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Background: Literature describing triggers of GFAP astrocytopathy (GFAP-A) is limited. We report a case of GFAP-A in a patient with recent messenger ribonucleic acid (mRNA) severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccination and discuss the possible pathogenesis. Case description: A 45-year-old gentleman presented with features of meningoencephalitis 31 days after the first dose and 4 days after the second dose of mRNA SARS-CoV-2 vaccination. He sequentially developed brainstem/cerebellar, autonomic and cord dysfunction. Cerebrospinal fluid was positive for GFAP autoantibody. Clinical improvement occurred after intravenous methylprednisolone and immunoglobulins. Conclusion(s): Although we are uncertain of a causal link of GFAP-A to mRNA vaccine, indirect activation of an underlying dysregulated immune milieu is plausible.Copyright © 2021 The Author(s)
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Purpose: To report single centre experience with use of wireless ultrasound probe for bedside venous line placement in COVID-19 patients. Material(s) and Method(s): From October 2020 to September 2021, we performed venous catheter insertions in 209 patients with COVID-19. The procedure was done at the angiographic suite or bedside. One hundred seventy-six patients with COVID-1 9 underwent bedside venous line placement. There were 115 males and 61 females with average age 74,9 years (from 16 to 96 years). We used two types wireless linear US probes with frequency 4-13 MHz (Clarius) or 7.5-10 MHz (LeapMed). Large 12-inch tablets were used to display the ultrasound image. Result(s): The venous line was successfully inserted in 172 (98,9%) patients at the first attempt. Four patients underwent second procedure because of vein dissection in 2 patients and hematoma and vein spasm in 2 patients. All repeated procedures were successful. The most common venous lines we used were midline in 143 patients. The PICC was inserted in 26 patients and central venous catheter (including dialysis catheter) was placed in 7 patients. The ECG was used bedside to verify the tip position of central inserted central venous catheter and PICCs. Conclusion(s): The use of wireless US probes is convenient for bedside venous line placement. The main advantage is simple manipulation, preservation of anti-epidemic conditions (even during non-pandemic COVID-19) and easier probe's dressing with sterile cover, because there is not cable between US probe and tablet (display). The use of wireless US probes makes the insertion of IV catheters in DIVA patients much more accessible and safer.
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Objective: The objective of this study was to determine factors that may affect anesthesia and surgical complications, difficult airway, and the need for intensive care unit (ICU) care in cleft lip and cleft palate (CLCP) surgeries. Materials and Methods: The study was a retrospective review of the records of 617 patients who underwent CLCP surgery between 2015–2019. Results: The number of anesthesia complications was higher in patients with difficult mask ventilation. Surgical complications were more common in patients >1 year of age. Isolated cleft palate (CP) surgery;presence of a concomitant disease, syndrome, or micrognathia;age >1 year;and the CP subtype were associated with a higher rate of difficult intubation. Isolated cleft palate, concomitant disease, syndrome, micrognathia, difficult intubation, difficult mask ventilation, and anesthesia complications were associated with ICU admission. Conclusion: The CP subtype was associated with a higher rate of difficult intubation and ICU hospitalization even in patients who were nonsyndromic and/or >1 year of age. Therefore, special attention should be paid to the anesthesia and surgical management of these patients.
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Aim: To report single centre experience with use of wireless ultrasound probe for bedside venous line placement in COVID-19 patients. Method: From October 2020 to September 2021, we performed venous catheter inser-tions in 209 patients with COVID-19. The procedure was done at the angiographic suite or bedside. One hundred seventy-six patients with COVID-19 underwent bedside venous line placement. There were 115 males and 61 fema-les with average age 74.9 years (from 16 to 96 years). We used two types wireless linear US probes: Clarius Scanner L7 HD (Clarius Mobile Health Corp, Vancouver, Kanada) or 4Echo LeapMed (Guide Imaging, Oostende, Belgie). Large 12.9-inch tablets (iPad Pro, Apple Inc, Cupertino, USA) were used to display the ultrasound image. The ECG was used to verify the tip position of central inserted central venous catheter and PICCs. Results: The venous line was successfully inserted in 172 (97.7 %) patients at the first attempt. Four patients underwent second procedure because of vein dissection in 2 patients and hematoma and vein spasm in 2 patients. All repeated procedures were successful. The most common venous lines we used were midline in 143 patients. The PICC was inserted in 26 patients and central venous catheter (including dialysis catheter) was placed in 7 patients. Conclusion: The use of wireless US probes is convenient for bedside venous line placement. The main advantage is simple manipulation, preservation of anti-epidemic conditions and easier probe’s dressing with sterile cover, because there is not cable between US probe and tablet.
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INTRODUCTION: Establishing intravenous access is essential but may be difficult to achieve for patients requiring isolation for severe acute respiratory syndrome coronavirus 2 infection. This study aimed to investigate the effectiveness of an infrared vein visualizer on peripheral intravenous catheter therapy in patients with coronavirus disease 2019. METHODS: A nonrandomized clinical trial was performed. In total, 122 patients with coronavirus disease 2019 who required peripheral intravenous cannulation were divided into 2 groups with 60 in the control group and 62 in the intervention group. A conventional venipuncture method was applied to the control group, whereas an infrared vein imaging device was applied in the intervention group. The first attempt success rate, total procedure time, and patients' satisfaction score were compared between the 2 groups using chi-square, t test, and z test (also known as Mann-Whitney U test) statistics. RESULTS: The first attempt success rate in the intervention group was significantly higher than that of control group (91.94% vs 76.67%, ê2 = 5.41, P = .02). The procedure time was shorter in the intervention group (mean [SD], 211.44 [68.58] seconds vs 388.27 [88.97] seconds, t = 12.27, P < .001). Patients from the intervention group experienced a higher degree of satisfaction (7.5 vs 6, z = -3.31, P < .001). DISCUSSION: Peripheral intravenous catheter insertion assisted by an infrared vein visualizer could improve the first attempt success rate of venipuncture, shorten the procedure time, and increase patients' satisfaction.
Subject(s)
COVID-19 , Catheterization, Peripheral , Catheterization, Peripheral/methods , Catheters , Humans , SARS-CoV-2 , VeinsABSTRACT
Introduction In the Viterbo province (3612 Km 2 divided into 60 municipalities) is operative a Domiciliary Hematologic Care Unit (DHCU) for clinical assistance to frail patients (pts) with hemopathies: DHCU nursing activity is done by 4 units who were employed during Covid-19 pandemia to avoid as possible risks of viral contagium due to hospital admissions of our pts. Aims To evaluate the entity and type of nursing management for frail pts followed by DHCU during the first year of Covid-19 pandemia. Methods All nursing activities from 3/2020 to 3/2021 in the lockdown framework were analysed. On the whole, 107 pts in 43 municipalities of Viterbo province were followed by DHCU nurses in the study period. Results Main features of the pts at baseline of domiciliary assistance are reported in the Table. At beginning of the study period (08/03/2020), 37 pts (34.5%) were already followed by DHCU, while 70 pts (65.5%) entered domiciliary assistance during the year of study. Median distance from DHCU central site to pts house was 25 Km [Interquartile range (IQR) 16 - 34]: distance from DHCU was < 20 Km in 32 cases (29.9%), ≥ 20 < 40 Km in 57 (53.2%) and ≥ 40 Km in 18 (16.9%). A total number of 2609 nursing accesses was done in the whole period. According to different procedures, 1152 blood samples were performed, with a median number of 7 (IQR 3 - 15) for each pts: in addition, there were 1040 accesses for chemotherapy (CHT) administration (108 cycles of azacytidine in 15 pts, 87 bortezomib-based cycles in 30 pts, 16 administrations of other CHTs in 2 pts) and 417 accesses for other procedures (260 venous catheter medications, 125 therapy other than CHT, 32 nursing assistances of transfusions or marrow aspirates). Finally, 20 pts were vaccinated at home with respective caregivers. During the entire study period, 2 pts (1.8%) developed Covid-19 infection while in home care. At the last follow-up (31/03/2021), 59 pts (55.1%) were alive and still followed by DHCU, 20 pts (18.6%) were alive and returned to sDay-Hospital (DH) setting due to improvement of clinical conditions and 28 pts (26.3%) died while in domiciliary assistance. Conclusions Domiciliary nurse assistance during Covid-19 pandemia allowed to follow in a safer way compared to standard DH/ordinary admission settings > 100 frail pts with hemopathies, most of them in 1 st or subsequent active lines of therapy, in a wide geographic area. In our opinion, this approach should represent the best type of assistance for a high rate of hematologic pts even beyond Covid-19 period of pandemia. [Formula presented] Disclosures: Stagno: Novartis: Consultancy, Honoraria, Other: Support for attending meetings and/or travel, Research Funding;Pfizer: Consultancy, Honoraria, Other: Support for attending meetings and/or travel;InCyte: Consultancy, Honoraria. Latagliata: BMS Cellgene: Honoraria;Pfizer: Honoraria;Novartis: Honoraria.