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Ultrasound Can identify Pregnant Woman with Preeclampsia at Risk for Respiratory Failure

By MedImaging International staff writers
Posted on 31 Mar 2014

Image: Ultrasound image of a lung (Photo courtesy of JP Rathmell).

Ultrasound imaging of the lungs could help clinicians rapidly determine if a pregnant woman with preeclampsia is at risk for respiratory failure.

The study’s findings were published in the April 2014 issue of the journal Anesthesiology. About 60,000 women worldwide die as a result of preeclampsia, which causes severely high blood pressure. Potential complications include stroke, bleeding and excess fluid in the lungs—called pulmonary edema—which can lead to respiratory failure. The study suggests that taking a lung ultrasound can help physicians easily determine whether a woman with preeclampsia is suffering from pulmonary edema and ensure she receives the appropriate treatment.

“Lung ultrasound is fast, safe, noninvasive, and easy to use,” said Marc Leone, MD, PhD, lead author of the study and vice chair of the department of anesthesiology and critical care medicine, Hopital Nord-Marseille (France). “We found it allowed us to quickly assess whether a woman with preeclampsia had pulmonary edema and confirm the severity of the condition.”

Clinicians frequently gauge urine output to determine if a woman needs fluid administration, but the results are wrong about half of the time. “Lung ultrasound enables the medical team to identify which women really need the fluid treatment,” noted Dr. Zieleskiewicz, the study's first author.

Pulmonary edema is typically caused by heart failure, but also can be caused by lung inflammation. Researchers analyzed the use of lung ultrasound imaging, which can evaluate lung edema, is easier to use than cardiac ultrasound, and can be performed with technology typically found in maternity wards. Lung ultrasound highlights white lines mimicking comet tails, irradiating from the border of the lungs. These lines represent water in the lungs. The detection of three or more lines strongly suggests the diagnosis of pulmonary edema.

Researchers performed both cardiac and lung ultrasound scans before and after delivery in 20 women with severe preeclampsia. Five of the 20 women (25%) had pulmonary edema prior to delivery according to lung ultrasound findings, whereas 4 (20%) had the disorder according to the cardiac ultrasound. The lung ultrasound identified a patient with noncardiac pulmonary edema, which the cardiac ultrasound did not detect.

These findings, according to the researchers, could help safeguard that pregnant women with pulmonary edema not be given intravenous or excess fluids, which worsens the disorder and can lead to respiratory failure. Typically, women with pulmonary edema are treated with oxygen and drugs to lower the blood pressure or rid the body of excess fluid. In real time, lung ultrasound scanning also serves to observe improvement or worsening of pulmonary edema.

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60 (612.97416687012): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

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62 (825.88195800781): SELECT fid FROM jos_deeppockets WHERE id=294751491 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294751491 AND published='1' LIMIT 1

63 (42.915344238281): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

64 (519.0372467041): select jos_twitters.link from jos_twitters where cat=10

65 (432.96813964844): select jos_facebook.link from jos_facebook where cat=10

66 (146.86584472656): select jos_google_plus.link from jos_google_plus where cat=10

67 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

68 (265.83671569824): SELECT fid FROM jos_deeppockets WHERE id=294751491 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294751491 AND published='1' LIMIT 1

69 (45.061111450195): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

70 (!!!!! 1557.1117401123): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294751491 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (401.02005004883): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294751491 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 1175.8804321289): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (!!!!! 1559.9727630615): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (412.94097900391): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (144.00482177734): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (152.8263092041): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (349.99847412109): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (445.84274291992): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (330.20973205566): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (452.04162597656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (159.02519226074): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (271.08192443848): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294751491 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (34.093856811523): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294751491 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (472.06878662109): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 2743.0057525635): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 3343.1053161621): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 2043.9624786377): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (801.80168151855): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (665.90309143066): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (379.08554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (738.14392089844): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (482.08236694336): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (756.02531433105): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (959.87319946289): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 1149.8928070068): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 4188.060760498): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

105 (728.84559631348): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

106 (!!!!! 1735.9256744385): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294751491 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (!!!!! 1578.8078308105): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294751491 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2478.1227111816): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

109 (!!!!! 6238.9373779297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

110 (!!!!! 6632.0896148682): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294751491 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 9595.1557159424): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294751491 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1739.0251159668): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (!!!!! 2391.0999298096): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 2027.0347595215): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

115 (!!!!! 2579.927444458): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

116 (!!!!! 4456.9969177246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

117 (!!!!! 1326.7993927002): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

118 (!!!!! 1708.984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

119 (!!!!! 6780.1475524902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

120 (!!!!! 2952.0988464355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

121 (623.94142150879): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

122 (!!!!! 1276.0162353516): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 68540.096282959): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 1681.0894012451): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294751491 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294751491 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 4643.9170837402): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (71.048736572266): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (672.1019744873): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (55.074691772461): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (704.05006408691): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (432.96813964844): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (55.074691772461): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (92.983245849609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (760.07843017578): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (52.928924560547): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 1192.8081512451): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 2943.9926147461): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (872.13516235352): SELECT name FROM jos_deeppockets WHERE id=214

138 (!!!!! 3041.0289764404): SELECT name FROM jos_deeppockets WHERE id=214

139 (667.09518432617): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (459.90943908691): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (571.96617126465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

142 (448.94218444824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

143 (!!!!! 10250.091552734): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1647.94921875): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294751491 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (315.90461730957): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294751491 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1072.883605957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (213.1462097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 1157.9990386963): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

149 (416.04042053223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

150 (!!!!! 1543.9987182617): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (513.07678222656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

152 (181.91337585449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

153 (389.09912109375): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294751491 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294751491 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (35.04753112793): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

155 (31.948089599609): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

156 (456.09474182129): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 1410.961151123): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

158 (225.06713867188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294751491 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294751491 AND published='1' LIMIT 1

159 (170.94612121582): select jos_twitters.link from jos_twitters where cat=10

160 (33.140182495117): select jos_facebook.link from jos_facebook where cat=10

161 (130.17654418945): select jos_google_plus.link from jos_google_plus where cat=10

162 (32.186508178711): select jos_linkedin.link from jos_linkedin where cat=10

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