.21; adjusted 95% CI,1.73-10.28). The propensity score regression analysis also indicated that perfusion defect could predict the poor prognosis(Propensity score adjusted OR,3.88). Conclusion: Perfusion defect of small vessel disease seems to have the influence on the recovery after lacunae. Further study may be needed to find whether the PWI can be useful for diagnosing the various etiology of lacunae.

Chronic Lymphocytic Leukemia: State of the Art and Beyond

2014 ◽  
Vol 12 (5S) ◽  
pp. 801-803
Author(s):  
John C. Byrd
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Kinase Inhibitors ◽  
State Of The Art ◽  
Lymphocytic Leukemia ◽  
Newly Diagnosed ◽  
Treatment Standard ◽  
Genetic Features ◽  
Treatment Paradigm ◽  
Genomic Studies ◽  
Poor Outcomes

In the treatment of chronic lymphocytic leukemia (CLL), select genomic studies can assist in risk stratification of newly diagnosed patients. Chemoimmunotherapy targeting CD20 offers a survival advantage in symptomatic patients both with and without these high-risk genetic features, though patients with del(17p13.1) have poor outcomes and require specific intervention. Obinutuzumab plus chlorambucil is a treatment standard for untreated elderly patients and is superior to rituximab plus chlorambucil. In the setting of relapsed CLL, the new kinase inhibitors have the potential to completely change the treatment paradigm of CLL.

scholarly journals A new look at the COVID-19 pathogenesis: the disease is a generalized viral vasculitis, and the lung tissue damage is a variant of angiogenic pulmonary edema

2020 ◽  
Author(s):  
Alexey Kubanov ◽  
Dmitriy Deryabin
Keyword(s):  
Respiratory Failure ◽  
Liquid Phase ◽  
Pulmonary Edema ◽  
Converting Enzyme ◽  
Hematogenous Spread ◽  
Pulmonary Tissue ◽  
Angiotensin Converting Enzyme 2 ◽  
Vascular Walls ◽  
Therapeutic Protocols ◽  
Lung Tissue Damage

Based on the data about angiotensin-converting enzyme 2 (ACE2) as the main receptor for SARS-CoV-2, hematogenous spread of the virus is hypothesized, followed by killing of ACE-2-expressing cells in the microvascular channels. Damage to the blood vessels (primarily arterioles) leads to the development of microtromboses and results in the exit of the blood liquid phase beyond the vascular walls, which is pathogenetically similar to the angiogenic edema development. In fact, this disorder is multi-organ in nature, and in the case of pulmonary tissue, its occur as pulmonary edema, the signs of which during CT scan precede predicts the development of respiratory failure. The hypothesized COVID-19 pathogenesis allows us to explain the causes and stages of occurrence of many symptoms of this disease. Possible changes in COVID-19 diagnostic and therapeutic protocols are discussed.

Shock and Pulmonary Edema In an Elderly Woman

1994 ◽  
Vol 29 (1) ◽  
pp. 71-72 ◽  
Author(s):  
Kirsten Vin-Christian ◽  
E. William Hancock
Keyword(s):  
Pulmonary Edema ◽  
Elderly Woman

scholarly journals P.066 Failing a dysphagia screen after acute ischemic stroke is highly predictive of poor outcomes

2016 ◽  
Vol 43 (S2) ◽  
pp. S36-S36
Author(s):  
RA Joundi ◽  
R Martino ◽  
G Saposnik ◽  
J Fang ◽  
V Giannakeas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Decubitus Ulcer ◽  
Stroke Severity ◽  
Term Care ◽  
Stroke Registry ◽  
Feeding Tubes ◽  
Multivariable Regression ◽  
Baseline Factors ◽  
Poor Outcomes

Background: Bedside dysphagia screening is recommended for all patients with acute ischemic stroke, in order to detect swallowing impairment early and prevent complications. However, limited data are available on outcomes associated with failing a dysphagia screen. Methods: We used the Ontario Stroke Registry to identify patients who were admitted to Regional Stroke Centres from 2010-2013 and received a dysphagia screen within 72 hours. We used multivariable regression to determine outcomes of patients who failed the dysphagia screen. Results: Among 5145 patients who underwent dysphagia screening, 2458 (47.8%) failed and 2687 (52.2%) passed. Patients who failed had more co-morbidities and presented with more severe strokes (mean NIHSS 11.0 vs. 5.4). Among those who failed, 9% required permanent feeding tubes, versus 0.1% among those who passed. After controlling for age, co-morbidities, and stroke severity, failing a bedside swallowing screen remained highly predictive of poor outcomes, including decubitus ulcer (adjusted odds ratio aOR 10.5), pneumonia (aOR 4.6), discharge to long-term care (aOR 4.1) and 30-day mortality (aOR 4.5; 16.6% vs. 2.2%). *All p <0.0001 Conclusions: Patients who failed a dysphagia screen on admission had dramatically worse outcomes after controlling for baseline factors. A bedside dysphagia screen provides immediate risk stratification for acute stroke patients and can be used to guide appropriate care.

scholarly journals The “Magic Bullet” is Here? Cell-Based Immunotherapies for Hematological Malignancies in the Twilight of the Chemotherapy Era

Cells ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1511
Author(s):  
Nina Miazek-Zapala ◽  
Aleksander Slusarczyk ◽  
Aleksandra Kusowska ◽  
Piotr Zapala ◽  
Matylda Kubacz ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Nk Cell ◽  
State Of The Art ◽  
Optimal Strategies ◽  
Magic Bullet ◽  
Standard Chemotherapy ◽  
Hematopoietic Stem ◽  
Graft Versus Host ◽  
Car T ◽  
Therapeutic Protocols

Despite the introduction of a plethora of different anti-neoplastic approaches including standard chemotherapy, molecularly targeted small-molecule inhibitors, monoclonal antibodies, and finally hematopoietic stem cell transplantation (HSCT), there is still a need for novel therapeutic options with the potential to cure hematological malignancies. Although nowadays HSCT already offers a curative effect, its implementation is largely limited by the age and frailty of the patient. Moreover, its efficacy in combating the malignancy with graft-versus-tumor effect frequently coexists with undesirable graft-versus-host disease (GvHD). Therefore, it seems that cell-based adoptive immunotherapies may constitute optimal strategies to be successfully incorporated into the standard therapeutic protocols. Thus, modern cell-based immunotherapy may finally represent the long‑awaited “magic bullet” against cancer. However, enhancing the safety and efficacy of this treatment regimen still presents many challenges. In this review, we summarize the up-to-date state of the art concerning the use of CAR-T cells and NK-cell-based immunotherapies in hemato-oncology, identify possible obstacles, and delineate further perspectives.

scholarly journals Does eloquence subtype influence outcome following arteriovenous malformation surgery?

2019 ◽  
Vol 131 (3) ◽  
pp. 876-883 ◽  
Author(s):  
Justin R. Mascitelli ◽  
Seungwon Yoon ◽  
Tyler S. Cole ◽  
Helen Kim ◽  
Michael T. Lawton
Keyword(s):  
Arteriovenous Malformation ◽  
Clinical Status ◽  
Venous Drainage ◽  
Motor Mapping ◽  
Poor Outcome ◽  
Significant Difference ◽  
Poor Outcomes ◽  
Average Size ◽  
Brain Avms

OBJECTIVEAlthough numerous arteriovenous malformation (AVM) grading scales consider eloquence in risk assessment, none differentiate the types of eloquence. The purpose of this study was to determine if eloquence subtype affects clinical outcome.METHODSThis is a retrospective review of a prospectively collected clinical database of brain AVMs treated with microsurgery in the period from 1997 to 2017. The only inclusion criterion for this study was the presence of eloquence as defined by the Spetzler-Martin grading scale. Eloquence was preoperatively categorized by radiologists. Poor outcome was defined as a modified Rankin Scale (mRS) score 3–6, and worsening clinical status was defined as an increase in the mRS score at follow-up. Logistic regression analyses were performed.RESULTSTwo hundred forty-one patients (49.4% female; average age 33.9 years) with eloquent brain AVMs were included in this review. Of the AVMs (average size 2.7 cm), 54.4% presented with hemorrhage, 46.2% had deep venous drainage, and 17.0% were diffuse. The most common eloquence type was sensorimotor (46.1%), followed by visual (27.0%) and language (22.0%). Treatments included microsurgery alone (32.8%), microsurgery plus embolization (51.9%), microsurgery plus radiosurgery (7.9%), and all three modalities (7.5%). Motor mapping was used in 9% of sensorimotor AVM cases, and awake speech mapping was used in 13.2% of AVMs with language eloquence. Complications occurred in 24 patients (10%). At the last follow-up (average 24 months), 71.4% of the patients were unchanged or improved and 16.6% had a poor outcome. There was no statistically significant difference in the baseline patient and AVM characteristics among the different subtypes of eloquence. In a multivariate analysis, in comparison to visual eloquence, both sensorimotor (OR 7.4, p = 0.004) and language (OR 6.5, p = 0.015) eloquence were associated with poor outcomes. Additionally, older age (OR 1.31, p = 0.016) and larger AVM size (OR 1.37, p = 0.034) were associated with poor outcomes.CONCLUSIONSUnlike visual eloquence, sensorimotor and language eloquence were associated with worse clinical outcomes after the resection of eloquent AVMs. This nuance in AVM eloquence demands consideration before deciding on microsurgical intervention, especially when numerical grading systems produce a score near the borderline between operative and nonoperative management.

Risk factors of COVID-19 mortality in Morocco: A retrospective cohort study (Preprint)

2021 ◽  
Author(s):  
Hind Ezzine ◽  
Khalid El Amrani ◽  
Mounia Addahbi ◽  
Mouad Merabet ◽  
Ibtissam Khoudri ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Stage ◽  
Clinical Status ◽  
Case Fatality ◽  
The Elderly ◽  
Epidemiological Surveillance ◽  
National Monitoring ◽  
Therapeutic Protocols

BACKGROUND Since reporting the first Sars-cov-2 infection cases in China, a national monitoring and response plan was developed and implemented in Morocco. The first COVID-19 case was detected in Morocco on 03/02/2020 and a several response measures were implemented. The scientific advisory committee set up therapeutic protocols for managing COVID-19 cases on 03/21/2020 that were used to treat all patients in public and private hospitals. OBJECTIVE To research associated factors with COVID-19 mortality in Morocco before and after the protocols adoption. METHODS We conducted a retrospective cohort study. We used the COVID-19 national epidemiological surveillance database, from March 2 to May 10. We focused only on confirmed cases of COVID-19, defined as any person with RT-PCR positive SARS-CoV-2. Two periods were defined according to the therapeutic protocols implementation in Morocco. The dependent variable was the outcome of COVID-19 patients. A logistic regression, using the Epi-info software (V 7.2), was performed to explain the outcome by the different explanatory variables: gender, age, comorbidities, clinical status at admission. The adjusted Odds Ratio for all variables used in the model were presented with their 95% confidence intervals. RESULTS From March 02 to May 10, Morocco registered 6072 cases of COVID-19; 14.1% (855) were registered before the therapeutic protocol implementation and 85.9% (5217) after. 56.1% (3409) patients were male, 91.4% (5449) were under the age of 65, only 2.7% (95) were admitted at a critical or severe clinical stage and 6.0% (366) had one or more comorbidities. The case fatality rate was 3.14% (191). Male gender (ORa=1.61; 95%CI: 1.01-2.58), age >65 years (ORa=4.69; 95%CI: 2.87-7.67), critical or severe status at admission (ORa=19.55; 95%CI: 11.12-34.38) and the presence of comorbidity (ORa=3.33; 95%CI: 2.00-5.53) were associated with death. The death risk after the protocols implementation was lower (ORa=0.22; 95%CI: 0.14-0.35). CONCLUSIONS To reduce mortality risk, the therapeutic protocols and early COVID-19 detection should be maintained to avoid severe forms, especially in the elderly and subjects with comorbidity. CLINICALTRIAL NA

The unusual use of epidural anesthesia for effective treatment of transfusion related circulatory overload in a parturient

2017 ◽  
Vol 6 (2) ◽  
Author(s):  
Ramon E. Abola ◽  
Joy Schabel
Keyword(s):  
Respiratory Failure ◽  
Pulmonary Edema ◽  
Epidural Anesthesia ◽  
Fluid Resuscitation ◽  
Postpartum Hemorrhage ◽  
Clinical Status ◽  
Volume Overload ◽  
Physiological Changes ◽  
Standard Medical Therapy ◽  
Circulatory Overload

Abstract We present the use of epidural anesthesia for the management of transfusion associated circulatory overload. After a vaginal delivery, a patient with preeclampsia and postpartum hemorrhage developed respiratory failure following rapid transfusion and fluid resuscitation. Her dyspnea and clinical status markedly improved after receiving an epidural bolus of 2-chlroprocaine. This unusual application of epidural anesthesia induces similar physiological changes to standard medical therapy for pulmonary edema and volume overload.

scholarly journals Pulmonary Edema Occurring after Nitric Acid Exposure

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Christopher W. Meaden ◽  
John S. Kashani ◽  
Stephen Vetrano
Keyword(s):  
Nitric Acid ◽  
Pulmonary Edema ◽  
Pulmonary Function Tests ◽  
Clinical Status ◽  
Plain Film ◽  
Strong Acid ◽  
Acute Onset ◽  
Severe Respiratory Distress ◽  
Work History ◽  
Chest X Ray

Nitric acid (HNO3) is a strong acid and oxidizing agent used for various applications including production of ammonium nitrate in the fertilizer industry. Nitrogen oxides formed when nitric acid interacts with the environment have been implicated in inhalation injuries. This describes a case of a 49-year-old male who presented to the emergency department complaining of an acute onset of shortness of breath approximately 12 hours after being exposed to nitric acid fumes. He presented with a room air oxygen saturation of 80 percent with moderate to severe respiratory distress. His plain film chest radiograph showed bilateral pulmonary infiltrates and pulmonary edema. Over a seven-day hospital course, he had an improvement in his clinical status and chest X-ray with normal pulmonary function tests one month after discharge. Although exposure to the fumes of nitric acid is known to cause delayed pulmonary edema, it is rarely reported in the medical literature. This case serves as a reminder to consider exposure to fumes of nitric acid in a patient presenting with pulmonary edema and highlights the importance of obtaining a work history.

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