A Multicenter, Prospective, Observational, Cohort-Controlled Study of Clinical Outcomes Following Coronavirus Disease 2019 (COVID-19) Convalescent Plasma Therapy in Hospitalized Patients With COVID-19.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused high inpatient mortality and morbidity throughout the world. COVID-19 convalescent plasma (CCP) has been utilized as a potential therapy for patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. This study evaluated the outcomes of hospitalized patients with COVID-19 treated with CCP in a prospective, observational, multicenter trial. METHODS: From April through August 2020, hospitalized patients with COVID-19 at 16 participating hospitals in Colorado were enrolled and treated with CCP and compared with hospitalized patients with COVID-19 who were not treated with convalescent plasma. Plasma antibody levels were determined following the trial, given that antibody tests were not approved at the initiation of the trial. CCP-treated and untreated hospitalized patients with COVID-19 were matched using propensity scores followed by analysis for length of hospitalization and inpatient mortality. RESULTS: A total of 542 hospitalized patients with COVID-19 were enrolled at 16 hospitals across the region. A total of 468 hospitalized patients with COVID-19 were entered into propensity score matching with 188 patients matched for analysis in the CCP-treatment and control arms. Fine-Gray models revealed increased length of hospital stay in CCP-treated patients and no change in inpatient mortality compared with controls. In subgroup analysis of CCP-treated patients within 7 days of admission, there was no difference in length of hospitalization and inpatient mortality. CONCLUSIONS: These data show that treatment of hospitalized patients with COVID-19 treated with CCP did not significantly improve patient hospitalization length of stay or inpatient mortality.

A Retrospective Cohort Study to Assess the Impact of an Inpatient Infectious Disease Telemedicine Consultation Service on Hospital and Patient Outcomes.

BACKGROUND: Here, we review our experience of providing inpatient infectious disease (ID) consultations using real-time interactive telemedicine assessments. We sought to obtain a baseline and document trends regarding the use of telemedicine ID (teleID) consults as an adjunct to the standard of care through the time period in which teleID consultations were introduced. METHODS: Data were pulled via manual, retrospective chart reviews of the electronic medical record. Primary outcomes included lengths of stay (LOS), antibiotic usage, and relapse incidences. RESULTS: There were a total of 244 patients at 1 remote hospital site who were provided with ID consultations, either in person, via teleID, or both. Before the availability of teleID (pre-teleID), there were 73 patients transferred for ID consults, while 171 patients were seen via teleID once available. While all 73 patients in the pre-teleID group were transferred from the remote hospital to the hub hospital, only 14 (8.2%) of all remote hospital patients assessed by teleID were transferred. Patient LOS across both facilities decreased when patients were seen via teleID, compared to pre-teleID (P = .0001). The median number of days that patients received antibiotics decreased in the teleID group (median 15, interquartile range [IQR] 9-25), compared to the pre-teleID group (median 19, IQR 11-28), but this decrease was not statistically significant (P = .0770). There was no statistically significant difference in relapse rates, although data were lacking because of patients being lost to follow-up. CONCLUSIONS: ID telemedicine practice directed at inpatients appears to be a promising route of care.

Manejo ambulatorio en la plastica de ligamento cruzado anterior. Anestesia espinal selectiva combinada con bloqueo femoral / Ambulatory management of the anterior cruciate ligament reconstruction. Spinal selective anesthesia combined with femoral nerve block

La cirugía de rodilla es una práctica habitual en nuestro medio. Una manera de disminuir los costos de la misma es realizarla en forma ambulatoria. En nuestro centro, entre enero del 2000 y diciembre del 2006, se realizaron 506 plásticas de ligamento cruzado anterior y 35 de ligamento cruzado posterior. Muchos autores reportaron la eficacia de la anestesia espinal selectiva en la cirugía ambulatoria y el bloqueo femoral para el manejo del dolor postoperatorio, pero pocos trabajos se presentaron combinando ambas técnicas para la reconstrucción del ligamento cruzado anterior ambulatorio. El propósito de este trabajo es presentar nuestra experiencia en la cirugía ambulatoria de la plástica de ligamento cruzado anterior con la anestesia espinal selectiva y el bloqueo crural de un miembro, evitando la internación, disminuyendo el gasto de medicación, mejorando la analgesia postoperatoria y la satisfacción del paciente. Todos evolucionaron sin complicaciones en el postoperatorio inmediato y fueron dados de alta de internación entre las 2 a 4 hs posterior al procedimiento. Concluimos que la combinación de ambas técnicas es una alternativa útil y segura para la reconstrucción del LCA ambulatorio.

Bloqueo del nervio peroneo profundo / Deep peroneal nerve block

En un trabajo de disección cadavérica, determinamos que: "a la altura de la línea intermaleolar, el nervio peroneo profundo se halla ubicado siempre por fuera o lateral al tendón del extensor propio del hallux y se ubica superficial o anterior a la arteria". Con el objetivo de evaluar clínicamente nuestros hallazgos en cadáveres, realizamos 116 bloqueos nerviosos (84 uni y 16 bilaterales) con este abordaje en 100 pacientes. El bloqueo fue efectivo en el 98,72 por ciento (114/116) y debió ser suplementado en el 1,72 por ciento (2/116). En conclusión, los hallazgos clínicos se correspondieron con los de la disección cadavérica y, por lo tanto, recomendamos que el punto de entrada de la aguja a la altura de la línea que une ambos maleolos sea inmediatamente lateral o externo al tendón del extensor propio del hallux, independientemente de la identificación o no del latido de la arteria tibial anterior.