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Assessment of quadriceps muscle thickness using bedside ultrasonography by nurses and physicians in the intensive care unit:Intra- and inter-operator agreement

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World Journal of Critical Care Medicine 2019年第7期8卷 127-134页

作者： Rohit Kumar Tajamul Hussain Shah Vijay Hadda Pawan Tiwari Saurabh Mittal karan madan Maroof Ahmad Khan Anant Mohan Department of Pulmonary Critical Care and Sleep MedicineAll India Institute of Medical SciencesNew Delhi 110029India Department of Biostatistics All India Institute of Medical SciencesNew Delhi 110029India

BACKGROUND Data regarding the agreement among multiple operators for measurement of quadriceps muscle thickness by bedside ultrasonography(USG)are *** To statistically assess the agreement among 5 operators for measurement of quadriceps muscle thickness on bedside *** This was a cross-sectional observational *** 5 operators of varied experience(comprised of 1 critical care consultant,2 fellows,and 2 nurses)independently measured quadriceps muscle thickness in triplicate for 45 critically ill patients each,using ***-and interrater agreement rates among the 5 operators were assessed using intraclass correlation coefficient(ICC)and expressed with 95%confidence interval(CI).RESULTS The 5 operators produced a total of 135 readings and 675 observations for ICC calculations to determine the intraoperator and interoperator variations *** intraoperator agreement,the overall ICC(95%CI)was 0.998(0.997,0.999)for operator 1,0.998(0.997,0.999)for operator 2,0.997(0.995,0.999)for operator 3,0.999(0.998,0.999)for operator 4,and 0.998(0.997,0.999)for operator *** interoperator agreement,the overall ICC(95%CI)was 0.977(0.965,0.986;P<0.001)for reading 1,0.974(0.960,0.984;P<0.001)for reading 2,and 0.975(0.961,0.985;P<0.001)for reading *** USG measurement of quadriceps muscle thickness was not dependent on clinical experience,supporting training for nurses in it.

关键词： Agreement Intensive care unit Critical illness Muscle thickness Quadricepsmuscle Ultrasonography

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Cavitary lung lesion 6 years after renal transplantation

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World Journal of Transplantation 2016年第2期6卷 447-450页

作者： Arun Kumar Subbiah Sudheer Arava Soumita Bagchi karan madan Chandan J Das Sanjay Kumar Agarwal Department of Nephrology All India Institute of Medical Sciences Department of Pathology All India Institute of Medical Sciences Department of Pulmonary medicine and sleep disorders All India Institute of Medical Sciences Department of Radiology All India Institute of Medical Sciences

The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal infections like Aspergillosis and Cryptococcosis need to be considered in these patients. Pulmonary cryptococcosis usually presents 16-21 mo after transplantation, more frequently in patients who have a high level of cumulative immunosuppression. Here we discuss an interesting patient who never received any induction/anti-rejection therapy but developed both BK virus nephropathy as well as severe pulmonary Cryptococcal infection after remaining stable for 6 years after transplantation. This case highlights the risk of serious opportunistic infections even in apparently low immunologic risk transplant recipients many years after transplantation.

关键词： Lung cavity Immunosuppression Renal transplantation

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