Complication Of Pneumonia Research Articles

A study of clinical profile and outcome of pneumonia associated with traditional child rearing practices in infants

Background: Customs and traditions are strictly followed in many Indian families, both rural and urban. Certain established child rearing practices are being advocated by elders and are being followed traditionally even today. Many of these practices play a significant role in causing pneumonia in children. This study was undertaken to compare and assess the clinical features and outcome of pneumonia occurring in children with traditional rearing practices and in infants without traditional child rearing practices and various factors influencing them. Methods: The present study is a prospective case control study, done in the department of paediatrics, Al-Ameen Medical College and Hospital Vijayapura, in which a total of 220 infants with clinical and/or radiological signs of pneumonia were enrolled during the period of March 2022 to February 2023. Results: 73 out of 220 infants (33%) with pneumonia had history of traditional child rearing practices. Demographic factors like combined families, young and illiterate mothers, lower socioeconomic status, domiciliary deliveries were found to be statistically significant. Increased clinical severity and prolonged outcome (60.4%) and complications (42.5%) were found to be more in pneumonia in infants associated with traditional child rearing practices. Conclusions: This study showed increased clinical severity and prolonged outcome and more complications of pneumonia in infants associated with traditional child rearing practices. High mortality (7.5%) was also seen. Most common traditional child rearing practices influencing outcome in infants are oil bath and blowing into the nose. Thus there is an urgent need to systematically study the utility, futility and possible dangers of a large number of traditional child rearing practices followed in infants.

Comparison of Pneumonia and Major Complications After Total Joint Arthroplasty With Spinal Versus General Anesthesia: A Propensity-matched Cohort Analysis.

Spinal anesthesia (SA) allows total joint arthroplasty to be done while minimizing opioids and systemic anesthetic agents compared with general anesthesia (GA). SA has been associated with shortened postoperative recovery; however, the relationship between SA, major postoperative complications, and pneumonia (PNA) remains unclear. Patients in a large, national database who underwent total hip arthroplasty or total knee arthroplasty from 2010 to 2020 were identified. 1:1 propensity score matching was used to create matched groups of patients who underwent SA and GA. The groups were matched by age, sex, chronic obstructive pulmonary disease, smoking status, Charlson Comorbidity Index, and American Society of Anesthesiology (ASA) classification. 1:1 matching was also done among the ASA classifications as a subanalysis. Overall, equally matched groups of 217,267 patients who underwent SA versus GA were identified. 850 patients (0.39%) developed postoperative PNA after GA versus 544 patients (0.25%) after SA ( P < 0.001). The risk of major complications was 6,922 (3.2%) in the GA group and 5,401 (2.5%) in the SA group ( P < 0.001). Similarly, the risk of unplanned postoperative reintubation was higher (0.18% versus 0.10%, P < 0.001) and mortality was higher (0.14% versus 0.09%, P < 0.001) in the GA group than in the SA group. In ASA 1 to 3 patients, the risk of PNA was 0.08% to 0.21% higher with GA than with SA. In ASA 4 patients, the risk of PNA was 0.42% higher in SA than in GA (1.92% versus 1.5%, P < 0.001) and the mortality rate was nearly doubled in GA than in SA (1.46% versus 0.77%, P = 0.017). Overall, GA was associated with a small but markedly higher rate of major complications, mortality, and PNA than SA in patients undergoing total joint arthroplasty when matching for differences in comorbidities. ASA 4 patients experienced the greatest increase in absolute risk of mortality with GA versus SA.

Malnutrition risk, outcomes, and costs among older adults undergoing elective surgical procedures: A retrospective cohort study.

We examine here the association between malnutrition risk and adverse health outcomes among older adult patients undergoing elective surgical procedures. We conducted a retrospective study using linked clinical and administrative databases. Malnutrition risk was assessed prior to surgery, defined by unintentional weight loss and decreased food intake. We performed a logistic regression analysis of the primary outcome, a composite adverse outcome measure, including death, bleeding, pneumonia, and other surgical complications. We conducted Fine-Gray proportional hazard regression analysis of hospital length of stay (LOS). We performed a generalized linear regression analysis of in-hospital cost data. All regression analyses controlled for frailty, age, sex, surgical category, and comorbidities. Of a total of 3457 older adult elective surgical patients (65-102 years), 310 (9.0%) screened positive for malnutrition risk. In multivariable regression analyses, malnutrition risk was associated with an increased risk of the composite adverse outcome (odds ratio [OR] = 1.74; 95% CI = 1.25-2.39), higher hospitalization costs (relative cost = 1.84; 95% CI = 1.59-2.13), and a decreased risk of discharge from the hospital (hazard ratio = 0.67; 95% CI = 0.59-0.77) compared with those who screened negative. Older adult patients with malnutrition risk were at an increased risk of adverse surgical outcomes, had longer LOS in the hospital, and incurred higher costs of care. It is important to screen for malnutrition risk and refer older adults for dietetic consults prior to elective surgery.

Bioengineered Neutrophil Extinguisher Targets Cascade Immune Pathways of Macrophages for Alleviating Cytokine Storm in Pneumonia.

Cytokine storm is a common complication of COVID-19 pneumonia and has been proven to contribute to high mortality rates. However, current treatment approaches exhibit limited potential to balance immune response and overproduction of inflammatory cytokines, leading to poor therapeutic outcomes. Herein, a smart bioengineered neutrophil, Extinguisher, composed of live neutrophils encapsulating the liposome formulation of NF-κB suppressor MLN4924 and STING inhibitor H-151 (Lip@MH), is developed for alleviating the hyperinflammatory cytokine storm. Extinguisher inherits motility and chemotaxis characteristics of neutrophils, allowing for the specific delivery and sustained release of Lip@MH within inflamed tissues. Subsequently, Lip@MH effectively transports anti-inflammatory agents into macrophages and synergistically inhibits inflammatory pathways of NF-κB and STING, leading to decreased production of cytokines. In vivo studies demonstrate that Extinguisher not only selectively accumulates at the site of pneumonia caused by Pseudomonas aeruginosa-induced acute lung injury but inhibits the production of inflammatory factors through regulating NF-κB/STING signaling pathways, thereby effectively calming cytokine storm. Importantly, Extinguisher significantly improves therapeutic benefits and survival in mice with acute pneumonia. Therefore, Extinguisher represents an appropriate combination of cell therapy and immunoregulation for cytokine storm intervention and may bring insights into the treatment of COVID-19 pneumonia.

Pulmonary Thromboembolism in Covid-19 Pneumonia: A Case Series and Update

BACKGROUND: COVID-19 is associated with lots of complications. Pulmonary thromboembolism is a rare complication of pneumonia that is showing a rising trend in the context of COVID-19. CASE PRESENTATION: We present the CTPA findings in 3 patients of pulmonary thromboembolism in patients with COVID-19 pneumonia. The patients had varying involvement of pulmonary arteries. We also provide and update on the published literature on covid pulmonary embolism in 2023. CONCLUSIONS: Pulmonary embolism can complicate Covid-19 pneumonia and lead to poorer prognosis. Hence, the correct diagnosis is imperative as prompt antithrombotic therapy can significantly reduce mortality and morbidity. There have been updates on pulmonary embolism in Covid-19 patients especially in late 2022 to early 2023 and they have been presented in this study.

Increased susceptibility to complicated pneumonia among egyptian children with FokI (rs2228570), not TaqI (rs731236), vitamin D receptor gene polymorphism in association with vitamin D deficiency: a case-control study

BackgroundDetermining a genetic contribution to the development of complicated community-acquired pneumonia in children may help understand underlying pathogenesis. We aimed to investigate the association between two vitamin D receptor (VDR) gene polymorphisms, FokI and TaqI, and susceptibility to complicated pneumonia in Egyptian children compared to uncomplicated pneumonia. Associations with 25 hydroxy-vitamin D serum level were studied.MethodsThis was a case-control study that included 320 participants divided into 2 groups: patients and controls. The patients’ group included 100 children hospitalized with complicated pneumonia and 100 with uncomplicated pneumonia. 120 age and sex-matched apparently healthy children served as controls. The VDR FokI and TaqI polymorphisms were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. 25 hydroxy-vitamin D level was estimated in serum using ELISA.ResultsRegarding FokI, homozygous CC genotype was more common in complicated (52%) than uncomplicated pneumonia (28%) and controls (10%) (OR = 65; 95%CI (5.13-822.63), p < 0.001) and (OR = 4.3; 95%CI (0.7-27.16), p = 0.003), respectively. Children carrying C allele possessed 3 higher odds for complicated than uncomplicated pneumonia (OR = 3.08; 95%CI (1.33–7.14), p < 0.001). Heterozygous CT genotype increased susceptibility to complicated pneumonia (OR = 13.7; 95%CI (4.6–40.1), p < 0.001), not uncomplicated pneumonia (OR = 1.56; 95%CI (0.86–2.85), p = 0.145). Among complicated pneumonia, vitamin D level was lower in CC (6.92 ± 2.6ng/ml) than CT (9.55 ± 3.2 ng/ml) and TT genotype carriers (13.13 ± 3.6ng/ml) (p < 0.001). There was no significant difference between patients and controls as regards TaqI genotypes and alleles.ConclusionIn association with vitamin D deficiency, VDR gene FokI polymorphism, not TaqI, is a genetic risk factor for complicated pneumonia in Egyptian children.

Epidemiology and characteristics of emergency department utilization by patients with amyotrophic lateral sclerosis in Korea from 2016 to 2020: A nationwide study.

Patients with amyotrophic lateral sclerosis (ALS) inevitably visit the emergency department (ED) due to their increased risk of respiratory failure and mobility limitations. However, nationwide data on ED visits by patients with ALS are limited. This study investigated the characteristics of patients with ALS-related ED visits. We conducted a cross-sectional study from 2016 to 2020, utilizing a nationwide ED database. The total number of patients with ALS who visited the ED and their primary reasons for visiting/diagnoses were analyzed. In total, 6036 visits to the ED were made by patients with ALS. Of these, 41.8% arrived by ambulance and 27.7% spent >9 h in the ED. Following ED treatment, 57.4% were hospitalized, including 19.3% admitted to the intensive care unit (ICU) and 5.4% who died in the hospital. The primary reasons for ALS-related ED visits were dyspnea (35.2%), feeding tube problems (10.1%), fever (7.8%), and mental status changes (3.6%). The most common diagnoses were pneumonia (14.5%), respiratory failure (5.7%), dyspnea (5.5%), aspiration pneumonia (4.3%), and tracheostomy complications (3.4%). Reasons for ED visits for patients with ALS include acute respiratory distress, as well as concerns related to tube feeding and tracheostomy. To reduce the risk of patients with ALS requiring ED visits, it is essential to ensure the provision of timely respiratory support and high-quality home-based medical care teams that can support and address patients before their condition deteriorates.

Identification of Hub Genes in the Pathogenesis of Bronchiolitis Obliterans via Bioinformatic Analysis and Experimental Verification.

Bronchiolitis obliterans (BO) is a chronic disease that can arise as a complication of severe childhood pneumonia and can also impact the long-term survival of patients after lung transplantation. However, the precise molecular mechanism underlying BO remains unclear. We aimed to identify BO-associated hub genes and their molecular mechanisms. BO-associated transcriptome datasets (GSE52761, GSE137169, and GSE94557) were downloaded from the Gene Expression Omnibus (GEO) database to identify differentially expressed genes (DEGs). Additional bioinformatics analyses, such as Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Protein-Protein Interaction (PPI) analyses, were performed to determine functional roles and DEG-associated regulatory networks. Prediction of hub genes using the 12 algorithms available in the Cytohubba plugin of Cytoscape software was also performed. Verification was performed using the BO mouse model. Our results revealed 57 DEGs associated with BO, of which 18 were down-regulated and 39 were up-regulated. The Cytohubba plugin data further narrowed down the 57 DEGs into 9 prominent hub genes (CCR2, CD1D, GM2A, TFEC, MPEG1, CTSS, GPNMB, BIRC2, and CTSZ). Genes such as CCR2, TFEC, MPEG1, CTSS, and CTSZ were dysregulated in 2,3-butanedione-induced BO mice, whereas TFEC, CTSS, and CTSZ were dysregulated in nitric acid-induced BO mouse models. Our study identified and validated four novel BO biomarkers, which may allow further investigation into the development of distinct BO diagnostic markers and novel therapeutic avenues.

Oral Care in Critically Ill Infants and the Potential Effect on Infant Health: An Integrative Review.

Critically ill infants admitted to the neonatal intensive care unit are at risk for ventilator-associated pneumonia and abnormal oral colonization. Adherence to evidence-based guidelines for oral care in critically ill adults is associated with improved short- and long-term health outcomes. However, oral care guidelines for critically ill infants admitted to the neonatal intensive care unit have not been established, possibly increasing their risk of ventilator-associated pneumonia and other health complications. To describe and summarize the evidence regarding oral care for critically ill infants admitted to the neonatal intensive care unit and to identify gaps needing further investigation. The MEDLINE (through PubMed) and CINAHL databases were searched for observational studies and randomized controlled trials investigating the effect of oral care on oral colonization, ventilator-associated pneumonia, and health outcomes of infants in the neonatal intensive care unit. This review of 5 studies yielded evidence that oral care may promote a more commensal oral and endotracheal tube aspirate microbiome. It may also reduce the risk of ventilator-associated pneumonia and length of stay in the neonatal intensive care unit. However, the paucity of research regarding oral care in this population and differences in oral care procedures, elements used, and timing greatly limit any possible conclusions. Oral care in critically ill infants may be especially important because of their suppressed immunity and physiological immaturity. Further appropriately powered studies that control for potential covariates, monitor for adverse events, and use recommended definitions of ventilator-associated pneumonia are needed to make clinical recommendations.

The spectrum of measles in COVID-19 pandemic; An observational study in children.

Objective: To assess the spectrum of measles during COVID-19 era among children. Study Design: Cohort study. Setting: Department of Pediatric, Dr. Ziauddin University Hospital, Kemari Karachi. Period: February 2019 to February 2021. Material &amp; Methods: Clinically diagnosed measles children of either gender aged between 3 months to 5 years admitted to our tertiary care center in the 2 years marked period of the study were analyzed. Measles was labeled as the presence of high grade fever (&gt;104 0F) and maculopapular rash. Medical history was noted and clinical examination was performed in all children. Necessary laboratory investigations like complete blood count and chest X-rays (CXR) were evaluated. All patients were treated as per standard institutional protocols. Outcomes were noted in terms of successful discharge or expiry. Results: In a total of 88 children, 55 (62.5%) were male. The mean age was 1.61±1.12 years while 49 (55.7%) children were aged ≤ 1 year. Twenty four (27.3%) children were fully vaccinated appropriate to their age. Fever and rash were found among all children (100%) while respiratory distress and coryza were reported by 82 (93.2%) and 51 (58.0%) children respectively. Overall duration of hospitalization was 7.02±2.32 days. Mortality was reported in 11 (12.5%) children while 76 (86.4%) children were successfully discharged. Development of acute respiratory distress (p=0.0011) and shock (p&lt;0.0001) proved to have significant association with mortality. Conclusion: Mortality was relatively high among children with measles during the COVID-19 pandemic era. During hospitalization, most frequent complications were pneumonia, and eye and/or mouth related complications. Development of acute respiratory distress and shock proved to have significant association with mortality.

Prognostic value of right ventricular dilatation on computed tomography pulmonary angiogram for predicting adverse clinical events in severe COVID-19 pneumonia.

Right ventricle dilatation (RVD) is a common complication of non-intubated COVID-19 pneumonia caused by pro-thrombotic pneumonitis, intra-pulmonary shunting, and pulmonary vascular dysfunction. In several pulmonary diseases, RVD is routinely measured on computed tomography pulmonary angiogram (CTPA) by the right ventricle-to-left ventricle (LV) diameter ratio > 1 for predicting adverse events. The aim of the study was to evaluate the association between RVD and the occurrence of adverse events in a cohort of critically ill non-intubated COVID-19 patients. Between February 2020 and February 2022, non-intubated patients admitted to the Amiens University Hospital intensive care unit for COVID-19 pneumonia with CTPA performed within 48 h of admission were included. RVD was defined by an RV/LV diameter ratio greater than one measured on CTPA. The primary outcome was the occurrence of an adverse event (renal replacement therapy, extracorporeal membrane oxygenation, 30-day mortality after ICU admission). Among 181 patients, 62% (n = 112/181) presented RVD. The RV/LV ratio was 1.10 [1.05-1.18] in the RVD group and 0.88 [0.84-0.96] in the non-RVD group (p = 0.001). Adverse clinical events were 30% and identical in the two groups (p = 0.73). In Receiving operative curves (ROC) analysis, the RV/LV ratio measurement failed to identify patients with adverse events. On multivariable Cox analysis, RVD was not associated with adverse events to the contrary to chest tomography severity score > 10 (hazards ratio = 1.70, 95% CI [1.03-2.94]; p = 0.04) and cardiovascular component (> 2) of the SOFA score (HR = 2.93, 95% CI [1.44-5.95], p = 0.003). Right ventricle (RV) dilatation assessed by RV/LV ratio was a common CTPA finding in non-intubated critical patients with COVID-19 pneumonia and was not associated with the occurrence of clinical adverse events.

Acute Respiratory Distress Syndrome (ARDS) Management Severe COVID-19

Introduction: The Coronavirus disease 2019 (COVID-19) caused a global pandemic and many management challenges. Acute Respiratory Distress Syndrome (ARDS) is one of the most common pneumonia complications in COVID-19 cases. ARDS in COVID-19 have worse outcomes and increased risk of intensive care unit (ICU) admission. Objective: This case report aims to recognize and understand ARDS management in a severe COVID-19 case. Case Report: A 68-year-old man with diabetes mellitus and hypertension arrived at the Emergency Room (ER) after experiencing five days of fever, cough, diarrhea with frequency of four times a day, weakness, and a positive antigen result for COVID-19 at admission. Anosmia was absent. The patient had been vaccinated for COVID-19 twice. The main problem was his desaturation of 88%, blood pressure of 156/73 mmHg, heart rate of 80x/minute, and respiratory rate of 20x/minute. However, the patient was alert and admitted to the isolation ward. After 21 days of hospitalization, the patient's condition worsened. The patient developed ARDS and was referred to the COVID ICU for 25 days and 20 days to the non-COVID ICU, where he was intubated, and a tracheostomy was performed. After 45 days of admission to the ICU, the patient's condition improved. Discussion: COVID-19 patients with ARDS should be immediately intubated when conditions such as dyspnea, RR&gt;30x/min, SpO2&lt;92% (for patients with no comorbidities) or &lt;95% (for patients with comorbidities), unconsciousness, or shock appears. Furthermore, other conditions, such as an HR&gt; of 120x/min and a ROX index of &lt;3.851, should be considered an indication for intubation. Conclusion: Timely intubation improves the outcome of COVID-19 patients with ARDS.

A Comparison of Postoperative Outcomes between Unilateral and Bilateral Palatoplasty: Analysis of 2015-2020 Pediatric NSQIP Data.

We sought to identify differences in 30-day medical and surgical complications in unilateral versus bilateral palatoplasty. The NSQIP-P 2015-2020 database was queried to identify cleft palate repairs using CPT codes. Cases were stratified as unilateral (Veau III) and bilateral (Veau IV) using ICD-9 and -10 codes. A nationally representative random sample. A total of 3791 cases were identified with 2608 undergoing unilateral repair and 1183 undergoing bilateral repair. The postoperative outcomes of interest included surgical complications (surgical site infections, wound dehiscence), medical complications (pneumonia, urinary tract infection, seizure, cardiac arrest, bleeding/transfusions, systemic sepsis, unplanned intubation), readmission, and reoperation. The bilateral cohort was older (696 days versus 619 days, P < .001) and had longer operative times (157.3 min versus 144.5 min, P < .001). The unilateral cohort had more comorbidities including developmental delay, structural CNS abnormalities, need for nutritional support, and bleeding disorders. The bilateral cohort had statistically significant higher occurrences of wound dehiscence (2.1% versus. 1.2%, P = .03) and readmission (3.2% versus 1.7%, P = .01). On multivariate analysis, bilateral cleft repair (OR: 1.83, CI: 1.176-2.840, P = .007) and ASA class 4 (OR: 13.1, CI 2.288- 62.586, P = .002) were associated with greater odds of readmission. Patients who underwent bilateral cleft repair had a higher proportion of 30-day postoperative complications and a two-fold increased odds of readmission. While palatoplasty is generally regarded as a safe procedure in the pediatric population, identifying factors related to an increased risk of early postoperative complications can help surgical teams better manage high-risk individuals.

Predictive Factors and Impact of Secondary Pulmonary Infection on Mortality in Patients with Hypoxemic COVID-19 Pneumonia: A Retrospective Cohort Study

Background: Secondary pulmonary infection (SPI) is a severe complication in patients with COVID-19. Objective: To investigate the risk factors, mortality rates, and complications associated with SPI in hypoxemic COVID-19 pneumonia patients. Materials and Methods: A retrospective cohort study was conducted at Saraburi Hospital, analyzing medical records of 512 hospitalized COVID-19 patients. The Fine-Gray model identified risk factors for SPI. Results: SPI was diagnosed in 25.4% of hypoxemic COVID-19 pneumonia patients. SPI patients (mean age of 65.9±15.1 years) had higher inflammation biomarkers, increased in-hospital mortality (IHM), and more complications than non-SPI patients. The primary pathogens causing IHM were gram-negative bacteria in 59.23%. Risk factors for SPI included age of 65 years or older (sHR 1.52; 95% CI 1.03 to 2.25; p=0.032), obesity (sHR 1.52; 95% CI 1.04 to 2.23; p=0.028), invasive mechanical ventilation (sHR 2.87; 95% CI 1.64 to 5.02; p&lt;0.001), lactate dehydrogenase (LDH) level of 520 U/L or more (sHR 2.37; 95% CI 1.69 to 3.33; p=0.027), and catheter-related bloodstream infection (sHR 2.74; 95% CI 1.71 to 4.40; p&lt;0.001). SPI patients had an IHM rate of 74.62%. Multivariable analysis showed higher IHM in SPI patients (aOR 5.29; 95% CI 2.70 to 10.36) compared to non-SPI patients. Conclusion: SPI is a common and harmful complication in hypoxemic COVID-19 pneumonia. Older age, obesity, invasive mechanical ventilation, elevated LDH levels, and catheter-related bloodstream infection are significant risk factors for SPI. Early detection and prevention strategies are crucial to mitigate the short-term consequences of SPI in COVID-19 patients. Keywords: COVID-19; Secondary pulmonary infection; Mortality; Risk factors

Cannabis Use Following Total Joint Arthroplasty is Associated With Increased Risks? A Meta-Analysis

BackgroundWith the increased legalization of cannabis, a new unknown emerges for orthopaedic surgeons and their patients. This systematic review aimed to (1) evaluate complications of cannabis use; (2) determine the effects of cannabis on pain and opioid consumption; and (3) evaluate healthcare utilizations associated with cannabis use among patients undergoing total joint arthroplasty (TJA). MethodsA systematic review was performed. A search of the literature was performed in 5 databases. We included studies between January 2012 and July 2022 reporting cannabis use and complications, pain management, opioid consumption, length of stay, costs, or functional outcomes following TJA. A meta-analysis of odds ratios (ORs) and continuous variables was performed. A total of 19 articles were included in our final analysis. ResultsCannabis use was associated with higher odds for deep vein thrombosis (DVT) (OR: 1.46, 95% Confidence Interval [CI]: 1.13 to 1.89) and revisions (OR: 1.47 [95% CI: 1.41 to 1.53]) in total knee arthroplasty (TKA). Cannabis use was associated with similar odds for DVT in total hip arthroplasty (THA) (OR: 1.30 [95% CI: 0.79 to 2.13]), pulmonary embolus in both TKA (OR: 1.29 [95% CI: 0.95 to 1.77]), THA (OR: 0.55 [95% CI: 0.09 to 3.28]), and cardiovascular complications in TKA (OR: 1.97 [95% Cl: 0.93 to 4.14]). Cannabis use did not alter pain scores, opioid consumption, or cost of care in THA (estimate: $2,550.51 [95% CI: $356.58 to $5,457.62]) but was associated with higher costs in TKA (estimate: $3,552.46 [95% CI: $1,729.71 to $5,375.22]). There was no difference in lengths of stay or functional outcomes; however, there may be a potentially increased risk for prosthetic complications, pneumonia, and cerebrovascular accidents among cannabis users. ConclusionCannabis use may be associated with an increased risk of DVTs, revisions, pneumonia, cerebrovascular accidents, and cardiac complications after TJA. Higher-level studies are needed to ascertain the impact of cannabis use for patients undergoing TJA.

Complications and outcome following staphylectomy and folded flap palatoplasty in dogs with brachycephalic obstructive airway syndrome.

To compare the prevalence of pre-, intra-, and postoperative variables and complications associated with staphylectomy (S) and folded flap palatoplasty (FFP). Retrospective study. Client-owned dogs (n = 124). Medical records of S and FFP dogs from a veterinary teaching hospital were reviewed between July 2012 and December 2019. Signalment, clinical pre-, intra-, and postoperative data were collected and reviewed. Median (interquartile range) was reported. A total of 124 dogs among 14 breeds underwent surgical treatment for an elongated soft palate with either a S (n = 64) or FFP (60). FFP dogs without concurrent non-airway procedures were associated with longer duration of surgery (p = .02; n = 63; S, median = 51 min [34-85]; FFP, median = 75 min [56.25-94.5]) and anesthesia (p = .02; n = 63; S, median = 80 min [66-125]; FFP, median = 111 min [91-140.8]). Neither soft palate surgery was associated with the occurrence of anesthetic complications (p = .30; 99/120; S, 49; FFP, 50), postoperative regurgitation (p = .18; 27/124; S, 17; FFP, 10), or with hospitalization duration (p = .94; n = 124; S, median = 1 day [1]; FFP, median = 1 [1]). Postoperative aspiration pneumonia (9/124; S, 4; FFP, 5) and major complications were rare (5/124; S, 3; FFP, 2). S and FFP had similar anesthetic and perioperative complications, although FFP dogs had longer anesthetic and operative times. Although FFP took longer, no other clinically significant differences were appreciated between S and FFP procedures. Because of limitations inherent in study design, surgeons should continue to use clinical judgment when deciding on a procedure.

Spontaneous bilateral pneumothorax in a previously healthy COVID-19 patient: A case report

Coronavirus disease 2019 (COVID-19) is commonly linked with mild cough, fever, and shortness of breath symptoms. However, there have been reports of pneumothorax, which particularly occurred at least 1 week following symptom onset in elderly COVID-19 patients. Spontaneous pneumothorax (SP) is an uncommon but possibly fatal complication of COVID-19 pneumonia and is rarely reported in non-intubated patients. We report a case of a healthy, non-smoker 35-year-old young woman who presented with a 7-day cough, fever, and sudden shortness of breath. She was diagnosed with severe COVID-19 pneumonia, experienced a right SP, and developed a second pneumothorax on the contralateral side. She improved gradually following chest tube insertion in the right lung and conservative management for the left pneumothorax.

Is High Body Mass Index Protective or Detrimental in Surgical Fixation of Hip Fractures?: A Spline Regression Analysis of 22,388 Patients.

We aimed to characterize the association between BMI as a continuous variable and 30-day postoperative outcomes following hip fracture surgery through:1)30-day readmission and reoperation; 2)local wound-related; and 3)systemic complications. The National Surgical Quality Improvement Program(NSQIP) database(January 2016-December,2019) was queried for patients undergoing hip fracture ORIF. Baseline patient demographics, comorbidities, and patient outcomes were recorded. Multivariable regression models accounted for baseline demographics, comorbidities, and fracture patterns. Significant associations were analyzed using spline regression models to evaluate the continuous association between BMI and the aforementioned outcomes. Spline models demonstrated a U-shaped curve for the odds of 30-day readmission and 30-day reoperation with nadirs at the BMI of 27.5Kg/m2 and 22.0Kg/m2. The odd ratios of superficial infection, deep infection, any wound complication, and inability to weight bear on POD 1 rose progressively starting at a BMI of 25.6Kg/m2, 35.5Kg/m2, 25.6Kg/m2, and 32.7Kg/m2 respectively. Odds of 30-day mortality, transfusion, pneumonia, and delirium were greatest at the lowest recorded BMI (11.9Kg/m2). BMI has a U-shaped association with 30-day readmission and reoperation. Conversely, the highest risk of mortality and systemic complications (transfusion, pneumonia, and delirium) were within the lower BMI range, with diminishing risk as BMI increased. Local wound complications and systemic sepsis exhibited a third unique pattern with progressive rise in odds as BMI increased. The odds of any-complications demonstrated a U-shaped pattern with a nadir in the overweight to obese I categories, suggesting patients may be at lowest risk within this range. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Higher rates of readmission following acute total hip arthroplasty versus open reduction internal fixation for elderly acetabular fractures, a national study from 2010 to 2019.

To evaluate the initial complications and short-term readmissions and reoperations following open reduction internal fixation (ORIF) versus acute total hip arthroplasty (THA) for elderly acetabular fractures. Retrospective database review. All hospitalizations in the National Readmissions Database (NRD) and National Inpatient Sample (NIS).Patients/Participants: Patients 60 years of age or older with closed acetabular fractures managed surgically identified from the NRD or NIS between 2010 and 2019. Acute THA with or without ORIF. 30, 90 and 180-day readmissions and reoperations, index hospitalization complications. An estimated 12,538 surgically managed acetabular fractures in elderly patients occurred nationally between 2010 and 2019, with 10,008 (79.8%) undergoing ORIF and 2,529 (20.2%) undergoing THA. Length of stay was 1.7 days shorter (p<0.001) and probability of non-home discharge was reduced (OR 0.68, p=0.009) for THA patients versus ORIF patients. THA was associated with lower rates of pneumonia (4.6 vs 9.1%, p<0.001) and other respiratory complications (10.2 vs 17.6%) versus ORIF. At 30 days, THA patients had higher rates of readmission (13.9 vs 10.1%, p=0.007), related readmission (5.4 vs 1.2%, p<0.001), readmission for dislocation (3.1 vs 0.3%, p<0.001), and reoperations (2.9 vs 0.9%, p=0.002). At 180 days, THA patients had higher rates of related readmission (10.1% vs 3.9%, p<0.001), readmission for dislocation (5.1% vs 1.3%, p<0.001) and readmission for SSI (3.4 vs 0.8%, p=0.005). Acute THA is associated with lower length of stay and certain index hospitalization complications, but higher rates of readmissions for related reasons and specifically for dislocation. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Differentiating malignant and benign pleural effusion in patients with lung cancer: an 18F-FDG PET/CT retrospectively study.

To explore the clinical role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in differentiating malignant pleural effusion (MPE) from benign pleural effusion (BPE) in patients with lung cancer. Over a 8-year period, we retrospectively reviewed PET/CT data of lung cancer patients with pleural effusion, with 237 participants enrolled for analysis. The nature of pleural effusion was confirmed using pleural cytology or biopsy. MPE versus BPE comparison and multiple regression analysis were performed. Receiver operating characteristic (ROC) curve analysis was used for evaluating the diagnostic performance. Of the 237 participants, 170 had MPEs and 67 had BPEs. Compared with BPEs, MPEs had higher pleural SUVmax and thicker pleura and were more common among non-small cell lung cancers, peripheral tumors, and women (p < 0.05). BPEs had larger and higher 18F-FDG uptake thoracic lymph nodes and more complications of pneumonia (p < 0.05) than MPEs. Multiple regression analysis was used to identify the pleural SUVmax (odds ratio, OR = 38.8), sex (OR = 0.033), and mediastinal lymphoid node size (OR = 0.86) as independent risk factors for MPEs. The sensitivity, specificity, and area under the ROC curve (AUC) in the combined ROC curve analysis by using the three factors were 95.3%, 95.5%, and 0.989, respectively. 18F-FDG PET/CT integrated imaging is an effective non-invasive method for differential diagnosis of MPE in patients with lung cancer. Pleural SUVmax combined with thoracic lymph nodes and sex has high diagnostic value.