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In expeditionary environments, the consistent availability of blood for casualty care is imperative yet challenging. Responding to evidence and the specific needs of its expeditionary context, the US Central Command (USCENTCOM) prioritized supplying stored low titer O whole blood (LTOWB) to its units from March, 2023 onward. A strategy was devised to set minimal LTOWB on-hand supply benchmarks, determined by the number of operating beds and point of injury teams. This transition led to a 54% reduction in orders for packed red blood cells. As a countermove, the Armed Services Blood Program (ASBP) enhanced LTOWB production at a conversion rate 2:1 from packed red blood cell to LTOWB. Consequently, there was a decline in expired blood products, and fulfillment rates for blood requests are projected to reach 100% consistently. This paper delves into the intricacies of the expeditionary blood supply, the rationale behind the LTOWB transition, the devised allocation strategy, and the subsequent impacts of this change.
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El Staphylococcus aureus causa una variedad de infecciones localizadas e invasivas supurativas y 3 síndromes mediados por toxinas: Síndrome de choque tóxico estafilocócico (STSS, por sus siglas en ingles), síndrome de piel escaldada estafilocócica (SSSS) e intoxicación alimentaria1. La escarlatina estafilocócica está relacionada con las toxinas del STSS y SSSS. De hecho, se pudieron describir dos síndromes diferentes cada uno relacionado a un tipo de toxina que eran formas atenuadas de estas entidades. El curso de esta patología generalmente es autolimitado, pero puede evolucionar rápidamente a enfermedad severa que ponga en peligro la vida. Un entendimiento de este conjunto de patologías nos permite abordar al paciente de una manera oportuna, manteniendo la vigilancia y en caso de ser necesario intervenir para evitar el advenimiento del STSS que puede desembocar en falla orgánica múltiple e incluso la muerte. Esta revisión se trata de un caso atendido en la unidad de quemados del Hospital del Niño Dr. José Renán Esquivel (HDNJRE) en el mes de mayo del 2023 con quemadura por contacto complicada con escarlatina estafilocócica. (provisto por Infomedic International)
Staphylococcus aureus causes a variety of localized and invasive suppurative infections and 3 toxin-mediated syndromes: staphylococcal toxic shock syndrome (STSS), staphylococcal scalded skin syndrome (SSSS) and food poisoning1 . Staphylococcal scarlet fever is related to STSS and SSSS toxins. In fact, two different syndromes each related to a type of toxin could be described which were attenuated forms of these entities. The course of this pathology is usually self-limiting, but can rapidly progress to severe life-threatening disease. An understanding of this set of pathologies allows us to approach the patient in a timely manner, maintaining vigilance and if necessary intervening to prevent the advent of STSS that can lead to multiple organ failure and even death. This review is about a case treated at the burn unit of the Hospital del Niño Dr. José Renán Esquivel (HDNJRE) in May 2023 with contact burn complicated by staphylococcal scarlet fever. (provided by Infomedic International)
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Cyclobutenone was characterized by high-resolution Fourier transform microwave spectroscopy for the first time. High-level, first-principles quantum chemical calculations at the B3LYP, CISD, MP2, and CCSD levels of theory were implemented to better understand the molecular structure and obtain model rotational and centrifugal distortion constants to aid in spectral assignment, and the results at the different levels of theory are compared. The assignment of the experimental spectrum provided fits of 2.7 kHz using Watson A-reduced and Watson S-reduced Hamiltonians. No tunneling splittings were observed, suggesting that cyclobutenone is not undergoing ring-puckering tunneling.
RESUMO
La lesión por inhalación es uno de los factores de riesgo que más contribuye a la mortalidad de pacientes quemados. La mortalidad asociada a la inhalación de humo es de 48 al 76%, se ha determinado que la mortalidad asociada con las quemaduras aumenta aproximadamente en 20% al combinarse con lesión por inhalación. En Panamá, específicamente en el Hospital del Niño Doctor José Renán Esquivel (HDNJRE), en los últimos 20 años han ocurrido 181 lesiones por inhalación, con una mortalidad asociada del 1.1%. Por esto la importancia de la detección temprana y manejo agresivo de esta patología. Presentamos el caso clínico de un paciente de 9 años quien sufre quemadura térmica por gasolina de un 25.5% y lesión por inhalación referido a nuestra unidad. (provisto por Infomedic International)
Inhalation injury is one of the risk factors that most contributes to the mortality of burned patients. Mortality associated with smoke inhalation ranges from 48 to 76%, and it has been determined that the mortality associated with burns increases by approximately 20% when combined with inhalation injury. In Panama, specifically in Hospital del Niño, in the last 20 years, 181 inhalation injuries have occurred, with an associated mortality of 1.1%. Therefore, the importance of early detection and aggressive management of this pathology. We present the clinical case of a 9-year-old patient who suffered a 25.5% gasoline thermal burn and inhalation injury referred to our unit. (provided by Infomedic International)
RESUMO
Introducción: Las infecciones intrahospitalarias se denominan Infecciones Asociadas a Cuidados de la Salud (IACS). Los pacientes quemados tienen un alto riesgo de infección como resultado del inmunocompromiso, estancias intrahospitalarias prolongadas y los procedimientos diagnósticos/terapéuticos requeridos para su manejo. La Unidad de Quemados en 2012 fue el segundo área con mayor tasa de IACS del Hospital del Niño (incidencia 21.2%). Objetivo: Determinar los factores de riesgo para el desarrollo de IACS en pacientes de la Unidad de Quemados del Hospital del Niño de Panamá atendidos desde el año 2009 al 2013. Material y método: Estudio observacional analítico retrospectivo con muestreo probabilístico. Se determinó la frecuencia y fuerza de asociación entre las variables a estudiar y el desarrollo de IACS mediante la prueba de desigualdad relativa (OR) con su intervalo de confianza correspondiente, un nivel de significancia del 95% y precisión de 0.05, previa verificación de la significancia estadística a través de la prueba X2. Resultados: los lactantes, quemaduras de III grado, extensión >10% de SCTQ, número de segmentos corporales quemados, días de estancia hospitalaria, uso de dispositivos invasivos y la realización de procedimientos quirúrgicos son factores de riesgo para el desarrollo de IACS en pacientes quemados. Por otra parte, el uso de coberturas biosintéticas confiere un factor protector. Conclusión: los quemados poseen características endógenas y exógenas para el desarrollo de IACS. Conocer su comportamiento representa una herramienta útil para su control y prevención.
Introduction: Healthcare-associated infections (HAIs) are infections that developed during a hospitalization. Burned patients are at high risk of infection as a result of the immune suppression, long hospital stays and diagnostic / therapeutic procedures required for its management. The Burn Unit on 2012 was the second area with the highest rate of HAIs of the institution (incidence 21.2%). Objective: Determine the risk factors for the development of HAIs in patients in the Burn Unit of Panama Children Hospital since 2009 to 2013. Material and method: A retrospective analytical and observational study with a probabilistic sampling. We determined the frequency and correlations between the variables and the development of HAIs by Odds Ratio (OR) with its corresponding confidence interval, a level of significance of 95% and a precision of 0.05, upon verification of statistical significance through X2. Results: infants, III degree burns, extension above 10% of Burned Body Surface Area, number of compromised body segments, length of hospital stay, use of invasive devices and surgical procedures are risk factors for the development of HAIs in burned patients. On the other hand, the use of burn wound dressings confers a protective factor for them. Conclusion: burned patients have endogenous and exogenous features that allow the development of HAIs. Knowing their behavior represents a useful tool in the control and prevention of them.
RESUMO
Pain pumps containing local anesthetics, with or without opioids, can be used for perioperative analgesia after arthroscopic shoulder surgery to reduce pain. Although several smaller studies have demonstrated the analgesic properties, no large series to date has reported the short-term complication rate of subacromial pain pumps. We prospectively studied (2005 to 2007) 583 patients who underwent arthroscopic shoulder surgery at a single outpatient surgery center and had intraoperative placement of a pain pump catheter into the subacromial space. Patients had at least 1 month of follow-up. No patient received perioperative brachial plexus regional anesthesia. There were no cases of infection, internal catheter breakage, pump failure, or hospital admission for pain control. The only complication was external catheter breakage that occurred when a patient attempted to remove the pump without removing the tape fastening the catheter at the skin. Subacromial pain pumps used for arthroscopic shoulder procedures are safe in the short-term.
