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Background and Clinical Significance: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but may underlie diverse and potentially life-threatening immune-related adverse events (irAEs). They may cause various conditions leading to respiratory failure, including myasthenic syndromes and myositis. However, diaphragmatic paralysis (DP) has rarely been reported. To describe patients with diaphragmatic paralysis in a pharmacovigilance registry, we searched the prospective REISAMIC registry at the Gustave Roussy Cancer Center (Villejuif, France) for cases of diaphragmatic palsy (DP) occurring from September 2014 to December 2021. Case Presentation: We identified three patients, in whom DP was confirmed by diaphragmatic ultrasonography, pulmonary function tests, and/or diaphragmatic electroneuromyogram. Diaphragmatic palsy was life-threatening in all patients, as it caused respiratory failure requiring mechanical ventilation. In all cases, a pre-existing subclinical paraneoplastic syndrome was detected. Onconeural antibodies (anti-titin and anti-VGCC) were detected in these patients before and after the initiation of ICI therapy, suggesting a mixed paraneoplastic syndrome with features overlapping those of myasthenic syndrome (myasthenia gravis in one patient and Lambert–Eaton syndrome in another) and myositis. Conclusions: Diaphragmatic palsy is a severe irAE potentially resulting from different mechanisms, including myositis and neuromuscular junction involvement (myasthenia gravis, Lambert–Eaton). Antineuronal antibodies associated with such conditions were already present in our patients prior to immunotherapy initiation, suggesting ICIs could trigger flare-ups of pre-existing silent paraneoplastic autoimmune conditions. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of diaphragmatic paralysis secondary to cardiac surgery is 0.4-16%. In this study, the necessity, timing, technique and results of diaphragmatic plication in cases of diaphragmatic paralysis due to phrenic nerve damage secondary to congenital heart surgery were examined. Methods: 1329 newborn and infant patients with congenital heart disease who underwent surgery in our clinic were examined. In patients with clinical respiratory distress, the diagnosis of diaphragmatic paralysis was confirmed fluoroscopically. All plications were performed via ipsilateral thoracotomy. Diaphragm muscle resection was not required in any patient. Results: The incidence of diaphragmatic paralysis secondary to phrenic nerve injury after congenital heart surgery was 1.3%. Biventricular repair was performed in 13 patients with diaphragmatic palsy and single ventricle palliation was performed in 5 patients. Five patients underwent right, 3 patients underwent left and 2 patients underwent bilateral diaphragmatic plication. The median weaning from mechanical ventilation after plication was 3 days (2-90 days) and the median intensive care unit stay was 11.5 days (4-49 days). The median follow-up period was 24 months (4-37 months). Mortality among patients with diaphragmatic paralysis secondary to the primary procedure was 11.1%. Conclusion: Although diaphragmatic plication does not affect the morbidity and mortality of the primary cardiac procedure, it reduces the morbidity and mortality secondary to respiratory complications caused by diaphragmatic paralysis. We think that the decision for diaphragmatic plication should not be delayed in the newborn and infant patient group and should be applied more aggressively and earlier, especially in patients with single ventricle pathology. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the associated implications and outcomes of diaphragmatic paralysis following pediatric cardiac surgery at a center specializing in congenital heart diseases. Methods: The eligibility criteria for this cross-sectional study included patients who underwent surgery between January 2020 and June 2021. We collected sociodemographic, anthropometric, cardiac diagnostic, surgical, diaphragmatic paralysis diagnostic, ventilatory, and temporal variables and those related to the outcome of diaphragmatic paralysis and hospital outcomes. We conducted descriptive and inferential (logistic regression model) statistical analysis. Results: Among a total of 246 patients, a prevalence of 2.4% of diaphragmatic paralysis was estimated, predominantly in those with cyanotic congenital heart disease. Patients with extubation failure were 3.59 times more likely to have diaphragmatic paralysis (p<0.05). The need for non-invasive ventilation increased the patient's chance of being diagnosed with diaphragmatic paralysis by 14 times (OR=14.29, p>0.05). Unilateral diaphragm injury and the necessity for surgical treatment by plication were predominant. All patients with diaphragmatic paralysis were in the intensive care unit discharged. Conclusion: Extubation failure and non-invasive support were associated with diaphragmatic paralysis. Outcomes included diaphragmatic plication and subsequent discharge from the intensive care unit. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the associated implications and outcomes of diaphragmatic paralysis following pediatric cardiac surgery at a center specializing in congenital heart diseases. Methods: The eligibility criteria for this cross-sectional study included patients who underwent surgery between January 2020 and June 2021. We collected sociodemographic, anthropometric, cardiac diagnostic, surgical, diaphragmatic paralysis diagnostic, ventilatory, and temporal variables and those related to the outcome of diaphragmatic paralysis and hospital outcomes. We conducted descriptive and inferential (logistic regression model) statistical analysis. Results: Among a total of 246 patients, a prevalence of 2.4% of diaphragmatic paralysis was estimated, predominantly in those with cyanotic congenital heart disease. Patients with extubation failure were 3.59 times more likely to have diaphragmatic paralysis (p0.05). Unilateral diaphragm injury and the necessity for surgical treatment by plication were predominant. All patients with diaphragmatic paralysis were in the intensive care unit discharged. Conclusion: Extubation failure and non-invasive support were associated with diaphragmatic paralysis. Outcomes included diaphragmatic plication and subsequent discharge from the intensive care unit.

Objective: To discuss the clinical presentation and successful treatment of a suspected case of intermediate syndrome due to organophosphate (OP) poisoning in a dog. Case summary: Two dogs presented with acute cholinergic signs after ingesting an OP insecticide containing 50% acephate. Clinical signs consistent with acute cholinergic crisis resolved in both dogs within 24 hours postingestion. One dog developed an onset of neurological signs consistent with intermediate syndrome approximately 24 hours postingestion. This patient's clinical signs resolved with the use of pralidoxime chloride. New or Unique Information Provided: OP poisoning most commonly presents as an acute cholinergic crisis, with rare instances of animals developing intermediate syndrome. Few reports of successful treatment and recovery from intermediate syndrome exist in the veterinary literature, particularly with instances in which 2 dogs within the same exposure setting were treated for acute cholinergic signs and only 1 progressed to an intermediate syndrome. This report also highlights the importance of early intervention with pralidoxime chloride prior to the onset of aging. [ABSTRACT FROM AUTHOR]

Polymyxin B (PMB) and colistin are bactericidal polypeptide antibiotics discovered in 1947 and 1949 for the treatment of gram-negative bacterial infections. Polymyxin was used clinically in the 1950s, but it was gradually replaced by other antibiotics in the 1980s because of its high nephrotoxicity and neurotoxicity. In recent years, the increase of multidrug-resistant negative bacteria has led to the resurgence of polymyxin use. However, its side effects are not clear. Respiratory paralysis caused by PMB-related neuromuscular blockade is a rare but potentially fatal effect. We report a case of respiratory paralysis probably caused by polymyxin B infusion. [ABSTRACT FROM AUTHOR]

Bilateral diaphragmatic paresis is a rare entity with unknown incidence and is associated with severe respiratory dysfunction. In this case report we present a 69-year-old patient who sought emergency services due to dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. The patient denied other complaints and mentioned that these symptoms began after being discharged from a hospitalisation for emphysematous acute cholecystitis, where he underwent laparoscopic cholecystectomy, which was complicated by extensive hemorrhage of the abdominal wall. On the physical examination, paradoxical breathing and peripheral oxygen saturation between 80-93% in supine and standing positions, respectively, were notable. The patient was admitted for further investigation, during which thoracic radiographs in inspiration and expiration showed no positional variation of the diaphragm, respiratory function tests revealed a restrictive pattern and electromyography demonstrated acute bilateral diaphragmatic neuropathic injury compatible with phrenic nerve injury. Therefore, by temporal correlation and exclusion of other apparent causes, an etiology in the context of the cholecystectomy was inferred. The patient was evaluated in a multidisciplinary manner and is currently undergoing a cardiopulmonary rehabilitation program in the Physical Medicine and Rehabilitation service, although with limited progress and still requiring non-invasive ventilation., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Martins et al.)

Introduction: Subaxial cervical spine injuries (SCSI) can lead to disastrous consequences such as quadriplegia, with/without respiratory paralysis (RP) and hemodynamic instability (HDI). Till date, there is no literature available for reporting outcomes of SCSI patients specifically pertaining to those presenting with RP/HDI and ours is the first study to document the same., Methods: Retrospective 6-year study from a tertiary trauma centre database including patients >/= 18 years of operated SCSI. Only patients with ASIA A grade with admission RP/HDI and unstable injuries (fractures, subluxations) were included. Patients with ASIA grade B and above, patients with non-osseous injuries (such as disc herniation, central cord syndrome etc.) were excluded., Results: 24 cases were analysed. C5 and C6 levels were the commonest. Vertebral listhesis/subluxation was the predominant radiological finding. The mean age was 47.4 years (22-79 years) and all, except one were males. Fall from height and road traffic accident (RTA) were the most common mechanisms of injury. The most common surgery was anterior discectomy and fusion followed by corpectomy. The overall mortality rate was 22/24 (92)%. Cord edema and hemorrhage had significant association with survival. None of the grade A survivors with HDI/RP showed improvement. The mean FU duration was 18.5 months (range, 16.5-20.5 months)., Conclusions: Subaxial ASIA A cervical spine injuries with pre-operative RP/HDI is an indicator for non-improvement. This is the first study documenting outcome in such patients. The mortality rate in these patients is very high and is an extremely poor prognostic factor for recovery. Hence, surgery in such patients need to be decided judiciously, especially in developing countries that has a significant financial impact on the family members., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Phrenic nerve palsy is a rare and mortal obstetric complication, and generally occurs with brachial plexus injury. Treatment options include surgical and conservative approach but there is no clear consensus yet. In this case, a Nigerian male baby with unilateral phrenic nerve palsy after traumatic delivery is presented. The patient had concomitant brachial plexus palsy on the right side. Cyanosis and respiratory distress developed following the birth. The patient was diagnosed with phrenic nerve palsy using chest x-ray and ultrasonography imaging. Non-surgical resolution was achieved and he was discharged after complete recovery. Phrenic nerve palsy is a rare cause of respiratory distress in newborns. It is often accompanied by brachial plexus palsy. The possibility of spontaneous recovery should be kept in mind before surgical options. [Med-Science 2021; 10(3.000): 1054-6]

The comatose patients with pontine hemorrhage of diameter greater than 2 cm have poor prognosis. A 59‐year‐old male was brought with Glasgow coma scale (GCS) score of E2M5V2. He was mechanically ventilated. Magnetic resonance imaging (MRI) showed a pontine hematoma, of size 3 cm. He improved. Glasgow outcome scale (GOS) score was five. A 57‐year‐old male was brought with GCS score E1M3V1. He was ventilated. MRI scan showed a pontine hematoma of size 2.8 cm. His GOS score was three at 6 months. This is a report of two survived cases of large pontine hematoma with poor prognostic factors. This is the first report of good recovery with large pontine hematoma to GOS 5. [ABSTRACT FROM AUTHOR]

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IntroductionThe aim of this study was to assess the volume of gas being poorly ventilated or non-ventilated within the lungs of patients treated with mechanical ventilation and suffering from acute respiratory distress syndrome (ARDS).MethodsA prospective, descriptive study was performed of 25 sedated and paralysed ARDS patients, mechanically ventilated with a positive end-expiratory pressure (PEEP) of 5 cmH2O in a multidisciplinary intensive care unit of a tertiary university hospital. The volume of poorly ventilated or non-ventilated gas was assumed to correspond to a difference between the ventilated gas volume, determined as the end-expiratory lung volume by rebreathing of sulphur hexafluoride (EELVSF6), and the total gas volume, calculated from computed tomography images in the end-expiratory position (EELVCT). The methods used were validated by similar measurements in 20 healthy subjects in whom no poorly ventilated or non-ventilated gas is expected to be found.ResultsEELVSF6 was 66% of EELVCT, corresponding to a mean difference of 0.71 litre. EELVSF6 and EELVCT were significantly correlated (r2 = 0.72; P < 0.001). In the healthy subjects, the two methods yielded almost identical results.ConclusionAbout one-third of the total pulmonary gas volume seems poorly ventilated or non-ventilated in sedated and paralysed ARDS patients when mechanically ventilated with a PEEP of 5 cmH2O. Uneven distribution of ventilation due to airway closure and/or obstruction is likely to be involved.