St Francis Medical Center

Background: Despite recent technological advancements, myocardial infarction complicated with cardiogenic shock is associated with high mortality. Impella has been advocated as an adjunct to the standard of care, but conflicting data has hindered greater utilization. We performed an updated meta-analysis with the recent data. Methods: We searched PubMed and Embase, screened 787 articles, and identified twelve studies that met eligibility criteria; these randomized controlled trials and cohort studies compared Impella to other mechanical circulatory support systems in patients with myocardial infarction complicated by cardiogenic shock. We evaluated groups with twenty-three metrics related to adverse events and clinical outcomes. A random effects model assessed heterogeneity between studies. Results: We did not find a statistically significant difference between groups across all twenty-three included metrics: in-house mortality, 30-day mortality, 6-month mortality, brain death, cardiovascular death, non-cardiac mortality, myocardial infarction, need for repeat percutaneous coronary intervention, need for left ventricular assist device, coronary bypass artery graft, stroke, limb ischemia, hemolysis, major bleeding, thrombosis, and sepsis. Table 1 Our subgroup analyses for intra-aortic balloon pump, extracorporeal membrane oxygenation, and medical management revealed similar results for mortality. In terms of bleeding, IABP was associated with better outcomes whereas ECMO was associated with worse outcomes than Impella. Impella was also associated with an increased risk of thrombosis as compared to IABP. Table 2,3,4 Conclusions: Our updated meta-analysis did not relate Impella use to better outcomes. Heterogeneity in the timing of device implantation calls for stricter reporting in subsequent larger, randomized controlled trials.

[This corrects the article DOI: 10.3389/fmed.2023.1122529.].

We present a case report of transverse myelitis as a presentation of disseminated histoplasmosis in an immunocompromised patient.

This case report describes a woman in her 70s with a medical history of sarcoidosis, atrial fibrillation, asthma, gastroesophageal reflux disease, Schatzki’s ring status after multiple dilations, pulmonary hypertension, and hypothyroidism who presented with a more than 10-year history of dysphagia and was found to have sarcoid involvement of the upper esophageal sphincter.

Critical Care Medicine: January 2021 - Volume 49 - Issue 1 - p 246 doi: 10.1097/01.ccm.0000727924.82385.3b

Critical Care Medicine: January 2021 - Volume 49 - Issue 1 - p 560 doi: 10.1097/01.ccm.0000730356.08852.80

Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Candida dubliniensis is an emerging pathogen implicated in a variety of infections in immunocompromised hosts. A 79-year-old male with autoimmune pancytopenia on chronic oral steroid therapy was admitted for suspected sepsis and started on empirical antibiotics and micafungin. He developed floaters and decreased vision while on this regimen and was diagnosed with bilateral candida endophthalmitis. Blood cultures grew C. dubliniensis.Intravenous therapy was switched to voriconazole and amphotericin B. He also received aggressive intravitreal antifungal therapy consisting of 100 μg/0.1 mL voriconazole (4 OD, 3 OS) and 5 μg/0.1 mL amphotericin B (3 OD, 1 OS) over 2 weeks that resulted in local control of infection. The right eye developed a retinal detachment 1 month after initial presentation that was repaired by 25-gauge pars plana vitrectomy, scleral buckle, laser and silicone oil. At the 15-month follow-up exam, subsequent to silicone oil removal, membrane peel and cataract surgery, OD visual acuity had improved to 20/80. OS was phakic and 20/25. Aggressive intravitreal antifungal therapy combined with intravenous therapy may control endophthalmitis and avoid the risks associated with pars plana vitrectomy during acute infection.