Decision-Making Prepandemic: University Curtailment of Academic Operations Closure Processes During the Novel Coronavirus Disease 2019 (COVID-19) Outbreak.

OBJECTIVE: Through in-depth interviews, this study aimed to understand perspectives of key stakeholders regarding the decision to curtail academic operations in the setting of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak before the declaration of a pandemic on March 11, 2020, and how such processes may be optimized in the future to best protect public health and safety. METHODS: Virtual interviews with key stakeholders from 4 academic institutions were conducted from September to December 2020 using a standardized interview question template. The interviews lasted approximately 30-45 minutes and each interview was recorded with permission. The interviews were then transcribed and reviewed for qualitative analysis. RESULTS: The decision to curtail academic operations involved several common themes, such as discussing how institutions would control the outbreak and the process of transitioning to virtual learning and remote work. Universities were monitoring other universities' responses as well as evaluating the prevalence of cases nationally and globally. Risks and challenges identified included housing for international students, financial implications, and loss of academic productivity. CONCLUSIONS: The decision-making process may be optimized in the future by focusing on communication within a smaller committee, prioritizing epidemiology over fiscal implications, and embracing an openness to consider new strategies. Further research regarding this topic should be pursued to best protect public health and safety.

Cardiac Tamponade Causing Predominant Left Atrial and Ventricular Compression After Left Ventricular Assist Device Placement.

BACKGROUND Cardiac tamponade is a life-threatening condition that occurs when pericardial fluid accumulates in the pericardial sac, causing compression of the heart and obstructive shock. This hemodynamic event typically occurs in right-sided cardiac chambers due to the low pressures of the right atrium and right ventricle. Patients undergoing left ventricular assist device (LVAD) placement are at particularly high risk of pericardial effusion development and potential cardiac tamponade because of the need for postoperative anticoagulation. CASE REPORT A 47-year-old man underwent LVAD placement for deteriorating biventricular function. After several days of stability postoperatively, he experienced dyspnea and had evidence of increasing hemodynamic compromise. He was immediately taken to the operating room, where transesophageal echocardiography showed near-complete collapse of the left atrium and left ventricle with preservation of the right heart chamber sizes in the setting of a large heterogenous posterior pericardial effusion. With swift surgical intervention, the cardiac tamponade was successfully evacuated and the patient regained hemodynamic stability. CONCLUSIONS Cardiac tamponade can present overtly or covertly, and should be high on the list of differential diagnoses in a patient with deterioration in hemodynamic status after cardiac surgery, especially after LVAD placement. Although cardiac tamponade usually affects right-sided cardiac chambers, the left-sided chambers can also be involved. Isolated left-sided cardiac tamponade is rare but can occur in the presence of a loculated posterior pericardial effusion, as seen in this patient.

Unexpected Evolution After Multivessel Coronary Artery Bypass Grafting in a Patient With Kawasaki Disease.

Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute vasculitis that frequently affects medium-sized blood vessels. The disease is usually self-limiting and most commonly affects children under five years of age. It often affects the coronary arteries and is the leading cause of acquired heart disease in developed countries. We report the case of a teenage boy who had a long-standing diagnosis of Kawasaki disease, underwent coronary artery bypass grafting surgery, and had a complicated medical course following the surgery.

A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplant for Clostridium difficile Infection in Immunocompromised Patients.

Background: Fecal microbiota transplantation (FMT) has been shown to be effective in recurrent Clostridium difficile (CD) infection, with resolution in 80% to 90% of patients. However, immunosuppressed patients were often excluded from FMT trials, so safety and efficacy in this population are unknown. Methods: We searched MEDLINE and EMBASE for English language articles published on FMT for treatment of CD infection in immunocompromised patients (including patients on immunosuppressant medications, patients with human immunodeficiency virus (HIV), inherited or primary immunodeficiency syndromes, cancer undergoing chemotherapy, or organ transplant, including-bone marrow transplant) of all ages. We excluded inflammatory bowel disease patients that were not on immunosuppressant medications. Resolution and adverse event rates (including secondary infection, rehospitalization, and death) were calculated. Results: Forty-four studies were included, none of which were randomized designs. A total of 303 immunocompromised patients were studied. Mean patient age was 57.3 years. Immunosuppressant medication use was the reason for the immunocompromised state in the majority (77.2%), and 19.2% had greater than one immunocompromising condition. Seventy-six percent were given FMT via colonoscopy. Of the 234 patients with reported follow-up outcomes, 207/234 (87%) reported resolution after first treatment, with 93% noting success after multiple treatments. There were 2 reported deaths, 2 colectomies, 5 treatment-related infections, and 10 subsequent hospitalizations. Conclusion: We found evidence that supports the use of FMT for treatment of CD infection in immunocompromised patients, with similar rates of serious adverse events to immunocompetent patients.