Objective The aim of the study is to characterize pressure injuries, identify risk factors, and develop a predictive model for pressure injuries at intensive care unit admission for critical COVID-19 patients. Design This study was a retrospective analysis of a consecutive sample of patients admitted to intensive care unit between May 2020 and September 2021. Inclusion criteria encompassed the diagnosis of acute respiratory distress syndrome due to SARS-CoV-2, requiring invasive mechanical ventilation more than 48 hrs. The following predictors were evaluated: sociodemographic characteristics, comorbidities, as well as clinical and laboratory findings at intensive care unit admission. The primary outcome was the presence of pressure injuries. Results Two hundred five patients were included, mostly males (73%) with a mean age of 62 yrs. Pressure injury prevalence was 58%. On multivariable analysis, male sex, hypertension, hemoglobin, and albumin at intensive care unit admission were independently associated with pressure injuries, constituting the PRINCOVID model. The model reached an area under the receiver operating characteristic curve of 0.71, surpassing the Braden scale (P = 0.0015). The PRINCOVID score ranges from 0 to 15, with two risk groups: “at risk”(≤7 points) and “high risk”(>7 points). Conclusions This study proposes PRINCOVID as a multivariable model for developing pressure injuries in critical COVID-19 patients. Based on four parameters (sex, hypertension, hemoglobin, and albumin at intensive care unit admission), this model fairly predicts the development of pressure injuries. The PRINCOVID score allows patients’ classification into two groups, facilitating early identification of high-risk patients.
Isolated hypoglossal nerve palsy is rare, usually unilateral, and typically associated with other neurologic lesions. Very few cases of bilateral hypoglossal nerve palsy have been reported. This report describes the case of a 34-year-old man who was admitted with community-acquired pneumonia and required invasive mechanical ventilation, after which severe tongue paresis, dysarthria, and dysphagia (Functional Oral Intake Scale (FOIS) 3) were reported. After the diagnostic workup, isolated cryptogenic bilateral hypoglossal nerve palsy was assumed, and a rehabilitation program was started. After hospital discharge, the patient presented with tongue atrophy; inability to elevate, protrude, or lateralize the tongue; dysarthria; and increased oral transit time with compensatory cervical extension when swallowing (FOIS 4). Four months after starting the rehabilitation program, there was evidence of improvement in tongue atrophy and mobility, along with a reduction of dysphagia severity (FOIS 6). About 10 months after starting the program, tongue mobility was almost normal, and the patient had a normal diet without limitations (FOIS 7). Despite the rarity of bilateral hypoglossal nerve palsy, this entity is associated with relevant functional impairments. A multidisciplinary approach to diagnosis and tailored rehabilitation programs are highly valuable in the management of these patients.
Aneurysmal bone cysts are rare lesions, comprising one to six percent of primary bone tumors. Despite benign, those may be locally aggressive. We report a pediatric case with an atypical presentation. The patient was a seven-year-old boy, admitted to an emergency room due to right inguinal pain, without a history of trauma. The symptoms had acute onset and worsened gradually for five days. Radiographs revealed a cystic lesion on the proximal right femur and two longitudinal fractures. After further diagnostic work-up and given the probable diagnosis of an aneurysmal bone cyst, surgical treatment was performed. The diagnosis was then confirmed by histopathological analysis. After surgery, the patient maintained severe pain, having an important range of motion (ROM) and muscular strength reduction on the affected limb. As so, the patient engaged in a daily tailored Physical Medicine and Rehabilitation (PMR) program, for four months. After concluding the treatment plan, the patient was asymptomatic: recovery of both ROM and muscular strength was achieved, as well as the ability to return to previous daily-life activities. This is a paradigmatic case in which a rare condition with a rare presentation was displayed after several others were ruled out, requiring a multidisciplinary approach.
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