- Home
- Search Results
Search Results
Filter :
FILTER BY keyword:
FILTER BY author:
- Mohammed Alkhatib [2]
- Ahmed Hatim [1]
- Ali S. Omrani [1]
- Awni Alshurafa [1]
- Eman Z. Elmekaty [1]
- Habib Ur Rehman [1]
- Joanne Daghfal [1]
- Mhd Baraa Habib [1]
- Mohamed Z. I. Elmekaty [1]
- Mohammad Edbais [1]
- Muhammad Abu Bakar [1]
- Muna A. Almaslamani [1]
- Phool Iqbal [1]
- Rim S. Alibrahim [1]
- Sunil Hassan Koya [1]
- [+] More [-] Less
FILTER BY language:
FILTER BY content type:
FILTER BY publication:
FILTER BY affiliation:
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar E-mail: [email protected] [1]
- Department of Hematology, Hamad Medical Corporation, Qatar [1]
- Department of Internal Medicine, Hamad Medical Corporation, Qatar Email: [email protected] [1]
- Department of Internal Medicine, New York Medical College/Metropolitan Hospital Center, New York, USA [1]
- Department of Medical ICU, Hamad Medical Corporation, Qatar [1]
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha Qatar [1]
- Department of Pediatrics, Medical Education, Hamad Medical Corporation, Doha, Qatar [1]
- Department of Pharmacy, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar [1]
- Department of Pharmacy, Rumailah Hospital, Hamad Medical Corporation, Doha Qatar [1]
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar#These authors contributed equally to this work [1]
- [+] More [-] Less
FILTER BY article type:
FILTER BY access type:
Dilemma of Thrombolysis in a patient with high-risk Pulmonary Embolism with severe Thrombocytopenia: A case report
Background: Managing a high-risk pulmonary embolism (PE) in a critically ill patient with severe thrombocytopenia can present a challenging dilemma. There is a high risk of fatal bleeding due to anticoagulation in high-risk PE with thrombocytopenia; therefore risks and benefits are balanced while dealing with such a critical scenario.
Case Report: We present a case of a female patient with thrombocytopenia who was admitted for management of lymphoma. Her hospital course was complicated by high-risk PE leading to acute respiratory failure and hypotension necessitating urgent transfer to the medical intensive care unit. She was intubated and placed on mechanical ventilation. Multiple cardiac arrests occurred due to compromised cardiac output from a severely dilated right ventricle on bedside transthoracic echocardiography. As a last resort to save her life in this critical state and severe thrombocytopenia she was given a half bolus dose of the recommended drug i.e. 50mg IV of Alteplase. Subsequently she stabilized and was extubated without any further complications.
Discussion: High-risk PE needs prompt management with anticoagulation to avoid fatal outcomes. However on the other hand anticoagulation carries a high risk of bleeding especially in patients with thrombocytopenia. These challenges prompt a modern perspective in situations where clear guidelines are absent.
Conclusion: We aim to discuss our contemporary clinical practice in managing such a complex case and highlight the need for further studies.
Remdesivir for patients with Coronavirus disease 2019 pneumonia requiring high oxygen support
Background: Treatment options for patients with critical Coronavirus Disease 2019 (COVID-19) are limited. This study aimed to describe the clinical characteristics and outcomes associated with remdesivir therapy in patients with COVID-19 who require non-invasive (NIV) ventilation or invasive mechanical ventilation (IMV).
Methods: Data were retrospectively extracted for adults with COVID-19 confirmed using polymerase chain reaction (PCR) between August 1 2020 and January 28 2021 who received ≥ 48 hours of remdesivir therapy while on NIV or IMV. Clinical improvement was defined as two-category improvement on an eight-point ordinal severity scale.
Results: A total of 133 individuals were included of which 114 (85.7%) were on NIV and 19 (14.3%) were on IMV at the time of remdesivir initiation. The majority of the patients were males (62.4%) and the median age was 56 years. All the patients received concomitant dexamethasone therapy. Remdesivir treatment was commenced after a median of 7 days from onset of symptoms and was continued for a median of 5 days.
Clinical improvement within 28 days was achieved in 101 patients (75.9%); among which 78.1% and 63.2% were subjected to baseline NIV and IMV respectively. Among the 11 (8.3%) patients who died of any cause by day 28 9 (7.9%) and 2 (10.5%) were subjected to baseline NIV and IMV respectively. The most frequent adverse events were sinus bradycardia (21 13.1%) and alanine transaminase increase (18 11.3%). Almost all adverse events were classified as Grades 1–3.
Conclusion: The use of remdesivir in combination with systemic corticosteroids is associated with high recovery rates and low all-cause mortality in patients with COVID-19 pneumonia who require NIV or IMV. The results need confirmation from clinical trials of appropriate design and size.