JournalTOCs

Southwest Respiratory and Critical Care Chronicles
Number of Followers: 1

This is an Open Access Journal

Open Access journal
ISSN (Print) 2325-9205
Published by Texas Tech University Health Sciences Center

[1 journal]

Pregnancy outcomes in patients with COVID-19: A retrospective chart review
and literature review
- Authors: Christopher Peterson, Mostafa Abohelwa, Sima Shahbandar, Dylan Landis, Nandini Ray, Nabeela Manal, Patrice Lamey, Akhila Reddy, Mariam Rizi, Drew Payne
  Pages: 1 - 8
  Abstract: Objective: Pregnant women are at a higher risk for severe 2019 novel coronavirus (COVID-19) infection compared to non-pregnant women. Because of this, careful monitoring and studies of this population should be carried out. Here we identify the clinical characteristics, neonatal outcomes, and population demographics of COVID-positive pregnant women admitted to the University Medical Center in Lubbock, Texas. Methods: This retrospective study reviewed a cohort of pregnant patients with confirmed COVID-19 admitted to Texas Tech University Health Sciences Center and its affiliated University Medical Center between April 12, 2020, and January 25, 2021 Results: Thirty-six patients met inclusion criteria. The average patient age was 29 ± 4.8 years, and 61.1% of patients identified their ethnicity as Hispanic or Latino origin. The mean length of stay was 3.3 ± 3.6 days, and the remaining number of weeks of pregnancy at delivery was 37.8 ± 2.3 weeks. No deaths occurred in the mothers; three pregnancies did not result in a live birth. Notable findings included an increased rate of pre-term births (18.2%), an increased rate of NICU admissions (16.7%), and an increased rate of gestational diabetes (13.9%) compared to national averages in pregnant women. Conclusions: Many of our findings confirmed the existing literature concerning pregnancy outcomes among COVID-19-positive pregnant women, including relatively high preterm birth and NICU admission rates. The number of women who identified their ethnicity as Hispanic or Latino was high, which may reflect the overall demographics in West Texas. Furthermore, our gestational diabetes rate was also higher than the national average, possibly reflecting the high obesity rates in this area. We recommend further research on the mechanisms of preterm birth in COVID-19 illness and on ways to improve the health and healthcare outcomes in West Texas residents.
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1203
  Issue No: Vol. 11, No. 48 (2023)
Percutaneous tracheostomy in patients with COVID-19 infection and acute
respiratory failure
- Authors: Tushi Singh, Hasham Sarwar, Andres Hurtado, Ebtesam Islam
  Pages: 9 - 13
  Abstract: Background: Tracheostomy is often performed in patients who need prolonged intubation. COVID -19 brought unforeseen challenges, thus altering previously established norms. In this study, the outcomes of the patients undergoing tracheostomy for respiratory failure due to COVID -19 were studied. Methods: This is a single center retrospective observational cohort study of patients who underwent percutaneous tracheostomies between March 1, 2020, and September 30, 2021, due to respiratory failure secondary to COVID-19. Inclusion criteria included performance of percutaneous tracheostomies on patients with confirmed diagnosis of COVID-19. Exclusion criteria included patients undergoing surgical tracheostomies, extubation prior to the performance of a tracheotomy, and death prior to the performance of the tracheotomy. Results: The study included 49 patients after reviewing the records of 101 patients who underwent tracheostomies during the study period. The average age of the population was 59 ± 11years; 33 patients (67%) were men. The median Sequential Organ Failure Assessment (SOFA) score on admission was 2. The median duration of mechanical ventilation prior to tracheostomy was 18 days; the median positive end expiratory pressure was 10 cm H2O and the median fraction of inspired oxygen (FiO2) was 0.45. Two patients died during the procedure, one secondary to cardiac arrest and one secondary to bleeding. Eighteen patients (38%) died after the procedure during hospitalization; the median length of mechanical ventilation for all patients was 32.5 days. Eleven patients (22%) were eventually decannulated. Twenty patients (40%) were discharged to rehabilitation, and nine patients (18%) were discharged home. Eighteen patients (36%) were alive at the end of 90 days. Twelve patients (26%) were lost to follow up after discharge from the hospital. At the time of the tracheostomy, 16 patients (32%) had moderate ARDS as per the Berlin definition, and 12 (24%) had severe ARDS. Conclusion: Tracheostomy is an important therapeutic intervention in critically ill patients requiring mechanical ventilation. The COVID-19 pandemic raised important concerns and uncertainties about the management of these patients and the safety of healthcare workers. In this study, 29 patients (59%) undergoing tracheostomies recovered enough to be discharged to rehabilitation or to their homes. The risks to patients and to healthcare workers seem reasonable, but the optimal timing is uncertain and is best tailored to each patient based on his/her clinical status and prognosis. Keywords: COVID-19, tracheostomy, mechanical ventilation, acute respiratory failure
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1205
  Issue No: Vol. 11, No. 48 (2023)
The impact of a “Back to Bedside” initiative on resident
education
- Authors: Nikhil Seth, Maryam Riaz, Anika Sikka, George Martinez
  Pages: 14 - 17
  Abstract: Background: Back to Bedside is an American Council of Graduate Medical Education
  (ACGME) sponsored program with the goal of giving trainees a chance to find deeper meaning
  in their clinical work. As technological advances have decreased the amount of time trainees are
  spending with patients, a program was started that gives residents the opportunity to explore
  their patient interaction and communication skills.
  Observations: Residents spent one week on an elective during which they had uninterrupted
  time during ten patient encounters and were able to address multiple factors. They assisted with
  goals of care discussions, education on illness, education on medications, and practiced their
  communication skills.
  Conclusion: Thirty-one residents participated and completed a survey after the elective.
  This elective proved to be of great benefit to residents in many areas. They found personal
  growth in their ability to communicate medical findings in an easy-to-understand format, an
  improvement in general communication skills, and an improvement in understanding routine and
  complex pathology. As effective communication is key to patient safety, this study proves that
  communication curricula can improve physician-patient interactions.
  Keywords: Communication, medical education, medical curriculum
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1183
  Issue No: Vol. 11, No. 48 (2023)
ChatGPT and Medicine: Fears, Fantasy, and the Future of Physicians
- Authors: Christopher Peterson
  Pages: 18 - 30
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1193
  Issue No: Vol. 11, No. 48 (2023)
Interpretable artificial intelligence (AI) – saliency maps
- Authors: Shengping Yang, Gilbert Berdine
  Pages: 31 - 37
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1209
  Issue No: Vol. 11, No. 48 (2023)
Compassion
- Authors: Connie Nugent
  Pages: 38 - 39
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1201
  Issue No: Vol. 11, No. 48 (2023)
The COVID-19 pandemic and births in Lubbock county
- Authors: Gilbert Berdine, Shengping Yang
  Pages: 40 - 42
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1195
  Issue No: Vol. 11, No. 48 (2023)
An unknown source of Micrococcus luteus bacteremia
- Authors: Addie Pederson, R. Boone Coleman, Mary Irving
  Pages: 43 - 45
  Abstract: Micrococcus luteus is a common organism in the human skin flora. It is an uncommon cause of pathogenic bloodstream infections, which occur mostly in immunocompromised patients. We report the clinical course of an 82-year-old man who underwent complex management of multiple diverticular abscesses and had three serial positive blood cultures for M. luteus. Despite treatment with vancomycin, the patient ultimately died due to septicemia secondary to mixed gastrointestinal flora and M. luteus. A source this infection was never definitely identified.
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1187
  Issue No: Vol. 11, No. 48 (2023)
Nasopharyngeal adenoid cystic carcinoma metastasis to the liver
- Authors: Wooyoung Jang, Akshay Raghuram, Dauod Arif
  Pages: 46 - 50
  Abstract: Adenoid cystic carcinoma (ACC) is a malignancy of the secretory epithelial cells of the
  salivary glands and constitutes less than 1% of all head and neck tumors. Metastasis occurs
  frequently and most commonly affects the lungs at a rate of 35 to 50%. In this case report, we
  present a rare case of nasopharyngeal ACC with distant metastasis to the liver. Our patient
  initially presented to the hospital with dental and sinus pain with initial imaging suggesting
  nasopharyngeal carcinoma invading the temporal lobe laterally and the cavernous sinus and
  clivus medially. The foramen ovale and the optic nerve were also involved, leading to loss of vision
  bilaterally. Immunohistochemical staining of the biopsy eventually led to the correct diagnosis
  of high-grade ACC, solid type. The patient’s hospital course was complicated, with pulmonary
  thrombosis eventually leading to hypoxic respiratory failure and death. Although this patient was
  initially diagnosed with nasopharyngeal carcinoma, thorough pathologic investigations allowed
  for a clearer understanding of the disease, primarily ACC’s eventual distal metastasis in the
  patient. In the future, providers should continue to keep ACC in their differential diagnosis list
  when evaluating patients with head and neck tumors, with the goal of maintaining locoregional
  control of the tumor.
  Keywords: adenoid cystic carcinoma, liver metastasis, nasopharyngeal salivary glands, head
  and neck cancer
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1173
  Issue No: Vol. 11, No. 48 (2023)
Late presentation of Noonan syndrome as atrial flutter in an adult
- Authors: Ola Al-Jobory, Anass Dweik, Anees Muhammed, Waqas Rasheed, Ibrahim Mohammed, Kelly McMaster, Rajeev Gulati
  Pages: 51 - 54
  Abstract: Noonan syndrome is a rare genetic disease with multisystemic manifestations, typically diagnosed in infancy and childhood. This case report presents a 53-year-old woman with no significant medical history who presented with shortness of breath and was subsequently diagnosed with Noonan syndrome. The patient exhibited characteristic facial dysmorphology, including a narrow face, low set ears, and pectus excavatum. Physical examination revealed a crescendo-decrescendo ejection murmur and bilateral lower limb edema. Atrial flutter with rapid ventricular response was detected, and further investigations revealed a large secundum atrial septal defect (ASD) and other cardiac abnormalities consistent with Noonan syndrome. The patient was transferred to a tertiary center for evaluation and management by adult congenital disease specialists. This case highlights the atypical presentation of Noonan syndrome in adulthood and emphasizes the importance of recognizing this condition in patients with cardiac anomalies, as it can impact perioperative management and necessitates genetic counseling. Keywords: Noonan syndrome, genetic disease, multisystemic manifestations, atrial septal defect, adult presentation
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1191
  Issue No: Vol. 11, No. 48 (2023)
“PEek-a-boo!” pulmonary embolus visualized by endobronchial
ultrasound
- Authors: Ricardo Franco
  Pages: 55 - 56
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1197
  Issue No: Vol. 11, No. 48 (2023)
Dysphagia and dyspnea due to osteophyte formation in the cervical spine
- Authors: William Derrick, Arunee Motes
  Pages: 57 - 58
  PubDate: 2023-07-19
  DOI: 10.12746/swrccc.v11i48.1199
  Issue No: Vol. 11, No. 48 (2023)