Pleural Space Infections.

Pleural space infections have been a well-recognized clinical syndrome for over 4000 years and continue to cause significant morbidity and mortality worldwide. However, our collective understanding of the causative pathophysiology has greatly expanded over the last few decades, as have our treatment options. The aim of this paper is to review recent updates in our understanding of this troublesome disease and to provide updates on established and emerging treatment modalities for patients suffering from pleural space infections. With that, we present a review and discussion synthesizing the recent pertinent literature surrounding the history, epidemiology, pathophysiology, diagnosis, and management of these challenging infections.

A computational investigation of COVID-19 transmission inside hospital wards and associated costs.

The COVID-19 pandemic has placed a particular burden on hospitals: from intra-hospital transmission of the infections to reduced admissions of non-COVID-19 patients. There are also high costs associated with the treatment of hospitalised COVID-19 patients, as well as reductions in revenues due to delayed and cancelled treatments. In this study we investigate computationally the transmission of COVID-19 inside a hospital ward that contains multiple-bed bays (with 4 or 6 beds) and multiple single-bed side rooms (that can accommodate the contacts of COVID-19-positive patients). The aim of this study is to investigate the role of 4-bed bays vs. 6-bed bays on the spread of infections and the hospital costs. We show that 4-bed bays are associated with lower infections only when we reduce the discharge time of some patients from 10 days to 5 days. This also leads to lower costs for the treatment of COVID-19 patients. In contrast, 6-bed bays are associated with reduced hospital waiting lists (especially when there are also multiple side rooms available to accommodate the contacts of COVID-19-positive patients identified inside the 6-bed bays).

Experience with OxyELITE pro and acute liver injury in active duty service members.

1,3-dimethylamylamine (DMAA) is a common additive in sport supplements that was banned by the FDA in 2013. Specifically, this additive received much publication for its role in causing adverse cardiovascular events, particularly sudden cardiac death. However, it has been our experience that products containing this additive may also lead to acute liver injury and liver failure. We present a series of seven cases encountered by a military treatment facility in Southern California which involved the use of OxyELITE Pro, a sport supplement containing DMAA, that all resulted in acute liver injury with two cases requiring transplant for acute liver failure. To our knowledge, this is the first case series reported involving OxyELITE Pro or other DMAA-containing supplements with a specific focus on acute liver injury. This review is limited by the paucity of clinical studies and trials based on OxyElite Pro and its effect on the liver. The presented cases are notably observation, and no standardized diagnostic or treatment protocol was utilized. This series is important to the general population as a whole due to the prevalence of sport supplement use, and is particularly important for practitioners who work with the military or athletic populations due to the high use in these demographics. These cases are followed by a brief discussion regarding DMAA.

An adult with a sinus venosus atrial septal defect and dilated cardiomyopathy.

Dilated cardiomyopathy, heart failure and atrial septal defects are well-recognised entities in isolation, but are rarely seen together. Now that 90% of children with congenital heart disease survive into adulthood, such combinations of disease are increasingly seen in adult cardiology. While most young patients with dilated cardiomyopathy respond well to medical therapy, some do not, and require more invasive management. We describe a 32 year-old man with dilated cardiomyopathy and a sinus venosus-type atrial septal defect associated with a remarkable pulmonary to systemic flow ratio of 5:1. We propose that the atrial septal defect blunted his heart failure symptoms by serving as a 'pop-off' valve and limiting pulmonary congestion. The patient ultimately failed medical management and received a left ventricular assist device. The case is presented along with a discussion of this unique pathophysiology and a brief review of the literature in this rapidly evolving field.

A cross-sectional study of the change in mastoid geometry with age in children without a history of otitis media.

OBJECTIVES/HYPOTHESIS: This study assessed the normal growth and development of mastoid air-cell system (MACS) geometry from infancy through adolescence. STUDY DESIGN: Cross-sectional study. METHODS: This cross-sectional study evaluated the change with age in MACS volume, surface area, and surface area/volume ratio in 36 (72 ears) individuals aged 1.6 to 18 years with no history of middle ear disease. The three MACS parameters were reconstructed using computed tomography (CT) scans judged by a radiologist to be normal. Linear regression was used to determine the relationship between the left and right values of each parameter, and between those parameters and age for male and female subjects. RESULTS: For all three MACS parameters, the right and left values were highly correlated. MACS volume and surface area for male and female subjects showed an increase between 1 and 18 years. The surface area/volume ratio for males was independent of age but showed a shallow increase for females. When averaged across all ages, the ratio was similar to those previously reported. CONCLUSIONS: The growth trajectory for MACS volume observed in this study was not consistent with other cross-sectional studies employing planimetry or CT of normal subjects that reported inconsistent results. Because of its potential role as a susceptibility factor for otitis media and other otologic problems, it is important to describe the growth and development of MACS geometry. Additional well-controlled studies of this phenomenon are needed to clarify which of the growth trajectories actually describe the growth process for the three parameters of interest.

Mastoid geometry in a cross-section of humans from infancy through early adulthood with a confirmed history of otitis media.

OBJECTIVE: This study describes the changes in mastoid air cell system (MACS) geometry with age in ears with a history of otitis media (OM), without (GR-I) or with (GR-II) middle ear fluid on the CT scan. METHODS: Thirty-seven (74 MACSs) CT scans were selected to approximate 4 MACSs/year between 1 and 18 years. For each MACS, the volume, surface area and surface area/volume ratio were reconstructed using standard procedures. Correlation analysis was used to define the left-right relatedness for the geometric parameters, and regression analysis was used to determine the effect of age on those parameters for each group. RESULTS: Twenty scans were from female and 17 from males. Fluid was observed in 12 left, 4 right and 10 bilateral MACSs. The MACS volume and surface area of GR-I increased with age, were significantly greater than those for age-matched MACSs in GR-II, but show large variability. Those measures in GR-II were independent of age and a large percentage of these MACS volumes was <5 ml. The surface-area/volume ratio for MACSs in both groups was independent of age and group assignment. The left-right correlations for the three geometric parameters of the MACS were significant for all MACS in the two groups, and for bilateral MACS concordant for group assignment. The left-right correlations for surface area and volume were not significant for bilateral MACSs discordant for group assignment. CONCLUSIONS: These results suggest that: the growth of MACS volume and surface area is genetically programmed but that this is disrupted by long-lasting OM; the effect of OM on MACS growth may depend on the duration and timing of the disease, and the MACS surface area/volume ratio does not explain the effect of MACS volume on the rate of gas exchange between middle ear and blood.