Publications by authors named "S J Carlan"

110 Publications

Characteristics, Comorbidities, Complications, and Outcomes Among 802 Patients With Severe Acute Respiratory Syndrome Coronavirus 2 in a Community Hospital in Florida.

Crit Care Explor 2021 May 12;3(5):e0416. Epub 2021 May 12.

Division of Academic Affairs and Research, Orlando Regional Healthcare, Orlando, FL.

Objectives: Coronavirus disease 2019 continues to increase throughout the United States. Despite the rapid progression of the disease, there is limited information of the factors associated with mortality in Florida. This study aims to review the demographics, characteristics, comorbidities, complications, and outcomes of hospitalized patients, and their association with mortality.

Design: Cohort study.

Setting: A community-based tertiary-care hospital of Orlando Health, Orlando Regional Medical Center.

Patients/subjects: Data of hospitalized patients who tested positive for severe acute respiratory syndrome coronavirus 2 between March 1, 2020, and August 31, 2020, at the Orlando Regional Medical Center.

Interventions: None.

Measurements And Main Results: Main data assessed included patient demographics, clinical characteristics, comorbidities, complications, outcomes, and inhospital mortality. The median age for hospitalized patients was 61 years; among them, 56% were males. Most were of African American ( = 288, 35.9%), Hispanic ( = 237, 29.6%), and Caucasian ( = 217, 27.1%) descent. More patients presented with symptoms developing at home ( = 589, 75.9%) than from skilled nursing and long-term acute care facilities. The most common comorbidities were diabetes mellitus (42.8%), obesity (39.2%), lung disease (23.3%), coronary artery disease (20.2%), and congestive heart failure (18.3%). Complications with higher odds of mortality were mechanical ventilation (odds ratio, 148.00, < 0.001), coinfections (odds ratio, 56.42, < 0.001), acute kidney injury (odds ratio, 84.01, < 0.001), atrial fibrillation (odds ratio, 28.30, < 0.001), acute myocardial infarction (odds ratio, 23.29, < 0.001), and acute venous thromboembolism (odds ratio, 26.43, < 0.001).

Conclusions: We identified an increase of severity of coronavirus disease 2019 within older patients of African American and Hispanic descent with comorbidities such as diabetes, coronary artery disease, congestive heart failure, chronic kidney disease, cancer, liver disease, or cerebrovascular disease. Noninvasive positive-pressure ventilation and high-flow nasal cannula oxygen may have helped avert mechanical ventilation, and this may have improved patient outcomes over the course of the study period.
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http://dx.doi.org/10.1097/CCE.0000000000000416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162958PMC
May 2021

Role of immunotherapy in oligometastatic nonsmall cell lung cancer.

BMJ Case Rep 2021 May 10;14(5). Epub 2021 May 10.

Department of Obstetrics and Gynecology, Orlando Health Corp, Orlando, Florida, USA

The approach to metastatic lung cancer has long been focused on palliation therapy and comfort care. Recently, significant subsets of patients who suffer from a limited form of the disease have shown curative outcomes. The oligometastatic disease theory was first introduced in 1995, and since has been applied to many solid tumours. In oligometastatic nonsmall cell lung cancer, current treatment strategies include surgery, radiation therapy and chemotherapy. There is evidence of astounding survival benefits in selected patients treated with immune checkpoint inhibitors. We present three cases with oligometastatic nonsmall cell lung cancer treated with pembrolizumab, an immune checkpoint inhibitor, and describe the outcomes. Immunotherapy with pembrolizumab appears to be an effective adjunctive treatment with low toxicity in oligometastatic nonsmall cell lung cancer.
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http://dx.doi.org/10.1136/bcr-2020-241070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112438PMC
May 2021

Methaemoglobinaemia from Vagisil creme in a 50-year-old woman.

BMJ Case Rep 2021 Mar 1;14(3). Epub 2021 Mar 1.

Department of Obstetrics and Gynecology, Orlando Health Corp, Orlando, Florida, USA

Methaemoglobinaemia is a life-threatening condition that results from increased methaemoglobin production. As methaemoglobin is unable to reversibly bind to oxygen potentially lethal hypoxia and functional anaemia can occur. Benzocaine can be used as a topical anaesthetic and can be found in many nonprescription preparations marketed for self-application. It is known to cause methaemoglobinaemia in rare cases but most reports describe the complication occurring during endoscopy procedures. Methaemoglobinaemia occurring after topical benzocaine use on the perineum of a perimenopausal woman is exceedingly rare. A 50-year-old woman with methaemoglobinaemia secondary to the perineal application of over-the counter Vagisil (benzocaine 20% and resorcinol 3%- an antiseptic and disinfectant, respectively) presented to the emergency department. She had been using Vagisil for severe, chronic vaginal itching. While methaemoglobinaemia secondary to excessive use of over-the-counter medications such as Vagisil creme is exceedingly rare, it should be included in the differential diagnosis.
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http://dx.doi.org/10.1136/bcr-2020-239697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929794PMC
March 2021

Pneumothorax and Pneumomediastinum Secondary to COVID-19 Disease Unrelated to Mechanical Ventilation.

Case Rep Crit Care 2020 23;2020:6655428. Epub 2020 Nov 23.

Division of Academic Affairs and Research, Orlando Regional Healthcare, Orlando, FL, USA.

In the recent worldwide coronavirus 2019 pandemic, a notable rise in pneumomediastinum and pneumothorax complications has been witnessed in numerous mechanically ventilated patients infected with severe acute respiratory syndrome coronavirus 2. Most cases have reported these complications as barotrauma from mechanical ventilation with COVID-19 disease. We aim to report three polymerase chain reaction-confirmed COVID-19 patients who developed pneumomediastinum and pneumothorax unrelated to mechanical ventilation. We originally analyzed 800 patients with COVID-19 disease at Orlando Regional Medical Center from March 1, 2020, to July 31, 2020, of which 12 patients developed pneumomediastinum and pneumothorax in their hospital course. Interestingly, three patients developed pneumomediastinum on chest imaging prior to intubation. We present these three patients, one female and two males, ages of 42, 64, and 65, respectively, who were diagnosed with COVID-19 disease through nasopharyngeal sampling tests with acute respiratory distress syndrome. Spontaneous pneumomediastinum and pneumothorax are potential complications of COVID-19 disease in the lungs unrelated to mechanical ventilation. This is similar to previous outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) diseases. Further investigation is needed to define the causality of pneumomediastinum in nonintubated COVID-19 patients to define the incidence of disease.
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http://dx.doi.org/10.1155/2020/6655428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686844PMC
November 2020

Acute Hepatitis E: A Rare Cause of Acute Liver Failure in a Patient With Acute Myeloid Leukemia.

Cureus 2020 Sep 24;12(9):e10628. Epub 2020 Sep 24.

Obstetrics and Gynecology, Orlando Regional Medical Center, Orlando, USA.

Immunocompromised patients are particularly at risk to develop hepatitis E virus (HEV) infection and its related complications. We present a rare case of HEV infection in a 35-year-old Hispanic female with concomitant acute myeloid leukemia (AML). The patient presented with acute liver failure within a few weeks after receiving a blood transfusion. Our case likely represented an acute de novo HEV infection after chemotherapy in a patient with concurrent AML, evidenced by the presence of anti-HEV IgM antibodies as well as histological findings, and with a previous history of recent transfusions being one of the strongest risk factors for transmission. Liver failure from an acute de novo hepatitis E infection with concurrent AML can be catastrophic in the immunosuppressed patient. Our case is particularly unique due to the uncommon presentation of acute hepatitis E in a non-pregnant reproductive aged Hispanic female with recently diagnosed AML. Clinicians should maintain a low threshold to test serum HEV-RNA if a patient presents with signs and symptoms suggestive of acute hepatitis.
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http://dx.doi.org/10.7759/cureus.10628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584302PMC
September 2020
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