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Is Intracranial Pressure Monitoring After Open Cranial Procedures Associated With Outcome?
No full textINTRODUCTION: It is unclear if intracranial pressure monitoring (ICPM) after open cranial procedures (craniotomy or craniectomy) (OC) for traumatic brain injury is associated with mortality. We hypothesized that ICPM placed early after OC was associated with lower mortality compared to no ICPM or delayed ICPM placement.
METHODS: Using 2020-2021 data from the American College of Surgeons Trauma Quality Improvement Program, patients ≥16 y from level 1 and 2 trauma centers who underwent OC were divided into two groups: ICPM placed within 72 h of OC (early) and no ICPM or ICPM placed after 72 h (none/delayed). Outcome was in-hospital mortality. Logistic regression was used to elucidate predictors of mortality.
RESULTS: A total of 19,830 patients (early ICPM, 29%) were included. Early patients were more likely to be from level 1 centers (63% versus 60%, P = 0.004), younger (median age 47 versus 60, P \u3c 0.0001), to have a lower Glasgow Coma Score (median, 6 versus 14, P \u3c 0.0001), higher injury severity score (median, 26 versus 26, P \u3c 0.0001), an unreactive pupil (33% versus 18%, P \u3c 0.0001), midline shift \u3e5 mm (69% versus 60%, P \u3c 0.0001), received ≥2 units of blood/first 4 h (14% versus 6%, P \u3c 0.0001) and higher mortality (31% versus 19%, P \u3c 0.0001) compared to none/delayed patients. Controlled for significant variables, early ICPM was associated with increased mortality (odds ratio 1.35, 95% confidence interval 1.24-1.47). Analysis of subjects with isolated brain injury found a similar association (odds ratio 1.32, 95% C1 1.15-1.52).
CONCLUSIONS: ICPM placed within 72 h of OC was associated with increased mortality. Indications for ICPM after OC should be investigated further in multicenter prospective studies
Take Two: Second Systolic Blood Pressure Provides Prognostic Information in Trauma.
No full textINTRODUCTION: An initial systolic blood pressure (SBP1) of \u3c 110 mmHg has been shown to predict mortality. However, SBP1 may not reflect hemodynamic changes during initial resuscitation. We aimed to determine if the second recorded blood pressure (SBP2) could provide additional prognostic value.
METHODS: An 8-year retrospective chart review was performed including patients who underwent trauma activations at a single institution. The initial systolic blood pressure (SBP 1) and second systolic blood pressure (SBP 2) were analyzed. Difference between the first and second systolic blood pressure (ΔSBP) was defined as SBP2 - SBP1. The primary outcome was inhospital mortality, and the secondary outcome was receipt of ≥2 units of blood in the first 4 h of admission. Univariable analysis and logistic regression analysis were performed to assess the relationship of SBP2 and ΔSBP with the study outcomes. Regression model fit was assessed by the likelihood ratio test and Akaike information criterion.
RESULTS: Eight thousand seven hundred and ninety-eight patients were included with 12% and 13% presenting with SBP1 \u3c 110 mmHg and SBP2 \u3c 110 mmHg, respectively. Four hundred and six (5%) died and 327 (4%) received ≥2 units of blood in the first 4 h. The addition of ΔSBP to regression models improved model fit in explaining the primary and secondary outcomes. Subgroup analysis found that the addition of ΔSBP improved model fit for those with penetrating mechanism of injury and those with Injury Severity Score of ≥9, but not for those with blunt moderate or severe traumatic brain injury.
CONCLUSION: SBP2 offers additional prognostic value in predicting trauma outcomes. Incorporating subsequent hemodynamic data during resuscitation beyond the initial SBP in trauma databases should be considered
Pediatric Functional Abdominal Pain Disorders: Examining the Relationship Between Understanding and Hope
Full text linkDemographic and Socioeconomic Differences in Pediatric Patient Emergency Department Visits for Nonurgent Versus Urgent Conditions
Full text linkComparing GAD-7 Anxiety Scores in Children with Sickle Cell Disease and Healthy Controls
Full text linkDiscovering the Availability and Need for Prenatal NICU Education Programs for High-risk Pregnancy Women
No full textUnderstanding Breast Cancer (BRCA) Mutations Through TikTok.
No full textTikTok is one of the biggest social media platforms where people look for support, seek advice, and educate themselves through videos created by other users. In today\u27s world, people frequently turn to the internet for easy access to health and medical information; it is no surprise that TikTok has helped facilitate the creation of online support groups for those who are overcoming various illnesses and diseases. Breast cancer (BRCA) is worldwide the most common cancer in women, and while BRCA discussions on TikTok have been researched previously, discussions surrounding the BRCA susceptibility gene mutations have not. This study aims to explore content on TikTok related to BRCA mutations and assess its impact on public awareness and physician involvement. One hundred videos were watched on TikTok after searching BRCA , BRCA1 , or BRCA2 . These videos were categorized into groups based on content creator and type of content. The content included discussion regarding preventative measures with BRCA mutations, BRCA and BRCA mutation, ovarian cancer and BRCA mutation, and various treatment options. The videos were also evaluated based on the number of views each video received. This study found that healthcare workers participated in BRCA-related TikTok videos at only 2.3% of all evaluated videos; 97.4% were created by laypersons. Of those videos created by non-medical personnel, 17.3% were educational. The majority (49.3%) were centered around preventative measures and treatments undergone after a BRCA mutation diagnosis. The treatment modality most discussed was double mastectomy at 68%, with 41.3% of those videos being preventative double mastectomies without a current cancer diagnosis. The video with the most views was with regard to motherhood and BRCA prevention at 2.3 million views; 10.4% of the videos discussed difficulties with BRCA in motherhood. Overall, this study highlights the importance of physician involvement in social media platforms. It also showcases how medical providers can use TikTok to better understand patients\u27 needs and discussions outside of the office with regard to their diagnosis
Choledocholithiasis Following an Orthotopic Liver Transplant: A Case Report and Brief Review of the Literature.
No full textWith advancements in transplant surgery, an orthotopic liver transplant remains the definitive treatment for end-stage liver disease. However, biliary complications, particularly strictures and choledocholithiasis, are among the most common causes of post-transplant morbidity and can significantly impact graft survival. Prompt recognition and timely intervention are essential to prevent progression to graft failure or the need for re-transplantation. We report a case of an orthotopic liver transplant patient who developed choledocholithiasis secondary to a duct-to-duct anastomotic biliary stricture. The patient was successfully managed with endoscopic retrograde cholangiopancreatography and biliary duct stent placement. This case highlights the importance of clinician awareness and the role of endoscopic therapy in the effective management of post-transplant biliary complications
Early Use Experience of the Crescent Right Atrial Cannula for Neonatal Veno-Venous Extracorporeal Membrane Oxygenation.
No full textVeno-venous (VV) extracorporeal membrane oxygenation (ECMO) is associated with fewer neurological complications and decreased mortality compared to veno-arterial (VA) ECMO in neonatal respiratory failure. The Crescent right atrial (RA) cannula is the only dual-lumen cannula for neonatal VV ECMO designed to have the tip in the right atrium. The purpose of this study is to describe the experience with early use of the Crescent RA cannula. We performed a retrospective cohort study of 58 neonates and infants cannulated from September 2021 through August 2023 at 15 institutions represented within the Children\u27s Hospital Neonatal Consortium (CHNC) ECMO Focus Group. Members provided information on patient characteristics, ECMO runs, complications, and outcomes. Data were analyzed with descriptive statistics. Imaging was used during cannulation in 79.3% of cases. Survival to discharge was 84.5%. There was one major cannula-related complication resulting in death. The most common complication was cannula malposition in 46.6% of patients, requiring surgical repositioning in 29.3% of the total cohort. Early use experience with the Crescent RA cannula suggests that it is effective and safe in most patients, but the cannula may require repositioning to achieve optimal ECMO support or if malpositioned. Based on these observations, we developed recommendations for cannulation and cannula surveillance
Age Matters: Key Contributors to Interferon Toxicity in Infants During Influenza Virus Infection.
No full textRespiratory viral infections are a leading cause of early childhood hospitalizations in the United States. Neonatal immune responses are reliant on innate mechanisms during the first few months of life. Interferons (IFNs) are a key component of this response. These antiviral cytokines are produced early in infection and aid in viral control and clearance. Although generally considered protective in the setting of respiratory viral infections, the recent literature has suggested that IFNs may exacerbate disease. In the process of promoting an antiviral environment, IFNs impede cell proliferation, contribute to pulmonary barrier disruption, and generate reactive oxygen species. This is not tolerated in the rapidly developing neonatal lung. Therefore, IFNs contribute to pathogenesis in the influenza-infected neonate. This review focuses on the potential mechanisms that drive IFN-induced toxicity in neonates and prospective therapeutics to mitigate this toxicity