Pub Date : 2024-01-29DOI: 10.12746/swrccc.v12i50.1261
Amanda Key, Addie Pederson, Jared Sant, Coby Ray
This study aims to provide a review of the existing literature on teprotumumab (Tepezza)-associated hearing-related adverse effects. A review of PubMed and Embase was conducted using keywords “teprotumumab,” “tepezza,” “hearing disorder[s],” “hearing loss,” and “ototoxicity.” These search results were filtered to include all clinical trials, observational studies, case reports, and case series relevant to the topic of teprotumumab-associated hearing disorders. Data collection from the 15 included studies consisted of: sample size, number and percentage of hearing disorders reported, types of hearing disorders, remission rates, timeline of symptom onset, predisposing risk factors, suggested screening guidelines, and treatment proposals. Teprotumumab-associated hearing disorders are reported in 7-81.5% (median 12%) of clinical study participants. Symptoms described include sensorineural hearing loss (SNHL), hypoacusis, autophony, ear fullness/pressure/plugging, patulous eustachian tube, and tinnitus. Most symptoms improve with discontinuation of teprotumumab, but some symptoms persist after completion of treatment, most commonly SNHL. Symptoms have been reported occurring 3-37 (median 8.4) weeks after treatment initiation, with the majority reported 6 weeks after treatment initiation. Additional prospective studies are needed to clarify how frequently teprotumumab causes ototoxicity. There remains a need for both standardized audiologic screening guidelines and treatment for patients in whom ototoxicity persists post-treatment. Key Words: teprotumumab, tepezza, hearing disorder[s], hearing loss, ototoxicity
{"title":"Teprotumumab-associated hearing-related adverse events","authors":"Amanda Key, Addie Pederson, Jared Sant, Coby Ray","doi":"10.12746/swrccc.v12i50.1261","DOIUrl":"https://doi.org/10.12746/swrccc.v12i50.1261","url":null,"abstract":"This study aims to provide a review of the existing literature on teprotumumab (Tepezza)-associated hearing-related adverse effects. A review of PubMed and Embase was conducted using keywords “teprotumumab,” “tepezza,” “hearing disorder[s],” “hearing loss,” and “ototoxicity.” These search results were filtered to include all clinical trials, observational studies, case reports, and case series relevant to the topic of teprotumumab-associated hearing disorders. Data collection from the 15 included studies consisted of: sample size, number and percentage of hearing disorders reported, types of hearing disorders, remission rates, timeline of symptom onset, predisposing risk factors, suggested screening guidelines, and treatment proposals. Teprotumumab-associated hearing disorders are reported in 7-81.5% (median 12%) of clinical study participants. Symptoms described include sensorineural hearing loss (SNHL), hypoacusis, autophony, ear fullness/pressure/plugging, patulous eustachian tube, and tinnitus. Most symptoms improve with discontinuation of teprotumumab, but some symptoms persist after completion of treatment, most commonly SNHL. Symptoms have been reported occurring 3-37 (median 8.4) weeks after treatment initiation, with the majority reported 6 weeks after treatment initiation. Additional prospective studies are needed to clarify how frequently teprotumumab causes ototoxicity. There remains a need for both standardized audiologic screening guidelines and treatment for patients in whom ototoxicity persists post-treatment. \u0000 \u0000Key Words: teprotumumab, tepezza, hearing disorder[s], hearing loss, ototoxicity","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140489329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-29DOI: 10.12746/swrccc.v12i50.1279
B. Songtanin
{"title":"Chronic tophaceous gout in a woman with extensive allergic history to gout medications","authors":"B. Songtanin","doi":"10.12746/swrccc.v12i50.1279","DOIUrl":"https://doi.org/10.12746/swrccc.v12i50.1279","url":null,"abstract":"","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"16 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140489352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-16DOI: 10.12746/swrccc.v12i50.1263
J. D. Payne, William Derrick, Katherine Wells
Syphilis cases have increased dramatically, with a 500% rise in Lubbock County from 2019 to 2023. Texas, alone, reported approximately 25% of U.S. congenital syphilis cases in 2022, indicating a broader public health threat. This rise in congenital syphilis is particularly concerning and a harbinger for systemic issues with the healthcare system. Healthcare professionals must screen patients for risk factors, increase routine testing and administer effective treatment protocols.
{"title":"Texas accounts for 25% of national congenital syphilis cases in 2022","authors":"J. D. Payne, William Derrick, Katherine Wells","doi":"10.12746/swrccc.v12i50.1263","DOIUrl":"https://doi.org/10.12746/swrccc.v12i50.1263","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Syphilis cases have increased dramatically, with a 500% rise in Lubbock County from 2019 to 2023. Texas, alone, reported approximately 25% of U.S. congenital syphilis cases in 2022, indicating a broader public health threat. This rise in congenital syphilis is particularly concerning and a harbinger for systemic issues with the healthcare system. Healthcare professionals must screen patients for risk factors, increase routine testing and administer effective treatment protocols. \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"50 7-8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140505830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.12746/swrccc.v11i49.1231
Ximena Solis, Ben Batson, Cristina Morataya, Kenneth Iwuji, Hannah Fairley, Wadih Chakkour, Kenneth Nugent, Ebtesam Islam
Background: Polymerase chain reaction (PCR) testing amplifies a specific DNA segment through heat cycling to identify pathogens for the diagnosis of infection. This testing allows for rapid detection of pathogens, before conventional blood culture results become available. The high mortality associated with severe sepsis and septic shock stresses the importance of early diagnosis and initiation of early antibiotic therapy. This study analyzed the association of the sepsis PCR results and antibiotic management, length of stay, and mortality outcomes in a medical intensive care unit (MICU).
Methods: This study is a retrospective, cross-sectional study on patients diagnosed with severe sepsis and septic shock based on ICD-10 codes, aged 18 years and older, admitted to the MICU at University Medical Center, Lubbock, Texas, between December 2016 to December 2020.
Results: Clinical information from 268 patients with the diagnosis of sepsis or septic shock was collected and analyzed. The mean age was 60.9 ± 15.6 years with a predominance of men (144, 53.7%) and Caucasian race (193,73.4%). A total of 101 patients (37.6%) had positive PCR results; overall, PCR test results had a diagnostic sensitivity of 91.2 %. The concordance between positive blood culture and positive PCR was 93.3 % (p <.0001). There was a significant correlation between PCR positivity and increased serum lactate levels (p=0.03), changes in antibiotics (P<0.00010), and increased mortality rate (p=0.04). There was no significant correlation between PCR positivity and length of stay (p=0.84).
Conclusion: In this study, PCR testing was an accurate tool for early identification of bacterial pathogens. A positive PCR was associated with higher serum lactate levels, higher mortality rates, and an increased frequency of antibiotic changes but was not associated with shorter ICU length of stay.
Key words: Sepsis, septic shock, PCR testing, outcomes
{"title":"The association of positive sepsis PCRs tests with patient mortality, length of stay, and antibiotic management in a medical intensive care unit","authors":"Ximena Solis, Ben Batson, Cristina Morataya, Kenneth Iwuji, Hannah Fairley, Wadih Chakkour, Kenneth Nugent, Ebtesam Islam","doi":"10.12746/swrccc.v11i49.1231","DOIUrl":"https://doi.org/10.12746/swrccc.v11i49.1231","url":null,"abstract":"Background: Polymerase chain reaction (PCR) testing amplifies a specific DNA segment through heat cycling to identify pathogens for the diagnosis of infection. This testing allows for rapid detection of pathogens, before conventional blood culture results become available. The high mortality associated with severe sepsis and septic shock stresses the importance of early diagnosis and initiation of early antibiotic therapy. This study analyzed the association of the sepsis PCR results and antibiotic management, length of stay, and mortality outcomes in a medical intensive care unit (MICU).
 Methods: This study is a retrospective, cross-sectional study on patients diagnosed with severe sepsis and septic shock based on ICD-10 codes, aged 18 years and older, admitted to the MICU at University Medical Center, Lubbock, Texas, between December 2016 to December 2020.
 Results: Clinical information from 268 patients with the diagnosis of sepsis or septic shock was collected and analyzed. The mean age was 60.9 ± 15.6 years with a predominance of men (144, 53.7%) and Caucasian race (193,73.4%). A total of 101 patients (37.6%) had positive PCR results; overall, PCR test results had a diagnostic sensitivity of 91.2 %. The concordance between positive blood culture and positive PCR was 93.3 % (p <.0001). There was a significant correlation between PCR positivity and increased serum lactate levels (p=0.03), changes in antibiotics (P<0.00010), and increased mortality rate (p=0.04). There was no significant correlation between PCR positivity and length of stay (p=0.84).
 Conclusion: In this study, PCR testing was an accurate tool for early identification of bacterial pathogens. A positive PCR was associated with higher serum lactate levels, higher mortality rates, and an increased frequency of antibiotic changes but was not associated with shorter ICU length of stay.
 Key words: Sepsis, septic shock, PCR testing, outcomes","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135781649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.12746/swrccc.v11i49.1239
Sulaiman Karim, Kenneth Nugent
Pneumomediastinum, characterized by the presence of air in the mediastinum, can be primary (spontaneous) or secondary. Although relatively rare and usually benign with an incidence of 1 in 7,000 to 12,000 hospital admissions, some cases can develop hemodynamic instability due to mechanical pressure, reducing venous return and may require emergency surgery. Prior to the COVID-19 pandemic, reports of tension pneumomediastinum were infrequent, and there was no consensus on the best surgical approach to manage this condition. This review considers the diverse presentations, underlying causes, and diagnostic and operative approaches in patients with COVID-19 infection and pneumomediastinum. A systematic search of databases, including PubMed and Scopus, was conducted. Articles were reviewed to identify the risk factors for pneumomediastinum, the hemodynamic consequences, and approaches to management in both COVID-19 and non-COVID-19 cases. In patients with COVID-19 infection, pneumomediastinum represents a risk factor for poor outcomes, especially in patients requiring mechanical ventilation. In patients with tension pneumomediastinum, surgical release of mediastinal air is essential and can use suprasternal incisions, lateral sternal incisions, or sternotomy, all with drains. These patients are also at increased risk for tension pneumothorax and may require surgical chest tubes.
Keywords: Pneumomediastinum, COVID-19, hemodynamics, surgical management, clinical challenges
{"title":"Presentation and management of pneumomediastinum in patients with COVID-19 infection","authors":"Sulaiman Karim, Kenneth Nugent","doi":"10.12746/swrccc.v11i49.1239","DOIUrl":"https://doi.org/10.12746/swrccc.v11i49.1239","url":null,"abstract":"Pneumomediastinum, characterized by the presence of air in the mediastinum, can be primary (spontaneous) or secondary. Although relatively rare and usually benign with an incidence of 1 in 7,000 to 12,000 hospital admissions, some cases can develop hemodynamic instability due to mechanical pressure, reducing venous return and may require emergency surgery. Prior to the COVID-19 pandemic, reports of tension pneumomediastinum were infrequent, and there was no consensus on the best surgical approach to manage this condition. This review considers the diverse presentations, underlying causes, and diagnostic and operative approaches in patients with COVID-19 infection and pneumomediastinum. A systematic search of databases, including PubMed and Scopus, was conducted. Articles were reviewed to identify the risk factors for pneumomediastinum, the hemodynamic consequences, and approaches to management in both COVID-19 and non-COVID-19 cases. In patients with COVID-19 infection, pneumomediastinum represents a risk factor for poor outcomes, especially in patients requiring mechanical ventilation. In patients with tension pneumomediastinum, surgical release of mediastinal air is essential and can use suprasternal incisions, lateral sternal incisions, or sternotomy, all with drains. These patients are also at increased risk for tension pneumothorax and may require surgical chest tubes.
 
 Keywords: Pneumomediastinum, COVID-19, hemodynamics, surgical management, clinical challenges","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135781466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.12746/swrccc.v11i49.1207
Akhila Reddy, Ebtesam Islam, Benjamin Batson, Madison Taylor
Pleural invasion is a recognized adverse prognostic factor in non-small cell lung cancer. Here, we document a case of non-small cell lung cancer in a 66-year-old male presenting with direct invasion of the tumor through lung pleura into the mediastinum. Pleural invasion can proceed past the elastic layer of the visceral pleura, classified as PL1. Less commonly, invasion to the surface of the visceral pleura or parietal pleura can occur and is classified as PL2 and PL3 respectively. PL2 invasion is associated with increased mortality; patients have lower overall survival compared to those without visceral pleural invasion (HR=2.447, 95% CI 0.336,0.579) and those with only PL1 invasion (HR=1.287, 95% CI 1.114, 1.487). Treatment of non-small cell lung cancer with pleural invasion includes surgery, chemotherapy, radiation, and immunotherapy.
胸膜浸润是公认的非小细胞肺癌的不良预后因素。在此，我们报告一位66岁男性非小细胞肺癌病例，表现为肿瘤经肺胸膜直接侵入纵隔。胸膜侵犯可越过内脏胸膜的弹性层，分类为PL1。不太常见的是，内脏胸膜表面或胸膜壁层也会发生侵犯，分别被分类为PL2和PL3。PL2侵袭与死亡率增加有关;与没有内脏胸膜浸润的患者(HR=2.447, 95% CI 0.336,0.579)和只有PL1浸润的患者(HR=1.287, 95% CI 1.114, 1.487)相比，患者的总生存率较低。胸膜浸润的非小细胞肺癌的治疗包括手术、化疗、放疗和免疫治疗。
{"title":"Pleural invasion in non-small cell lung cancer","authors":"Akhila Reddy, Ebtesam Islam, Benjamin Batson, Madison Taylor","doi":"10.12746/swrccc.v11i49.1207","DOIUrl":"https://doi.org/10.12746/swrccc.v11i49.1207","url":null,"abstract":"Pleural invasion is a recognized adverse prognostic factor in non-small cell lung cancer. Here, we document a case of non-small cell lung cancer in a 66-year-old male presenting with direct invasion of the tumor through lung pleura into the mediastinum. Pleural invasion can proceed past the elastic layer of the visceral pleura, classified as PL1. Less commonly, invasion to the surface of the visceral pleura or parietal pleura can occur and is classified as PL2 and PL3 respectively. PL2 invasion is associated with increased mortality; patients have lower overall survival compared to those without visceral pleural invasion (HR=2.447, 95% CI 0.336,0.579) and those with only PL1 invasion (HR=1.287, 95% CI 1.114, 1.487). Treatment of non-small cell lung cancer with pleural invasion includes surgery, chemotherapy, radiation, and immunotherapy.","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135781651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.12746/swrccc.v11i49.1243
Gilbert Berdine
{"title":"Adverse consequences of separating patients from family in the intensive care unit","authors":"Gilbert Berdine","doi":"10.12746/swrccc.v11i49.1243","DOIUrl":"https://doi.org/10.12746/swrccc.v11i49.1243","url":null,"abstract":"","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135781337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.12746/swrccc.v11i49.1235
Gilbert Berdine, Jose Ramos
Images that demonstrate large and obvious abnormalities sometimes distract the provider from the careful review necessary to make the correct diagnosis. In situations in which the differential diagnosis has a leading diagnosis that is correct almost all time, it is easy to be misled by more obvious possibilities, failing to spend enough time to see the important details, and pursuing therapy that might not result in a good patient outcome. The purpose of this case report is to help readers from making analogous errors in future cases similar to this one.
Key words: pleural effusion, endobronchial obstruction, lung cancer, complications, chest tube
{"title":"A case of mistaken identity","authors":"Gilbert Berdine, Jose Ramos","doi":"10.12746/swrccc.v11i49.1235","DOIUrl":"https://doi.org/10.12746/swrccc.v11i49.1235","url":null,"abstract":"Images that demonstrate large and obvious abnormalities sometimes distract the provider from the careful review necessary to make the correct diagnosis. In situations in which the differential diagnosis has a leading diagnosis that is correct almost all time, it is easy to be misled by more obvious possibilities, failing to spend enough time to see the important details, and pursuing therapy that might not result in a good patient outcome. The purpose of this case report is to help readers from making analogous errors in future cases similar to this one.
 
 Key words: pleural effusion, endobronchial obstruction, lung cancer, complications, chest tube","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"36 4 Pt 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135781650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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