Review of culprit drugs associated with patients admitted to the burn unit with the diagnosis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome.

Purpose: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are severe and potentially lethal adverse drug reactions characterized by acute inflammation of the skin, mucous membranes, and ocular surface that typically occurs within weeks of a culprit drug ingestion. The purpose of this study is to report a retrospective trend analysis of SJS spectrum diagnoses and associated culprit drugs in patients admitted to the Loyola University Medical Center (LUMC) Burn Unit, the major referral center in the Chicagoland region for patients with SJS disease spectrum.

Methods: The electronic medical records (EMR) of 163 patients with a diagnosis of SJS/TENS admitted to the LUMC Burn Unit from 2000 to 2019 were reviewed.

Burn Resuscitation Practices in North America: Results of the Acute Burn ResUscitation Multicenter Prospective Trial (ABRUPT).

Objectives: ABRUPT was a prospective, noninterventional, observational study of resuscitation practices at 21 burn centers. The primary goal was to examine burn resuscitation with albumin or crystalloids alone, to design a future prospective randomized trial.

Summary Background Data: No modern prospective study has determined whether to use colloids or crystalloids for acute burn resuscitation.

Racial And Socioeconomic Differences Affect Outcomes in Elderly Burn Patients.

Background: Race and socioeconomic status influence outcomes for adult and pediatric burn patients, yet the impact of these factors on elderly patients (Medicare eligible, 65 years of age) remains unknown.

Methods: Data pooled from three verified burn centers from 2004 to 2014 were reviewed retrospectively. Age, race, gender, percent total body surface area (%TBSA) burn, mortality, length of stay (LOS), LOS per %TBSA burn, and zip code which provided Census data on race, poverty, and education levels within a community were collected.

A Needs Assessment for Incoming Surgical Interns: Communication Effectiveness Is the Most Important Skill.

Introduction: Medical schools and surgical programs have implemented a "boot camp" to assist medical students' transition into surgical interns and help them contend with a deluge of new responsibilities. This study aims to determine what faculty, residents, and medical students identify as the most critical topics for a surgical boot camp curriculum.

Methods: Forty-five-question survey was developed through an iterative review with multiple surgical colleagues in conjunction with the American College of Surgeons/Association of Program Directors/the Association of Surgical Education resident prep curricular modules.

Transient Improvement in Erythropoiesis Is Achieved Via the Chaperone AHSP With Early Administration of Propranolol in Burn Patients.

Burn patients experience erythropoietin resistant anemia in which early commitment and late maturation of erythroblasts are defective. The authors previously showed that propranolol (Prop) treatment restores erythroid committed progenitors, but terminal maturation remains impaired. Hemoglobinization and maturation occur during terminal erythropoiesis and these processes are aided by an erythroblast intrinsic functional protein called alpha-hemoglobin stabilizing protein (AHSP).

A Shift in Myeloid Cell Phenotype via Down Regulation of Siglec-1 in Island Macrophages of Bone Marrow Is Associated With Decreased Late Erythroblasts Seen in Anemia of Critical Illness.

Burn injury has been shown to significantly dampen erythropoiesis in both burn patients and in murine models. Our previous findings elucidated the erythropoietin independent defects in red cell development stages involving erythroid progenitor production and late stage erythroblast enucleation processes. We hypothesized that macrophages (MØ) in erythroblast islands (EBI) could be yet another roadblock impeding erythropoiesis following burn injury.

Is Tracheostomy Insertion an Indication for Gastrostomy Insertion?

The aim of the study was to determine the frequency of surgical patients who undergo tracheostomy and gastrostomy insertion during the same hospitalization. Secondary outcomes included ICU and hospital length of stay (LOS) for patients who underwent concomitant tracheostomy and gastrostomy those who did not. This study is a retrospective review of trauma and acute care surgery (ACS) patients between 2006 and 2015 who underwent tracheostomy.

How Does SCORTEN Score?

The Toxic Epidermal Necrolysis-specific severity of illness score (SCORTEN) was developed to predict mortality in patients with Stevens Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Several studies have attempted to assess the accuracy of SCORTEN with mixed results. The objective of this study is to compare the predicted and actual mortality for patients with SJS/TEN admitted to a single high-volume burn center.

Seeing the forest beyond the trees: Predicting survival in burn patients with machine learning.

Background: This study aims to identify predictors of survival for burn patients at the patient and hospital level using machine learning techniques.

Methods: The HCUP SID for California, Florida and New York were used to identify patients admitted with a burn diagnosis and merged with hospital data from the AHA Annual Survey. Random forest and stochastic gradient boosting (SGB) were used to identify predictors of survival at the patient and hospital level from the top performing model.

Cervical spine clearance when unable to be cleared clinically: a pooled analysis of combined computed tomography and magnetic resonance imaging.

Background: The role of cervical spine magnetic resonance imaging (MRI) in the evaluation of clinically unevaluable blunt trauma patients has been called into question by several recent studies.

Methods: A PubMed search was performed for all studies comparing computed tomography and MRI in the assessment of the cervical spine in patients who cannot be evaluated clinically. The radiologic findings and clinical outcomes from each study were collated for analysis.

Effect of aging on renal function plus monitoring and support.

Several anatomic changes and physiologic alterations occur in the aging kidney, awareness of which is essential for the early recognition of acute kidney injury (AKI) to improve outcomes in hospitalized geriatric patients. There are no unique diagnostic methods or treatment modalities in the care of the geriatric patient with AKI. Therapy is mainly supportive, and the full spectrum of treatment options, including renal replacement therapy (RRT), should not be withheld from a patient based on age.

Rhabdomyolysis in the intensive care unit.

Rhabdomyolysis is a clinical syndrome defined by muscle breakdown and subsequent release of intracellular contents. There are many etiologies of rhabdomyolysis, classified here as congenital and acquired; compartment syndrome secondary to trauma with reperfusion injury is one common precipitating factor. Regardless of the underlying etiology, the pathophysiology follows a similar pathway via myocyte destruction and release of myoglobin into the systemic circulation.

The evolution and long-term results of laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease.

Background: For nearly 2 decades, the laparoscopic correction of gastroesophageal reflux disease (GERD) has demonstrated its utility. However, the surgical technique has evolved over time, with mixed long-term results. We briefly review the evolution of antireflux surgery for the treatment of GERD, provide an update specific to the long-term efficacy of laparoscopic antireflux surgery (LARS), and analyze the factors predictive of a desirable outcome.

Postoperative pyoderma gangrenosum after elective abdominoplasty: a case report and review of the literature.

Pyoderma gangrenosum (PG) is a relatively uncommon disease that can present after a bevy of inciting events, ranging from posttraumatic and postoperative states to association with a number of systemic inflammatory disorders. Various classification schemes have been described to further delineate the underlying cause, including ulcerative, pustular, vegetative, bullous, peristomal, and pathergic forms of PG. Pathergic PG develops at the site of a previous trauma.