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Cheong I, Tamagnone FM. Color M-mode in Transcranial Duplex Sonography: A Novel Approach for Diagnosing Right-to-Left Shunt. Neurocrit Care 2024; 40:816-818. [PMID: 37704935 DOI: 10.1007/s12028-023-01843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina.
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Cheong I, Otero Castro V, Sosa FA, Tort Oribe B, Früchtenicht MF, Tamagnone FM, Merlo PM. Passive leg raising test using the carotid flow velocity-time integral to predict fluid responsiveness. J Ultrasound 2024; 27:97-104. [PMID: 37668901 PMCID: PMC10909041 DOI: 10.1007/s40477-023-00824-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE The passive leg raising test (PLR) is a noninvasive method widely adopted to assess fluid responsiveness. We propose to explore if changes in the carotid flow assessed by echo-Doppler can predict fluid responsiveness after a PLR. METHODS We conducted a performance diagnostic study in two intensive care units from Argentina between February and April 2022. We included patients with signs of tissular hypoperfusion that required fluid resuscitation. We labeled the patients as fluid responders when we measured, after a fluid bolus, an increase greater than 15% in the left ventricle outflow tract (LVOT) VTI in an apical 5-chamber view and we compared those results with the carotid flow (CF) velocity-time integral (VTI) from the left supraclavicular region in a semi-recumbent position and during the PLR. RESULTS Of the 62 eligible patients, 50 patients (80.6%) were included. The area under the ROC curve for a change in CF VTI during the PLR test was 0.869 (95% CI 0.743-0.947). An increase of at least of 11% in the CF VTI with the PLR predicted fluid-responsiveness with a sensitivity of 77.3% (95% CI 54.6-92.2%) and specificity of 78.6% (95% CI 59-91.7%). The positive predictive value was 73.9% (95% CI 57.4-85.6%) and the negative predictive value was 81.5% (95% CI 66.5-90.7%). The positive likelihood ratio was 3.61 and the negative likelihood ratio was 0.29. CONCLUSION An increase greater than 11% in CF VTI after a PLR may be useful to predict fluid responsiveness among critically ill patients.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
| | - Victoria Otero Castro
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina
| | - Fernando Ariel Sosa
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of Critical Care Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Bárbara Tort Oribe
- Department of Critical Care Medicine, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Pablo Martín Merlo
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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Cheong I, Avanzato L, Bermeo M, Mazzola MV, Baiona GA, Santagiuliana MS, Gómez RA, Merlo PM, Tamagnone FM. Effect of prone position on right ventricular dysfunction due to pulmonary embolism assessed by speckle tracking echocardiography. J Ultrasound 2024; 27:161-168. [PMID: 36153781 PMCID: PMC10908959 DOI: 10.1007/s40477-022-00729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/03/2022] [Indexed: 10/14/2022] Open
Abstract
Prone position has shown beneficial hemodynamic effects in patients with right ventricular dysfunction associated with acute respiratory distress syndrome decreasing the right ventricle afterload. We describe the case of a 57-year-old man with right ventricular dysfunction associated with pulmonary thromboembolism with severe hypoxemia that required mechanical ventilation in prone position. With this maneuver, we verified an improvement not only in his oxygenation, but also in his right ventricular function assessed with speckle tracking echocardiography. Our case shows the potential beneficial effect of the prone position maneuver in severely hypoxemic patients with right ventricular dysfunction associated with pulmonary thromboembolism.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
| | - Lucila Avanzato
- Department of Critical Care Medicine, Sanatorio de los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina
| | - Milton Bermeo
- Department of Critical Care Medicine, Sanatorio de los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina
| | - María Virginia Mazzola
- Department of Critical Care Medicine, Sanatorio de los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina
| | - Gastón Adrián Baiona
- Department of Critical Care Medicine, Sanatorio de los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina
| | - María Soledad Santagiuliana
- Department of Critical Care Medicine, Sanatorio de los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina
| | - Raúl Alejandro Gómez
- Department of Critical Care Medicine, Sanatorio de los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina
| | - Pablo Martín Merlo
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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Cheong I, Bermeo M, Tamagnone FM, Merlo PM. Incidental Diagnosis of Left Pneumothorax Using a New Variant of the Lung Point Sign During Cardiac Ultrasound. J Emerg Med 2024; 66:e354-e356. [PMID: 38267299 DOI: 10.1016/j.jemermed.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 10/01/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Pneumothorax is a common issue in the intensive care unit and emergency department, often diagnosed using lung ultrasound. The absence of lung sliding and the presence of the lung point sign are characteristic findings for pneumothorax. We describe a case of left pneumothorax diagnosed incidentally while performing a cardiac ultrasound through a new variant of the lung point sign. CASE REPORT A 60-year-old patient with a medical history of diabetes, stroke, and right colon cancer underwent urgent surgical treatment for intestinal sub-occlusion. In the intensive care unit, the patient required mechanical ventilation due to shock unresponsive to fluid administration, and hemodynamic monitoring was performed using echocardiography. During systole in an apical four-chamber view, the abrupt vanishing of the heart was observed. When evaluating the tricuspid annular plane systolic excursion (TAPSE) using M-mode, the interposition of the stratosphere sign during mid-systole prevented the visualization of the TAPSE peak. Lung ultrasound revealed the absence of lung sliding and the presence of the lung point sign on the left side of the thorax, confirming the diagnosis of pneumothorax. A chest x-ray study further confirmed the diagnosis, and urgent drainage was performed. The patient showed improvement in hemodynamic and respiratory conditions and was successfully weaned from mechanical ventilation, and eventually discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: By incorporating the lung ultrasound findings, including this new variant of the lung point sign, into their diagnostic approach to pneumothorax, emergency physicians can promptly initiate appropriate intervention, such as chest tube insertion, leading to improved patient outcomes.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina; Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina
| | - Milton Bermeo
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina
| | | | - Pablo Martín Merlo
- Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina
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Cheong I, Imbelloni MI, Gómez RA, Álvarez Vilariño FM, Baiona GA, Tamagnone FM. Non-invasive diagnosis of diaphragmatic paralysis in botulism using ultrasound. Toxicon 2024; 239:107609. [PMID: 38216093 DOI: 10.1016/j.toxicon.2024.107609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
This case study explores foodborne botulism, a severe illness caused by botulinum neurotoxin-contaminated food. It leads to bilateral descending paralysis, involving the diaphragm. We highlight diaphragmatic ultrasound as a non-invasive diagnostic tool. A 50-year-old obese male developed diplopia and weakness after consuming contaminated food, rapidly progressing to severe symptoms. Mechanical ventilation became necessary due to respiratory failure. Diaphragmatic ultrasound confirmed bilateral diaphragm paralysis despite early antitoxin treatment. The patient experienced complications, requiring tracheostomy and rehabilitation. After five months, he fully recovered diaphragmatic function. This study underscores botulism's life-threatening nature and the vital role of supportive care. Diaphragmatic ultrasound is a safe and effective method for assessing diaphragmatic function in such cases, obviating ionizing radiation exposure. We recommend its routine use for evaluating botulism-induced paralysis.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina; Argentinian Critical Care Ultrasonography Association (ASARUC), Argentina.
| | - Mariano Iván Imbelloni
- Department of Critical Care, Clínica de Internación Aguda en Rehabilitación y Cirugía (CIAREC), Buenos Aires, Argentina
| | - Raúl Alejandro Gómez
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina
| | | | - Gastón Adrián Baiona
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina; Department of Critical Care, Clínica de Internación Aguda en Rehabilitación y Cirugía (CIAREC), Buenos Aires, Argentina
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Cheong I, Otero Castro V, Álvarez Vilariño FM, Gómez RA, Furche MA, Merlo PM, Tamagnone FM. Predicting mortality in severe Covid-19 Pneumonia: the role of right ventricular dysfunction. J Clin Monit Comput 2024; 38:131-137. [PMID: 37851152 DOI: 10.1007/s10877-023-01092-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE There is evidence that COVID-19 can have a clinically significant effect on the right ventricle (RV). Our objective was to enhance the efficiency of assessing RV dilation for diagnosing ACP by utilizing both linear measurements and qualitative assessment and its usefulness as an independent predictor of mortality. METHODS This is an observational, retrospective and single-center study of the Intensive Care Unit of the Sanatorio de Los Arcos in Buenos Aires, Argentina from March 2020 to January 2022. All patients admitted with acute respiratory distress syndrome due to COVID-19 pneumonia (C-ARDS) on mechanical ventilation who were assessed by transthoracic echocardiography (TTE) were included. RESULTS A total of 114 patients with C-ARDS requiring invasive mechanical ventilation were evaluated by echocardiography. 12.3% had RV dilation defined as a RV basal diameter greater than 41 mm, and 87.7% did not. Acute cor pulmonale (ACP) defined as RV dilation associated with paradoxical septal motion was found in 6.1% of patients. 7% had right ventricular systolic dysfunction according to qualitative evaluation. The different RV echocardiographic variables were studied with a logistic regression model as independent predictors of mortality. In the multivariate analysis, both the RV basal diameter and the presence of ACP showed to be independent predictors of in-hospital mortality with OR of 3.16 (95% CI 1.36-7.32) and 3.64 (95% CI 1.05-12.65) respectively. CONCLUSION An increase in the RV basal diameter and the presence of ACP measured by TTE are independent predictors of in-hospital mortality in patients with C-ARDS.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
| | - Victoria Otero Castro
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, Buenos Aires, Argentina
| | | | - Raúl Alejandro Gómez
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, Buenos Aires, Argentina
| | - Mariano Andrés Furche
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, Buenos Aires, Argentina
| | - Pablo Martín Merlo
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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Cheong I. Diaphragmatic excursion with Color M-mode tissue Doppler imaging. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00001-5. [PMID: 38242356 DOI: 10.1016/j.redare.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Affiliation(s)
- I Cheong
- Department of Critical Care Medicine, Sanatorio De Los Arcos, Buenos Aires, Argentina; Argentinian Critical Care Ultrasonography Association (ASARUC), Argentina.
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Cheong I. Transoral and Transesophageal Point-of-Care Ultrasound in the Diagnosis of Bilateral Carotid Artery and Aortic Dissections. Neurocrit Care 2024:10.1007/s12028-023-01909-9. [PMID: 38191980 DOI: 10.1007/s12028-023-01909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Juan B. Justo 909, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina.
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Longo S, Cheong I, Siri JE, Tamagnone F, Acosta C. Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:48-53. [PMID: 37678467 DOI: 10.1016/j.redare.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/07/2023] [Indexed: 09/09/2023]
Abstract
Video-assisted thoracoscopy (VATS) cardiac surgery requires one-lung ventilation (OLV) and transoesophageal ultrasound (TOE) monitoring. Colour and spectral Doppler make it possible to study the pattern of blood flow in the pulmonary vessels within the atelectatic lung. In this case report we describe how TOE can be used to detect blood flow within the atelectatic lung and to assess pulmonary vascular resistance (PVR) and right ventricular (RV) afterload. FINDINGS: Three anaesthetised, mechanically ventilated adults scheduled for cardiac surgery by VATS were scanned with TOE. After left OLV, the transducer was rotated away from the heart to obtain 2D colour Doppler images of blood flow within the consolidated lung parenchyma. We were able to identify the flow pattern of the intrapulmonary branches of the pulmonary artery. PVR was recorded using pulsed cardiac Doppler at baseline, after induction of general anaesthesia, 20 min after OLV and at the end of OLV, and after performing an alveolar recruitment manoeuvre (ARM) that led to complete resolution of the aforementioned consolidation. CONCLUSIONS: TOE is a semi-invasive imaging tool that can be used to diagnose and study PVR-induced atelectasis and to analyse the resulting pulmonary shunt and its possible effect on PVR.
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Affiliation(s)
- S Longo
- Anestesiología, Hospital Privado Universitario de Córdoba, Argentina; Asociación Argentina de Ultrasonografía Crítica (ASARUC), Argentina.
| | - I Cheong
- Unidad de Cuidados Intensivos, Sanatorio de Los Arcos, Buenos Aires, Argentina; Asociación Argentina de Ultrasonografía Crítica (ASARUC), Argentina
| | - J E Siri
- Anestesiología, Hospital Privado Universitario de Córdoba, Argentina
| | - F Tamagnone
- Asociación Argentina de Ultrasonografía Crítica (ASARUC), Argentina
| | - C Acosta
- Anestesiología, Hospital Privado de la Comunidad de Mar del Plata, Argentina
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Cheong I, Benay C, Tamagnone FM, Merlo PM. Lung consolidation as an acoustic window to superior vena cava by transthoracic ultrasonography in the intensive care unit. J Echocardiogr 2023; 21:173-174. [PMID: 35947297 PMCID: PMC9363265 DOI: 10.1007/s12574-022-00584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/24/2022] [Accepted: 07/31/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
| | - Cristian Benay
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of Critical Care Medicine, Hospital General de Agudos Bernardino Rivadavia, Buenos Aires, Argentina
| | | | - Pablo Martín Merlo
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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Cheong I. Recognition of Bronchopleural Fistula After Lung Abscess Rupture Using Lung Ultrasound. J Cardiothorac Vasc Anesth 2023; 37:2171-2172. [PMID: 37517960 DOI: 10.1053/j.jvca.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina; Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina.
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Vilariño FMÁ, Cheong I, Gómez RA. The value of speckle tracking echocardiography in diagnosing minoxidil-induced cardiotoxicity: a case report. J Ultrasound 2023:10.1007/s40477-023-00814-3. [PMID: 37566196 DOI: 10.1007/s40477-023-00814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023] Open
Abstract
Minoxidil is a drug designed for the treatment of arterial hypotension. Due to its secondary effect of hypertrichosis, it is also used for alopecia treatment. We present a case of a 50-year-old female patient who was orally consuming Minoxidil for medical reasons. She presented with severe hypotension, requiring vasoactive drugs, and evidence of myocardial injury was detected using speckle tracking echocardiography. It is worth noting that the patient did not have any coronary heart disease, and the myocardial injury was found to be associated with Minoxidil consumption. Remarkably, the patient showed signs of reversal 72 h after stopping the drug. To our knowledge, this is the first reported case of subendocardial injury associated with Minoxidil, using speckle tracking echocardiography. In the resolution of the case, it was essential to rule out differential diagnoses, administer vasopressors, and use the speckle tracking echocardiography, which allowed for the objective assessment of myocardial injury and the monitoring of the patient during their hospitalization.
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Affiliation(s)
| | - Issac Cheong
- Department of Critical Care Medicine, CABA, Sanatorio de Los Arcos, Juan B. Justo 909, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
| | - Raúl Alejandro Gómez
- Department of Critical Care Medicine, CABA, Sanatorio de Los Arcos, Juan B. Justo 909, Buenos Aires, Argentina
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Cheong I, Mazzola MV, Besada DA, Tamagnone FM. Utility of transcranial color-coded duplex sonography in diagnosis and monitoring of PICA aneurysm in subarachnoid hemorrhage. J Clin Ultrasound 2023; 51:931-933. [PMID: 36992659 DOI: 10.1002/jcu.23458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 06/02/2023]
Abstract
This case describes the successful use of transcranial color-coded duplex sonography (TCCD) to diagnose a posterior circulation aneurysm in a patient with subarachnoid hemorrhage. A 33-year-old, was admitted to the ICU after a brain CT scan showed peritroncal subarachnoid hemorrhage. TCCD revealed a rounded image with color Doppler near the P1 portion of the right posterior cerebral artery, which was later confirmed to be a 4 mm aneurysm at the right posterior inferior cerebellar artery (PICA). The aneurysm was treated with coil exclusion and TCCD confirmed its disappearance post-treatment. While TCCD has limitations, including its inability to detect small aneurysms, it is a noninvasive diagnostic tool that provides real-time visualization of the brain and allows for follow-up evaluations. This case demonstrates the potential usefulness of TCCD in diagnosing cerebral aneurysms in patients with subarachnoid hemorrhage and for follow-up evaluations post-treatment.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
| | | | - Diego Alejandro Besada
- Department of Interventional Neuroradiology, Sanatorio de Los Arcos, Buenos Aires, Argentina
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Cheong I, Amador EDO, Gómez RA, Vilariño FMÁ, Furche MA, Tamagnone FM. Evaluating the Utility of Portal Vein Pulsatility Index for Detecting Fluid Unresponsiveness in the Intensive Care Unit. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00346-4. [PMID: 37330331 DOI: 10.1053/j.jvca.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE The primary aim of the authors' study was to evaluate the capacity of the portal vein pulsatility index (PVP) to detect fluid unresponsiveness in patients admitted to intensive care. DESIGN This was a retrospective, diagnostic accuracy study SETTING: At a tertiary medical-surgical intensive care unit in Buenos Aires, Argentina. PARTICIPANTS Patients were included during usual care in the intensive care unit, who were evaluated by ultrasonography for the flow of the portal vein, calculating their PVP prior to fluid expansion. INTERVENTIONS Patients who exhibited an increase of <15% in left ventricle outflow tract velocity-time integral after receiving 500 mL of Ringer Lactate were considered non-responders to fluids. MEASUREMENTS AND MAIN RESULTS The authors included a total of 63 patients between January 2022 and October 2022. The area under the receiver operating characteristic curve for PVP to predict fluid unresponsiveness was 0.708 (95% CI 0.580 to 0.816). A value of the PVP >32% predicted fluid unresponsiveness with a sensitivity of 30.8% (95% CI 17% to 47.6%) and specificity of 100% (95% CI 85.8 to 100). The positive predictive value was 100%, and the negative predictive value was 47.1% (95% CI 41.9% to 52.3%). CONCLUSIONS Although PVP has limited value as the sole indicator for fluid management decisions, it can be used as a stopping rule or combined with other diagnostic tests to improve the accuracy of fluid responsiveness assessment.
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Affiliation(s)
- Issac Cheong
- Department of critical care medicine, Sanatorio De los Arcos, Buenos Aires, Argentina; Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina.
| | - Elías Daniel Olarte Amador
- Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina; Department of critical care medicine, Clínica Pediátrica Sanitas, Bogotá, Colombia
| | - Raúl Alejandro Gómez
- Department of critical care medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
| | | | - Mariano Andrés Furche
- Department of critical care medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
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Cheong I, Feijoo J, Tamagnone FM. Cerebral circulatory arrest diagnosed with transoral Doppler ultrasonography. J Clin Ultrasound 2023; 51:742-744. [PMID: 36426722 DOI: 10.1002/jcu.23404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 05/03/2023]
Abstract
We describe the case of a patient with malignant stroke in whom brain death was diagnosed by evaluating the neck vessels by transoral ultrasonography.
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Affiliation(s)
- Issac Cheong
- Department of critical care medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
| | - José Feijoo
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of critical care medicine, Hospital de Agudos Bernardino Rivadavia, Buenos Aires, Argentina
| | - Francisco Marcelo Tamagnone
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of critical care medicine, Hospital Militar Campo de Mayo, Buenos Aires, Argentina
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Cheong I, Otero Castro V, Sosa FA, Tort Oribe B, Merlo PM, Tamagnone FM. Carotid flow as a surrogate of the left ventricular stroke volume. J Clin Monit Comput 2023; 37:661-667. [PMID: 36399216 DOI: 10.1007/s10877-022-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022]
Abstract
Transthoracic echocardiography (TTE) is a fundamental tool for hemodynamic monitoring in critical patients. It allows evaluating the left ventricle's stroke volume based on the measurement of the velocity-time integral (VTI) of the left ventricle outflow tract (LVOT). However, in the intensive care unit obtaining adequate echocardiographic views may present a challenge. We propose to measure, as a surrogate of the stroke volume, the carotid flow with a novel technique. This is an observational, prospective, and simple blind study, conducted in the intensive care unit of Sanatorio de los Arcos and Hospital Aleman, in Buenos Aires, Argentina. We measured the carotid systodiastolic flow (CSD) VTI and the carotid systolic flow (CS) VTI at the level of the left supraclavicular fossa and we compared it with the LVOT VTI obtained by TTE. We evaluated 43 subjects. Spearman's correlation coefficient between LVOT VTI and CS VTI was 0.81 (95% CI 0.67-0.89) and between LVOT VTI and CSD VTI was 0.89 (95% CI 0.81-0.94). The Bland-Altman method analysis of the 5-chamber apical window LVOT VTI compared to the CSD VTI showed a bias of - 0.2 (95% CI - 0.82 to 0.43), with a concordance interval between - 4.2 (95% CI - 5.2 to - 3.1) and 3.8 cm (95% CI 2.7 to 4.9). The percentage error was 37.9%. Almost 100% of the values fell within the concordance limits, and no trend was observed in bias across the spectrum of mean variables. Although the CSD VTI could not be interchangeable with the LVOT VTI, it could be considered as its surrogate.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio de los Arcos, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
| | - Victoria Otero Castro
- Department of Critical Care Medicine, Sanatorio de los Arcos, Buenos Aires, Argentina
| | - Fernando Ariel Sosa
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of Critical Care Medicine, Hospital Aleman, Buenos Aires, Argentina
| | - Bárbara Tort Oribe
- Department of Critical Care Medicine, Hospital Aleman, Buenos Aires, Argentina
| | - Pablo Martín Merlo
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Hospital de Agudos Bernardino Rivadavia, Buenos Aires, Argentina
| | - Francisco Marcelo Tamagnone
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Hospital Militar Campo de Mayo, Buenos Aires, Argentina
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Cheong I, Otero Castro V, Feijoo J, Mármol PDB, Tamagnone FM. Short Axis In-Plane Ultrasound-Guided Technique for Internal Jugular Vein Cannulation. J Emerg Med 2023; 64:488-490. [PMID: 37002164 DOI: 10.1016/j.jemermed.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/05/2023] [Accepted: 02/17/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Real-time ultrasound (US)-guided venipuncture has become the standard of care due to its reduced complications and higher success rate. There are various techniques for US-guided cannulation of the internal jugular vein (IJV); the transversal and longitudinal views are the most widely used. There is a less commonly used technique that combines the benefits of both methods. DISCUSSION Two main techniques for central line US-guided cannulation of the IJV are based on the location of the probe relative to the vessel and are known as the transversal view and the longitudinal view. The transversal view may make it difficult to identify the tip of the needle as it enters the vein, and the longitudinal view may not allow for visualization of surrounding structures. A third and less commonly used technique, the short axis in-plan view, aims to combine the benefits of both previous methods. In this technique, the entire needle can be tracked in real time as it enters the IJV, while also providing visualization of surrounding structures. CONCLUSIONS The short axis in-plane view technique for central venous line placements allows for real-time US-guided needle venipuncture with simultaneous visualization of surrounding structures.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina; Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina
| | - Victoria Otero Castro
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
| | - José Feijoo
- Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina; Department of Critical Care Medicine, Hospital Bernardino Rivadavia, Buenos Aires, Argentina
| | | | - Francisco Marcelo Tamagnone
- Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina; Hospital Militar Campo de Mayo, Buenos Aires, Argentina
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18
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Tamagnone FM, Cheong I, Luna E, Previgliano I, Otero Castro V. Ultrasound-guided cerebral resuscitation in patients with severe traumatic brain Injury. J Clin Monit Comput 2023; 37:359-363. [PMID: 36454340 DOI: 10.1007/s10877-022-00954-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022]
Abstract
Traumatic brain injury (TBI) is a worldwide public health concern given its significant morbidity and mortality, years of potential life lost, reduced quality of life and elevated healthcare costs. The primary injury occurs at the moment of impact, but secondary injuries might develop as a result of brain hemodynamic abnormalities, hypoxia, and hypotension. The cerebral edema and hemorrhage of the injured tissues causes a decrease in cerebral perfusion pressure (CPP), which leads to higher risk of cerebral ischemia, herniation and death. In this setting, our role as physicians is to minimize damage by the optimization of the CPP and therefore to reduce mortality and improve neurological outcomes. Performing a transcranial doppler ultrasound (TCD) allows to estimate cerebral blood flow velocities and identify states of low flow and high resistance. We propose to include TCD as an initial assessment and further monitoring tool for resuscitation guidance in patients with severe TBI. We present an Ultrasound-Guided Cardio-cerebral Resuscitation (UGCeR) protocol in Patients with Severe TBI.
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Affiliation(s)
| | - Issac Cheong
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
- Department of critical care medicine, Sanatorio De los Arcos, Buenos Aires, Argentina.
- Department of critical care medicine, Sanatorio De los Arcos, Juan B. Justo 909, Buenos Aires, Argentina.
| | - Ezequiel Luna
- Department of critical care medicine, Sanatorio Guemes, Buenos Aires, Argentina
| | - Ignacio Previgliano
- Maimonides University, Buenos aires, Argentina
- Hospital General de Agudos J. A. Fernández, Buenos Aires, Argentina
| | - Victoria Otero Castro
- Department of critical care medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
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Cheong I, Bermeo M, Granberg G, Tamagnone FM. Tips for carotid ultrasound in the intensive care unit. J Ultrasound 2023; 26:277-283. [PMID: 35918601 PMCID: PMC10063759 DOI: 10.1007/s40477-022-00708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022] Open
Abstract
The ultrasonography of carotid arteries plays a key role in evaluating cerebrovascular disease. There are some useful considerations to perform it correctly in the intensive care unit, such as using different kind of transducer, Doppler mode optimization, and the correct interpretation of the findings.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
| | - Milton Bermeo
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
| | - Guido Granberg
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of Critical Care Medicine, Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa, Argentina
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Cheong I, Bermeo M, Tamagnone FM. Transorbital Ultrasonography Used to Detect Papilledema, in a Patient With Intracranial Hypertension. Journal of Diagnostic Medical Sonography 2023. [DOI: 10.1177/87564793231153866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Intracranial hypertension (IH) is an important cause of secondary brain injury, and it is often associated with poor outcomes; due to that monitoring of intracranial pressure (ICP) is essential for the management of neurocritical patients. Although invasive methods have been the gold standard for ICP monitoring, recent non-invasive ultrasonography techniques have been used to estimate ICP. Among the most used methods are the measurement of the diameter of the optic nerve sheath and transorbital ultrasonography to evaluate papilledema. This presented case is of a patient with refractory IH due to subarachnoid hemorrhage, measured through an intraventricular catheter. A transorbital sonogram was performed and showed the presence of papilledema.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
- Argentinian Critical Care Ultrasonography Association, Buenos Aires, Argentina
| | - Milton Bermeo
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
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21
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Cheong I, Otero Castro V, Brizuela M, Früchtenicht MF, Merlo PM, Tamagnone FM. Passive leg raising test to predict fluid responsiveness using the right ventricle outflow tract velocity-time integral through a subcostal view. J Ultrasound 2022:10.1007/s40477-022-00719-7. [PMID: 36127570 DOI: 10.1007/s40477-022-00719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/10/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE The passive leg raising test (PLR) produces a reversible increase in venous return and, if the patient's ventricles are preload dependent, in the cardiac output. As this effect occurs in seconds, the transthoracic echocardiography is optimal for its real time assessment. The utility of the PLR for monitoring fluid responsiveness through the measurement of the left ventricle outflow tract velocity-time integral (LVOT VTI) in an apical 5-chamber view is well stablished. To achieve this view in critically ill patients is often challenging. The aim of this study is to explore the accuracy for predicting fluid responsiveness of the change in the right ventricle outflow tract velocity-time integral (RVOT VTI) from a subcostal view during a PLR. METHODS This is a diagnostic accuracy study carried out in two centers in Argentina. We included patients admitted to the intensive care unit from January 2022 to April 2022, that required fluid expansion due to signs of tissular hypoperfusion. We measured the RVOT VTI from a subcostal view in a semi-recumbent position and during the PLR, and the LVOT VTI in an apical 5-chamber view before and after a fluid bolus. If the LVOT VTI increased by 15% after the fluid bolus, the patients were considered fluid responders. RESULTS We included 43 patients. The area under the ROC curve for a change in the RVOT VTI during the PLR was 0.879 (95% CI 0.744-0.959). A change of 15.36% in the RVOT VTI with the PLR predicted fluid responsiveness with a sensitivity of 85.7% (95% CI 57.2%-98.2%) and specificity of 93.1% (95% CI 77.2-99.2). The positive predictive value was 85.7% (95% CI 60.8%-95.9%) and the negative predictive value was 93.1% (95% CI 78.8%-98%). The positive likelihood ratio was 12.43 and the negative predictive value was 0.15. CONCLUSION The RVOT VTI change during a PLR is suitable for the prediction of fluid responsiveness in critically ill patients.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina.
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
| | - Victoria Otero Castro
- Department of Critical Care Medicine, Sanatorio De los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina
| | - Matías Brizuela
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of Critical Care Medicine, Sanatorio Privado del Interior SRL, Córdoba, Argentina
| | | | - Pablo Martín Merlo
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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Cheong I. Heart Failure Due to Liver Involvement of Hereditary Hemorrhagic Telangiectasia, Diagnosed by Point-of-Care Ultrasonography. Journal of Diagnostic Medical Sonography 2022. [DOI: 10.1177/87564793221123075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Osler-Weber-Rendu syndrome, also known as hereditary hemorrhagic telangiectasia (HHT), is a rare inherited disorder characterized by the presence of systemic arteriovenous malformations, which most commonly affects the liver. One of the most serious complications of liver compromise is high output heart failure (HOHF). In this case study, point-of-care ultrasonography is utilized as a means to describe the diagnostic findings of an intensive care unit patient diagnosed with liver involvement of HHT and the development of HOHF.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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23
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Cheong I. Multiple organ dysfunction due to inferior vena cava thrombosis diagnosed by point-of-care ultrasound in the intensive care unit. J Clin Ultrasound 2022; 50:940-941. [PMID: 35584041 DOI: 10.1002/jcu.23235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/25/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
We describe the case of a 75-years-old woman with history of left renal cell carcinoma that presented multiple organ dysfunction due to IVCT diagnosed by point-of-care ultrasound (POCUS) in the intensive care unit (ICU).
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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24
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Cheong I. A case of lung point sign in a patient with pneumothorax under high frequency oscillatory ventilation. Sonography 2022. [DOI: 10.1002/sono.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Issac Cheong
- Department of critical care medicine Sanatorio De los Arcos Buenos Aires Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC) Buenos Aires Argentina
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25
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine Sanatorio De los Arcos Buenos Aires Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC) Buenos Aires Argentina
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26
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Cheong I. Ultrasonography in the diagnosis of lung abscess. J Clin Ultrasound 2022; 50:628-629. [PMID: 35285031 DOI: 10.1002/jcu.23192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
This case demonstrates the usefulness of lung ultrasound in the diagnosis of lung abscess, which showed a rounded hypoechoic image within a left basal consolidation in a critically ill patient requiring mechanical ventilation support.
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Affiliation(s)
- Issac Cheong
- Department of critical care medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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27
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Cheong I. A case of heart point sign by lung ultrasound in a patient with pneumothorax. Sonography 2022. [DOI: 10.1002/sono.12316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine Sanatorio De los Arcos Buenos Aires Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC) Buenos Aires Argentina
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28
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Cheong I. Ultrasonography through the craniectomy in the diagnosis of brain abscess. J Clin Ultrasound 2022; 50:696-697. [PMID: 35524504 DOI: 10.1002/jcu.23218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
Brain abscess is a focal area of necrosis, which may occur after neurosurgical procedures. Transcranial color-coded duplex sonography (TCCS) is a valuable tool of monitoring in the intensive care unit (ICU), providing information in B-mode, color and pulsed wave Doppler mode. We describe the case of a critically ill patient with brain abscess diagnosed by TCCS.
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Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
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29
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Cheong I, Bermeo M, Merlo PM, Tamagnone FM. A new approach of non‐invasive hemodynamic assessment by echocardiography in the intensive care unit: The right intercostal transhepatic window. Echocardiography 2022; 39:752-754. [DOI: 10.1111/echo.15353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Issac Cheong
- Intensive Care Unit Sanatorio De los Arcos Buenos Aires Argentina
| | - Milton Bermeo
- Intensive Care Unit Sanatorio De los Arcos Buenos Aires Argentina
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30
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Cheong I, Castro VO, Tamagnone FM. Utility of transoral and transcranial ultrasonography in the diagnosis of internal carotid dissection: a case report. J Neurocrit Care 2022. [DOI: 10.18700/jnc.210033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Scanlon C, Mueller SG, Tosun D, Cheong I, Garcia P, Barakos J, Weiner MW, Laxer KD. Impact of methodologic choice for automatic detection of different aspects of brain atrophy by using temporal lobe epilepsy as a model. AJNR Am J Neuroradiol 2011; 32:1669-76. [PMID: 21852375 DOI: 10.3174/ajnr.a2578] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE VBM, DBM, and cortical thickness measurement techniques are commonly used automated methods to detect structural brain changes based on MR imaging. The goal of this study was to demonstrate the pathology detected by the 3 methods and to provide guidance as to which method to choose for specific research questions. This goal was accomplished by 1) identifying structural abnormalities associated with TLE with (TLE-mts) and without (TLE-no) hippocampal sclerosis, which are known to be associated with different types of brain atrophy, by using these 3 methods; and 2) determining the aspect of the disease pathology identified by each method. MATERIALS AND METHODS T1-weighted MR images were acquired for 15 TLE-mts patients, 14 TLE-no patients, and 33 controls on a high-field 4T scanner. Optimized VBM was carried out by using SPM software, DBM was performed by using a fluid-flow registration algorithm, and cortical thickness was analyzed by using FS-CT. RESULTS In TLE-mts, the most pronounced volume losses were identified in the ipsilateral hippocampus and mesial temporal region, bilateral thalamus, and cerebellum, by using SPM-VBM and DBM. In TLE-no, the most widespread changes were cortical and identified by using FS-CT, affecting the bilateral temporal lobes, insula, and frontal and occipital lobes. DBM revealed 2 clusters of reduced volume complementing FS-CT analysis. SPM-VBM did not show any significant volume losses in TLE-no. CONCLUSIONS These results demonstrate that the 3 methods detect different aspects of brain atrophy and that the choice of the method should be guided by the suspected pathology of the disease.
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Affiliation(s)
- C Scanlon
- Center for Imaging of Neurodegenerative Diseases and Department of Radiology, University of California-San Francisco, CA, USA
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Mueller SG, Laxer KD, Barakos J, Cheong I, Garcia P, Weiner MW. Widespread neocortical abnormalities in temporal lobe epilepsy with and without mesial sclerosis. Neuroimage 2009; 46:353-9. [PMID: 19249372 DOI: 10.1016/j.neuroimage.2009.02.020] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 01/20/2009] [Accepted: 02/16/2009] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Extrafocal structural abnormalities have been consistently described in temporal lobe epilepsy (TLE) with mesial temporal lobe sclerosis (TLE-MTS). In TLE without MTS (TLE-no) extrafocal abnormalities are more subtle and often require region of interest analyses for their detection. Cortical thickness measurements might be better suited to detect such subtle abnormalities than conventional whole brain volumetric techniques which are often negative in TLE-no. The aim of this study was to seek and characterize patterns of cortical thinning in TLE-MTS and TLE-no. METHODS T1 weighted whole brain images were acquired on a 4 T magnet in 66 subjects (35 controls, 15 TLE-MTS, 16 TLE-no). Cortical thickness measurements were obtained using the FreeSurfer software routine. Group comparisons and correlation analyses were done using the statistical routine of FreeSurfer (FDR, p=0.05). RESULTS TLE-MTS and TLE-no showed both widespread temporal and extratemporal cortical thinning. In TLE-MTS, the inferior medial and posterior temporal regions were most prominently affected while lateral temporal and opercular regions were more affected in TLE-no. The correlation analysis showed a significant correlation between the ipsilateral hippocampal volume and regions of thinning in TLE-MTS and between inferior temporal cortical thickness and thinning in extratemporal cortical regions in TLE-no. CONCLUSION The pattern of thinning in TLE-no was different from the pattern in TLE-MTS. This finding suggests that different epileptogenic networks could be involved in TLE-MTS and TLE and further supports the hypothesis that TLE-MTS and TLE-no might represent two distinct TLE syndromes.
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Affiliation(s)
- S G Mueller
- Center for Imaging of Neurodegenerative Diseases and Department of Radiology, University of California, San Francisco, CA 94121, USA.
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Cheong HS, Yoon D, Kim LH, Park BL, Lee HW, Han CS, Kim EM, Cho H, Chung ER, Cheong I, Shin HD. Titin-cap (TCAP) polymorphisms associated with marbling score of beef. Meat Sci 2007; 77:257-63. [PMID: 22061598 DOI: 10.1016/j.meatsci.2007.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 03/13/2007] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
Marbling score (MS) is the major qualitative trait that affects carcass quality in beef cattle. In this study, we examined the association between genetic polymorphisms of the titin-cap gene (TCAP) and carcass traits in Korean native cattle (also known as Hanwoo). By direct DNA sequencing in 24 unrelated Korean cattle, we identified five sequence variants in 1.2kb of TCAP. Among them, four common polymorphic sites were selected for genotyping in the beef cattle (n=437). Pair-wise linkage analysis with four polymorphisms showed strong linkage disequilibrium (LD), and three major haplotypes (freq.>0.1) were constructed. Statistical analysis revealed that polymorphisms in intron1 (g.346G>A) and exon2 (g.592-597CTGCAG[Leu-Gln]insdel) showed significant association with marbling score (P(cor.)=0.003 and 0.02, respectively). One haplotype, ht2[C-G-G-del], also showed significant association with MS (P(cor.)=0.0004). Our findings suggest that polymorphisms in TCAP might be among the important genetic factors involved in carcass quality in beef cattle.
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Affiliation(s)
- H S Cheong
- Department of Genetic Epidemiology, SNP Genetics, Inc., Rm 1407, Complex B, WooLim Lion's Valley, 371-28, Gasan-Dong, Geumcheon-Gu, Seoul, 153-803, Republic of Korea
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35
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Hooi PY, Yong CM, Cheong I. A study of the appropriateness of antibiotic use in the medical wards of a tertiary teaching hospital in Malaysia. Int J Clin Pract 2001; 55:272-4. [PMID: 11406914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
A prospective study was conducted to determine the proportion of patients who received an antibiotic within 12 hours of admission to the medical wards. During the four-week study, 234 patients were admitted to medical wards from casualty; 68 patients (29%) received an antibiotic. The survey indicated that antibiotics were inappropriate in 22-65% of those treated. This study also shows that as many as 67% of patients who received intravenous antibiotics could have been equally well treated with oral preparations.
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Affiliation(s)
- P Y Hooi
- Department of Pharmacy, National University of Malaysia
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36
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Kan CH, Lee SK, Low CS, Velusamy SS, Cheong I. A validation study of the Siriraj Stroke Score. Int J Clin Pract 2000; 54:645-6. [PMID: 11221275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
A cross-sectional study was conducted on 160 Malaysian patients to validate the usefulness of the Siriraj Stroke Score (SSS) for differentiating intracerebral haemorrhage and infarction following acute strokes. Our results indicate that the score lacks sensitivity and specificity. It should thus not be used in epidemiological studies to determine stroke types in a community. More importantly, in the absence of information from neuroimaging of the brain, it cannot be used safely by physicians to assess the need or otherwise of thrombolytic and/or anticoagulant therapy after an acute stroke.
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Affiliation(s)
- C H Kan
- Department of Medicine, National University of Malaysia
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37
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Tan HJ, Cheong I, Muhaizan WM. Disseminated histoplasmosis in AIDS: a report of three patients. Med J Malaysia 2000; 55:259-262. [PMID: 19839156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. Although uncommon, it should be considered among the list of important opportunistic infections in severely immunocompromised patients. Patients living with AIDS are at particular risk of disseminated histoplasmosis. Diagnosis requires a high level of clinical suspicion. The infection is best confirmed by demonstration of the organism in tissue specimens or by culture. Amphotericin B is the most effective drug for severe disseminated histoplasmosis. Response is good but life-long maintenance is required to prevent relapse.
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Affiliation(s)
- H J Tan
- Department of Medicine, Faculty of Medicine, Hospital Universiti Kebangsaan Malaysian, Jalan Tenteram, Cheras, 56000 Kuala Lumpur
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38
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Wood E, Cheong I, Lee C. A study of chest infections in HIV seropositive patients in Kuala Lumpur. Int J Clin Pract 1998; 52:23-6. [PMID: 9536563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A retrospective study of 144 adults with HIV infection was conducted to investigate the prevalence of upper and lower respiratory tract infections (URTIs and LRTIs). The patients were divided into two groups: those with acquired HIV through intravenous drug abuse (IVDA), and those who had acquired HIV through 'other' risk behaviours. LRTIs were more prevalent than URTIs overall, and LRTIs were significantly more common (p < 0.001) in IVDAs than in the other-risk group. Tuberculosis (40%) and bacterial pneumonias (33%) comprised the majority of LRTIs among IVDAs, while Pneumocystis carinii pneumonia (40%) was the commonest LRTI in the other-risk group. Analysis of CD4 T-lymphocyte counts indicated that HIV-seropositive IVDAs are at greater risk of developing chest infections at higher CD4 counts than other-risk patients. The IVDAs were also found to have a much higher rate of co-infection with hepatitis C and B, which may be a factor accelerating the progression from HIV infection to AIDS. The mean time averaged for the two groups from known seroconversion to development of respiratory tract infection is only 1.37 years, which suggests HIV-infected patients are presenting late for treatment in Malaysia.
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Affiliation(s)
- E Wood
- Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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39
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Cheong I, Lim A, Lee C, Ibrahim Z, Sarvanathan K. Epidemiology and clinical characteristics of HIV-infected patients in Kuala Lumpur. Med J Malaysia 1997; 52:313-7. [PMID: 10968106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Between 1987 to 1995, a total of 334 patients infected with HIV were treated at the Hospital Kuala Lumpur. There were 159 Malays, 108 Chinese, 64 Indians, and 3 from other ethnic groups. Three hundred and twenty-one (96.1%) of these individuals were males and 262 (65.9%) were between the ages of 26-45 years. Intravenous drug users made up 77% (256) of the attributable risk behaviour from the group although many of them also had added risk behaviours like heterosexual activity with multiple partners (50 patients), tattoos (7 patients), homosexual practice (4 patients) and previous transfusions (3 patients). The others acquired their infection through heterosexual promiscuity (59 patients), homo/bisexual activity (7 patients), previous transfusion (5 patients) and tattoos (1 patient). Sixty-six patients (all males) had since progressed to full blown AIDS and 10 have died. The two commonest AIDS-defining events were tuberculosis infection and Pneumocystic carinii pneumonia occurring in 37 (56%) and 15 (22.7%) of patients respectively. Forty-one patients with AIDS presented for the first time with their AIDS-defining infections. The mean CD4 count of the patients when they progressed to AIDS was 130/mm3. The mean time for progression from "known" seropositivity to AIDS was 2.42 years. These results suggest that Malaysians infected with HIV are not coming forward for treatment until they are in the advanced stage of the disease.
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Affiliation(s)
- I Cheong
- Department of Medicine, Universiti Kebangsaan Malaysia
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40
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Abstract
A cross-sectional study was undertaken to determine the clinical profile, haematological and biochemical changes, seroprevalence of common opportunistic pathogens, and AIDS-defining events in 49 Malaysian male drug addicts with HIV infection. Their mean age was 33.2 years, the majority had been injecting drugs for more than 5 years and 88% reporting sharing needles. Fatigue, weight loss and night sweats were common presenting symptoms and the most frequent physical findings were hepatomegaly (57%), lymphadenopathy (35%) and thrush (29%). Pulmonary infections were the commonest complications seen (61%) and of these, 13 had septic pulmonary emboli, 7 had bacterial pneumonias, 7 had pulmonary tuberculosis, and 4 had Pneumocystis carinii pneumonia. Eight patients had infective endocarditis and 5 had infected pseudoaneurysm in the groin. Anaemia (82%), leucocytosis (53%), hypoalbuminaemia (43%), hyperglobulinaemia (88%), elevated liver enzymes and hyponatraemia (57%) were frequent laboratory findings. The prevalence of HCV, HBV, cytomegalovirus and toxoplasma infection (by serology) were 100%, 12.2%, 72.7% and 59% respectively. All 7 patients with AIDS (4 P. carinii pneumonia, 2 extrapulmonary tuberculosis, and one oesophageal candidiasis) presented with their AIDS-defining illness, suggesting that HIV-infected intravenous drug user (IVDU) patients present late in the course of the disease.
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Affiliation(s)
- K Y Yoong
- Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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41
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Cheong I. The legal acceptability of an electronic medical record. Aust Fam Physician 1997; 26:37-41. [PMID: 9009015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The acceptability of an electronic medical record in a court presents a challenge to the legal system which has yet to be met. A definitive solution must straddle the boundaries of the disciplines of law, medicine and information technology. This paper discusses the law as it relates to evidence, information security as it applies to assuring the integrity of an electronic record, and solutions for the GP. While a definitive answer to the problem of legal acceptability of electronic medical records is not offered, the issues are explored in order to stimulate discussion among the relevant disciplines, for only through the cooperation of experts in these fields can a solution ultimately be found.
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Affiliation(s)
- I Cheong
- Royal Australian College of General Practitioners
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42
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Paton NI, Cheong I, Kong NC, Segasothy M. Mortality in Malaysians with systemic lupus erythematosus. Med J Malaysia 1996; 51:437-41. [PMID: 10968030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
One hundred and two patients attending the systemic lupus erythematosus (SLE) clinic of the Department of Medicine, Universiti Kebangsaan Malaysia, were studied retrospectively to determine their survival rates and causes of death. There were 21 deaths. The 1, 5, and 10 year survival rates were 93%, 86% and 70% respectively. There was a bimodal pattern of mortality with more patients dying in the first 2 years or after 5 years of disease. Infection was the direct cause of death in 52% and contributed to a further 19% of deaths. Patients with lupus nephritis had a higher relative risk (RR) of death (RR = 4.34, p < 0.02) although there was no significant increase in risk with any particular histological type on biopsy. Cerebral lupus (RR = 3.08, p < 0.001) and methylprednisolone treatment (RR = 6.24, p < 0.001) were also associated with increased risk of death. Increased awareness of infection and earlier use of antibiotic therapy may improve survival of patients suffering from SLE.
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Affiliation(s)
- N I Paton
- Department of Infectious Diseases, St. George's Hospital, Medical School, Tooting, London, United Kingdom
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Cheong I, Samsudin LM, Law GH. Methicillin-resistant Staphylococcus aureus bacteraemia at a tertiary teaching hospital. Br J Clin Pract 1996; 50:237-239. [PMID: 8794598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Between July and December 1994, 25 patients with MRSA bacteraemia were treated at the Hospital Kuala Lumpur, a tertiary hospital in Malaysia with 3000 beds. The patients included 15 males and 10 females whose mean age was 46.7 years (range 13-75). The sources of their MRSA were: Urology/Nephrology, 11; General ICU, six; Orthopaedic, four; Medicine, three; Surgery, one. Their underlying diseases were: end-stage and chronic renal failure, 11; burns, three; acute necrotising pancreatitis, two; haematological malignancies, two; and one each of fracture of the neck of the femur, pustular psoriasis, alcoholic cirrhosis, liver abscess, peptic ulcer (antrectomy), choledochol cyst, and abdominal aneurysm with gangrene of the legs. Six patients were also diabetic. A total of 19 infections were considered nosocomial. The duration of hospital stay ranged from one to 60 days, mean 16 days. On the day of blood culture, 20 patients (80%) were febrile and 15(60%) had leucocytosis. A total of 14 patients were considered to have received prolonged broad-spectrum antibiotics before the bacteraemia; of these, 11 had had either a third-generation cephalosporin and/or a quinolone. The primary foci of infection were: vascular access dialysis catheters, six; infected AV fistulae, three; non-surgical wounds, five; orthopaedic pin, one; multiple venous lines and catheters, nine; unknown, one. The sensitivities to anti-MRSA antibiotics were: vancomycin, 100%; fusidic acid, 96%; rifampicin, 96%; ciprofloxacin and perfloxacin 28% each. In all, 13 patients (52%) eventually died; nine of these deaths were directly attributed to MRSA bacteraemia. The microbiological eradication rate was 88%. Mortality was significantly associated with duration of hospital stay and failure to remove the infected catheters/peripheral lines after the development of MRSA bacteraemia.
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Affiliation(s)
- I Cheong
- Department of Medicine, Universiti Kebangsaan Malaysia, Hospital Kuala Lumpur, Malaysia
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Abstract
The latex of pokok ipoh (Antiaris toxocaria) and the root bark of akar ipoh (Strychnos species) have been the main sources of the poisonous principles in dart and arrow poisons prepared throughout south-east Asia. We report a fatal case of rhabdomyolysis and acute oliguric renal failure following oral ingestion of blowpipe dart poison. To our knowledge this is the first such report.
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Affiliation(s)
- L M Ho
- Department of Medicine, University of Kebangsaan, Malaysia
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45
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Moore CS, Cheong I. Audit of imported and domestic malaria cases at Kuala Lumpur Hospital. Br J Clin Pract 1995; 49:304-7. [PMID: 8554954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The clinical, haematological and biochemical profiles of all domestic and imported malaria cases admitted to the Hospital Kuala Lumpur were analysed. The most common malaria types were Plasmodium falciparum (39.5%) and Plasmodium vivax (42%). The most common patient type was men aged 29-40 years (reflecting the high mobility of this group, many of whom were illegal immigrants). Misdiagnosis on admission was frequently due to the variable clinical presentation of the disease and the difficulties of obtaining an accurate history. Associated haematological abnormalities were common. Chloroquine resistance was diagnosed in four P. falciparum patients and in one P. falciparum/vivax patient. Overall, imported malaria did not seem more severe than domestic. The three patients with cerebral malaria survived. One patient died of acute liver failure. The large influx of illegal immigrants to Malaysia has resulted in a surge in malaria infection; illegal immigrants remain a source of chloroquine resistance.
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Affiliation(s)
- C S Moore
- Department of Medicine, University Kebangsaan Malaysia, Kuala Lumpur
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46
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Anandan S, Othman M, Cheong I, Chin GL. Scleroderma secondary to silica exposure--a case report. Singapore Med J 1995; 36:559-61. [PMID: 8882549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In recent years there have been many reports of connective tissue diseases especially scleroderma following exposure to silica and silicone. We report a 51-year-old Chinese who developed a scleroderma-like disease and pulmonary silicosis eight years after exposure to silica. To our knowledge, this is the first case to be reported in Malaysia.
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Affiliation(s)
- S Anandan
- Department of Medicine, Universiti Kebangsaan Malaysia, Kuala, Lumpur
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47
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Ibrahim NM, Cheong I. Adult dengue haemorrhagic fever at Kuala Lumpur Hospital: retrospective study of 102 cases. Br J Clin Pract 1995; 49:189-191. [PMID: 7547159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A retrospective study involving 102 adults with dengue haemorrhagic fever (DHF) was conducted to investigate the demographic aspect, clinical presenting features, laboratory investigations, complications, and mortality associated with the disease. The clinical diagnosis of DHF was in accordance with WHO recommendations. Epistaxis, gingivitis, haematemesis and gastritis were among the common complications. Platelet levels tended to decline from a higher value on admission (mean 67,000/mm3) to lower levels on subsequent days, with the lowest (mean 61,000/mm3) being on day 6 of the fever. Hyponatraemia (46.8%) was commonly observed. Morbidity of DHF was significant (29.4%) but the case fatality rate remained low (2.0%) in our adults, suggesting that adults are less likely than children to suffer from shock syndrome.
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Affiliation(s)
- N M Ibrahim
- Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur
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48
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Affiliation(s)
- M Yong
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda, Kuala Lumpur
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49
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Cheong I, Tan SC, Wong YH, Zainudin BM, Rahman MZ. Methicillin-resistant Staphylococcus aureus (mrsa) in a Malaysian hospital. Med J Malaysia 1994; 49:24-8. [PMID: 8057986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Between August 1990 to November 1991, 905 of 2583 (35.4%) isolates of Staphylococcus aureus were found to be methicillin-resistant in a general hospital in Malaysia. A detailed study of 539 of these isolates showed a high prevalence of methicillin resistant Staphylococcus aureus (MRSA) in the surgical/orthopaedic wards, paediatric wards and the special care unit. The yield of MRSA was highest from wounds/ulcers/skin swabs accounting for 64.2 per cent followed by 6.9 per cent in blood cultures. Vancomycin remains the drug of choice with no resistance detected. The resistance to ciprofloxacin was 6.7 per cent, rifampicin 4.5 per cent and fusidic acid 2.0 per cent. Most isolates were resistant to aminoglycosides. In view of the high prevalence of MRSA in this hospital, the authorities must introduce more effective measures to control its spread as a nosocomial pathogen. Otherwise it may seriously disrupt the efficient delivery of health care services in the country.
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Affiliation(s)
- I Cheong
- Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur
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50
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Abstract
The medical records, retinal drawings and fundus photographs of all patients with cytomegalovirus retinitis (CMVR) and AIDS in Edinburgh between 1986-1992 were reviewed to determine the efficacy of treatment in preserving vision. Ophthalmoscopic features of CMVR were observed in 32 eyes of 24 patients with AIDS, 19 males and 5 females. HIV transmission in this group was by homo/bisexual contact (16), injection drug use (7) and blood transfusion (1). Unilateral blurring was the commonest visual symptom although 9 (38%) patients had no visual symptoms. All patients presented with a corrected visual acuity of 6/12 or better in at least one eye. Following treatment with systemic ganciclovir or foscarnet 16 patients (66%) developed toxic side-effects of therapy and 13 (54%) experienced a recurrence of CMVR. Four (17%) patients developed a retinal detachment in one eye. The mean survival was 8.3 months after the diagnosis of CMVR. At final follow-up, between 2-26 months after the diagnosis of CMVR, 21 (87.5%) patients retained useful vision (6/18 or better) although 3 (12.5%) were effectively blind (less than 6/60). We conclude that with prompt diagnosis and treatment of CMVR vision can be preserved in the majority of cases.
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Affiliation(s)
- B Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh, UK
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