Ketamine-based sedation use in mechanically ventilated critically ill patients with COVID-19: A multicenter cohort study

Backgrounds: Ketamine possesses analgesia, anti-inflammation, anticonvulsant, and neuroprotection properties. However, the evidence that supports its use in mechanically ventilated critically ill patients with COVID-19 is insufficient. The study's goal was to assess ketamine's effectiveness and safety in critically ill, mechanically ventilated (MV) patients with COVID-19. Methods: Adult critically ill patients with COVID-19 were included in a multicenter retrospective-prospective cohort study. Patients admitted between March 1, 2020, and July 31, 2021, to five ICUs in Saudi Arabia were included. Eligible patients who required MV within 24 hours of ICU admission were divided into two sub-cohort groups based on their use of ketamine (Control vs. Ketamine). The primary outcome was the length of stay (LOS) in the hospital. P/F ratio differences, lactic acid normalization, MV duration, and mortality were considered secondary outcomes. Propensity score (PS) matching was used (1:2 ratio) based on the selected criteria. Results: In total, 1,130 patients met the eligibility criteria. Among these, 1036 patients (91.7 %) were in the control group, whereas 94 patients (8.3 %) received ketamine. The total number of patients after PS matching, was 264 patients, including 88 patients (33.3 %) who received ketamine. The ketamine group's LOS was significantly lower (beta coefficient (95 % CI): −0.26 (−0.45, −0.07), P = 0.008). Furthermore, the PaO2/FiO2 ratio significantly improved 24 hours after the start of ketamine treatment compared to the pre-treatment period (6 hours) (124.9 (92.1, 184.5) vs. 106 (73.1, 129.3; P = 0.002). Additionally, the ketamine group had a substantially shorter mean time for lactic acid normalization (beta coefficient (95 % CI): −1.55 (−2.42, −0.69), P 0.01). However, there were no significant differences in the duration of MV or mortality. Conclusions: Ketamine-based sedation was associated with lower hospital LOS and faster lactic acid normalization but no mortality benefits in critically ill patients with COVID-19. Thus, larger prospective studies are recommended to assess the safety and effectiveness of ketamine as a sedative in critically ill adult patients

Ectopic Lacrimal Gland Tissue: A Systematic Review

Purpose: To review the clinical and histopathological findings associated with ectopic lacrimal gland tissue. Methods: A systematic review of the literature on ectopic lacrimal gland tissue was performed. Studies which met clinical and histolopathological criteria for ectopic lacrimal gland tissue written in English and published in peer-reviewed journals were included. Results: Sixty-nine publications detailing 180 cases of ectopic lacrimal gland tissue were published between 1946 and 2018. Males were affected slightly more than females (57% vs. 43%) and 95% cases were unilateral. Patients presented at a mean age of 21 years, most commonly with a mass, although orbital lesions commonly presented with proptosis. The most common location for ectopic lacrimal gland tissue was epibulbar conjunctiva (62%), other locations included orbital (16%), eyelid (11%), intraocular (9%), lacrimal sac (2%), and nasal mucosa (0.6%) sites. Most lesions (86%) were locally resected. The most common histological types were complex choristomas (56%) and simple choristomas (38%). However, neoplastic transformation to pleomorphic adenoma (5%), adenocystic carcinoma (0.6%), and adenocarcinoma (0.6%) was reported. Conclusions: Ectopic lacrimal gland tissue is rare but should be considered in the differential diagnosis of masses in the epibulbar conjunctiva, eyelid, orbit, and lacrimal sac, particularly in childhood, as the diverse way it presents means that it may mimic more common choristomas. It can undergo neoplastic transformation in the same way as can the lacrimal gland and incomplete excision can result in recurrence

Conjunctival Pediatric Follicular Lymphoma: Case Report and Literature Review

Follicular lymphoma (FL) is the second most commonly reported B-cell lymphoma and accounts for 6% of all orbital lymphomas. FL presentation in the pediatric population is rare. This study reported an 18-year-old male with a pink elevated lesion in the conjunctiva of the left eye and normal ocular parameters. Following a complete excisional biopsy, the lesion was oval and smooth grossly and showed dense proliferation with a high nuclear-cytoplasmic ratio microscopically. Immunohistochemical studies revealed positive CD20 and bcl-6 while bcl-2 was negative, which is a common feature for pediatric FL in contrast to bcl-2 positivity found by immunohistochemistry in FL occurring in adult patient population. No signs of recurrence were observed over 2 years of follow-up. This study adds a new case to the existing few reports. Interestingly, all reported cases were males including the patient, mean duration of onset was 5 months, and mean duration of follow-up was 18.4 months. The authors emphasize that total surgical excision with close monitoring is reasonable management of such clinical entity