OBJECTIVES

The current study aimed to evaluate the impact of an interprofessional simulation-based training program on providers' perception, knowledge, and confidence in proning of pregnant patients with Acute Respiratory Distress Syndrome due to COVID -19 or other causes.

A total of 124 healthcare workers who took part in the management of patients in COVID wards and ICUs participated in the study. The simulation workshop was conducted on May 2022 and the participants were divided into interprofessional teams. Standardized patients and mannequins were used to simulate patients with ARDS. Standardized checklists for proning were used. The participants were debriefed after. The participants completed pre- and post-simulation questionnaires.

After the simulation workshop, the participants’ perception on the benefit of prone position in the ventilation of patients with ARDS, level of confidence in handling proning of pregnant patients, comfort in speaking to patient and next of kin regarding prone ventilation, and knowledge on proning significantly improved. Subgroup analysis
showed statistically significant improvements in knowledge scores among registered nurses, resident physicians, and participants with varying degrees of experience managing COVID-19 patients and proning pregnant patients. Majority of participants deemed it was easy to turn patients in the prone position using the supportive pillow as well as expressed confidence in doing the procedure.

Objective: Our study aimed to compare the posterior interposition technique against the posterolateral transosseous technique in the same cadaver specimens. Methods: Computer and cadaver models of 2 fixation techniques were developed. The computer model was constructed to analyze bone volume removed during implant placement and the bony surface area available for fusion. The cadaver model included quasi-static multidirectional bending flexibility and dynamic fatigue loading. Relative motions between the sacrum and ilium were measured intact, after joint destabilization, after fixation with direct-posterior and posterolateral techniques, and after 18,500 cycles of fatigue loading. Relative positions between each implant and the sacrum and ilium were measured after fixation and fatigue loading to ascertain the quality of the bone-implant interface. The 2 techniques were randomized to the left and right sacroiliac joints of the same cadavers. Results: The posterior interposition technique removed less bone volume and facilitated a larger surface area available for bony fusion. Posterior interposition significantly reduced the nutation/counternutation motion of the sacroiliac joint (42% ± 8%) and reduced it more than the posterolateral transosseous technique (14% ± 4%). Upon fatigue loading, the posterior interposition implant maintained the bone-implant interface across all specimens, while the posterolateral transosseous implant migrated or subsided in 20%–50% of specimens. Conclusion Posterior interposition fixation of the sacroiliac joint reduces joint motion. The amount of fixation from the posterior technique is superior and more durable than the amount of fixation achieved by the posterolateral technique.

Purpose: Pott’s puffy tumor (PPT), characterized by frontal bone osteomyelitis and subperiosteal abscess, typically arises as a complication of head trauma or frontal sinusitis and is associated with diverse triggers. Since 2001, PPT, previously considered rare in the pediatric population, has been increasingly reported, underscoring heightened recognition. By outlining specific protocols and guidelines, a clinical pathway (CP) facilitates rapid identification and treatment of PPT. Methods: We reviewed 11 cases of PPT in patients aged 0 to 18 years who were either hospitalized or discharged from 2 large hospitals in South Florida, United States, from January 31, 2016 through February 1, 2019. This multicenter retrospective case review was complemented by a comprehensive literature review. Additionally, the study team proposed a diagnostic CP tailored for the emergency department setting. Variables of interest included demographic data, clinical presentation, imaging studies, medical and surgical management details, laboratory/microbiological data, and clinical outcomes. Results: A total of 11 patients with PPT were identified, of whom 8 and 7 were boys and African Americans, respectively. The common symptoms were fever, headache, and frontal edema. All patients underwent antibiotic therapy for 6-8 weeks, as well as both computed tomography and magnetic resonance imaging. The imaging studies showed intracranial complications in the 10 patients such as epidural abscess, which were caused by Streptococcus pneumoniae, Streptococcus intermedius, Streptococcus pyogenes, Eikenella spp., and methicillin-sensitive Staphylococcus aureus. The 10 patients underwent endoscopic sinus surgeries, with 6 of them also doing craniotomies. No mortality or sequelae was reported. Conclusion This study contributes to the growing body of literature on PPT, shedding light on its evolving epidemiology, clinical manifestations, and management strategies while emphasizing the pivotal role of emergency physicians for optimal outcomes. The proposed CP aims to establish a standard of care that can be adopted across various pediatric emergency departments.

Hermansky-Pudlak syndrome (HPS), both alone and in conjunction with pulmonary fibrosis (HPS-PF), is a rare, genetically heterogeneous, autosomal recessive disorder that affects multiple organs, including the lungs. In cases of HPS-PF, pulmonary fibrosis is preceded by local inflammation. We present a case of HPS-PF that exhibited histological evidence of extracellular traps (ETs) ensnaring macrophages, leading to cell death in a process known as ETosis. To our knowledge, ETosis has not been previously reported in the HPS-PF population and may represent a mechanism by which pulmonary fibrosis develops in these patients. Further research is needed to explore the potential connection between ETosis and HPS-PF, as this understanding could offer insights into the disease mechanism and pave the way for the development of novel treatment modalities.

Objective: Patients with severe symptomatic aortic stenosis are assessed for coronary artery disease (CAD) prior to transcatheter aortic valve implantation (TAVI) with treatment implications. Invasive coronary angiography (ICA) is the recommended modality but is associated with peri-procedural complications. Integrating machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) into existing TAVI-planning CT protocol may aid exclusion of significant CAD and thus avoiding ICA in selected patients. Materials and Methods: A single-center, retrospective study was conducted, 41 TAVI candidates with both TAVI-planning CT and ICA performed were analyzed. CT datasets were evaluated by a ML-based CT-FFR software. Beta-blocker and nitroglycerin were not administered in these patients. The primary outcome was to identify significant CAD. The diagnostic performance of CT-FFR was compared against ICA. Results: On per-patient level, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 89%, 94%, 80%, 97% and 93%, respectively. On per-vessel level, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 75%, 94%, 67%, 96% and 92%, respectively. The area under the receiver operative characteristics curve per individual coronary vessels yielded overall 0.90 (95% confidence interval 85%–95%). ICA may be avoided in up to 80% of patients if CT-FFR results were negative. Conclusion ML-based CT-FFR can provide accurate screening capabilities for significant CAD thus avoiding ICA. Its integration to existing TAVI-planning CT is feasible with the potential of improving the safety and efficiency of pre-TAVI CAD assessment.

In the context of a global shortage of glucagon-like peptide-1 (GLP-1) receptor agonists, we assessed the impact of discontinuing dulaglutide on metabolic control in individuals with type 2 diabetes. Our analysis included data from 69 individuals and revealed a significant deterioration in glycemic control following the discontinuation. Specifically, the average hemoglobin A1c level increased from 7.0%±0.9% to 8.1%±1.4% (P<0.001), and fasting glucose levels rose from 129±31 to 156±50 mg/dL (P<0.001) within 3 months after stopping the medication. Alternative treatments such as dipeptidyl peptidase-4 inhibitors and sodium glucose cotransporter- 2 inhibitors were insufficient substitutes, highlighting the essential role of continuous GLP-1 receptor agonist therapy in maintaining metabolic health.

Cadaveric dissection has remained an integral part of anatomical education globally; hence, the profiles of cadavers, their gross tissue and microbial integrity has great implication in anatomical education. This study determined the profiles, gross tissue and microbial integrity of cadavers used in South-western Uganda (SWU) medical schools. A cross-sectional study was carried out for three months in anatomy and microbiology laboratories of SWU medical teaching institutions. Ethical approval was obtained, cadavers were proportionately selected and examined grossly, and surface swabs taken for microbial analysis. Data collected was entered into Microsoft Excel, cleaned, and exported to Stata version 17 for analysis. Majority of cadavers were male (68%), adult (96%), blacks (100%), unknown cause of death (96%), obtained as unclaimed bodies (100%) and with no cadaver record tag (96%). Nearly a half (48%) cadavers had disrupted dentition, 68% had poor muscle integrity and 80% with abnormal fat. About 27% cadavers had poor surface microbial integrity among which 62.5% had a mixture of both bacteria and fungi, 25.0% had only fungi while 12.5% had only bacteria. A high number of cadavers had micro-organisms on their surfaces with majority having a mixture of bacteria and fungi. Majority of cadavers had poor gross tissue integrity. Better cadaver preservation methods should be adopted. To advocate for the establishment of cadaver donation policy and programs through which good quality cadavers can be obtained.

Cadaveric dissection has remained an integral part of anatomical education globally; hence, the profiles of cadavers, their gross tissue and microbial integrity has great implication in anatomical education. This study determined the profiles, gross tissue and microbial integrity of cadavers used in South-western Uganda (SWU) medical schools. A cross-sectional study was carried out for three months in anatomy and microbiology laboratories of SWU medical teaching institutions. Ethical approval was obtained, cadavers were proportionately selected and examined grossly, and surface swabs taken for microbial analysis. Data collected was entered into Microsoft Excel, cleaned, and exported to Stata version 17 for analysis. Majority of cadavers were male (68%), adult (96%), blacks (100%), unknown cause of death (96%), obtained as unclaimed bodies (100%) and with no cadaver record tag (96%). Nearly a half (48%) cadavers had disrupted dentition, 68% had poor muscle integrity and 80% with abnormal fat. About 27% cadavers had poor surface microbial integrity among which 62.5% had a mixture of both bacteria and fungi, 25.0% had only fungi while 12.5% had only bacteria. A high number of cadavers had micro-organisms on their surfaces with majority having a mixture of bacteria and fungi. Majority of cadavers had poor gross tissue integrity. Better cadaver preservation methods should be adopted. To advocate for the establishment of cadaver donation policy and programs through which good quality cadavers can be obtained.

Growth hormone (GH) is crucial for childhood growth and body composition. In pediatric GH deficiency (pGHD), the pituitary gland fails to produce sufficient GH, which affects linear growth in childhood. pGHD is conventionally treated with daily recombinant human GH (rhGH); however, because GH therapy lasts throughout childhood, adherence to daily rhGH treatment can be low, resulting in suboptimal effectiveness. Somatrogon is a long-acting GH analog designed to address the challenges associated with daily GH therapy for pGHD. Somatrogon administered once per week is a potential alternative to daily GH therapy. The use of somatrogon is supported by phase II and III clinical trials demonstrating that once-weekly injections are noninferior to once-daily somatropin injections in terms of efficacy, safety, and tolerability and have the advantage of reduced treatment burden. This review summarizes the clinical trials of somatrogon and discusses the therapeutic profile and effects of treating pGHD with reduced injection frequency.