Late-onset left atrial appendage occlusion device-related thrombus attributed to mitral bioprosthetic stenosis: a case report.

Background: Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke prevention in select patients with atrial fibrillation (AF). In this study, we describe the case of a patient with delayed device-related thrombus (DRT) at 13 months post-LAAO in a setting of atrial stasis due to a worsening mitral bioprosthetic stenosis.

Case Summary: A 69-year-old woman with a history of rheumatic mitral stenosis and regurgitation post-bioprosthetic mitral valve replacement (6 years prior) and paroxysmal AF was referred for percutaneous LAAO due to recurrent severe gastrointestinal bleeding while on anticoagulation.

Implementing a Peer Support Program for Second Victims.

The second victim phenomenon describes the distress frequently experienced by health care providers after an unintentional medical error or unexpected adverse event. However, few health care institutions have initiatives that proactively address this phenomenon. The pilot project discussed in this article aimed to create a peer support program for health care providers experiencing the second victim phenomenon.

Pulmonary Vein Thrombus After Mitral Valve Transcatheter Edge-to-Edge Repair.

A 76-year-old female with a complicated medical history presented for Watchman (Boston Scientific) placement 2 months after mitral valve transcatheter edge-to-edge repair (TEER). Preoperative workup before Watchman placement confirmed the presence of a thrombus in the left superior pulmonary vein. Post-procedure mitral valve TEER transesophageal echocardiogram showed no thrombus in the left atrium appendage or pulmonary veins.

PremieFeed: Investigating Preterm Infant Feeding Behaviors, Growth, and Caregiver Experiences in the First Weeks After NICU Discharge.

Purpose: This study aimed to longitudinally investigate the preterm infant feeding regimens, feeding behaviors, effect on infant growth, and caregiver perceptions and experiences with feeding in the first 4 weeks following hospital discharge.

Background: Preterm infants face high nutritional risk due to their underdeveloped gastrointestinal systems and feeding coordination.

Methods: Caregivers of preterm infants were recruited to participate in a weekly telephone survey for the first 4 weeks following the infant's hospital discharge.

All that Doesn't Enhance Isn't a Thrombus: Pitfalls Using Cardiac MRI TI 600 Sequence to Distinguish Between Cardiac Thrombus Versus Myxoma.

A 51-year-old male with a complicated medical history presented with shortness of breath. Preoperative workup confirmed the presence of a large atrial mass. However, delayed gadolinium enhancement CMR with long inversion time (TI 600) showed lack of enhancement, which was suggestive of a thrombus.

Multicenter comparison of antiplatelet treatment strategies for urgent/emergent neuroendovascular stenting.

Background: Emergent neuroendovascular stenting presents challenges for the utilization of antiplatelet agents.

Methods: This was a multicenter, retrospective cohort of patients who underwent emergent neuroendovascular stenting. The primary endpoints were thrombotic and bleeding events in relation to the timing of antiplatelet administration, route of administration, and choice of intravenous (IV) agent and the study investigated practice variability in antiplatelet utilization.

Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents.

Background: Dual antiplatelet therapy (DAPT) is commonly employed for neuroendovascular stenting due to the significant risk of thromboembolism. Clopidogrel and aspirin are most often selected as initial DAPTs; however, there is limited literature available to support guidance of DAPT in this setting. The objective of this study was to evaluate safety and efficacy in patients whose final regimen included either DAPT with aspirin and clopidogrel (DAPT-C) or DAPT with aspirin and ticagrelor (DAPT-T).

A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2020.

The number of articles related to antimicrobial stewardship published each year has increased significantly over the last decade. Keeping up with the literature, particularly the most innovative, well-designed, or applicable to one's own practice area, can be challenging. The Southeastern Research Group Endeavor (SERGE-45) network reviewed antimicrobial stewardship-related, peer-reviewed literature from 2020 that detailed actionable interventions.

The impact of antihypertensive use in the treatment of acute ischemic stroke in patients receiving alteplase.

Background: Treatment of acute ischemic stroke (AIS) with intravenous alteplase within 4.5 h of symptom onset is associated with neurologic improvement. High baseline blood pressure (BP) and BP variability during the first 24 h of AIS is associated with increased early adverse events and death.

Unprovoked serotonin syndrome-like presentation of SARS-CoV-2 infection: A small case series.

Clinicians and researchers have reported an array of neurological abnormalities in coronavirus disease 2019 (COVID-19), and while serotonin excess has been observed we are unaware of reports of central nervous system serotonin toxicity in COVID-19. We present two cases that resemble serotonin syndrome in COVID-19, but without identifiable inciting medications. A 54-year-old with multiple sclerosis and diabetes mellitus presented with altered mental status.

Lactate Dehydrogenase B and Pyruvate Oxidation Pathway Associated With Carfilzomib-Related Cardiotoxicity in Multiple Myeloma Patients: Result of a Multi-Omics Integrative Analysis.

Multiple myeloma (MM) is the second most frequent hematologic cancer in the United States. Carfilzomib (CFZ), an irreversible proteasome inhibitor being used to treat relapsed and refractory MM, has been associated with cardiotoxicity, including heart failure. We hypothesized that a multi-omics approach integrating data from different omics would provide insights into the mechanisms of CFZ-related cardiovascular adverse events (CVAEs).

Evaluation of a risk assessment model to predict infection with healthcare facility-onset Clostridioides difficile.

Purpose: We evaluated a previously published risk model (Novant model) to identify patients at risk for healthcare facility-onset Clostridioides difficile infection (HCFO-CDI) at 2 hospitals within a large health system and compared its predictive value to that of a new model developed based on local findings.

Methods: We conducted a retrospective case-control study including adult patients admitted from July 1, 2016, to July 1, 2018. Patients with HCFO-CDI who received systemic antibiotics were included as cases and were matched 1 to 1 with controls (who received systemic antibiotics without developing HCFO-CDI).

Hypokalemic Periodic Paralysis Masquerading as a Compressive Neuraxial Lesion Following Lumbar Epidural Placement in a Parturient: A Case Report.

We report the management of a parturient with undiagnosed hypokalemic periodic paralysis (HOKPP) who underwent epidural analgesia for labor, complicated by an unintentional dural puncture, and the eventual use of epidural anesthesia for cesarean delivery. Following discharge, she represented with lower extremity paresis. After being evaluated for a compressive neuraxial lesion, she made a full recovery following potassium repletion.

Using buprenorphine to treat neonatal abstinence syndrome: a quality improvement study.

Objective: To assess if treating neonatal abstinence syndrome (NAS) with sublingual buprenorphine (SLB) would decrease the mean duration of therapy (DOT) and length of birth hospital stay (LOS).

Study Design: Conducted at a tertiary hospital with >6000 annual deliveries and a 2% incidence of NAS, a quality improvement study using plan-do-study-act (PDSA) cycles were utilized. Outcomes were measured using statistical process control (SPC) charts.

Carotid stenosis, stroke, and carotid artery revascularization.

Atherosclerotic disease of the carotid artery places patients at risk of ischemic stroke and consequently is a target of medical, endovascular and open surgical management. Various imaging modalities are used to characterize anatomy/severity of carotid disease and justify intervention, each having advantages and disadvantages. Carotid revascularization techniques including carotid artery stenting, carotid endarterectomy, and transcarotid artery revascularization vary in invasiveness and are not equally suitable for certain subsets of patients.

Stenting the carotid artery from radial access using a Simmons guide catheter.

Background: Carotid artery stenting (CAS) is a procedure for stroke prevention, usually done from femoral artery access. Reports of CAS using radial artery access have adopted techniques similar to those used for transfemoral CAS. Initial experience with a simpler and lower profile technique for transradial carotid stenting is described here.

Comparison of neonatal outcomes with use of a soybean oil-based injectable lipid emulsion vs a 4-oil emulsion product.

Purpose: Results of a study comparing the safety and efficacy outcomes with use of a soybean oil-based injectable lipid emulsion (SO-ILE) vs a 4-oil alternative product in a neonatal population are presented.

Methods: In an institutional review board-approved, multicenter retrospective review, the medical records of 328 patients who were born at a gestational age of ≤34 weeks, had a birth weight of 500 to 2,000 g, were admitted to one of 2 neonatal intensive care units (NICUs) within a large health system, and received at least 7 days of a parenteral nutrition containing either lipid emulsion product were reviewed: 151 (46%) had received SO-ILE and 177 (54%) had received SMOFlipid (Fresenius Kabi). The primary outcome of the study was a composite of development of cholestasis and development of hypertriglyceridemia.

Melflufen and Dexamethasone in Heavily Pretreated Relapsed and Refractory Multiple Myeloma.

Purpose: Melphalan flufenamide (melflufen) is a first-in-class peptide-drug conjugate that targets aminopeptidases and rapidly and selectively releases alkylating agents into tumor cells. The phase II HORIZON trial evaluated the efficacy of melflufen plus dexamethasone in relapsed and refractory multiple myeloma (RRMM), a population with an important unmet medical need.

Patients And Methods: Patients with RRMM refractory to pomalidomide and/or an anti-CD38 monoclonal antibody received melflufen 40 mg intravenously on day 1 of each 28-day cycle plus once weekly oral dexamethasone at a dose of 40 mg (20 mg in patients older than 75 years).

Ultra-Early Venous Thromboembolism (VTE) Prophylaxis in Spontaneous Intracerebral Hemorrhage (sICH).

Objective: To determine if ultra-early (<24 h) venous thromboembolism (VTE) prophylaxis was associated with hematoma growth in spontaneous intracerebral hemorrhage (ICH).

Background: Patients with ICH have a high risk of VTE. Pharmacological prophylaxis such as unfractionated heparin (UFH) have been demonstrated to reduce VTE.