Microbiological assessment of COVID-19 associated acute invasive fungal rhinosinusitis: A tertiary hospital based study

Background:  Acute invasive fungal rhinosinusitis (AIFRS) is an emerging disease on top of SARS CoV-2 virus infection and associated with severe and fatal prognosis especially in the presence of other immunosuppressive conditions. Aim of study: Identification of the causative agents of AIFRS in COVID-19 patients and its impact on the survival outcome. Methods: This retrospective study was carried out on 70 clinically and radiologically diagnosed AIFRS patients either in concomitant with COVID-19 infection or following recovery. Exudates from the lesions were collected during surgical debridement. Both microbiological and pathological examinations were done to identify the type of the causative fungi followed by assessment of the relation between different type of fungi and the outcome in the affected patients. Results: Positive fungal cultures were detected in 54 cases out of 70 where Mucor species were the most common isolates (42 patients) and only 12 cases were proven to be Aspergillus species. All patients were diabetic and under steroid therapy. Mortality rate was 42.9% and 25% in mucormycosis and aspergillosis respectively. High dose of steroid together with Mucor species infection were the most important risk factors in determining the prognosis and the outcome of the infection. Conclusion: Microbiological diagnosis together with other methods plays an important role in accurate and rapid diagnosis of AIFRS in association with COVID-19 for proper management and improving the outcome

PATHOPHYSIOLOGY, INVESTIGATIONS, AND TREATMENT OF PATIENTS WITH BICUSPID AORTIC VALVE

Bicuspid aortic valve is a congenital anomaly of the heart in which the aortic valve has two loops instead of the normal three. It causes valve degeneration and is associated with dilation of the aorta. This exercise discusses the role of inter-professional team in improving the management of patients with bicuspid aortic valves and describes the diagnosis and management of this problem. The purpose of this review article is to describe the epidemiology of bicuspid aortic valve, describe the presentation of patients with bicuspid aortic valve, summarize the use of electrocardiogram and echocardiogram in bicuspid aortic valve evaluation, and explain the importance of collaboration and communication. Interprofessional team to improve care coordination for patients with bicuspid aortic valve

ETIOLOGY, INVESTIGATIONS, AND TREATMENT IN CASES OF CONSTRICTIVE PERICARDITIS

The fibroelastic sac that covers the heart is known as the pericardium. It has an effect on cardiac hemodynamics and serves as a protective barrier. Constrictive pericarditis is a condition in which the pericardium grows granulation tissue, causing a loss of pericardial elasticity and ventricular filling limitation. Although it is usually a chronic condition, subacute, transient, and occult variants have been reported. The pathogenesis, symptoms, and diagnosis of constrictive pericarditis, as well as the role of the interprofessional team in its treatment, are covered in this exercise. This review article aims to describe the pathophysiology of constrictive pericarditis, review a patient's presentation with constrictive pericarditis, summarise constrictive pericarditis options for treatment, and discuss the importance of improving care coordination among interprofessional team members to enhance constrictive pericarditis patient outcomes. The 10-year survival rate for patients who get a pericardiectomy is around 50%. Medical treatment alone results in a short lifespan

PATHOPHYSIOLOGY, INVESTIGATIONS, AND MANAGEMENT OF UNSTABLE ANGINA: A REVIEW

Unstable angina pectoris is a phenomenon that disrupts the early recovery phase of acute myocardial infection, the emergence of new ischemic symptoms, the development of more severe pain, usually at rest, or the formation of intermittent ischemic events. ۔ Acute myocardial infarction is the most serious complication of unstable angina pectoris, which can affect up to 25% of patients within three months of the onset of symptoms. Physically, changes in ECG and hemodynamics usually occur before the onset of pain. The following hemodynamic changes and an increase in oxygen demand in the already ischemic heart respond positively, leading to further instability in unstable angina. Hemodynamic changes may be the result of abnormal stress response or excessive chemotherapeutic discharge. While coronary spasm may play a role in the pathogenesis of unstable angina, other factors such as bleeding in the wall of the atherosclerotic plaque, peripheral embolization, alteration, or platelet aggregation in the coronary artery from nearby soft cholesterol "abscess". Feedback should also be considered. Along with medications such as nitrates, calcium antagonists, and warnings, beta-adrenergic blockers are used to stimulate coronary and peripheral vasodilation and reduce cardiac effort. Treatment with aortic counter-pulsating balloons is recommended for those who have failed to respond to pharmacological treatment. Emergency surgery should be performed voluntarily. The full clinical and pathological compatibility of unstable angina pectoris is still unknown. Future issues will revolve around further investigations into entity procedures, treatment and prevention. The purpose of this review is to explain the pathophysiology of unstable angina, highlight changes in ECG in the assessment of unstable angina, and improve the outcome of patients with unstable angina. Consider the need to strengthen the coordination of care within the team

A REVIEW ON MITRAL REGURGITATION: PATHOPHYSIOLOGY, INVESTIGATIONS AND TREATMENT

Background: The retrograde movement of blood from the left ventricle (LV) into the left atrium (LA) through the mitral valve (MV) causes a systolic murmur heard best at the apex of the heart with radiation to the left axilla. MR is the most common valvular anomaly in the globe, affecting around 2% of the population and increasing in incidence with age. This activity examines the diagnosis and treatment of mitral regurgitation, emphasizing the importance of the healthcare team in assessing and treating patients with this illness. Conclusion: The goal of this review article is to identify the etiology and epidemiology of mitral regurgitation medical conditions and emergencies, review the proper history, physical, and evaluation of mitral regurgitation, outline the treatment and management options for mitral regurgitation, and describe interprofessional team strategies for improving care coordination and communication to advance mitral regurgitation and improve outcomes

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Predictive value of serum YKL-40, interleukin-37, and cancer antigen 125 panel in noninvasive staging of endometriosis

Background: The diagnosis of advanced endometriosis remains challenging with considerable limitations in the diagnosis of retroperitoneal and deep infiltrating lesions. Thus, a well-defined panel of inexpensive, noninvasive inflammatory biomarkers could be a crucial tool for appropriate staging for women with suspected endometriosis. The aim of this work is to explore the potential use of serum YKL-40, interleukin-37 (IL-37), and cancer antigen 125 (CA125) for noninvasive staging of endometriosis patients for proper intervention and most optimal management of the condition. Methods: This study was conducted on 90 women, who had undergone laparoscopic or laparotomy surgery due to suspected pelvic endometriosis. Blood samples for serum YKL-40, IL-37, and CA125 levels assay were taken from all participants at admission for laparoscopy or laparotomy. After histopathological confirmation of the diagnosis, the selected cases were immunostained for YKL-40, IL-37, and CA125. Results: YKL-40, IL-37, and CA125 serum levels were significantly elevated in patients with endometriosis than healthy controls. Moreover, the association between the serum level and immunoexpression and grading of endometriosis. A triple combination panel of serum YKL-40, IL-37, and CA125 was found to have the best sensitivity and specificity (96.67% and 100.0%, respectively) compared to any single serum marker alone or double combination panel in predicting the severity of endometriosis. Conclusions: A triple combination panel of serum YKL-40, IL-37, and CA125 could be used in the future for predicting endometriosis stage, providing a practical reference for making better-informed decisions on the best treatment plan

Noninvasive ventilation in COVID-19 patients aged ≥ 70 years : a prospective multicentre cohort study

Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods: This is a substudy of COVIP study-an international prospective observational study enrolling patients aged >= 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876). Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV

Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Purpose The number of patients >= 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (+/- 2 years), Sequential Organ Failure Assessment (SOFA) score (+/- 2 points), clinical frailty scale (+/- 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear