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1.
Journal of Investigative Dermatology ; 142(8, Supplement):B38, 2022.
Article in English | ScienceDirect | ID: covidwho-1936828
3.
J Eur Acad Dermatol Venereol ; 36(6): 790-796, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1673165

ABSTRACT

Scalp dysesthesia is an abnormal sensation of the scalp in the absence of cutaneous disease. It is characterized by a burning and/or itching sensation and can be related to a variety of neurogenic or psychogenic causes. This condition is extremely bothersome and is also common- especially among the geriatric population, in women, in patients with diabetes mellitus, and patients with psychiatric history. However, despite its prevalence in many populations, there are limited data about its causes and characteristics. Given its limited cutaneous manifestations, it is also easily misdiagnosed and an underrecognized cause of scalp pruritus in the dermatological community. Therefore, education on scalp dysesthesia is paramount to helping physicians identify and provide appropriate treatment for these patients. This review focuses predominantly on the neurogenic causes (with a brief review of psychogenic itch) of scalp dysesthesia and the therapeutics that have been found to be effective for this condition. Neurogenic causes of scalp dysesthesia occur with damage to the central or peripheral pathways of itch sensation, resulting in modification and heightened sensitivity of nerves that result in abnormal sensations in the absence of or out of proportion to external stimuli. A comprehensive review of etiologies is provided here, ranging from lesions to the central nervous system caused by cervical spine disease, trigeminal trophic syndrome, tumor, stroke, and multiple sclerosis, to small-fiber neuropathies caused by diabetes, brow lifts, keloid, and burn scarring. Recently, there have also been reports of scalp dysesthesias associated with post-infectious COVID-19. Treatment options tailored toward disease severity and different causes of disease will also be discussed. By elucidating the different mechanisms and therapeutic treatments of scalp dysesthesia, we hope to provide clinicians with the tools to identify and treat this condition as well as encourage further research into its etiologies and therapeutics.


Subject(s)
COVID-19 , Skin Diseases , Aged , Female , Humans , Paresthesia/etiology , Pruritus/etiology , Scalp , Skin Diseases/complications
4.
Medical Journal of Malaysia ; 76(SUPPL 1):47, 2021.
Article in English | EMBASE | ID: covidwho-1378745

ABSTRACT

Kaposi Sarcoma is a low-grade malignant mesenchymal neoplasm commonly associated with acquired immunodeficiency syndrome (AIDS). It primarily affects the cutaneous layer of the face and extremities and also oropharyngeal mucosa. Involvement of the larynx is somewhat unusual, with sparse information in the English literature. Herein, the author reported a case of a 27-year-old gentleman with Human immunodeficiency virus (HIV) on HAART treatment, who presented with progressive dysphonia and globus sensation of 1-month duration. In addition to the multiple purplish raised papules over his right forearm, a similar violaceous lesion was observed arising from the lingual surface of the epiglottis via flexible bedside laryngoscopy. Biopsy of the lesions confirmed the diagnosis of Kaposi Sarcoma. The clinical conundrum of managing this case was well illustrated with the concurrent diagnosis of COVID-19 in him. Detailed counselling on the treatment options of the laryngeal lesion was arranged, involving a multidisciplinary approach. The patient then opted for concurrent chemoradiotherapy. Chemotherapy offers the benefit of laryngeal preservation in Kaposi sarcoma involving the larynx and may be considered as a treatment option in patients with high risk of surgical intervention.

5.
Chest ; 158(4):A630-A631, 2020.
Article in English | EMBASE | ID: covidwho-866551

ABSTRACT

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: After the novel coronavirus disease (COVID-19), was declared a pandemic, New York quickly became the new epicenter of the disease, with Queens County reporting the most confirmed cases in the United States. This study was conducted during the peak of COVID-19 in Queens. Due to the severity of the disease and limited resources, patients were intubated at varying degrees of oxygenation. This study examines the preoxygenation state of COVID-19 ARDS patients prior to intubation and its implication on clinical outcomes. METHODS: At a single acute tertiary care hospital located in Queens, New York, all patients admitted between March 15 and April 15, 2020 were screened. Active COVID-19 status was confirmed with reverse transcriptase-polymerase chain reaction assay on nasopharyngeal samples. All COVID-19 patients who were intubated with documented pre-intubation oxygen saturation (PreO2) were included. All data were collected from the electronic health record, including laboratory data, ventilator settings, and hospital course. Peri-intubation cardiac arrest events up to 24 hours post-intubation and mortality during the study period were examined as outcomes. Data was analyzed with SPSS (version 25). Continuous variables were tested using independent T-tests. All tests of significance were two-tailed, and a p-value of 0.05 was considered significant. RESULTS: A total of 192 patients were included in the study. They had a mean age of 61.2 ± 12.2 years, and 130 (64.1%) were men. The mean preO2 of all patients was 71.3 ± 13.6, and the mean peri-intubation PF ratio was 120.84 ± 58.6. 32 out of 192 patients (16.7%) with peri-intubation cardiac arrest demonstrated significantly lower preO2 (p=0.03) compared to those without. These 32 patients also demonstrated more days with symptoms prior to intubation (p=0.004). 121 patients who expired during the clinical course demonstrated lower PreO2 (p=0.60) and PF Ratios (p=0.48) compared to the 71 patients who did not, but these comparisons were not statistically significant. Patients who expired demonstrated fewer symptomatic days prior to intubation than those who did not, but this was not statistically significant (p=0.06). CONCLUSIONS: At the time of intubation, the patients had significant hypoxemia and severe ARDS by PF ratio. Lower oxygenation prior to intubation is associated with an increase in peri-intubation complications. CLINICAL IMPLICATIONS: Due to unclear pathophysiology of ARDS in COVID-19, the optimal timing of intubation continues to be debated. Physicians should consider intubation earlier in the disease course prior to significant hypoxemia, which may have a negative impact on peri-intubation complications. Clinical outcome was further impacted by the restriction on preoxygenation of the patients prior to intubation, given its risk of viral aerosolization. Means of preoxygenating with minimal risk of disease spread should continue to be explored. DISCLOSURES: Advisory Committee Member relationship with Ambu Please note: $1-$1000 by Olumayowa Abe, source=Admin input, value=Honoraria No relevant relationships by Ahmed Al-Ghrairi, source=Web Response No relevant relationships by Christian Castaneda, source=Web Response No relevant relationships by Ettaib El Marabti, source=Web Response No relevant relationships by Hadya Elshakh, source=Web Response No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Michael Karass, source=Admin input No relevant relationships by Miri Kim, source=Web Response No relevant relationships by Jack Mann, source=Web Response No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Fizza Sajid, source=Web Response No relevant relationships by Angelina Voronina, source=Web Response

6.
Chest ; 158(4):A577, 2020.
Article in English | EMBASE | ID: covidwho-860869

ABSTRACT

SESSION TITLE: Advances in the Care of Mechanically-Ventilated Patients SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Psychomotor agitation is one of the reasons for noninvasive ventilation (NIV) failure. Judicious sedation may mitigate agitation and improve patient-ventilator synchrony in patients receiving NIV. Dexmedetomidine is an alpha-2 adrenergic receptor agonist that exhibits sedative, anxiolytic, and analgesic properties. It can provide moderate sedation without compromising the respiratory drive. This study aims to summarize the existing evidence for dexmedetomidine use in patients receiving NIV. METHODS: Studies reviewed were selected based on relevance from a meta-analysis search conducted in Medline, EMBASE, Cochrane library, and Academic Search Elite to include all published randomized controlled trials through April 2020. Prospective studies were selected if they compared dexmedetomidine with other sedative agents or no sedation in patients who require NIV. Review Manager 5.3 (The Cochrane Collaboration) was used for meta-analysis and a random effect model was applied for statistical analysis. RESULTS: Six randomized controlled trials with a total of 505 patients matched the inclusion criteria. Forty-four patients (20.1%) in the dexmedetomidine group and 96 patients (39.8%) in the control group required escalation of therapy from NIV to intubation. Dexmedetomidine infusion significantly reduced the intubation rate (pooled odds ratio, 0.37;95% CI: 0.24-0.58;p<0.0001) and ICU length of stay by 2.9 days (95% CI: -4.38 to -1.44;p =0.0001). However, dexmedetomidine did not change the mortality rate (pooled odds ratio, 0.46;95% CI: 0.1-1.78;p=0.26). Finally, patients who received dexmedetomidine infusion had a lower incidence of delirium (pooled odds ratio, 0.26;95% CI: 0.15-0.45;p=0.003) but were more prone to bradycardia and hypotension. CONCLUSIONS: The present analysis suggests that dexmedetomidine use in patients receiving NIV could mitigate agitation and improve NIV tolerance. For patients who require sedation while receiving NIV, dexmedetomidine may be the preferred sedative agent as it does not carry deleterious effects on ventilatory function. Dexmedetomidine reduces the incidence of delirium but may affect hemodynamic profiles more than other agents. Given the heterogeneity and small sample size of included studies, future large-scale studies are needed to examine the role of dexmedetomidine use in patients receiving NIV. CLINICAL IMPLICATIONS: Dexmedetomidine could be the preferred sedative agent for patients who have NIV intolerance due to agitation. Our analysis showed that clinical outcomes of dexmedetomidine use in NIV were encouraging, though further prospective studies are needed to confirm these results. In the era of COVID-19, dexmedetomidine could potentially reduce patients’ need for ventilators and optimize resource utilization. DISCLOSURES: No relevant relationships by Wei-cheng Chen, source=Web Response No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Chi Chan Lee, source=Web Response No relevant relationships by Hsin-Ti Lin, source=Web Response

7.
Chest ; 158(4):A634, 2020.
Article in English | EMBASE | ID: covidwho-860847

ABSTRACT

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: After the novel coronavirus disease (COVID-19), was declared a pandemic, New York quickly became the new epicenter of the disease. This study was conducted during the peak of COVID-19 in Queens. Many COVID-19 patients with severe acute respiratory distress syndrome (ARDS) required endotracheal intubation and heavy sedation for prolonged periods of time. Unplanned extubation (UE) events have a notable impact on clinical course and outcome. [1] Self-extubation (SE) is the most common reason for UE, and inadequate sedation is one of its most significant risk factors. [1,2] This study examines factors associated with SE events in patients with ARDS in COVID-19. METHODS: At a single acute tertiary care hospital located in Queens, New York, all patients with SARS-CoV-2 infection admitted between March 15, 2020 and April 15, 2020, were screened. Active COVID-19 status was confirmed with reverse transcriptase-polymerase chain reaction assay performed on nasopharyngeal samples. All patients who underwent endotracheal intubation were included in the study. All data were collected from the electronic health record for 28-day outcomes. All UE events, including SE and other causes for UE, number and dosages of sedatives at the time of SE, adverse events, such as cardiac arrest and anoxic brain injury following UE, were examined. RESULTS: A total of 205 patients were included in the study. Of these, 24 patients (11.7%) had one or more UE. Nine were due to SE (4.4%). None of these patients had plans for extubation. Only one was not on sedation due to a delay on the general medicine floor. The rest were sedated on 2 or more sedatives, including continuous infusions of opioids, propofol, dexmedetomidine, and ketamine at high doses. (Table 1) Five patients out of 9 with SE got reintubated right after SE event (55.6%). Two patients with SE events did not require reintubation (22.2%). There were 2 cardiac arrests following 9 SE events (22.2%), and only 1 patient survived. The 28-day mortality for patients with SE and patients without any UE were 66.7 % and 62%, respectively. CONCLUSIONS: Multiple SE events occurred in ARDS in COVID-19 patients, who were on multiple sedatives without any plans for extubation trial. In comparison with SE in other ARDS patients, these patients required higher doses of sedatives to achieve adequate sedation. SE events also had a significant rate of complication. Although this study is limited by its small sample size, it provides a narrative of what the experience has been with the COVID-19 patients. This highlights the need for further studies with higher statistical power in order to better understand the disease characteristics. CLINICAL IMPLICATIONS: Critical care physicians should consider tracheostomy in ARDS patients with COVID-19, to prevent complications of heavy sedation required for endotracheal intubation and complications of SE. DISCLOSURES: Advisory Committee Member relationship with Ambu Please note: $1-$1000 by Olumayowa Abe, source=Admin input, value=Honoraria No relevant relationships by Ahmed Al-Ghrairi, source=Web Response No relevant relationships by Ettaib El Marabti, source=Web Response No relevant relationships by Hadya Elshakh, source=Web Response No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Michael Karass, source=Admin input No relevant relationships by Miri Kim, source=Web Response No relevant relationships by Jack Mann, source=Web Response No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Fizza Sajid, source=Web Response No relevant relationships by Angelina Voronina, source=Web Response

8.
Chest ; 158(4):A632-A633, 2020.
Article in English | EMBASE | ID: covidwho-860846

ABSTRACT

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: As of May 2020, Queens County, New York reported the most confirmed cases of the novel coronavirus disease (COVID-19) in the United States. This study was conducted during the peak of COVID-19 in Queens. Many COVID-19 patients with acute respiratory distress syndrome (ARDS) required mechanical ventilation via endotracheal intubation for extended periods of time. This study examines the length of ventilation via endotracheal tube (ETT) and the outcome of extubation attempts (EXA). METHODS: At a single acute tertiary care hospital located in Queens, New York, all patients with COVID-19 admitted between March 15 to April 15, 2020, who were intubated with ETT were included. All data were collected from the electronic health record until April 25, 2020. Hospital course, extubation events, reintubation events, and number of tracheostomies were gathered. Number of ventilated days via ETT and mortality were studied as outcomes. Patients were divided into those who expired with ETT, were successfully extubated at first EXA, failed EXA, and underwent tracheostomy. Cardiac arrest and anoxic brain injury were studied as adverse events. RESULTS: 205 patients were included. Their mortality was 63.4% with 130 in-hospital deaths, of which 110 patients (54.7%) expired while on ventilator via ETT. 13 out of 205 patients (5.4%) were successfully extubated on first attempt, of which 2 were unplanned self-extubation events. The average ventilated days via ETT for this group was 9.36 days (SD 4.7 days). 7 out of 205 patients (3.4%) failed EXA. The average time to EXA in this group was 9.29 days (SD 5.8 days). There were 0 reported cardiac arrests or anoxic brain injuries following EXA. The average time from EXA to reintubation was 1.14 days (SD 1.9 days). 2 of the 7 patients who failed EXA expired on ventilator support via ETT. 36 out of 205 patients underwent tracheostomy. The mortality rate for this group was 19.4% (SD). The average ventilated days via ETT was 16.2 days (SD 5.3 days). CONCLUSIONS: COVID-19 patients that were intubated for severe ARDS had a notable mortality rate, and those who survived required a prolonged course of ventilation. Both groups of successful extubation and failed extubation had similar time on endotracheal ventilation prior to the attempt, making it an unlikely factor determining successful extubation. Patients who were able to undergo tracheostomy had lower mortality, but it is unclear if there was a direct correlation, as patients were generally less ill to be able to undergo such a procedure. CLINICAL IMPLICATIONS: Patients with severe ARDS in COVID-19 required a prolonged course of mechanical ventilation and exhibited a high likelihood of failure to extubate. In order to avoid the complications of prolonged ventilation via ETT, early tracheostomy should be considered. In the future, a larger cohort of patients should be examined to provide statistical reinforcement of our findings. DISCLOSURES: Advisory Committee Member relationship with Ambu Please note: $1-$1000 by Olumayowa Abe, source=Admin input, value=Honoraria No relevant relationships by Ahmed Al-Ghrairi, source=Web Response No relevant relationships by Christian Castaneda, source=Web Response No relevant relationships by Ettaib El Marabti, source=Web Response No relevant relationships by Hadya Elshakh, source=Web Response No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Michael Karass, source=Admin input No relevant relationships by Miri Kim, source=Web Response No relevant relationships by Jack Mann, source=Web Response No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Fizza Sajid, source=Web Response No relevant relationships by Angelina Voronina, source=Web Response

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