The diaphragm is the main inspiratory muscle, and diaphragmatic weakness can lead to respiratory failure. Diaphragmatic weakness or paralysis commonly presents in association with more generalised neuromuscular disorders. However, it can be caused by other pathologies, such as trauma, compression, infection and inflammation [1]. Isolated diaphragmatic palsy (DP) is well-described [2], but often missed in adults [3], especially in bilateral diaphragmatic palsy (BDP) where both domes of the diaphragm are elevated.
Dual antiplatelet therapy (DAPT) using aspirin and ticlopidine, a thienopyridine P2Y12 inhibitor, was introduced, decreasing the rate of stent thrombosis to about 1%. Continuation of dual antiplatelet therapy (DAPT) until Coronary artery bypass graft (CABG) increases the risk of excessive perioperative bleeding, transfusions, and re-exploration for bleeding as shown in RCTs observational studies and metanalyses. Therefore, it is recommended that the P2Y12 inhibitor should be discontinued whenever possible before elective CABG. For clopidogrel, it was shown in the CABG sub-study of the CURE trial that discontinuation ≥ 5 days before CABG did not increase the risk of bleeding complications. For prasugrel, a longer time interval (7 days) is recommended due to the longer offset time compared to clopidogrel. In a single institution Dutch registry encompassing 705 consecutive patients who underwent isolated on-pump CABG, ticagrelor discontinuation > 72 h and clopidogrel discontinuation > 120 h before surgery were not associated with an increased risk of bleeding-related complications. Prospective data were collected on 150 consecutive patients who were admitted with ACS (Acute coronary syndrome) for CABG from 1 st October 2017 onwards. Elective admissions for CABG were excluded. There was a significant delay in between stopping and the day of Surgery in multiple patients. There were 25 patients who were admitted with ACS for CABG and they were without clopidogrel for more than 10 days, 20 patients stayed without Ticagrelor preoperatively. From this study, it was evident that the guideline was partially met. Appropriate stopping of P2Y12 inhibitors should be considered before surgery according to the guidelines to achieve successful perioperative haemostasis.
Enterovirus D68 (EV-D68) is a non-polio enterovirus that occasionally causes respiratory illnesses. EV-D68 infections have occurred over the last couple of years and have a high prevalence worldwide. This virus has recently been linked to acute flaccid paralysis and particularly affects children. We report the case of a young adult who presented with acute neurological manifestations along with respiratory involvement. EV-D68 was detected in the patient's broncho-alveolar lavage and was followed by a prolonged recovery period. Clinicians should consider EV-D68 infection in the differential diagnosis of acute flaccid paralysis (AFP) and respiratory failure.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.