Risk Of Severe Complications Research Articles

Management of anterior fossa cephaloceles.

Skull base cephaloceles (SBCs) are defined as herniation of intracranial content through the skull base and are classified based on composition, etiology, and topographic location. Anterior SBCs frequently protrude in the sinonasal cavity, and consequently are at potential risk of infection. Therefore, the current recommendation is to treat SBCs with the primary intent of preventing meningitis, and surgery represents the mainstay of treatment. Anterior SBCs may display a wide spectrum of severity and complexity, and in each case the risks and benefits of surgical approaches are to be carefully weighted based on thorough assessment of symptoms, age, general conditions, location and size of the lesion, as well as expertise of the surgeon. In the last 30 years, the evolution and diffusion of transnasal endoscopic surgery have substantially changed the surgical management of the majority of SBC. In the past, they were treated exclusively with open transcranial approaches that may be burdened by relevant morbidity and risk for severe complications. The transnasal endoscopic corridor now provides easy access to the lesion and different reconstructive strategies using endonasal pedicled flaps, without any external incision, cranioplasty or brain manipulation. However, there are still scenarios in which an exclusive transnasal endoscopic route is contraindicated. The aim of the present review was to provide an overview on the comprehensive management of anterior SBC, with a particular focus on lesions suitable for endoscopic surgery. Furthermore, special aspects of SBC management in children and adults will be highlighted.

Global Leadership Initiative on Malnutrition Criteria Predict Pulmonary Complications and 90-Day Mortality after Major Abdominal Surgery in Cancer Patients.

Although several studies have reported an association between malnutrition and the risk of severe complications after abdominal surgery, there have been no studies evaluating the use of Global Leadership Initiative on Malnutrition (GLIM) criteria for predicting postoperative pulmonary complications (PPCs) following major abdominal surgery in cancer patients. This study aimed to investigate the association among the diagnosis of malnutrition by GLIM criteria, PPCs risk and 90-day all-cause mortality rate following major abdominal surgery in cancer patients. We prospectively analyzed 218 patients (45% male, mean age 70.6 ± 11.2 years) with gastrointestinal cancer who underwent major abdominal surgery at our hospital between October 2018 and December 2019. Patients were assessed preoperatively using GLIM criteria of malnutrition, and 90-day all-cause mortality and PPCs were recorded. In total, 70 patients (32.1%) were identified as malnourished according to GLIM criteria, of whom 41.1% fulfilled the criteria for moderate and 12.6% for severe malnutrition. PPCs were detected in 48 of 218 patients (22%) who underwent major abdominal surgery. Univariate logistic regression analysis revealed that the diagnosis of malnutrition was significantly associated with the risk of PPCs. Furthermore, in multivariate model analysis adjusted for other clinical confounding factors, malnutrition remained an independent factor associated with the risk of PPCs (RR = 1.82; CI = 1.21–2.73) and 90-day all-cause mortality (RR = 1.97; CI = 1.28–2.63, for severely malnourished patients). In conclusion, preoperative presence of malnutrition, diagnosed by the use of GLIM criteria, is associated with the risk of PPCs and 90-day mortality rate in cancer patients undergoing major abdominal surgery.

Molecular Association of Coronavirus with Diabetes Mellitus Type 2 in Pakistan

Patients with COVID-19 who have elevated blood sugar levels without a previous diagnosis of diabetes may be at a high risk of death and an increased risk of severe complications from the infectious disease, a new study says. We aimed to briefly review the general characteristics of the novel coronavirus (SARS-CoV-2) and provide a better understanding of the coronavirus disease (COVID-19) in people with diabetes, and its management.

Predictors of avascular necrosis of the trochlea after pediatric supracondylar humerus fractures

Abstract Background Supracondylar fractures of the humerus are the most common type of elbow fractures in childhood. Due to the potential risk of severe complications, trauma surgeons should address them with caution. Avascular necrosis of the trochlea presents a rare but oftentimes disabling complication and should not be underestimated. The aim of the present study was to identify possible predictors of avascular necrosis of the trochlea following pediatric supracondylar humerus fractures. Methods We reviewed the available body of literature reporting clinical outcomes, complications, and possible predictors of avascular necrosis of the trochlea after supracondylar humerus fractures in childhood. Data on patient age, sex, the affected side, fracture classification, treatment, the number of K‑wires, time to surgery, complications, and the time from injury to diagnosis of avascular necrosis were obtained. This study was performed according to the PRISMA guidelines. Results Eight clinical studies were included, comprising 30 patients with avascular necrosis after supracondylar fractures in childhood. The mean age at the time of injury was 5 years (min. 2; max. 10; SD: 2.8 years). In all, 18 patients (60.0%) were male, 11 (36.7%) were female, and one was unknown (3.3%). Five patients (16.7%) had a Gartland type I, three (10.0%) a type II, and 22 (73.3%) a type III fracture of the distal humerus. Six patients (20.0%) were treated conservatively, whereas 24 patients (80.0%) underwent operative treatment. The mean time from injury to diagnosis of avascular necrosis was 33 months (min. 4; max. 84; SD: 24.5 months). Conclusion The available literature on avascular necrosis of the trochlea following pediatric supracondylar humerus fractures is limited. While it can occur in any supracondylar fracture, fracture displacement may be considered a risk factor.

Access-Site Complications in Transfemoral Neuroendovascular Procedures: A Systematic Review of Incidence Rates and Management Strategies.

The femoral artery is the most common access route for cerebral angiography and neurointerventional procedures. Complications of the transfemoral approach include groin hemorrhages and hematomas, retroperitoneal hematomas, pseudoaneurysms, arteriovenous fistulas, peripheral artery occlusions, femoral nerve injuries, and access-site infections. Incidence rates vary among different randomized and nonrandomized trials, and the literature lacks a comprehensive review of this subject. To gather data from 16 randomized clinical trials (RCT) and 17 nonrandomized cohort studies regarding femoral access-site complications for a review paper. We also briefly discuss management strategies for these complications based on the most recent literature. A PubMed indexed search for all neuroendovascular clinical trials, retrospective studies, and prospective studies that reported femoral artery access-site complications in neurointerventional procedures. The overall access-site complication rate in RCTs is 5.13%, while in in non-RCTs, the rate is 2.78%. The most common complication in both groups is groin hematoma followed by access-site hemorrhage and femoral pseudoaneurysm. On the other hand, wound infection was the least common complication. The transfemoral approach in neuroendovascular procedures holds risk for several complications. This review will allow further studies to compare access-site complications between the transfemoral approach and other alternative access sites, mainly the transradial approach, which is gaining a lot of interest nowadays.

From reconstruction to function : Hands-on training in tympanoplasty using real-time feedback

HintergrundIn der Mittelohrchirurgie bedarf es ausgezeichneter feinmotorischer Fertigkeiten. Aufgrund des hohen Komplikationspotenzials im Mittelohr ist die Ausbildung dieser Fertigkeiten am Modell anzustreben.FragestellungWie gut ist die Ausbildungsmöglichkeit an geeigneten Modellen? Können die am Modell erlernten Fertigkeiten in die intraoperative Situation übertragen werden? Beeinflusst das Modell und die Ausbildung daran die zukünftige Ohrchirurgie?Material und MethodeVorliegende Publikationen und eigene Erfahrungen am Dresdener Tympanoplastikmodell (DTM) wurden analysiert und diskutiert.ErgebnisseObwohl die Mittelohrchirurgie hohe Anforderungen an den Ausführenden stellt und am Sinnesorgan Ohr schwerwiegende Komplikationen drohen, gibt es bisher nur wenige Trainingsmöglichkeiten dafür. Das DTM ist ein validiertes Übungsmodell, das diese Lücke schließen kann. Durch eine Real-Time-Feedback-Variante des Modells kann auch das Verständnis für Rekonstruktionsqualität und intraoperative akustische Noxen verbessert werden. Die Übertragung des Real-Time-Feedback-Gedankens in die reale Mittelohrchirurgie kann die Rekonstruktionsqualität zukünftig verbessern.SchlussfolgerungenDas Training an geeigneten Modellen ist speziell beim Erlernen der Mittelohrchirurgie anzustreben. Mit dem Real-Time-Feedback kann beim Lernen und Operieren eine weitere Sinneswahrnehmung in die eigene und fremde Qualitätskontrolle der Tympanoplastik sehr wirksam einbezogen werden.

MM-269: Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not standard of care in patients with multiple myeloma (MM), but it is a potential treatment option and associated with a high risk of severe complications. Aim: To study the effectiveness of allo-HSCT for young patients with MM. Materials and methods: From 2013 to 2018, eight patients (6 male, 2 female) with MM, aged from 27 to 55 years (median 39 years), underwent allo-HSCT. All patients had adverse prognostic factors. During the induction therapy, the patients received from 2 to 4 lines of therapy. Before the auto-HSCT, a VGPR was achieved in 1 patient, a PR in 4 patients and a progression of disease in 3 patients. Seven patients underwent a tandem auto/allo-HSCT and one patient underwent an allo-HSCT. In all cases, an HLA-identical sibling donor was used. Reduced intensity conditioning regimen (fludarabine + busulfan + ATG) was performed in all patients. Immunosuppressive therapy included cyclophosphamide at +3 and +4 days. Results: The duration of agranulocytosis ranged from 12 to 26 days (median 19 days) after allo-HSCT. Acute GVHD was developed in 62.5% of cases, of which severe GVHD was noted in 25% of patients. 5 patients achieved CR; 3 patients had a VGPR 5 months after allo-HSCT. All patients achieved 100% donor molecular chimerism. When observed for 15 to 79 months (median 51 months) after allo-HSCT, CR was achieved in 62.5% of the patients. One patient died due to complications of severe GVHD. In 2 cases, 12 and 19 months after allo-HSCT, against the background of 100% molecular chimerism, myeloma progression was observed. 6-year PFS was 75%, 6-year OS was 89%, with a median observation of 51 months. Conclusion: Allo-HSCT can be considered as an effective treatment for young patients with high-risk MM. 6-year PFS and 6-year OS were 75% and 89%, respectively. A stringent CR was achieved in 62.5% of patients. Myeloma progression was noted in 2 cases against the background of 100% donor bone marrow chimerism. Severe acute GVHD was observed in 25% of cases. The high frequency of GVHD requires close monitoring and timely treatment. The transplant-related mortality rate was 12.5%.

Sünnet Komplikasyonları: Sekiz yıllık deneyimimiz

Background: Most circumcision practices in our country are still carried out by medical officers or circumcisers. The present study aims to determine the types of circumcision complications, their frequencies and possible causes.Methods: A total of 103 patients between 0-18 years of age, who were admitted to the Pediatric Surgery Clinic of our hospital due to circumcision complaints between January 2012 and December 2019, were included in the study. The demographic data, treatments, and clinical follow-up of the patients were obtained from file records retrospectively.Results: The mean age of the patients was 3.9 ± 3.8 years. Of the circumcisions, 58 (56.3%) were performed at home or in a health cabin, while 45 (43.7%) were conducted in a hospital setting. Of these, 68 (66%) were performed by a circumciser or health officer, and 35 (34%) by a physician. The most common early circumcision complication was penile hemorrhage or hematoma (25.2%) and the most common late circumcision complication was inadequate circumcision and glans adherent skin bridges (17.5%). The major complications were glans penile amputation, necrosis, and excessive incision of the penis skin in 7 (6.7%) patients. Of these patients, 6 (85.7%) were circumcised by a health officer or circumciser.Conclusions: Circumcision is a surgical procedure that should be performed by specialist physicians where the necessary conditions for the surgical procedure are met. As society becomes more aware of this issue, the frequency of circumcision complications and the risk of severe complications will decrease.

A 10-year retrospective survey of acute childhood osteomyelitis in Stockholm, Sweden.

Children with osteomyelitis present with a range of signs and symptoms and with varying degree of severity. The purpose of this study was to provide data on a population-based 10-year material of children with acute osteomyelitis. All children, 0-14 years in Stockholm Region with acute osteomyelitis hospitalised in July 2005-June 2015, were retrospectively studied. Time to hospital presentation, disease localization, inflammation markers, imaging procedures, microbiology, severity classified by the presence of complications, surgical procedures, hospital length of stay and seasonal variation were recorded. There were 430 children with acute osteomyelitis; 61% were boys. The incidence per 100 000 person-years was 11.6; 9.3 in girls and 13.1 in boys. Median age at admission was 2.9 years with no peak later in childhood. Median time from first symptom to diagnosis was 4 days (range 1-21) and 48% of the cases were localised to femur or tibia. Mean C-reactive protein was 59 mg/L (range 1-376). Blood (n = 82) or tissue cultures (n = 54) were positive in 118 (28%) children. The most common pathogen was Staphylococcus aureus (n = 88) followed by Streptococcus pyogenes (n = 12). Surgery was performed in 71 children (17%). There was no mortality. Severe complications were seen in 14 (3.3%) children, five of whom were admitted to intensive care. Median hospital length of stay was 4 days (range 1-60). Osteomyelitis in children is a diagnostic challenge with a low yield of positive bacterial cultures. Few children with uncomplicated disease need surgery, but the risk of severe complications is not negligible.

Obesity in Living-Donor Kidney Transplant: What Risks for the Donor and the Recipient?

For a kidney transplant candidate, a living-donor kidney transplant is the best option: it offers the longest survival to the recipient. Currently, more than 27000 living-donor kidney transplants are done each year in the world. More than 25% of all living kidney donors are now considered obese at the time of donation compared with fewer than 8% in the 1970s, and the proportion of obese recipients is doubling every 15 years as a result of the global epidemic of obesity. Obesity exposes both the donor and recipient to multiple complications: first, of an immediate surgical nature in the intra- and postoperative periods, then of a medical nature in the short and long term. Although surgical complications are well known and better mastered thanks to great technical progress, long-term medical complications can be severe and compromise patient survival and that of the transplanted kidney. For the recipient, the benefits of kidney transplant compared with end-stage renal disease are significant despite all the risks and complications caused by obesity. For the donor, however, no risk of severe complications is acceptable, and the main objective of pretransplant explorations is to ensure that the donation of a kidney occurs in complete safety for the donor. In the presence of obesity, if the donor is highly motivated and barring other exclusion criteria, it is mandatory to clearly inform the donor of all potential obesity-related risks, to strongly encourage him/her to lose weight before the donation, and to maintain this weight afterward.

Use of totally implantable venous port systems in children hematology clinic

Relevance.Reliable and long-term venous access is one of the most important condition for a successful leukemia therapy in children. Safe and convenient access to a central vein allows to provide chemotherapy, adjuvant treatment, parenteral nutrition and blood transfusion. It decreases the likelihood of phlebitis development and reduction of the peripheral venous network in comparison with peripheral venous access. The use of totally implantable venous port systems reduces risks of severe complications associated with re-catheterization of the central vein thus it improves patient’s quality of life.The purpose of the studyis a retrospective assessment of the experience of use and analysis of the complications of totally implantable venous port systems in children with diseases of the blood system.Materials and methods.The data of 61 patients of the pediatric hematology clinic with venous port systems have been analyzed.Results.Perioperative complications developed in 3 (4.9 %) patients Median time of using of port systems was 679 catheter-days. Delayed complications requiring removal of the device developed in 8 (13.1 %) patients. Infectious complications were the reason for device removal in 3 (2.9 %) patients, mechanical complications in 5 (8.2 %) patients. No thrombotic complications were found.Conclusions.The use of venous port systems in children with hematologic diseases for a long period of time is an effective and safe way for central venous access providing.

The utility of brain biopsy in pediatric cryptogenic neurological disease.

The authors' aim was to characterize a single-center experience of brain biopsy in pediatric cryptogenic neurological disease. The authors performed a retrospective review of consecutive brain biopsies at a tertiary pediatric neurosciences unit between 1997 and 2017. Children < 18 years undergoing biopsy for neurological pathology were included. Those with presumed neoplasms and biopsy performed in the context of epilepsy surgery were excluded. Forty-nine biopsies in 47 patients (25 females, mean age ± SD 9.0 ± 5.3 years) were performed during the study period. The most common presenting symptoms were focal neurological deficit (28.6%) and focal seizure (26.5%). Histopathological, microbiological, and genetic analyses of biopsy material were contributory to the diagnosis in 34 cases (69.4%). Children presenting with focal seizures or with diffuse (> 3 lesions) brain involvement on MRI were more likely to yield a diagnosis at biopsy (OR 3.07 and 2.4, respectively). Twelve patients were immunocompromised and were more likely to yield a diagnosis at biopsy (OR 6.7). Surgery was accompanied by severe complications in 1 patient. The most common final diagnoses were infective (16/49, 32.7%), followed by chronic inflammatory processes (10/49, 20.4%) and occult neoplastic disease (9/49, 18.4%). In 38 cases (77.6%), biopsy was considered to have altered clinical management. Brain biopsy for cryptogenic neurological disease in children was contributory to the diagnosis in 69.4% of cases and changed clinical management in 77.6%. Biopsy most commonly revealed underlying infective processes, chronic inflammatory changes, or occult neoplastic disease. Although generally safe, the risk of severe complications may be higher in immunocompromised and myelosuppressed children.

Distribution of Patients at Risk for Complications Related to COVID-19 in the United States: Model Development Study.

BackgroundCoronavirus disease (COVID-19) has spread exponentially across the United States. Older adults with underlying health conditions are at an especially high risk of developing life-threatening complications if infected. Most intensive care unit (ICU) admissions and non-ICU hospitalizations have been among patients with at least one underlying health condition.ObjectiveThe aim of this study was to develop a model to estimate the risk status of the patients of a nationwide pharmacy chain in the United States, and to identify the geographic distribution of patients who have the highest risk of severe COVID-19 complications.MethodsA risk model was developed using a training test split approach to identify patients who are at high risk of developing serious complications from COVID-19. Adult patients (aged ≥18 years) were identified from the Walgreens pharmacy electronic data warehouse. Patients were considered eligible to contribute data to the model if they had at least one prescription filled at a Walgreens location between October 27, 2019, and March 25, 2020. Risk parameters included age, whether the patient is being treated for a serious or chronic condition, and urban density classification. Parameters were differentially weighted based on their association with severe complications, as reported in earlier cases. An at-risk rate per 1000 people was calculated at the county level, and ArcMap was used to depict the rate of patients at high risk for severe complications from COVID-19. Real-time COVID-19 cases captured by the Johns Hopkins University Center for Systems Science and Engineering (CSSE) were layered in the risk map to show where cases exist relative to the high-risk populations.ResultsOf the 30,100,826 adults included in this study, the average age is 50 years, 15% have at least one specialty medication, and the average patient has 2 to 3 comorbidities. Nearly 28% of patients have the greatest risk score, and an additional 34.64% of patients are considered high-risk, with scores ranging from 8 to 10. Age accounts for 53% of a patient’s total risk, followed by the number of comorbidities (29%); inferred chronic obstructive pulmonary disease, hypertension, or diabetes (15%); and urban density classification (5%).ConclusionsThis risk model utilizes data from approximately 10% of the US population. Currently, this is the most comprehensive US model to estimate and depict the county-level prognosis of COVID-19 infection. This study shows that there are counties across the United States whose residents are at high risk of developing severe complications from COVID-19. Our county-level risk estimates may be used alongside other data sets to improve the accuracy of anticipated health care resource needs. The interactive map can also aid in proactive planning and preparations among employers that are deemed critical, such as pharmacies and grocery stores, to prevent the spread of COVID-19 within their facilities.

Formulation and standardization of gluten free flour mix

People with severe form of gluten intolerance for long period are at risk for several complications leading to malnutrition. The only dietary treatment for celiac disease is to follow a gluten-free diet. The gluten free diet is a lifetime requirement. Gluten free diet improves symptoms, heals intestinal damage, and prevents further damage. A study was undertaken with an objective to formulate and standardize Gluten free flour mix. Gluten free flour mix was formulated by conducting 6 treatments using millets and legume viz. Ragi, Amaranth, Buckwheat and Fava bean. Result revealed that Gluten free flour mix 25 g of ragi, 25 g of amaranth, 25 g of fava bean flour and 25 g of buckwheat flour was found to be the best acceptable formulation. The acceptable combination can be used in the preparation of various food products.

The frequency and clinical presentation of Zika virus coinfections: a systematic review

BackgroundThere is limited knowledge on the influence of concurrent coinfections on the clinical presentation of Zika virus (ZIKV) disease.MethodsTo better understand the types, frequencies and clinical manifestations of ZIKV coinfections,...

Determination of cut-off and correlates of delay in treatment-seeking of febrile illness: a retrospective analysis

BackgroundEarly diagnosis and treatment of malaria symptoms reduces the risk of severe complication and malaria transmission. However, delay in malaria diagnosis and treatment is a major public health problem in India. The primary aim of the study was to determine cut-off for the delay in seeking treatment of fever, and the secondary aim was to identify the factors associated with delay in malaria-endemic areas of Assam, Northeast India.MethodsThe present study analysed data from two prior cross-sectional surveys (community- and hospital-based) that was conducted to study the health-seeking behaviour of people residing in high malaria-endemic areas of Assam, Northeast India. The hospital-based survey data were used to determine optimal cut-off for the delay in reporting, and further, used to identify the factors associated with delay using community-based data.ResultsMean age of fever cases was similar in both community- and hospital-based surveys (23.1 years vs 24.2 years, p = 0.229). Delay in reporting fever was significantly higher among hospital inpatients compared to community-based fever cases (3.6 ± 2.1 vs 4.0 ± 2.6 days; p = 0.006). Delay of > 2 days showed higher predictive ability (sensitivity: 96.4%, and ROC area: 67.5%) compared to other cut-off values (> 3, > 4, and > 5 days). Multivariable logistic regression analysis revealed that the adjusted odds ratio (aOR) of delay was significantly higher for people living in rural areas (1.52, 95%CI: 1.11–2.09), distance (> 5 km) to health facility (1.93, 95%CI: 1.44–2.61), engaged in agriculture work (2.58, 95%CI: 1.97–3.37), and interaction effect of adult male aged 20–40 years (1.71, 95%CI: 1.06–2.75).ConclusionThe delay (> 2 days) in seeking treatment was likely to be twice among those who live in rural areas and travel > 5 km to assess health care facility. The findings of the study are useful in designing effective intervention programmes for early treatment of febrile illness to control malaria.

Disparities in the Population at Risk of Severe Illness From COVID-19 by Race/Ethnicity and Income

Identifying those at heightened risk of severe illness from novel coronavirus disease 2019 (COVID-19) is essential for modeling the disease, designing return-to-work criteria, allo-cating economic assistance, advancing health equity, and limiting morbidity and mortality. The U.S. Centers for Disease Control and Prevention has identified the criteria associated with the risk of severe complications from COVID-19 infection (Appendix Table 1, available online).1 Structural inequities have shaped racial, ethnic, and income disparities for the majority of these criteria.

Potential algorithm of prostate cancer management during the pandemic of coronavirus infection (COVID-19)

The World Health Organization has announced the coronavirus infection pandemic (COVID-19), associated with a high risk of severe complications requiring intensive care. The following is a possible algorithm for the choice of treatment tactics for prostate cancer during the COVID-19 pandemic, aimed at achieving 3 main goals: reducing the risk of life-threatening complications of the tumor process, minimizing the risk of “crossing” the profiles of adverse events associated with prostate cancer treatment and viral infection, and diminishing the risk of COVID-19 contamination for prostate cancer patients. The proposed algorithm is a personal view of the authors and is not an official recommendation.

Factors Affecting the Implementation Process of Pertussis [Tdap] Immunization in Pregnant Women in an Italian Region: A Qualitative Study.

Whooping cough (pertussis) represents one of the most prevalent vaccine-preventable diseases in Western countries, capable of causing disease in infants, with a high risk of severe complications. To protect new-borns from pertussis, many countries have introduced the acellular pertussis adult vaccine in combination with tetanus and diphtheria toxoids for women in the third trimester of pregnancy. Thanks to the approval of the new National Immunization Prevention Plan 2017–2019: Italy is among those countries. The Italian health-care system is a regionally based National Health Service, therefore, regions organize and implement new vaccination strategy on their own. This study focuses on Tuscany's experience in implementing the maternal pertussis vaccination. The present study had a qualitative design: we obtained information about the implementation process through interviews with relevant stakeholders involved in the planning or implementation of vaccination programme at different levels. We noticed heterogeneous implementation's status between Tuscan Health Care Departments. The most frequently reported barriers influencing the success of the implementation process of this prevention strategy included: lack of accountability, lack of enabling instruments, financial constraints, logistics barriers, training deficiencies, attitudes of health care workers, and lack of communication experts. The implementation of new vaccination programs is complex and challenging. Often the importance of education and information activities targeting health professionals are underestimated and underfunded. These elements would need to be carefully considered and adequate provisions should be made to address them when designing and implementing effective vaccine interventions.

Complications in the adult asplenic patient: A review for the emergency clinician.

The spleen performs several important physiologic functions. However, patients can have functional asplenia or have their spleen removed for a number of reasons, which can put them at risk for several dangerous complications. This narrative review provides a focused evaluation of adult asplenic patients and complications in the emergency departing setting. The spleen plays integral roles in the immune and reticuloendothelial systems and also modulates the inflammatory and coagulation cascades. Asplenia refers to the anatomic or physiologic loss of splenic function, which may be due to trauma, immunological, hematological, or oncological etiologies. Asplenic patients are at risk for several complications including infection, arterial and venous thrombosis, and pulmonary hypertension. Fever in an asplenic patient and overwhelming post-splenectomy infection (OPSI) are medical emergencies with a high mortality and require rapid evaluation and management with broad-spectrum antibiotics. Asplenic patients are at increased risk of arterial thrombosis, such as coronary artery disease, and venous thrombosis including deep venous thrombosis, pulmonary embolism, and splenic and portal vein thrombosis. Management of venous thrombosis includes anticoagulation. Pulmonary hypertension with associated right ventricular dysfunction may also occur in asplenia. These patients require hemodynamic stabilization with an emphasis on inciting causes and treatment of the pulmonary hypertension. The spleen is an integral organ involved in several physiologic functions. Asplenia, or absence of spleen function, is associated with severe complications. Knowledge of these complications can improve the care of these patients.