Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.

No abstract

Drug-induced hypothyroidism has been often observed with the use of lithium in patients with mental disorders. However, atypical antipsychotic medications, especially those with serotonin 2c (5HT2c) blockade like dibenzodiazepines have not been examined for their association with the occurrence of subclinical hypothyroidism. Atypical antipsychotic medications are commonly used in patients with psychiatric disorders, specifically in schizophrenia and schizoaffective disorders. The objective of this retrospective case analysis is to examine the thyroid function of patients with schizophrenia or schizoaffective disorder receiving dibenzodiazepines. This study includes patients that are on one or more of these atypical anti-psychotic agents: clozapine, olanzapine, quetiapine. Clinical outcome measured includes the effect on dibenzodiazepines on thyroid function (e.g. TSH, Free T4, and T4).A total of 42 charts of the patients were included in the study. Out of the 42 patients, 13 had normal thyroid labs, 11 had abnormal thyroid labs, and 18 patients had a diagnosis of hypothyroidism, and currently on a thyroid medication. Therefore, 31% of these patients were found to have normal thyroid levels, while 69% of these patients were found to have either slightly abnormal thyroid indices (subclinical hypothyroidism), or an impairment of thyroid function.The results of our study show that in patients with schizophrenia or schizoaffective disorder that are on clozapine, olanzapine, quetiapine, or any combination of the four, a higher percentage of them exhibited abnormal thyroid function with subclinical hypothyroidism, or on thyroid supplements. Future studies may be warranted to further evaluate the effect of antipsychotics with 5HT2c blockade on thyroid function.

There is significant morbidity and mortality from pneumonia in leukemic and bone marrow transplant patients. We sought to explore the diagnostic yield of bronchoalveolar lavage (BAL) in these patients with new pulmonary infiltrates. A retrospective chart review of approximately 200 Non- human immunodeficiency virus (HIV) leukemic and Hematopoietic stem cell transplantation (HSCT) patients who underwent bronchoscopy at a single academic cancer center was performed. Antimicrobial use for less than 24 hours at the time of BAL was associated with a higher yield in this population (56.8% versus 32.8%, p<0.001). This supports performing bronchoscopy with BAL within 24 hours of antimicrobial therapy in leukemic and HSCT patients.

No abstract