No abstract

With an advance in therapy, there are increasing emerging and re-emerging opportunistic infections among patients with hematologic conditions and malignancy. Herein, we present a 56-year-old woman with primary myelofibrosis who developed combined tuberculosis (TB) and cryptococcosis with extensive pulmonary, pleural, and nodal involvement during ruxolitinib therapy. Marked clinical and radiologic improvements were undoubtedly evident after receiving anti-TB and antifungal therapies and pleural drainage. Hence, the presence of atypical clinical and radiologic manifestations and incomplete responses, despite receiving adequate antimicrobial treatment, should raise concerns regarding the combined emerging and re-emerging opportunistic infections and the possibility of unusual radiologic manifestations of cryptococcosis in a ruxolitinib-treated patient.

Background: The amount of energy delivered from the ventilator applied to the lungs within a given timeframe, is defined as mechanical power (MP). Recently, low MP is one of the new concepts in lung-protective ventilation strategies that may associate with survival benefit. However, measuring MP requires additional calculations not being carried-out in usual clinical care and the reports about MP were mostly a cross-sectional data. The real-time changes or dynamic data of MP was scarcely reported. Our objective is to investgate the association between the dynamic changes of MP and clinical outcomes in critically ill patients. Methods: This will be a prospective, observational study performed in a single center. Adult patients admitted to medical intermediate and intensive care units who requiring invasive mechanical ventilation will be consecutively enrolled. The patients’ ventilators will be connected to the specific investigator’s computer system for continuously real-time data recording for at least 24 hours. The primary outcome is in-hospital mortality. Hypothesis: We hypothesize that excessive mechanical power during mechanical ventilation contributes to ventilator-induced lung injury, thus real-time continuously mechanical power monitoring may reduce adverse events associated with mechanical ventilation. Ethic: The study protocol has been approved by the Institution Review Board of Ramathibodi Hospital, Mahidol University, Thailand (No. MURA2021/680). Trial registration: TCTR20220202010