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Distinct type 1 immune networks underlie the severity of restrictive lung disease after COVID-19.
No full textThe variable origins of persistent breathlessness after coronavirus disease 2019 (COVID-19) have hindered efforts to decipher the immunopathology of lung sequelae. Here we analyzed hundreds of cellular and molecular features in the context of discrete pulmonary phenotypes to define the systemic immune landscape of post-COVID lung disease. Cluster analysis of lung physiology measures highlighted two phenotypes of restrictive lung disease that differed according to their impaired diffusion and severity of fibrosis. Machine learning revealed marked CCR
UNDERSTAFFED AND OVERWORKED: THE STARK REALITY OF ACUTE CARE SURGEON STAFFING IN THE UNITED STATES: AN EAST MULTI-CENTER STUDY.
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Dragon\u27s Breath: Diffuse Cortical Infarcts and Leukoencephalopathy after Chasing the Dragon with Fentanyl (P8-13.015).
No full textOBJECTIVE: NA.
BACKGROUND: Chasing the dragon refers to inhalation of heroin vapor after heating on aluminum foil sheets. Inhalation is thought to bring greater highs from vapors immediately reaching the brain, leading to users chasing the feeling of euphoria. This method of usage has been reported to cause toxic leukoencephalopathy with predilection for the cerebellum. Pathophysiology involves accumulation of opioids into myelin sheaths leading to spongiform degeneration of white matter via oligodendrocyte vacuolization. We present an extremely rare case of fatal leukoencephalopathy with diffuse cerebral and cerebellar infarcts secondary to chasing the dragon with fentanyl.
DESIGN/METHODS: NA.
RESULTS: A 49-year-old woman presented after becoming acutely unresponsive following fentanyl vapor inhalation. Urine drug screen was positive for fentanyl. Serial CT head imaging revealed evolving bilateral cerebellar hypodensities. She was transferred to a tertiary-care center for neurology and neurosurgery evaluation. Shortly after arrival, she decompensated due to cerebral edema requiring emergent suboccipital craniotomy. Subsequent MRI brain confirmed extensive areas of acute infarction on diffusion-weighted imaging involving multiple vascular territories within deep white matter, brainstem, and cerebellum, with FLAIR sequencing demonstrating a pattern of widespread hyperintensity consistent with leukoencephalopathy. Despite aggressive measures, patient\u27s neurologic examination remained extremely poor. She was transitioned to comfort measures per family request and passed away shortly thereafter, with ultimate diagnosis of toxic leukoencephalopathy secondary to fentanyl inhalation.
CONCLUSIONS: Fentanyl is the deadliest of all opioids with overdose rates rising 2.5 times faster than those associated with heroin. It is important for neurologists to recognize potential neurological complications associated with fentanyl usage as the opioid epidemic continues to escalate. To our knowledge, fentanyl inhalation resulting in leukoencephalopathy has only ever been described in one previous case report. Our case highlights fentanyl inhalation as a potential cause of toxic leukoencephalopathy and offers an opportunity to raise awareness of this alternate cause of chasing the dragon
Is the Atlantoaxial Level Overlooked in the Radiologic Interpretation of Cervical Magnetic Resonance Imaging?
No full textSTUDY DESIGN: Retrospective analysis.
OBJECTIVE: The purpose of this study is to quantify the rate at which the atlantoaxial level is omitted from official cervical magnetic resonance imaging (MRI) radiologic reports and to identify potential missed pathology, emphasizing the need for improved standardization of evaluation.
SUMMARY OF BACKGROUND DATA: MRI is a readily utilized modality for evaluating the axial skeleton. In our experience, the atlantoaxial level of the cervical spine is often overlooked on MRI radiologic reports in the absence of trauma or obvious pathology.
METHODS: The preoperative MRIs and associated radiologic reports of 219 patients undergoing cervical decompression and fusion in a single year were collected. The inclusion or omission of distinct evaluation at the atlantoaxial level within each radiologic report was recorded. All imaging was then reviewed. The atlantoaxial level was specifically evaluated, and any pathology was noted and compared with the official radiologic reports. The rates of atlantoaxial evaluation omission from the radiologic reports and missed pathology at this level were primarily and secondarily reported.
RESULTS: MRI studies were performed at 101 different institutions, with reports issued by 126 individual radiologists. Specific documentation of atlantoaxial evaluation was noted in 32 (14.6%) radiology reports, with the remaining 187 cases (85.4%) including no mention of this level. Upon independent re-review of the imaging, pathology was noted at the atlantoaxial level in 18 patients (8.2%), totaling 19 abnormal findings. Such findings were absent from the official reports in 13 of these cases (5.9% of the total study population).
CONCLUSIONS: In our study, formal documentation was omitted from 85% of reports resulting in missed pathology in nearly 6% of cases. This study underscores the importance of thorough imaging interpretation and clinical correlation with patient symptoms. In addition, it highlights the need for standardized reporting of these studies to prevent potential morbidity associated with a missed diagnosis
Breast Cancer Risk, Screening, and Risk Reduction in Young Females.
No full textScreening and prevention strategies for breast cancer (BC) have focused on women over 40 years of age. While BC prevalence under 40 is low, affected patients have more aggressive cancers and a poorer prognosis. Those with identifiable risk factors may benefit from screening for early detection and prevention strategies. This paper reviews the current literature and guidelines regarding BC risk. Screening guidelines and prevention strategies are also reviewed, with a focus on females under the age of 40
Attitudes toward Sustainability among Surgeons at Ten Academic Hospitals in the United States: Are we Ready, Willing, and Incentivized to Change?
No full textOBJECTIVE: Given the outsized contribution of surgical care to the carbon footprint of the health sector, we aim to understand attitudes towards sustainability among academic surgeons in the United States (U.S.).
SUMMARY BACKGROUND DATA: The healthcare sector accounts for 8.5% of United States (U.S.) greenhouse gas emissions-of which one third come from surgical care. Though prior studies suggested that surgeons are aware of operating room waste and interested in improving sustainability, they were not nationally representative and did not ask about specific changes surgeons were willing to make or what incentives would promote such changes. In this study, we aim to ascertain a more granular understanding of surgeons\u27 views on sustainability in a representative sample of U.S. academic surgeons.
METHODS: We surveyed surgeons at ten academic surgery programs representing all U.S. geographic regions. The survey contained questions on general attitudes towards sustainability, willingness to make sustainable changes, and the degree to which certain incentives would motivate change. Surgeons rated questions on Likert scales, and we calculated the proportion of respondents who indicated strongly positive responses.
RESULTS: Overall, 247 out of 523 surgeons (47%) responded to the survey. Similar majorities of respondents felt that the problem of operating room waste was critical (n=155, 63%) and were motivated to improve the sustainability of their practices (n=160, 65%). Five respondents (2%) felt their institution put effort into sustainability education. Most respondents (n=243, 98%) were willing to make at least one of the sustainable practice changes in our survey, with the greatest number willing to reduce items on their preference cards following periodic review (n=227, 92%). Respondents were more motivated by personal cash incentives than non-cash or departmental incentives. Using factor analysis, we derived five factors from survey responses: (1) general attitudes, (2) education, (3) willingness, (4) responsiveness to personal cash incentives, and (5) responsiveness to other incentives.
CONCLUSIONS: Surgeons understand that operating room waste is a problem and most say they are willing to make individual changes to improve operating room sustainability. However, a majority would be motivated to improve sustainability by personal cash incentives which are rarely implemented. Additional work will be needed to operationalize surgeons\u27 positive views on sustainability into practice changes that meaningfully impact climate change
