Massive hemoptysis due to pulmonary tuberculosis is a life-threatening complication; it occurs as a result of the erosion of one of the pulmonary vessels. Tuberculous vascular lesions can also lead to arteritis, thrombosis, arterial dilation and Rasmussen aneurysms. "Rasmussen aneurysm" is a rare cause of hemoptysis. The extent of hemoptysis varies in severity from mild to life threatening, which is more common. Here, we report a case of a 45-year-old Indian male who initially presented with cough, and generalized weakness; his clinical, laboratory, and radiological findings were highly suggestive of pulmonary tuberculosis. Following medical ward admission, two weeks later he had worsening of his respiratory status complicated by massive hemoptysis and dropped oxygen saturation requiring intubation and admission to the intensive care unit. His computed tomography angiography revealed localized aneurysmal dilatation of the pulmonary artery in the left lower lobe (Rasmussen aneurysm); embolization was performed successfully. Due to the poor respiratory reservoir in most pulmonary TB cases, interventional radiology is preferred over surgery.

Ascaris lumbricoides infestation can cause a variety of intestinal complications, but severe gastrointestinal bleeding is rare. A thorough evaluation is needed for travelers and migrants with massive gastrointestinal bleeding, especially in those patients who have undergone multiple upper and lower endoscopies with no certain cause. We present a challenging case of massive small bowel bleeding due to Ascaris infection.

Datura stramonium (also called thorn apple or Jimson weed) is a plant that contains atropine, scopolamine, and hyoscyamine, giving it anticholinergic effects when consumed. We report the case of a 32-year-old male in Qatar who intentionally ingested seeds from Jimson weed mixed with milk. The patient became severely confused and delirious, eventually requiring admission to the intensive care unit (ICU) for two days for management. The patient was discharged safely with no complications afterward. The case is unique in that Jimson weed is not common in Qatar, and due to the adverse effects of this plant, this case serves to highlight to both the general population and healthcare professionals the effects of ingestion and the appropriate management plan for toxicity caused by Jimson weed.

Background: Angiotensin II is a peptide hormone vasopressor that activates angiotensin type 1 (AT1) receptors leading to vasoconstriction, the augmentation of arterial blood pressure (ABP), and organ perfusion. Angiotensin II was found to increase the ABP in catecholamine-refractory vasodilatory shock. Whether this effect improves the chances of survival or not remains inconclusive. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of angiotensin II in vasoplegic shock. Objectives: To evaluate the clinical significance of angiotensin II effects in vasoplegic shock concerning the hemodynamic impact, mortality outcomes, and side effects. Methods: Following PRISMA guidelines, we searched PubMed and EMBASE for experimental and observational studies published in English exploring the clinical outcomes of angiotensin II use in vasodilatory shock till 1 July 2024. Two independent authors assessed the quality and risk of bias of the included studies. A random effect model (Mantel–Haenszel) was used to combine data. The primary outcome was in-hospital mortality associated with angiotensin II use in comparison to standard therapy, while the secondary outcomes were mean arterial pressure (MAP) change, multi-organ failure (MOF), and the incidence of atrial fibrillation (AF). The Q test and I² were used to examine heterogeneity, with I² > 50% indicating marked heterogeneity. Results: A total of eight studies (n = 974) comparing angiotensin II to standard therapy in vasoplegic shock were included in the systematic review, with three studies comprising 461 patients included in the final analysis of the primary outcome. Only one study evaluated the use of angiotensin II as a primary vasopressor, while the rest reported angiotensin II use in catecholamine-refractory vasodilatory shock. Overall, angiotensin II use was associated with similar in-hospital mortality compared to standard therapy (risk ratio [RR] = 0.83; 95% CI, 0.68–1.02, I² = 0%). Likewise, there was no difference in MOF and AF (MOF: RR = 1.01; 95% CI, 0.61–1.65, I² = 0%; AF: RR = 1.27; 95% CI, 0.38–4.23, I² = 5%). However, angiotensin II use demonstrated a significant MAP increase (mean difference = −9.60; 95% CI, −9.71, −9.49, I² = 0%). Conclusions: In vasodilatory shock, angiotensin II use demonstrated comparable in-hospital mortality compared to standard therapy. Nevertheless, it resulted in significant MAP change, which may encourage clinicians to use it in cases of profound hypotension.

This systematic review and meta-analysis aimed to evaluate clinical outcomes associated with different systemic heparin protocols (conservative v standard intensity) during extracorporeal membrane oxygenation (ECMO) support. Included studies comprised both venovenous and venoarterial ECMO modalities. A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The PubMed, Cochrane Library, and Scopus databases were searched through November 15, 2024, for studies comparing conservative anticoagulation (no or low-target activated partial thromboplastin time [aPTT] of 40-60 seconds, anticoagulation monitoring) with standard anticoagulation (standard heparin target aPTT of 60-80 seconds). Studies were conducted in intensive care units across multiple international centers. Eight studies (601 patients; 280 in the conservative group and 321 in the standard group) were included in the meta-analysis. Conservative (no or low-target aPTT of 40-60 seconds, anticoagulation monitoring) versus standard anticoagulation (standard heparin target aPTT of 60-80 seconds). Primary outcomes included mortality, major bleeding, and thrombosis; secondary outcomes were stroke, limb ischemia, and circuit thrombosis. Random-effects models assessed outcomes, with heterogeneity evaluated using the Q test and I² statistic. A total of 698 studies were identified (PubMed, 461; Cochrane Library, 94; Scopus, 143). After removal of duplicates, 358 records were screened, and 245 studies were excluded. Twenty-seven studies underwent full-text review, with 13 meeting the inclusion criteria. Eight studies (601 patients; 280 in the conservative group and 321 in the standard group) were included in the meta-analysis. Mortality was similar between the conservative group (131 of 280 patients [46.8%]) and the standard group (159 of 321 [49.5%]) (odds ratio [OR], 1.04 [95% confidence interval (CI), 0.53-2.05]; I² = 64%). Thrombotic events were assessed in 4 studies (26 of 123 in the conservative group [21.1%] v 47 of 178 in the standard group [26.4%]; OR, 0.60 [95% CI, 0.33-1.09]; I² = 0%). Stroke (5 of 127 v 5 of 178), limb ischemia (10 of 87 v 20 of 147), and circuit thrombosis (15 of 141 v 15 of 191) did not differ between groups. However, major bleeding significantly favored conservative strategies (7 studies; 74 of 251 [29.5%] v 157 of 297 [52.9%]; OR, 0.40 [95% CI, 0.18-0.91]; p = 0.03; I² = 72%). The findings of this systematic review and meta-analysis indicate a potential association between conservative anticoagulation strategies during ECMO and reduced bleeding events without increased mortality or thrombotic complications, including stroke, limb ischemia, and circuit thrombosis. Given the low event rates, wide CIs, and absence of a formal power calculation, these null findings should not be interpreted as evidence of equivalence.