Rare Presentation of Primary Pleural Ewing Sarcoma With a Mass Extending Into the Right Ventricle: A Case Report.

Primary pleural Ewing sarcoma is a rare type of Ewing sarcoma with only a few case reports identified in the literature. The condition is challenging to diagnose with deceiving symptoms and wide differential diagnosis. Diagnosis is confirmed with a combination of radiological and pathological assessment. Treatment is similar to other types of Ewing sarcoma with chemotherapy and surgery being the mainstay of treatment. We identify an unusual presentation of pleural Ewing sarcoma in a 31-year-old male with a mass extending into the right ventricular outlet causing rapid deterioration of the patient.

Is Atrial Fibrillation a Risk Factor for Worse Outcomes in Severe COVID-19 Patients: A Single Center Retrospective Cohort.

INTRODUCTION: New onset atrial fibrillation leads to worse outcomes in patients with sepsis. The association between new onset atrial fibrillation (AF) in COVID19 patients with COVID19 outcomes are lacking. This study aims to determine whether new onset atrial fibrillation in COVID19 patients admitted in the ICU is a risk factor for death or requirement of mechanical ventilation (MV). METHODS: This is a retrospective study conducted in a cohort of COVID-19 patients admitted to Bahrain Defence Force COVID19 Field ICU between April 2020 to November 2020. Data were extracted from the electronic medical records. The patients who developed new onset AF during admission were compared to patients who remained in sinus rhythm. Multivariate logistic regression models were used to control for confounders and estimate the effect of AF on the outcomes of these patients. RESULTS: Our study included a total of 492 patients out of which 30 were diagnosed with new onset AF. In the AF group, the primary outcome occurred in 66.7% of patients (n = 20). In the control group, 17.1% (n = 79) developed the primary outcome. Upon adjusting for the confounders in the multivariate regression model, AF had an odds ratio of 3.96 (95% CI: 1.05-14.98; p = 0.042) for the primary outcome. CONCLUSION: Our results indicate that new onset AF is a risk factor for worse outcomes in patients admitted with COVID19 in the ICU.

Randomized controlled trial of convalescent plasma therapy against standard therapy in patients with severe COVID-19 disease.

Convalescent plasma (CP) therapy in COVID-19 disease may improve clinical outcome in severe disease. This pilot study was undertaken to inform feasibility and safety of further definitive studies. This was a prospective, interventional and randomized open label pilot trial in patients with severe COVID-19. Twenty COVID-19 patients received two 200 ml transfusions of convalescent patient CP over 24-h compared with 20 who received standard of care. The primary outcome was the requirement for ventilation (non-invasive or mechanical ventilation). The secondary outcomes were biochemical parameters and mortality at 28 days. The CP group were a higher risk group with higher ferritin levels (p < 0.05) though respiratory indices did not differ. The primary outcome measure was required in 6 controls and 4 patients on CP (risk ratio 0.67, 95% CI 0.22-2.0, p = 0.72); mean time on ventilation (NIV or MV) did not differ. There were no differences in secondary measures at the end of the study. Two patients died in the control and one patient in the CP arm. There were no significant differences in the primary or secondary outcome measures between CP and standard therapy, although a larger definitive study is needed for confirmation. However, the study did show that CP therapy appears to be safe in hospitalized COVID-19 patients with hypoxia.Clinical trials registration NCT04356534: 22/04/2020.

Unusual Cardiac Presentation of COVID-19 with Significant Sinus Pauses.

There is growing evidence of cardiac complications due to corona virus disease 2019 (COVID 19). Our case is a case of a young patient with COVID-19 and symptomatic sinus pauses.

The Effect of Using Different Types of Forceps in the Efficacy of Transbronchial Lung Biopsy.

BACKGROUND: Transbronchial lung biopsy (TBBX) is a common respiratory diagnostic procedure performed to investigate several lung diseases. There are different types of forceps used to perform this procedure. The alligator and cupped (oval) forceps are most commonly used ones. To date, there are few studies that have compared the efficacy of these two types of forceps. This study compares the two types of forceps relating to the rate of complications and diagnostic value. METHODS: In this retrospective observational study, 40 patients who underwent TBBX using the alligator forceps were compared to a previous group of 40 patients who underwent the same procedure using the cupped forceps. The two groups were compared with respect to the rate of complications (bleeding and pneumothorax), diagnostic value and size of biopsies. RESULTS: The rate of complications was higher in patients who underwent TBBX using alligator forceps, in which seven patients (17.5%) had significant bleeding in the group that used alligator forceps versus three patients (7.5%) in cupped forceps group. Pneumothorax developed in three patients, all of whom were in the alligator forceps group. While there was no significant difference in the adequacy and size of the samples, the diagnostic yield was higher in the cupped forceps group. CONCLUSIONS: The results of the study showed that using cupped forceps in performing TBBX had fewer complications (pneumothorax and bleeding) and a higher diagnostic yield in comparison with alligator forceps, but the difference did not reach a statistical significant value.