Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces for Prophylactic Pain Control in Neurofibromatosis Type 1 Amputees.

Neurofibromatosis type 1 (NF1) is an inherited multisystem disorder that affects one in 2500 to one in 5000 people. Neurofibromas are the second-most common benign peripheral nerve sheath tumors arising from Schwann cells and are associated with neurofibromatosis. Chronic pain and opioid use is elevated in patients with NF1 when neurofibromas are associated with sensory nerves.

Use of Subclavian Extracorporeal Carbon Dioxide Removal for COVID-19 Acute Respiratory Distress Syndrome as a Bridge to Lung Transplantation.

Severe acute hypercapnia is independently associated with increased adverse effects and intensive care unit mortality in mechanically ventilated patients. During the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic, some patients were placed on extracorporeal carbon dioxide removal support when extracorporeal membrane oxygenation (ECMO) support was at capacity or not offered. We present a patient with severe acute respiratory distress syndrome caused by COVID-19 pneumonia, who was supported with Hemolung Respiratory Assist System (ALung Technologies, Inc.

Feasibility of Exenatide, a GLP-1R Agonist, for Treating Cocaine Use Disorder: A Case Series Study.

Cocaine use remains a serious public health problem associated with a marked increase in overdose deaths in the past decade. No medications have yet been proven to be effective for the treatment of cocaine use disorder (CUD). Among the highly promising medications have been glucagon-like peptide 1 receptor agonists (GLP-1RA) that are currently used for the treatment of type 2 diabetes mellitus and weight management.

The reports of my death are greatly exaggerated: An evaluation of futility cut points in massive transfusion.

Background: Following COVID and the subsequent blood shortage, several investigators evaluated futility cut points in massive transfusion. We hypothesized that early aggressive use of damage-control resuscitation, including whole blood (WB), would demonstrate that these cut points of futility were significantly underestimating potential survival among patients receiving >50 U of blood in the first 4 hours.

Methods: Adult trauma patients admitted from November 2017 to October 2021 who received emergency-release blood products in prehospital or emergency department setting were included.

Attention to Detail: The Effect of Fluoroscopic Parallax on Limb Alignment Assessment During Corrective Osteotomy.

Background: The accuracy of a corrective osteotomy is dependent on many factors. One error rarely considered is using noncentered fluoroscopic imaging to assess intraoperative alignment. This study quantified the coronal alignment error produced by visual parallax per interval changes in vertical and horizontal positioning of the C-arm and alignment rod during intraoperative evaluation.

Is Low-Titer Group O Whole Blood Truly a Universal Blood Product?

Background: Whole blood was historically transfused as a type-specific product. Given recent advocacy for low-titer group O whole blood (LTOWB) as a universal blood product, we examined outcomes after LTOWB transfusion stratified by recipient blood groups.

Study Design: Adult trauma patients receiving prehospital or in-hospital transfusion of LTOWB (November 2017 to July 2020) at a single trauma center were prospectively evaluated.

Concerns About Hospital-based Managed Alcohol Programs.

This case commentary involves a hospital-based managed alcohol program that uses a standardized protocol for administration of beverage alcohol (vodka or beer) in hospitalized patients with alcohol use disorder in an urban hospital in Canada. Issues of concern include addressing alcohol use during hospitalization directly with motivational interviewing instead of permitting consumption of alcohol, dangers of beverage alcohol in hospitalized patients, and risk of worsening alcohol withdrawal syndrome. Ethical principles are also briefly addressed as they apply to managed alcohol programs.

Decreasing Foot Traffic in the Orthopedic Operating Room: A Narrative Review of the Literature.

Introduction: Surgical site infections (SSIs) are implicated in poor outcomes in orthopedic surgical patients. Decreasing foot traffic in orthopedic surgical suites is correlated with the reduction of SSI risk. This review aims to understand the background and significance of the problem, isolate factors contributing to the movement in and out of operating rooms, and identify interventions that decrease traffic in procedure areas.

Is There a Higher Risk of Mother-to-child Transmission of HIV Among Pregnant Women With Perinatal HIV Infection?

Cases of mother-to-child-transmission in the Surveillance Monitoring of ART Toxicities Study of Pediatric HIV/AIDS Cohort Study were identified from 2007 to 2015. Among 2123 births, 9 infants were HIV infected, giving a mother-to-child-transmission rate of 0.5% (95% confidence interval: 0.

Comparison of Children's Menu Items at Full- and Quick-Service Restaurants.

Objectives: The proportion of food consumed by children from restaurants tripled during the last 4 decades and that coincided with the increased rate of obesity. Despite the presence of data linking quick-service (QS) food consumption to poor diet quality, studies comparing the nutrition content of the children's menu items at QS restaurants (QSRs) with those at full-service restaurants (FSRs) are limited. The objectives of this study were to examine the nutrition content of common children's menu items at both QSRs and FSRs and compare these data with recommendations reported by the .

The hyperfibrinolytic phenotype is the most lethal and resource intense presentation of fibrinolysis in massive transfusion patients.

Background: Among bleeding patients, we hypothesized that the hyperfibrinolytic (HF) phenotype would be associated with the highest mortality, whereas shutdown (SD) patients would have the greatest complication burden.

Methods: Severely injured patients predicted to receive a massive transfusion at 12 Level I trauma centers were randomized to one of two transfusion ratios as described in the Pragmatic, Randomized, Optimal Platelet and Plasma Ratio trial. Fibrinolysis phenotypes were determined based on admission clot lysis at 30 minutes (LY30): SD ≤0.

Intravenous Acetaminophen for Perioperative Pain Control in Adult Elective Neurospine Surgical Patients: A Retrospective Case-Control Study.

Adding intravenous (IV) acetaminophen to an opioid-based regimen as multimodal pain management for perioperative pain control in adults undergoing spine surgery can lead to effective pain control, reduce the risk of opioid-related adverse effects, and facilitate postoperative neurologic evaluation for surgical outcomes. This descriptive pilot study investigated the analgesic effect of a single dose of IV acetaminophen administered intraoperatively as routine practice for perioperative pain management for adults undergoing elective spine surgery. A retrospective comparative cohort study compared an IV acetaminophen group with a group not receiving IV acetaminophen for primary outcomes measured by visual analog scale (VAS) and associated secondary outcomes.

FDG PET/CT in Malignant Eccrine Spiradenoma.

Malignant eccrine spiradenoma is very rare skin appendageal cancer. We report a 64-year-old man who presented with a 6-month history of a rapidly growing mass in his groin. Physical examination revealed a 10-cm, ulcerated, fungating mass involving the entire right ilioinguinal region.

A call for formal telemedicine training during stroke fellowship.

During the 20 years since US Food and Drug Administration approval of IV tissue plasminogen activator for acute ischemic stroke, vascular neurology consultation via telemedicine has contributed to an increased frequency of IV tissue plasminogen activator administration and broadened geographic access to the drug. Nevertheless, a growing demand for acute stroke coverage persists, with the greatest disparity found in rural communities underserved by neurologists. To provide efficient and consistent acute care, formal training in telemedicine during neurovascular fellowship is warranted.

Poor Man's Methadone: A Case Report of Loperamide Toxicity.

Loperamide, a common over-the-counter antidiarrheal drug and opioid derivative, is formulated to act upon intestinal opioid receptors. However, at high doses, loperamide crosses the blood-brain barrier and reaches central opioid receptors in the brain, leading to central opiate effects including euphoria and respiratory depression. We report the case of a young man found dead in his residence with a known history of drug abuse.

Investigation of Pertussis Cases in a Texas County, 2008-2012.

Objectives: Within the past 25 years, there has been a dramatic increase in the incidence of pertussis cases in the United States. As such, this investigation reports on the high-risk groups and describes risk factors of pertussis cases in a large Texas county.

Methods: This study was a cross-sectional analysis of data collected by health department employees using the Texas Department of State Health Service's Pertussis Case Track Record, which is the standard investigation form for collecting vital information on pertussis cases.

Early surgical intervention for blunt bowel injury: the Bowel Injury Prediction Score (BIPS).

Background: Computed tomography (CT) scan of the abdomen has been used for 30 years to evaluate the stable blunt trauma patient. However, the early diagnosis of blunt hollow viscus injury (BHVI) remains a challenge. Delayed diagnosis and intervention of BHVI lead to significant morbidity and mortality.

Yield of diagnostic tests and its impact on cost in adult patients with syncope presenting to a community hospital.

Objectives: Total annual costs for syncope-related hospitalizations were $2.4 billion in 2000. The aim of this study was to examine the type and number of tests ordered for patients admitted with syncope and whether these tests helped establish the cause.

Azithromycin efficacy in the treatment of Chlamydia trachomatis among detained youth.

We assessed the efficacy of azithromycin among detained adolescents with Chlamydia trachomatis. Infected adolescents took azithromycin and submitted a test of cure. Of the 128 youth, 5 patients experienced treatment failure.