The Patient's Perspective: Burn Reconstructive Surgery During the COVID-19 Pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, hospital systems delayed or halted elective surgeries and outpatient care, profoundly disrupting reconstructive burn treatment ranging from surgery to postoperative therapy. This study aims to characterize burn patients' perspectives on reconstructive surgery during COVID-19. A 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA-verified Burn Center was administered.

Persistent airflow obstruction in inner-city children with asthma.

Airway remodeling has been shown to be persistent in patients with asthma despite treatment with controller medications. Patients with early airflow obstruction may continue to experience poor lung function despite treatment. To determine whether early airflow obstruction in inner-city children with asthma persists despite guideline-based asthma care.

American Association for the Surgery of Trauma Prevention Committee review: Family Justice Centers-a not-so-novel, but unknown gem.

The American College of Surgeons Committee on Trauma requires that trauma centers demonstrate adequate financial support for an injury prevention program as part of the verification process. With the ongoing challenges that arise with important social determinants of health, trauma centers have the important task of navigating a patient through the complex process of obtaining services and tools for success. This summary from the American Association for the Surgery of Trauma Prevention Committee focuses on a model that has been present for several years, but has not been brought to full awareness in the trauma world.

Homeless Tent Fires: A Descriptive Analysis of Tent Fires in the Homeless Population.

Tent fires are a growing issue in regions with large homeless populations given the rise in homelessness within the United States and existing data that suggest worse outcomes in this population. The aim of this study was to describe the characteristics and outcomes of tent fire burn injuries in the homeless population. A retrospective review was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 2015 and December 2020.

From the hospital to the streets: Bringing care to the unsheltered homeless in Los Angeles.

Homelessness is a neglected crisis throughout the United States. In Los Angeles (L.A.

Mass Casualty and the Role of the Anesthesiologist.

The anesthesiologist, upon completion of their training, is expected to be the liaison to the operating room and the patient. Key components of the anesthesiologist's training and daily routine make them an ideal participant and leader when it comes to their potential involvement in a mass casualty event. Airway expertise, vascular access, ongoing triage, hemodynamic vigilance, resuscitation, and real-time adaptation to a changing and critical care environment are a few of the skills that encompass the daily routine and value the anesthesiologist brings to an emergency management team.

Improvements and Gaps in Financial Risk Protection Among Veterans Following the Affordable Care Act.

Background: Despite public perception, most of the nearly 20 million US veterans have health coverage outside the Veterans Health Administration (VHA), and VHA eligibility and utilization vary across veterans. Out-of-pocket healthcare spending thus remains a potential source of financial hardship for veterans. The Affordable Care Act (ACA) aimed to expand health insurance access, but its effect on veterans' financial risk protection has not been explored.

A Fatal Case of Toxic Epidermal Necrolysis Combined With Vanishing Bile Duct Syndrome and Hemophagocytic Lymphohistiocytosis.

This case report describes a case of fatal toxic epidermal necrolysis complicated by both vanishing bile duct syndrome and hemophagocytic lymphohistiocytosis due to Influenza B infection. Here we highlight the potential for complex morbidity secondary to underlying autoimmune hypersensitivity. Furthermore, the stepwise progression of these pathologies is noted, with the initial epidermal lesions first progressing to cholestatic injury and then subsequently to the hematologic manifestations.

Evaluation of Time-Limited Trials Among Critically Ill Patients With Advanced Medical Illnesses and Reduction of Nonbeneficial ICU Treatments.

Importance: For critically ill patients with advanced medical illnesses and poor prognoses, overuse of invasive intensive care unit (ICU) treatments may prolong suffering without benefit.

Objective: To examine whether use of time-limited trials (TLTs) as the default care-planning approach for critically ill patients with advanced medical illnesses was associated with decreased duration and intensity of nonbeneficial ICU care.

Design, Setting, And Participants: This prospective quality improvement study was conducted from June 1, 2017, to December 31, 2019, at the medical ICUs of 3 academic public hospitals in California.

First-trimester serum BAFF:sFlt-1 ratio as a candidate early biomarker of spontaneous abortion.

Problem: Immunologic, angiogenic, and anti-angiogenic factors are associated with spontaneous abortion (SAB). B cell-activating factor (BAFF), a proliferation-inducing ligand (APRIL), placental growth factor (PlGF), and soluble fms-like tyrosine kinase-1 (sFlt-1) may play a role in SAB and may serve singly or in combination as an early biomarker of SAB.

Method Of Study: In this prospective observational study, serum sFlt-1, PIGF, BAFF, and APRIL levels were measured in the first trimester of pregnancy in a medically diverse group of women and in non-pregnant controls.

Intestinal Metaplasia of the "Cardia": Accurate Differentiation of Gastric or Esophageal Origin With an Expanded Biopsy Protocol.

Whether intestinal metaplasia (IM) distal to the endoscopic gastroesophageal junction (GEJ), that is, the cardia, is gastric or esophageal or both is controversial. Biopsies from this region are believed to be unreliable in resolving this issue and are not recommended. Our objective was to develop an accurate method of histologic diagnosis for IM of the cardia.

Distance Between Home and the Admitting Hospital and Its Effect on Survival of Low Socioeconomic Status Population With Bacteremia.

Objective: Bacteremia is the presence of bacteria in the bloodstream. The objective of this study was to determine the relationship between low socioeconomic status (SES) and the epidemiology, process of care, and outcomes of patients with bacteremia (SAB).

Methods: We conducted a multicenter, retrospective, cohort study that evaluated adult patients with SAB in 3 Los Angeles County hospitals from July 15, 2012, through May 31, 2018.

Practical assessment of different saw types for field amputation: A cadaver-based study.

Introduction: Field amputation can be life-saving for entrapped patients requiring surgical extrication. Under these austere conditions, the procedure must be performed as rapidly as possible with limited equipment, often in a confined space, while minimizing provider risk. The aim of this study was to determine the ideal saw, and optimal approach, through bone or joint, for a field amputation.

Damage Control Laparotomy in the Cirrhotic Trauma Patient is Highly Lethal: A Matched Cohort Study.

Introduction: Damage control laparotomy (DCL) has revolutionized trauma care and is considered the standard of care for severely injured patients requiring laparotomy. The role of DCL in cirrhotic patients has not been investigated.

Methods: A matched cohort study using American College of Surgeons Trauma Quality Improvement Program database including patients undergoing DCL within 24 hours of admission.

Isolated traumatic brain injury: Routine intubation for Glasgow Coma Scale 7 or 8 may be harmful!

Introduction: Despite strong recommendations, there is no direct evidence supporting routine intubation of trauma patients with Glasgow Coma Scale (GCS) score of 7 or 8. We hypothesized that routine intubation may not be beneficial in isolated blunt head injury.

Methods: A retrospective Trauma Quality Improvement Program study, including adult blunt trauma patients with GCS score of 7 or 8 and isolated head injury, was performed.

Combined immune checkpoint blockade increases CD8+CD28+PD-1+ effector T cells and provides a therapeutic strategy for patients with neuroblastoma.

Immune checkpoint therapy has resulted in minimal clinical response in many pediatric cancers. We sought to understand the influence of immune checkpoint inhibition using anti-PD-1 and anti-CTLA-4 antibodies individually, in combination, and after chemotherapy on immune responses in minimal and established murine neuroblastoma models. We also sought to understand the role of the tumor microenvironment (TME) and PD-L1 expression and their alteration post-chemotherapy in our models and human tissues.

Intra-Abdominal Hemorrhage Control: The Need for Routine Four-Quadrant Packing Explored.

Background: Routine four-quadrant packing (4QP) for hemorrhage control immediately upon opening is a standard practice for acute trauma laparotomy. The aim of this study was to evaluate the utility of 4QP for bleeding control in acutely injured patients undergoing trauma laparotomy.

Methods: Retrospective single-center study (01/2015-07/2019), including adult patients who underwent trauma laparotomy within 4 h of admission.

"Safer at home": The effect of the COVID-19 lockdown on epidemiology, resource utilization, and outcomes at a large urban trauma center.

Background: The COVID-19 pandemic has affected the entire global health care system. In California, because of a high burden of cases, a lockdown order was announced on March 19, 2020. This study investigated the impact of the lockdown on the epidemiology and outcomes of trauma admissions at the largest trauma center in Los Angeles.

Impact of COVID-19 infection among cancer patients treated at the Los Angeles County Medical Center.

We conducted a retrospective analysis of cancer patients who presented to the hospital with COVID-19 infection at a safety-net hospital in Los Angeles, California, from March 2020 to June 2020. From a list of 1,163 COVID-19+ adult patients, we selected the first 50 patients with malignancy for a preliminary analysis. There were 23 males (46.

Fractional CO laser treatment for burn scar improvement: A systematic review and meta-analysis.

Burn injury can cause abnormal healing and pathologic scar formation that significantly impairs patients' ability to return to baseline levels of functioning. Quality of life can be significantly diminished due to pain, stiffness, contracture, and the psychological burden of disfigurement. Traditional scar therapies such as silicone sheeting and compression garments are highly reliant on patient compliance, and have not demonstrated satisfactory efficacy.

Pharmacology, Dosing, and Side Effects of Rifabutin as a Possible Therapy for Antibiotic-Resistant Infections.

has among the highest rates of antibiotic resistance encountered in hospitals. New therapies are critically needed. We found that rifabutin has previously unrecognized hyperactivity against most strains of Here we review the pharmacology and adverse effects of rifabutin to inform potential oral dosing strategies in patients with infections.