A Retrospective Study of Dexamethasone, Remdesivir, and Baricitinib in Severe COVID-19.

Purpose: RECOVERY, ACTT-1, and ACTT-2 trials have demonstrated that utilization of dexamethasone, remdesivir, or a combination of remdesivir with baricitinib leads to mortality benefit and faster time to recovery, respectively. However, no studies have investigated the benefit of triple therapy of dexamethasone, remdesivir, and baricitinib. We investigate the benefits of triple therapy compared to dual therapy of dexamethasone with remdesivir in patients with severe COVID-19 on HFNC. Materials and Methods: A retrospective data analysis was performed on patients with severe COVID-19 requiring HFNC and evaluated for hospital discharge status, requirement of mechanical ventilation, length of stay, and days on HFNC. Results: Among 191 patients with severe COVID-19, 81 patients received dexamethasone, remdesivir, and baricitinib. Patients receiving triple therapy had a significant survival benefit (HR 0.52; P=0.042). Treatment with triple therapy vs. dual therapy also trended towards less requirement of mechanical ventilation (OR 0.66; P=0.26). There was no significant change in length of stay (mean 13.74 vs. 13.31; P=0.74) or days on HFNC (mean 8.95 vs. 7.28 days, P=0.16). Conclusions: The use of dexamethasone, remdesivir, and baricitinib in patients with severe COVID-19 requiring HFNC was associated with a significant survival benefit in comparison to dual therapy of dexamethasone with remdesivir.

Exploring Data and Literature Currently Available on the COVID-19 Vaccines.

The COVID-19 pandemic has been labeled one of the most lethal pandemics in human history. As a result, there has been a high level of urgency throughout the world to establish successful vaccinations to subdue the effects of the virus and return to a level of normalcy. This study aims to investigate the different COVID-19 vaccines available both in the United States and across the globe. Through exploration of how the vaccines were developed, how they elicit immunity, their efficacy, and their safety profiles, this review has the goal of increasing the amount of knowledge regarding the vaccines available to combat SARS-CoV-2, while also providing an epidemiological and biostatistical approach to interpreting acquired data available on the vaccines.

Diagnostic yield of electromagnetic navigational bronchoscopy in a low volume center when performed by community pulmonologists.

INTRODUCTION: Electromagnetic navigational bronchoscopy (ENB) may be used for evaluation of pulmonary nodules. The purpose of this study was to determine the yield of ENB at a low volume center (0-4 cases per month), where the cases were performed by community pulmonologists neither trained in interventional pulmonology nor an expert in electromagnetic navigational bronchoscopy. The primary endpoint was to find the diagnostic yield of ENB at our center. A safety analysis was also performed to evaluate complications during the procedures. MATERIALS AND METHODS: A retrospective chart review of all the patients who had undergone ENB from January 2019 to January 2021 was performed. A total of 29 ENB procedures were performed during that time frame. Four ENB procedures were performed for fiducial placement and were not included in the study. RESULTS: Diagnosis was made in 72% of patients (18 cases out of 25 cases). With the exception of a single pneumothorax, no other complications were found. CONCLUSIONS: In conclusion our study shows that ENB, performed at low volume center by physicians not formally trained in interventional pulmonology or considered as experts in the procedure, has a high diagnostic yield and a good safety profile. This study shows that ENB may be performed by community pulmonologists at low volume center with a diagnostic yield comparable to high volume centers. This will be help improve access of ENB to more patients.

The Utility of Point-of-Care Ultrasound for Post-Bronchoscopy Pneumothorax Evaluation.

We present a case of a 65-year-old female with a prior history of B-cell lymphoma with new CT chest findings of a nodule requiring an electromagnetic navigational bronchoscopy with transbronchial biopsies. Post-bronchoscopy, the patient complained of dyspnea and left scapular pain despite two normal anterior-posterior chest X-rays. Point-of-care ultrasound of the lung demonstrated a lack of lung sliding, which was confirmed via a right lateral decubitus chest X-ray. This case illustrates the utility and superiority of lung point-of-care ultrasound while highlighting the limitations of conventional imaging modalities in a post-bronchoscopy evaluation.

Intrapulmonary Sequestration: A Rare Occurrence.

Pulmonary sequestration is a rare occurrence. Here, we present a case of a 45-year-old female who, on CT scan of the chest, was found to have a left lower lobe consolidation. Despite antibiotic treatment, the consolidation remained persistent. On repeat imaging with CT scan with contrast, it was found that the consolidation was pulmonary sequestration. The patient was referred to cardiothoracic surgery to remove pulmonary sequestration through video-associated thoracoscopic surgery.

Esmolol Use in Dual Axis Defibrillation Resistant Ventricular Fibrillation.

Cardiac arrest in an event of acute myocardial infarction most commonly results in life-threatening ventricular tachycardia or ventricular fibrillation (VF). Patients who remain in VF despite optimal epinephrine, amiodarone, and three or more attempts at 200 joules of biphasic current defibrillation are known to be in an electrical storm. Here, we describe a case of defibrillation refractory VF responding to intravenous esmolol resulting in a successful return of spontaneous circulation. Learning objective. This case reinforces the growing body of evidence supporting esmolol as a novel treatment approach for refractory VF before the cessation of resuscitative efforts.

A Coronavirus Disease 2019 (COVID-19) Patient with Multifocal Pneumonia Treated with Hydroxychloroquine.

After an outbreak in December 2019 in Wuhan, Hubei Province of China, coronavirus disease 2019 (COVID-19) has rapidly become a pandemic. The 2019 novel coronavirus (2019 nCov), now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a wide spectrum of illness and patients with underlying comorbidities have a high mortality. Here we present a 49-year-old male patient with comorbid conditions who presented with fever, cough, myalgia and shortness of breath for five days with likely exposure to a COVID-19 contact. A computed tomography scan of the thorax revealed multifocal bilateral ground-glass lung opacities with areas of subpleural sparing. He tested positive for SARS-CoV-2 by nucleic acid amplification. Hydroxychloroquine therapy was started, and the patient responded favorably with improvement of symptoms. Early diagnosis and self-isolation or quarantine remain key to stemming the tide of the contagion as there is a real risk of the healthcare system being overwhelmed.

Long-term Impact of E-cigarette and Vaping Product Use-associated Lung Injury on Diffusing Capacity for Carbon Monoxide Values: A Case Series.

There has been an outbreak of lung injury associated with e-cigarettes and vaping in the United States since early 2019. We present two cases who were admitted to the hospital with shortness of breath and cough. Chest imaging showed they had interstitial changes. They were diagnosed with e-cigarette and vaping product use-associated lung injury (EVALI) and treated with steroids and supportive management. With an improvement in symptoms, they were discharged home. On follow-up in the clinic, both patients were asymptomatic and had complete resolution of radiographic abnormalities. However, pulmonary function testing showed reduced diffusion capacity for carbon monoxide (DLCO). Total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in the first one second (FEV-1), and the FEV-1/FVC ratio were normal.

Cerebellar Haemorrhage Leading to Sudden Cardiac Arrest.

INTRODUCTION: Intracranial haemorrhage (ICH) is a known, but a rare cause of out of hospital cardiac arrest (OHCA). It results in the development of non-shockable rhythms such as asystole or pulseless electrical activity (PEA). CASE REPORT: A 77- years old male had an OHCA without any prodrome. An emergency medical services (EMS) team responded to an emergency call and intubated the patient at the site before transporting him to the Acute Care Hospital, New Brunswick, New Jersey, USA. On admission, a non-contrast computed tomography scan of the head revealed a large cerebellar haemorrhage. Non-traumatic ICH is a rare cause of OHCA. Although subarachnoid haemorrhage causing cardiac arrest has been described in the literature, cerebellar haemorrhage leading to cardiac arrest is rare. The mechanism by which ICH patients develop cardiac arrest is likely explained by a massive catecholamine surge leading to cardiac stunning. CONCLUSION: A non-shockable rhythm in the seting of a sudden cardiac arrest should raise alarms for a primary non-cardiac ethology, especially a primary cerebrovascular event. The absence of brainstem reflexes increases the likelihood of an intracranial process.

Vaping-associated Lung Injury.

Many cases related to vaping-associated lung injury have recently been reported to the Center for Disease Control (CDC). It is, therefore, important for clinicians to be aware of this disease. Here, we present the case of a 46-year-old female patient, who had recently started vaping. She presented to the hospital with dyspnea; since her condition deteriorated quickly, she was mechanically ventilated for acute respiratory failure. When a computed tomography angiography (CTA) chest was performed, patchy alveolar opacities were seen throughout both lungs. The patient's workup for infectious and cardiac etiology was negative. She was diagnosed with vaping-associated lung injury. Later, she recovered and was discharged to a rehabilitation center.

Plasma cell leukemia.

We present a rare case report of a patient diagnosed with primary plasma cell leukemia (PCL) who presented with atypical signs and symptoms which acutely evolved into life-threatening multi-organ failure. This case raises questions regarding the latest diagnostic guidelines and therapeutic options in the management of acute PCL and reinforces the need for prompt treatment after diagnosis.

Trends of Cannabis Use Disorder in the Inpatient: 2002 to 2011.

OBJECTIVES: The nationwide prevalence of cannabis use/abuse has more than doubled from 2002 to 2011. Whether the outpatient trend is reflected in the inpatient setting is unknown. We examined the prevalence and incidence of cannabis abuse/dependence as determined by discharge coding in a 10-year (2002-2011) National Inpatient Sample, as well as various trends among demographics, comorbidities, and hospitalization outcomes. METHODS: Cannabis abuse/dependence was identified on the basis of International Classification of Diseases, 9th Revision, Clinical Modification codes 304.3* and 305.2* in adults aged 18 years or more. We excluded cases coded "in remission." National estimates of trends and matched-regression analyses were conducted. RESULTS: Overall, 2,833,567 (0.91%) admissions with documented cannabis abuse/dependence were identified, patients had a mean age of 35.12 ± 0.06 years, 62% were male, and there was an increasing trend in prevalence from 0.52% to 1.34% (P <.001). The mean Charlson Comorbidity Index was 0.47 ± 0.006, and inpatient mortality was 0.41%. All of the above demonstrated an increasing trend (P <.001). Mean length of stay was 6.23 ± 0.06 days. The top primary discharge diagnoses were schizoaffective/mood disorders, followed by psychotic disorders and alcoholism. Asthma prevalence in nontobacco smokers had a steeper increase in the cannabis subgroup than in the noncannabis subgroup (P = .002). Among acute pancreatitis admissions, cannabis abusers had a shorter length of stay (-11%) and lower hospitalization costs (-7%) than nonabusers. CONCLUSION: Cannabis abuse/dependence is on the rise in the inpatient population, with an increasing trend toward older and sicker patients with increasing rates of moderate to severe disability. Psychiatric disorders and alcoholism are the main associated primary conditions. Cannabis abuse is associated with increased asthma incidence in nontobacco smokers and decreased hospital resource use in acute pancreatitis admissions.

Successful lung transplantation from a donor with a saddle pulmonary embolus.

Pulmonary embolus has received scant attention as a contraindication to lung donation. Reported is a case of a saddle pulmonary embolus successfully treated with thrombolytics in a donor whose lung was ultimately successfully transplanted. Discussed are the theoretical likelihood of thromboembolus in potential lung donors and the possible implications of pulmonary embolism on donor selection and lung physiology around the time of transplantation.