RationaleKetamine has been used as a sedative analgesic in trauma setting, but data regarding its efficacy and safety is lacking in severe ARDS. This retrospective study aims to determine if Ketamine is safer as a sedative agent in mechanically ventilated patients. During the COVID pandemic, as there was a shortage of sedative agents, Ketamine was used. ObjectivesThe primary objective was to compare the safety of ketamine to other sedatives. The secondary objective was to compare the effect of ketamine to other sedatives regarding the need for vasopressor, incidence of delirium, infectious complications, acute kidney injury, hospital length of stay, and length of ventilator days. MethodsA retrospective, observational cohort study was conducted. Measurements and Main ResultsOne hundred and twenty-four patients (63 men and 61 women) were included. Thirty-four patients received ketamine, while 90 patients received other traditionally used sedatives such as propofol and midazolam. The patients' median age was 64 years in the ketamine group and 68 years in the non-ketamine group. Seventeen patients in the ketamine group (50%) and 65 patients (72%) in the non-ketamine group had mortality (p < 0.02). The hospital length of stay was 22.85 days (± 16.36) in the ketamine group and 15.62 days (± 14.63) in the non-ketamine group (p < 0.02). There was no statistically significant difference among the outcomes of the need for vasopressor, the incidence of delirium, infectious complications, and acute kidney injury. ConclusionsKetamine as a sedative-analgesic agent in COVID-19 patients with severe acute respiratory distress syndrome demonstrated safety with reduced mortality. The ketamine group had a higher hospital length of stay, but a similar complication profile compared to the non-ketamine group. Further prospective randomized controlled trials are warranted to confirm these findings.
In December 2019, China reported a cluster of pneumonia patients infected by a new virus from the coronavirus family called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus quickly spread around the world and infected millions of people, and the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. Although some patients show only mild or even asymptomatic response to this infection, severe disease with rapid progression to acute respiratory distress and multiorgan failure is also commonly seen. In this report, we discuss three cases of HIV patients who survived COVID-19.
Diabetic patients have a higher risk of infections which is the leading trigger of diabetic ketoacidosis. The second most common infection in diabetics is urinary tract infection (UTI). Elevation of glucose level induces an inflammatory process within numerous tissues in the body leading to disturbance in cytokines level and oxidative stress. This study is divided into two parts, firstly it was to investigate the prevalence of asymptomatic bacteriuria (ASB) and urinary tract infections in 84 Type 1 diabetes patients, 63 Type 2 diabetes patients and 57 ketoacidotic patients, and to determine the uropathogens responsible for ASB and UTIs as well as their antimicrobial susceptibility pattern. The second part is to determine the level of IL-1β, IL-6 and superoxide dismutase (SOD) in blood samples of diabetic and ketoacidotic patients. Escherichia coli was the most common isolated bacterial uropathogen followed by Enterococcus faecalis, Staphylococcus saprophyticus and Pseudomonas aeruginosa. These isolates showed 100% sensitivity to cephalothin, imipenem, linezolid, teicoplanin, ceftobiprole and piperacillin-tazobactam. Upon examining cytokines level in diabetic patients, results showed higher levels of IL-1β and IL-6 than control samples, indicating inflammation and disturbance in the regulation of metabolic, regenerative, and neural processes, while SOD examination showed lower levels than control samples, indicating both micro-and macrovascular diabetic complications.
Multiple sclerosis (MS) is an autoimmune disease in which the body's immune system destroys myelin causing disruption of signals from the brain to the rest of the body. MS can be triggered by a variety of reasons. In this study, we present the case of a patient who developed neurological symptoms immediately (one day) after receiving the hepatitis B vaccine. The temporality of symptoms makes us question whether there is an association between the hepatitis B vaccine and MS. We would like to emphasize the importance of considering MS as a side effect of the hepatitis B vaccine and adding MS to the differential diagnosis of a patient who presents with neurological symptoms after receiving the hepatitis B vaccine.
Obstructive fibrinous tracheal pseudomembrane (OFTP) is a relatively rare complication of endotracheal intubation. OFTP, which may cause fatal airway obstruction, is perhaps more common than reported in the literature. Although little is known about the mechanisms that play a role in the development of OFTP, it is hypothesized that OFTP results from ischemic injury to tracheal mucosa. Diagnosis is made using rigid bronchoscopy, which is also used for excision and removal of the pseudomembrane. Here we present a case of OFTP in a patient who was intubated for three days, developed symptoms three days after extubation, and ultimately spontaneously expelled the tracheal pseudomembrane.
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