Use of ultrasound guidance to improve the safety of percutaneous dilatational tracheostomy: a literature review

Patients in ICUs frequently require tracheostomy for long-term ventilator support, and the percutaneous dilatational tracheostomy (PDT) method is preferred over surgical tracheostomy. The use of ultrasound (US) imaging to guide ICU procedures and interventions has recently emerged as a simple and noninvasive tool. The current evidence regarding the applications of US in PDT is encouraging; however, the exact role of US-guided dilatational tracheostomy (US-PDT) remains poorly defined. In this review, we describe the best available evidence concerning the safety and efficacy of US-PDT and briefly delineate the general principles of US image generation for the airway and of US-PDT procedures.     

Energy Transfer Studies in Tb3+-Yb3+ Co-Doped Phosphate Glasses

Detailed optical properties of Tb³⁺-Yb³⁺ co-doped phosphate glasses were performed based on their emission spectra and decay measurements. Under blue excitation of Tb³⁺ at 488 nm, the intensity of Yb³⁺ emissions gradually enhanced upon increasing the Yb³⁺ content until 1 mol% indicated an energy transfer from Tb³⁺ to Yb³⁺. Otherwise, under near infrared excitation of Yb³⁺ at 980 nm, these glasses exhibit intense green luminescence, which led to cooperative sensitization of the ⁵D₄ level of Tb³⁺ ions. A cooperative energy transfer mechanism was proposed on the basis of the study on the influence of Yb³⁺ concentration on up-conversion emission intensity, as well as the dependence of this up-conversion intensity on near infrared excitation power. Moreover, the temporal evolution of the up-conversion emissions have been studied, which was in positive agreement with a theoretical model of cooperative up-conversion luminescence that showed a temporal emission curve with rise and decay times of the involved levels.     

Descending necrotizing mediastinitis

Descending necrotizing mediastinitis (DNM) is a rare but severe life threatening complication of oropharyngeal infections. We report a young lady who had severe pharyngitis complicated by anterior neck infection that descended to the mediastinum causing necrotizing mediastinitis. The course of her illness was complicated with septic shock, acute kidney injury, tracheo-esophageal fistula, and critical illness polyneuropathy. There was considerable delay in her diagnosis; however, she survived after aggressive surgical intervention, wide spectrum antibiotics, and appropriate intensive care management. Early and repeated chest imaging using computed tomography was vital for the detection and follow up of this case. There is a need to increase physicians’ awareness of this condition that can complicate odontogentic or pharyngeal infection, procedures, or trauma.Descending necrotizing mediastinitis (DNM) is a rare but severe life threatening complication of infection in the oropharyngeal region that descends to the mediastinum through the connecting deep and superficial cervical fascial planes.1 The primary origin of the infection can be an odontogenic infection, pharyngeal soft tissue infection, sinusitis, or following cervical trauma.2,3 It is associated with high mortality unless it is diagnosed and treated promply.4 Old age and chronic medical conditions are important predisposing factors.2,3 We report a young patient with DNM who survived despite a considerable delay in diagnoses and a complicated course in the intensive care unit (ICU). We report this particular case to draw the clinician’s attention to this rare, but potentially fatal complication of common odontogenic and cervical infections, and emphasize the importance of early recognition and prompt management.     

Molecular Detection of Candidatus Orientia chuto in Wildlife,Saudi Arabia

Scrub typhus is a zoonosis caused by 3 species of Orientia bacteria, including Candidatus Orientia chuto. This species is known only from a human case in Dubai and infections in wildlife in Kenya. We report molecular detection of Candidatus O. chuto in 2 wild rodent species from Saudi Arabia.     

LE SULFATE DE MAGNESIUM : MOLECULE ADJUVANTE DANS LA PREMIERE HEURE DE PRISE EN CHARGE DE LA FIBRILLATION ATRIALE RAPIDE AUX URGENCES.

Introduction:

Rapid Atrial fibrillation (AF) is a common arrhythmia in emergency department (ED) that requires an urgent control of ventricular rate.

Aim:

To evaluate the safety and efficiency of magnesium sulfate as an adjunctive therapy in addition to usual care for rapid AF in emergency department.   

Methods:

This was a prospective, randomized, double-blind study. We included patients who presented to ED with rapid AF >110 batt/min. Group A received 3g of magnesium in 100mL of glucose solution and group B received 100 ml of glucose solution. Primary endpoint was slowing the ventricular rates to less than 110 beats/ min in the first 12 hours of management.   

Results:

One hundred and three patients were included. Fifty-three patients in group A with a mean heart rate of 146 ± 18 beats / min and fifty patients in group B with a mean heart rate of 143 ± 17 beats / min. A significantly greater number of patients slowed down their ventricular rate in group A during the first hour of management (p = 0.02). After 12 hours, mean heart rate was significantly lower in group A (p = 0.04).

Conclusion:

The use of 3 g of magnesium sulfate slowed down the ventricular rate of a larger number of patients with rapid AF in the first hour of management. Only minor adverse effects were registered.     

Yield and complications of flexible fiberoptic bronchoscopy in a teaching hospital

OBJECTIVE: To assess the diagnostic yield and safety of flexible fiberoptic bronchoscopy (FFB). METHODS: A retrospective review of bronchoscopy reports and corresponding patients charts over 3 years from January 2004 - December 2006 in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Indication for procedure, suspected diagnosis, final diagnosis, and complications were reported. RESULTS: Out of 720 patients, 707 (98.2%) patients had a full follow up. Five hundred and ninety-two (83.7%) underwent FFB for diagnostic purposes and 115 (16.3%) for therapeutic purposes. The mean age was 42 -/+ 18 years. Infection, including mycobacterium tuberculosis, and malignancy were the 2 main indications for FFB (35.9% and 25.9%). The overall diagnostic yield was 58%. Tuberculosis was diagnosed in 67% of suspected cases, whereas bacterial pneumonia was diagnosed in 40.5%. Malignancy was confirmed in 61.2% of suspected cases. Bronchoscopy diagnosed 37 (43%) of 86 patients with interstitial lung disease. The diagnostic yield was 57% for sarcoidosis, 40% for usual interstitial pneumonia and 88% for bronchiolitis obliterans organizing pneumonia. The overall complication rate was 5%; pneumothorax occurred in 0.56% and was associated exclusively with transbronchial biopsy. No mortality was observed. CONCLUSION: Flexible fiberoptic bronchoscopy is a useful diagnostic tool with a low rate of complications. The diagnostic yield in our institution is similar to that reported in Western series.     

Osteoporosis Caused by Mutations in PLS3: Clinical and Bone Tissue Characteristics

Mutations in PLS3 have been identified as a cause of bone fragility in children, but the bone phenotype associated with PLS3 mutations has not been reported in detail. PLS3 is located on the X chromosome and encodes the actin‐binding protein plastin 3. Here we describe skeletal findings in 4 boys from 2 families with mutations in PLS3 (c.994_995delGA; p.Asp332* in family 1; c.1433T > C; p.Leu478Pro in family 2). When first evaluated between 4 and 8 years of age, these boys had a history of one to four long‐bone fractures. Mild vertebral compression fractures were identified in each boy. No obvious extraskeletal disease manifestations were present. Lumbar spine areal bone mineral density (LS‐aBMD) Z‐scores ranged from –1.7 to –3.5, but height was normal. Iliac bone histomorphometry in 2 patients showed low trabecular bone volume and a low osteoid maturation time but normal bone formation rate and osteoclast surface. Quantitative backscattered electron imaging (qBEI) did not reveal a major abnormality in bone mineralization density distribution. The 2 boys from family 1 received oral alendronate for 6 years, which normalized LS‐aBMD. The mothers of the 4 boys did not have a history of fractures and had normal LS‐aBMD. However, one of these mothers had low bone mass at the distal radius, as measured by peripheral quantitative computed tomography (pQCT). In conclusion, hemizygous mutations in PLS3 are associated with osteoporosis and bone fragility in childhood, but in contrast to bone fragility caused by mutations in collagen type I encoding genes, there is no hypermineralization of mineralized bone matrix. © 2014 American Society for Bone and Mineral Research.