Twin pregnant woman with COVID-19: a case report

A Case of pregnant woman (G2Ab1, twin pregnancy with microinjection, Gestational Age 23 weeks and 3 days) referred to our center with a complaints of fever and dry cough and dyspnea. She was admitted with a diagnosis of COVID-19. During the hospitalization, O2 saturation progressively decreased, which led to patient get intubate. Gradual recovery with treatment occurred and the patient was extubed. Unfortunately, she was intubated again due to decreased O2 saturation, 5 days later. Liver enzymes increased, then both fetuses died intrauterine, the cardiac output then declined to 10% and the mother died within hours

Comparison of non-invasive to invasive oxygenation ratios for diagnosing acute respiratory distress syndrome following coronary artery bypass graft surgery: a prospective derivation-validation cohort study

Objective: To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (SpO2)/ fraction of inspired oxygen (Fi O2) and partial pressure of alveolar oxygen (PAO2)/Fi O2 may be used as effective surrogates for the partial pressure of arterial oxygen (PaO2)/Fi O2. Also, to determine the SpO2/Fi O2 and PAO2/Fi O2 values that correspond to PaO2/Fi O2 thresholds for identifying acute respiratory distress syndrome (ARDS) in patients following coronary artery bypass graft (CABG) surgery. Methods: A prospective derivation-validation cohort study in the Open-Heart ICU of an academic teaching hospital. Recorded variables included patient demographics, ventilator settings, chest radiograph results, and SPO2, PaO2, PAO2, SaO2, and Fi O2. Linear regression modeling was used to quantify the relationship between indices. Receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the threshold values. Results: One-hundred seventy-five patients were enrolled in the derivation cohort, and 358 in the validation cohort. The SPO2/Fi O2 and PAO2/Fi O2 ratios could be predicted well from PaO2/Fi O2, described by the linear regression models SPO2/Fi O2 = 71.149 + 0.8PF and PAO2/Fi O2 = 38.098 + 2.312PF, respectively. According to the linear regression equation, a PaO2/Fi O2 ratio of 300 equaled an SPO2/Fi O2 ratio of 311 (R2 0.857, F 1035.742, < 0.0001) and a PAO2/Fi O2 ratio of 732 (R2 0.576, F 234.887, < 0.0001). The SPO2/Fi O2 threshold of 311 had 90% sensitivity, 80% specificity, LR+ 4.50, LR- 0.13, PPV 98, and NPV 42.1 for the diagnosis of mild ARDS. The PAO2/Fi O2 threshold of 732 had 86% sensitivity, 90% specificity, LR+ 8.45, LR- 0.16, PPV 98.9, and NPV 36 for the diagnosis of mild ARDS. SPO2/ Fi O2 had excellent discrimination ability for mild ARDS (AUC ± SE = 0.92 ± 0.017; 95% CI 0.889 to 0.947) as did PAO2/ Fi O2 (AUC ± SE = 0.915 ± 0.018; 95% CI 0.881 to0.942). Conclusions: PaO2 and SaO2 correlated in the diagnosis of ARDS, with a PaO2/Fi O2 of 300 correlating to an SPO2/ Fi O2 of 311 (Sensitivity 90%, Specificity 80%). The SPO2/ Fi O2 ratio may allow for early real-time rapid identification of ARDS, while decreasing the cost, phlebotomy, blood loss, pain, skin breaks, and vascular punctures associated with serial arterial blood gas measurements

Subcutaneous Emphysema as an Ominous Side Effect in COVID-19 Patients under Mechanical Ventilation, Report of 7 Cases

Today, due to the pandemic of novel coronavirus 2019 (COVID-19), extensive information over all parts of the world is spreading rapidly. We present seven cases of COVID-19 patients with pneumothorax as one of the ominous side effects of the disease and a strong predictor of death which is a new challenge in controlling the transmission and distribution of the disease

Review of therapeutic agents for the treatment of COVID-19

In late December 2019, a cluster of unexplained pneumonia cases has been reported in Wuhan, China, named coronavirus disease 2019 (COVID -19) which has been spreading in 204 countries. In this review, the mains pharmaceutical option quoted previously and especially available for ICU patients are reviewed

Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial

Abstract Objective To determine if real-time compression feedback using a non-automated hand-held device improves patient outcomes from in-hospital cardiac arrest (IHCA). Methods We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in the mixed medical--surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard manual chest compressions or compressions performed with real-time feedback using the Cardio First Angelâ„¢ (CFA) device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes were survival to ICU and hospital discharge. Results One thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC was significantly improved in the CFA group (66.7% vs. 42.4%, P-‰&lt;-‰0.001), as was survival to ICU discharge (59.8% vs. 33.6%) and survival to hospital discharge (54% vs. 28.4%, P-‰&lt;-‰0.001). Outcomes were not affected by intra-group comparisons based on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-group comparisons of non-intubated patients, but not intubated ones. Conclusion Use of the CFA compression feedback device improved event survival and survival to ICU and hospital discharge. Trial registration The study was registered with Clinicaltrials.gov ( NCT02845011 ), registered retrospectively on July 21, 2016

تعيين عوامل منجر به عمل هاي مجدد در بخش(تروما) مراقبت هاي ويژه جراحي مغز و اعصاب بيمارستان لقمان به منظور بهبود کيفيت

Background and Objective: &nbsp;neurosurgery reoperation that occurs for various reasons such as complications of primary surgery, planned reoperation, emergency or unplanned reoperation, and increase the financial burden of the hospital and the patient, poor prognosis, and increase the length of stay in hospital and intensive care unit for the patient. Neurosurgery patients are among the patients in whom reoperations need to be evaluated. Determining the factors leading to reoperations in the Neurosurgery Intensive Care Unit determines the causes and improves the quality of the system to prevent preventable reoperations. Materials and Methods: In this cross-sectional retrospective study, the information of patients undergoing reoperation including the type of disease and initial surgery, reasons for reoperation were identified. The frequency of each of the three variables was examined in pairs. All reoperations and returns to the operating room during 5 consecutive years were reviewed. Information of all patients including demographic information, underlying disease, smoking and alcohol, cause of primary and reoperation surgery, medical history, type of operation, complications of the surgery, postoperative care were examined. Results: In this study, it was found that age, sex, initial diagnosis, the distance between surgery and readmission, underlying disease, ICU admission, were not associated with the occurrence of neurosurgery reoperation. Variables associated with the occurrence of neurosurgery reoperation include open surgery, surgical disease including Cerebrovascular, duration of the first surgery, first emergency surgery, duration of further anesthesia in the first operation, bleeding rate and need for a packed cell, Need to receive FFP, some hospital complications Conclusion: Determining the factors that cause neurosurgery re-operation, prevent such surgeries if possible and reduce costs and hospital load, and also patients suffer fewer complications and mortality. &nbsp; How to cite this article: Goharani R, Ghasemi AR, Hajiesmaeili MR, Banar S, Alibabaei A, Shojaei SP, Dosara MA, Shafigh N, Nateghinia S. Determining the Factors Leading to Reoperations in the (Trauma) Intensive Care Unit of Neurosurgery of Loghman Hakim Hospital to Improve the Quality. Irtiqa Imini Pishgiri Masdumiyat. 2021;9(2):133-43.سابقه و هدف: جراحی مجدد مغز و اعصاب به دلایل مختلفی از جمله عوارض جراحی اولیه ، جراحی مجدد برنامه ریزی شده ، جراحی مجدد اورژانسی یا برنامه ریزی نشده انجام می شود، سبب افزایش بار مالی بیمارستان و بیمار، پیش آگهی ضعیف و افزایش مدت اقامت در بیمارستان و بخش مراقبت های ویژه برای بیمار می شود. بیماران جراحی مغز و اعصاب از جمله بیمارانی هستند که جراحی مجدد در آنها نیازمند ارزیابی است. تعیین عوامل منجر به جراحی مجدد در بخش مراقبت های ویژه جراحی مغز و اعصاب دلایل&nbsp; این جراحی های مجدد را تعیین می کند و کیفیت سیستم را برای جلوگیری از جراحی های مجدد قابل پیشگیری بهبود می بخشد. روش بررسي: در این مطالعه مقطعی گذشته نگر، اطلاعات بیماران تحت جراحی مجدد از جمله نوع بیماری، جراحی اولیه و دلایل عمل مجدد مشخص شد سپس فراوانی هر یک از سه متغیر به صورت جفت بررسی شد. کلیه جراحی های مجدد و بازگشت به اتاق عمل طی 5 سال متوالی و همچنین اطلاعات کلیه بیماران از جمله اطلاعات دموگرافیک ، بیماری زمینه ای ، سیگار و الکل ، علت جراحی اولیه و جراحی مجدد ، سابقه پزشکی ، نوع عمل ، عوارض جراحی ، مراقبت های بعد از عمل مورد بررسی قرار گرفت. یافته ها: در این مطالعه مشخص شد که سن ، جنس ، تشخیص اولیه ، فاصله بین جراحی و بستری مجدد ، بیماری زمینه ای ، بستری در ICU&nbsp; با بروز جراحی مجدد مغز و اعصاب ارتباط ندارد. متغیرهای مرتبط با وقوع جراحی مجدد مغز و اعصاب شامل جراحی باز ، بیماری مغزواعصاب از جمله Cerebrovascular ، مدت زمان جراحی اول ، اولین جراحی اورژانسی ، مدت بیهوشی بیشتر در اولین عمل ، میزان خونریزی و نیاز به packed cell، نیاز به دریافت FFP ، برخی از عوارض بیمارستان بودند. نتیجه گیری: با تعیین عواملی که باعث جراحی مجدد جراحی مغز و اعصاب می شود ، در صورت امکان از چنین جراحی هایی جلوگیری می شود و هزینه ها و بار بیمارستان کاهش می یابد ، همچنین بیماران از عوارض و مرگ و میر کمتری رنج خواهند برد. How to cite this article: Goharani R, Ghasemi AR, Hajiesmaeili MR, Banar S, Alibabaei A, Shojaei SP, Dosara MA, Shafigh N, Nateghinia S. Determining the Factors Leading to Reoperations in the (Trauma) Intensive Care Unit of Neurosurgery of Loghman Hakim Hospital to Improve the Quality. Irtiqa Imini Pishgiri Masdumiyat. 2021;9(2):133-43

Sinopharm (HB02)-associated vaccine-induced immune thrombotic thrombocytopenia: a case report

Abstract Background Vaccine-induced thrombotic thrombocytopenia is associated with the coronavirus disease 2019 vaccines. It has been reported by vector-based vaccines. To the best of our knowledge, there is no report about vaccine-induced thrombotic thrombocytopenia in whole-virus vaccines. We are presenting the first case of vaccine-induced thrombotic thrombocytopenia with this type of vaccine. Case presentation An 18-year-old male Caucasian patient with complaints of severe abdominal, low back, and lower extremity pain presented to the medical center. He received the first dose of the Sinopharm (HB02) vaccine against coronavirus disease 2019 10 days before hospital attendance. In the laboratory examination, decreased platelet count and increased D-dimer were observed. During hospital admission, the diagnosis of pulmonary embolism was reached. He received vaccine-induced thrombotic thrombocytopenia therapy consisting of intravenous immune globulin and direct oral anticoagulant. Platelet count increased and he was discharged after 1 month. Conclusion This case highlights the possibility of vaccine-induced thrombotic thrombocytopenia occurrence by whole-virus coronavirus disease 2019 vaccines. Compared with vector-based vaccines, this phenomenon is rare for whole-virus vaccines. More studies on this type of vaccine regarding thrombotic thrombocytopenia should be considered