Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1115
J. Rahesh, Tavien Mapp, Anant Gonugunta, Iqra Kazi, Sarah Day, Mousab Diab, R. Ratheesh, T. Naguib
Granulomatosis with polyangiitis (GPA) is a rare systemic small-vessel vasculitis. This inflammatory reaction can affect the upper and lower respiratory tract, as well as the kidneys. The expected age of presentation is in the sixth and seventh decades of life, and Caucasians are mostly affected. The cornerstone of treatment is high-dose glucocorticoids in combination with immunosuppressant, steroid-sparing drugs, which leads to remission in almost 80% of patients. We present an unusual case of a 55-year-old Hispanic woman presenting with acute kidney injury secondary to treatment-resistant GPA. The failure of standard treatment is extremely rare. In addition, this patient presented with primarily renal symptoms, even though head and neck and airway symptoms are expected in almost all cases initially.Keywords: Granulomatosis with polyangiitis, renal failure, treatment failure
{"title":"Treatment-resistant granulomatosis with polyangiitis: An unusual presentation","authors":"J. Rahesh, Tavien Mapp, Anant Gonugunta, Iqra Kazi, Sarah Day, Mousab Diab, R. Ratheesh, T. Naguib","doi":"10.12746/swrccc.v11i47.1115","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1115","url":null,"abstract":"Granulomatosis with polyangiitis (GPA) is a rare systemic small-vessel vasculitis. This inflammatory reaction can affect the upper and lower respiratory tract, as well as the kidneys. The expected age of presentation is in the sixth and seventh decades of life, and Caucasians are mostly affected. The cornerstone of treatment is high-dose glucocorticoids in combination with immunosuppressant, steroid-sparing drugs, which leads to remission in almost 80% of patients. We present an unusual case of a 55-year-old Hispanic woman presenting with acute kidney injury secondary to treatment-resistant GPA. The failure of standard treatment is extremely rare. In addition, this patient presented with primarily renal symptoms, even though head and neck and airway symptoms are expected in almost all cases initially.Keywords: Granulomatosis with polyangiitis, renal failure, treatment failure","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85685335","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 : 2023-04-25DOI: 10.12746/swrccc.v11i47.1175
Shengping Yang, G. Berdine
{"title":"Trial sequential analysis","authors":"Shengping Yang, G. Berdine","doi":"10.12746/swrccc.v11i47.1175","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1175","url":null,"abstract":"","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78754746","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 : 2023-04-25DOI: 10.12746/swrccc.v11i47.1119
Cole Pollina, Luis Fernandez-Nava, Cooper Phillips
Propofol (Diprivan) is the most widely used intravenous (IV) anesthetic for the induction and maintenance of general anesthesia. Its rapid onset, fast recovery, and antiemetic properties make propofol a popular anesthetic drug over competing drugs, such as etomidate, ketamine, and halogenated gases. While there is general agreement about the physiological effects of propofol, inconsistent dosing metrics likely complicate its disputed effects on peri- and post-operative hemodynamics and cardiac function in the literature. This review provides the rationale for the recommended dosing metric of propofol and clarifies the bodily effects of dose-appropriate propofol use. This was achieved through a systematic review of propofol’s mechanism of action and observed physiological effects with respect to body habitus, age, and sex.Keywords:propofol, anesthesia, hemodynamics, induction
{"title":"The effects of body habitus, age, and sex on adequate propofol dosing and infusion for general anesthesia","authors":"Cole Pollina, Luis Fernandez-Nava, Cooper Phillips","doi":"10.12746/swrccc.v11i47.1119","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1119","url":null,"abstract":"Propofol (Diprivan) is the most widely used intravenous (IV) anesthetic for the induction and maintenance of general anesthesia. Its rapid onset, fast recovery, and antiemetic properties make propofol a popular anesthetic drug over competing drugs, such as etomidate, ketamine, and halogenated gases. While there is general agreement about the physiological effects of propofol, inconsistent dosing metrics likely complicate its disputed effects on peri- and post-operative hemodynamics and cardiac function in the literature. This review provides the rationale for the recommended dosing metric of propofol and clarifies the bodily effects of dose-appropriate propofol use. This was achieved through a systematic review of propofol’s mechanism of action and observed physiological effects with respect to body habitus, age, and sex.Keywords:propofol, anesthesia, hemodynamics, induction","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78766019","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 : 2023-04-25DOI: 10.12746/swrccc.v11i47.1165
J. Ramos
The clinical use of neuromuscular blocker agents (NMBAs) in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) is a controversial topic in critical care medicine. Of the two classes of NMBAs, the most widely used are the non-depolarizing agents including cisatracurium. Some of the benefits attributed to this class of medications for patients with ARDS include a decreased inflammatory response, prevention of ventilator dyssynchrony, and improved oxygenation. The mortality benefit of this intervention was recently studied by two main trials, ACURASYS and ROSE, which showed improved patient outcomes, but no mortality benefit was obtained. The decision to use NMBAs in the clinical practice has to be made in a case-by-case basis taking in consideration different scenarios.
{"title":"Neuromuscular blocker agents in mechanically ventilated patients with ARDS","authors":"J. Ramos","doi":"10.12746/swrccc.v11i47.1165","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1165","url":null,"abstract":"The clinical use of neuromuscular blocker agents (NMBAs) in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) is a controversial topic in critical care medicine. Of the two classes of NMBAs, the most widely used are the non-depolarizing agents including cisatracurium. Some of the benefits attributed to this class of medications for patients with ARDS include a decreased inflammatory response, prevention of ventilator dyssynchrony, and improved oxygenation. The mortality benefit of this intervention was recently studied by two main trials, ACURASYS and ROSE, which showed improved patient outcomes, but no mortality benefit was obtained. The decision to use NMBAs in the clinical practice has to be made in a case-by-case basis taking in consideration different scenarios.","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"144 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79705649","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 : 2023-04-25DOI: 10.12746/swrccc.v11i47.1161
G. Berdine
{"title":"Medicare: an unexpected beneficiary of COVID","authors":"G. Berdine","doi":"10.12746/swrccc.v11i47.1161","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1161","url":null,"abstract":"","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"106 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77759277","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 : 2023-01-24DOI: 10.12746/swrccc.v11i46.1131
Michel Juarez, Ana Cordón, R. Franco, R. Butler, Mahmoud Abdelnabi
{"title":"Chronic cavitary pulmonary aspergillosis presents as chronic dry cough","authors":"Michel Juarez, Ana Cordón, R. Franco, R. Butler, Mahmoud Abdelnabi","doi":"10.12746/swrccc.v11i46.1131","DOIUrl":"https://doi.org/10.12746/swrccc.v11i46.1131","url":null,"abstract":"","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82101710","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 : 2023-01-24DOI: 10.12746/swrccc.v11i46.1139
Shengping Yang, G. Berdine
{"title":"Artificial intelligence in biomedical research","authors":"Shengping Yang, G. Berdine","doi":"10.12746/swrccc.v11i46.1139","DOIUrl":"https://doi.org/10.12746/swrccc.v11i46.1139","url":null,"abstract":"","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82485916","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 : 2023-01-24DOI: 10.12746/swrccc.v11i46.1133
A. Motes
Critically ill patients often experience pain from an underlying illness or injury, a recent surgical or other invasive procedure, or various interventions in the intensive care unit (ICU), e.g., endotracheal intubation, vascular access devices, nasogastric tubes, urinary catheters, mechanical ventilation, and routine nursing care, such as repositioning. Opioids remain the mainstay medication for pain control in the ICU; however, they can have adverse effects, including over-sedation, respiratory depression, opioid-induced constipation, opioid dependence and withdrawal, which result in increased length of ICU/hospital stay, health care costs, morbidity, and mortality. In this review, we summarize the mechanism of action, usual doses, side effects, recent studies of opioids that are frequently used in adult ICUs, and pain assessment tools for monitoring pain in adult ICU patients. Keywords: analgesia, opioids, intensive care unit, pain assessment tools
{"title":"Pain management in the intensive care unit","authors":"A. Motes","doi":"10.12746/swrccc.v11i46.1133","DOIUrl":"https://doi.org/10.12746/swrccc.v11i46.1133","url":null,"abstract":"Critically ill patients often experience pain from an underlying illness or injury, a recent surgical or other invasive procedure, or various interventions in the intensive care unit (ICU), e.g., endotracheal intubation, vascular access devices, nasogastric tubes, urinary catheters, mechanical ventilation, and routine nursing care, such as repositioning. Opioids remain the mainstay medication for pain control in the ICU; however, they can have adverse effects, including over-sedation, respiratory depression, opioid-induced constipation, opioid dependence and withdrawal, which result in increased length of ICU/hospital stay, health care costs, morbidity, and mortality. In this review, we summarize the mechanism of action, usual doses, side effects, recent studies of opioids that are frequently used in adult ICUs, and pain assessment tools for monitoring pain in adult ICU patients. \u0000 \u0000Keywords: analgesia, opioids, intensive care unit, pain assessment tools","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89627962","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 : 2023-01-24DOI: 10.12746/swrccc.v11i46.1111
T. Mcmahon, Hisham Ali, Regina Bundoc-Baronia, T. McGovern
The transition of power from a failing Weimer Republic to the National Socialist (Nazi) government was characterized by many economic and politically-motivated changes. Economic crises and the overcrowding of psychiatric hospitals in Germany were the setting for these events. The eugenics movement, although not unique to Germany in the 1920s, would eventually culminate in the compulsory sterilization, euthanasia, and extermination in concentration camps. Historical accounts tend to focus on political and military leaders with the role of medical professionals often overlooked or forgotten. Additionally, there are connections between these programs and medical research. This article aims to elucidate the factors that influenced their role in this historical tragedy and their current implications on how physicians train, learn, and practice role of the medical professionals.
{"title":"Revisiting psychiatric support for the National Socialist Agenda in Germany: Implications for medical and residency training","authors":"T. Mcmahon, Hisham Ali, Regina Bundoc-Baronia, T. McGovern","doi":"10.12746/swrccc.v11i46.1111","DOIUrl":"https://doi.org/10.12746/swrccc.v11i46.1111","url":null,"abstract":"The transition of power from a failing Weimer Republic to the National Socialist (Nazi) government was characterized by many economic and politically-motivated changes. Economic crises and the overcrowding of psychiatric hospitals in Germany were the setting for these events. The eugenics movement, although not unique to Germany in the 1920s, would eventually culminate in the compulsory sterilization, euthanasia, and extermination in concentration camps. Historical accounts tend to focus on political and military leaders with the role of medical professionals often overlooked or forgotten. Additionally, there are connections between these programs and medical research. This article aims to elucidate the factors that influenced their role in this historical tragedy and their current implications on how physicians train, learn, and practice role of the medical professionals.","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86186583","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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