Serotonin Surge: Intravenous Escitalopram as a Rare Cause of Drug-Induced Aplastic Anaemia.

Unlabelled: Escitalopram is a commonly prescribed medication that has infrequently been implicated in drug-induced thrombocytopenia (DITP) but has never been associated with aplastic anaemia in the literature. We present an extremely rare case of hypoproliferative pancytopenia due to self-administered intravenous (IV) injection of escitalopram. The crux of this case is the unusual trilineage cytopenia.

Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure.

Background: De novo hypoxemic respiratory failure is defined as significant hypoxemia in the absence of chronic lung disease such as COPD, and excluding respiratory failure occurring in the immediate postoperative or postextubation period. We aimed to evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in patients with de novo hypoxemic respiratory failure.

Methods: We performed electronic database searches of PubMed, Cochrane Library, and Embase from inception to December 2018 to include randomized controlled trials that compared various oxygenation strategies in cases of de novo hypoxemic respiratory failure occurring in adult subjects without a preexisting chronic lung disease and excluding respiratory failure in the immediate postoperative or postextubation periods.

Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator.

Background: The novel Surgical Risk Preoperative Assessment System (SURPAS) requires entry of five predictor variables (the other three variables of the eight-variable model are automatically obtained from the electronic health record or a table look-up), provides patient risk estimates compared to national averages, is integrated into the electronic health record, and provides a graphical handout of risks for patients. The accuracy of the SURPAS tool was compared to that of the American College of Surgeons Surgical Risk Calculator (ACS-SRC).

Methods: Predicted risk of postoperative mortality and morbidity was calculated using both SURPAS and ACS-SRC for 1,006 randomly selected 2007-2016 ACS National Surgical Quality Improvement Program (NSQIP) patients with known outcomes.

The utility of presacral drainage in penetrating rectal injuries in adult and pediatric patients.

Background: With changing weaponry associated with injuries in civilian trauma, there is no clinical census on the utility of presacral drainage (PSD) in penetrating rectal injuries (PRIs), particularly in pediatric patients.

Methods: Patients with PRI from July 2004-June 2014 treated at two free-standing children's hospitals and two adult level 1 trauma centers were compared by age (pediatric patients ≤16 years) and PSD. A stratified analysis was performed based on age.

Direct peritoneal resuscitation improves mesenteric perfusion by nitric oxide dependent pathways.

Background: Direct peritoneal resuscitation (DPR) has been shown to increase survival after intestinal ischemia and reperfusion injury (I/R). We have previously appreciated that minimum essential medium (MEM), a synthetic cell culture medium with bovine serum, glutamine, and antibiotics, contributes to these benefits. We hypothesized that (1) DPR using MEM as a dialysate would increase mesenteric perfusion, improve intestinal mucosal injury, and limit intestinal and hepatic inflammation after intestinal I/R and (2) these improvements would be dependent on endothelial nitric oxide pathways.

Hydrogen Sulfide: A Potential Novel Therapy for the Treatment of Ischemia.

Hydrogen sulfide (H2S) is a novel signaling molecule most recently found to be of fundamental importance in cellular function as a regulator of apoptosis, inflammation, and perfusion. Mechanisms of endogenous H2S signaling are poorly understood; however, signal transmission is thought to occur via persulfidation at reactive cysteine residues on proteins. Although much has been discovered about how H2S is synthesized in the body, less is known about how it is metabolized.

Hydrogen sulfide improves intestinal recovery following ischemia by endothelial nitric oxide-dependent mechanisms.

Hydrogen sulfide (HS) is an endogenous gasotransmitter that has vasodilatory properties. It may be a novel therapy for intestinal ischemia-reperfusion (I/R) injury. We hypothesized that ) HS would improve postischemic survival, mesenteric perfusion, mucosal injury, and inflammation compared with vehicle and ) the benefits of HS would be mediated through endothelial nitric oxide.

Mesenchymal stromal cell therapy for the treatment of intestinal ischemia: Defining the optimal cell isolate for maximum therapeutic benefit.

Intestinal ischemia is a devastating intraabdominal emergency that often necessitates surgical intervention. Mortality rates can be high, and patients who survive often have significant long-term morbidity. The implementation of traditional medical therapies to prevent or treat intestinal ischemia have been sparse over the last decade, and therefore, the use of novel therapies are becoming more prevalent.

Harvest tissue source does not alter the protective power of stromal cell therapy after intestinal ischemia and reperfusion injury.

Background: Transplantation of mesenchymal stromal cells (MSCs) may be a novel treatment for intestinal ischemia. The optimal stromal cell source that could yield maximal protection after injury, however, has not been identified. We hypothesized that (1) MSCs would increase survival and mesenteric perfusion, preserve intestinal histologic architecture, and limit inflammation after intestinal ischemia and reperfusion (I/R) injury, and (2) MSCs harvested from different sources of tissue would have equivalent protective properties to the intestine after I/R inury.