Clinical Outcomes of Early Versus Late Enteral Nutrition Support in Critically Ill Trauma Patients With Isolated Traumatic Brain Injury.

INTRODUCTION: This study aims to compare the impact of early initiation of enteral feeding initiation on clinical outcomes in critically ill adult trauma patients with isolated traumatic brain injuries (TBI). METHODS: A retrospective cohort analysis of the American College of Surgeons Trauma Quality Program Participant Use File 2017-2021 dataset of critically ill adult trauma patients with moderate to severe blunt isolated TBI. Outcomes included ICU length of stay (ICU-LOS), ventilation-free days (VFD), and complication rates. Timing cohorts were defined as very early (<6 hours), early (6-24 hours), intermediate (24-48 hours), and late (>48 hours). RESULTS: 9210 patients were included in the analysis, of which 952 were in the very early enteral feeding initiation group, 652 in the early, 695 in intermediate, and 6938 in the late group. Earlier feeding was associated with significantly shorter ICU-LOS (very early: 7.82 days; early: 11.28; intermediate 12.25; late 17.55; P < .001) and more VFDs (very early: 21.72 days; early: 18.81; intermediate 18.81; late 14.51; P < .001). Patients with late EF had a significantly higher risk of VAP than very early (OR .21, CI 0.12-.38, P < .001) or early EF (OR .33, CI 0.17-.65, P = .001), and higher risk of ARDS than the intermediate group (OR .23, CI 0.05-.925, P = .039). CONCLUSION: Early enteral feeding in critically ill adult trauma patients with moderate to severe isolated TBI resulted in significantly fewer days in the ICU, more ventilation-free days, and lower odds of VAP and ARDS the sooner enteral feeding was initiated, with the most optimized outcomes within 6 hours.

Virtual Signaling and Emerging Trends in its Use Across Surgical Specialties.

INTRODUCTION: This study aims to evaluate program signaling in surgical specialties, analyze its influence on residency applications, and provide recommendations for enhancing its consistency and effectiveness. METHODS: This cross-sectional study analyzed AAMC ERAS data from the 2021 to 2022 and 2023 residency match cycles, focusing on surgical specialties including general surgery, neurological surgery, obstetrics and gynecology, and orthopedic surgery. RESULTS: A positive correlation existed between the number of signals received and the number of applicants to a program across 4 surgical specialties. 10% of programs in each specialty received between 17% and 28% of all signals. There was a negative correlation between the number of current DO residents at a program and the number of signals received. Amongst surgical specialties, those with more signals per applicant had a more equitable distribution of signals across competitive programs. University programs received the most signals, programs were less likely to receive signals if they had a higher percentage of DO residents, and IMG applicants were less likely to send signals. CONCLUSION: Specialties with more signals per applicant had a more equitable distribution of signals across competitive programs, and university programs received proportionally more signals than community programs. Further research is required to investigate the disparities in signaling and the impact of signaling on successful matching.

Evaluating the effectiveness and outcomes associated with direct peritoneal resuscitation in damage control surgery patients with and without hemorrhagic shock.

INTRODUCTION: This narrative review aims to evaluate the efficacy of adjunct direct peritoneal resuscitation (DPR) in the treatment of adult damage control surgery (DCS) patients both with and without hemorrhagic shock, and its impact on associated outcomes. METHODS: PubMed, Google Scholar, EMBASE, ProQuest, and Cochrane were searched for relevant articles published through April 13th, 2023. Studies assessing the utilization of DPR in adult DCS patients were included. Outcomes included time to abdominal closure, intra-abdominal complications, in-hospital mortality, and ICU length of stay (ICU LOS). RESULTS: Five studies evaluating 437 patients were included. In patients with hemorrhagic shock, DPR was associated with reduced time to abdominal closure (DPR 4.1 days, control 5.9 days, p = 0.002), intra-abdominal complications including abscess formation (DPR 27 %, control 47 %, p = 0.04), and ICU LOS (DPR 8 days, control 11 days, p = 0.004). Findings in patients without hemorrhagic shock were conflicting. Closure times were decreased in one study (DPR 5.9 days, control 7.7 days, p < 0.02) and increased in another study (DPR 3.5 days, control 2.5 days, p = 0.02), intra-abdominal complications were decreased in one study (DPR 27 %, control 47 %, p = 0.04) and similar in another, and ICU LOS was decreased in one study (DPR 17 days, control 24 days, p < 0.002) and increased in another (DPR 13 days, control 11.4 days, p = 0.807). CONCLUSION: In patients with hemorrhagic shock, adjunct DPR is associated with reduced time to abdominal closure, intra-abdominal complications such as abscesses, fistula, bleeding, anastomotic leak, and ICU LOS. Utilization of DPR in patients without hemorrhagic shock showed promising but inconsistent findings.

The National Resident Matching Program: An Outdated Business Model Due for Reform.

INTRODUCTION: This study aims to examine the trends across the entire NRMP application cycles from 2007-2008 to 2022-2023, specifically exploring trends across competitive surgical specialties to assess the efficacy of the existing NRMP business model and provide evidence-based recommendations to better address the current needs of both applicants and programs. METHODS: A cross-sectional study exploring the trends in the mean number of applicants and mean number of total ranked positions per applicant across surgical, the top 5 most competitive surgical specialties, and non-surgical specialties from 2007-2008 to the 2022-2023 match cycles utilizing data from the NRMP database. RESULTS: Over the studied 16 match cycles, the mean number of applicants to surgical specialties has increased by 47.99% and the mean number of total ranked positions per applicant has increased by 88.07%. For the top 5 most competitive specialties, the mean number of applicants has increased by 57.66% and the mean number of total ranked positions per applicant has increased by 83.33%. CONCLUSION: Trends across the 16 most recent NRMP cycles show evidence of increased congestion in the match system, the burden of which is primarily placed on applicants. Our findings support the need for drastic reform in the NRMP to relieve this burden, and we discuss practical solutions to allow the NRMP to better meet the needs of applicants and residency programs alike.

Enhancing safety & reducing fatalities in U.S. national parks: An evaluation of injury trends and policy implications in the ten most visited parks.

INTRODUCTION: National parks in the United States experience a significant number of annual visits, and with increasing popularity, injuries are expected to rise. This study aims to assess fatal injuries in the top ten most visited U.S. national parks from 2013 to 2022 to improve current policies and develop effective prevention strategies. METHODS: A cross-sectional study was conducted using public National Park Service data. Data including visitor demographics, injury cause, and location, were collected. Fatal injuries were categorized by season, age group, and gender. RESULTS: Summer had the highest total number of fatal injuries. The winter season had the highest rate of fatal injuries per 10 million visitors. The number of fatal injuries per 10 million visitors decreased from 2013 to 2022 for most parks. The South Region reported the highest total number of fatalities. The West Region demonstrated higher rates when adjusted for visitor volume. Fatal injuries were most prevalent in the 35-44 age group, followed by the 15-24 and 25-34 age groups, with the least incidents in the 0-14 age group, and were more common among males (71.5 % of total injuries). CONCLUSION: This study found the highest number of total injuries occurring in summer; however, winter presented a higher risk per visitor. Slips and falls were the most common cause of injuries, requiring targeted safety measures. Males in the 35-44 age group reported the highest fatality rates. These findings highlight the necessity for improved monitoring and reporting to better understand injury causes and formulate specific, evidence-based policies for prevention.

Icteric Leptospirosis Leading to Multiorgan Failure and Concomitant Pancreatitis.

Leptospirosis is a zoonotic disease caused by the spirochete Leptospira interrogans with a majority of cases occurring in the tropics. Diagnosing leptospirosis is challenging due to the variable and non-specific clinical presentation. While severe leptospirosis may present with renal failure, liver failure, and pulmonary hemorrhage, there are few described cases of renal failure and liver failure accompanied by pancreatitis and dysrhythmias, particularly in temperate climates. We present a case of severe leptospirosis presenting with bilateral calf pain, acute oliguric renal failure, acute liver failure, dysrhythmias, and pancreatitis. Clinicians must consider this diagnosis in temperate climates and consider testing and empirically treating for leptospirosis in patients with similar symptom constellations, vague symptoms, and lab abnormalities of unknown etiology.

Nationwide Trends in COVID-19 Cases and SARS-CoV-2 RNA Wastewater Concentrations in the United States.

Wastewater-based epidemiology has emerged as a promising technology for population-level surveillance of COVID-19. In this study, we present results of a large nationwide SARS-CoV-2 wastewater monitoring system in the United States. We profile 55 locations with at least six months of sampling from April 2020 to May 2021. These locations represent more than 12 million individuals across 19 states. Samples were collected approximately weekly by wastewater treatment utilities as part of a regular wastewater surveillance service and analyzed for SARS-CoV-2 RNA concentrations. SARS-CoV-2 RNA concentrations were normalized to pepper mild mottle virus, an indicator of fecal matter in wastewater. We show that wastewater data reflect temporal and geographic trends in clinical COVID-19 cases and investigate the impact of normalization on correlations with case data within and across locations. We also provide key lessons learned from our broad-scale implementation of wastewater-based epidemiology, which can be used to inform wastewater-based epidemiology approaches for future emerging diseases. This work demonstrates that wastewater surveillance is a feasible approach for nationwide population-level monitoring of COVID-19 disease. With an evolving epidemic and effective vaccines against SARS-CoV-2, wastewater-based epidemiology can serve as a passive surveillance approach for detecting changing dynamics or resurgences of the virus.

Metabolic disorders and inflammation are associated with familial combined hyperlipemia.

BACKGROUND: Familial Combined Hyperlipidemia (FCH) is related to different metabolic disorders. The objective of this study was to evaluate the presence of alterations of hydrocarbonated metabolism and lipid profile together with inflammatory and adhesion molecules in subjects with FCH compared to controls. METHODS: 75 HFC patients and 75 healthy individuals were studied. Glucose, insulin, HOMA-IR index and lipid parameters, in addition to anti-oxidized LDL antibodies (Anti ox-LDL), small and dense LDL (sdLDL) and HDL subfractions, proinflammatory cytokines and adhesion molecules were measured. RESULTS: FCH patients showed higher levels of hydrocarbonated metabolism parameters, total cholesterol, triglycerides, LDLc, Apolipoprotein B and non-HDLc (p < .001), and lower levels of HDLc (p < .001) and Apolipoprotein AI (p < .05) than controls. In addition, the inflammatory markers hsCRP, IL-6, IL-8, P-selectin, E-selectin and ICAM were all higher with (p < .05) respect to controls. The increase of sdLDL was correlated with the presence of IR and IL-6 levels. Significant differences in diameter and percentage of phenotype B LDL, small HDL subfractions and Anti ox-LDL were also detected between patients and controls. CONCLUSIONS: The lipid characteristics of FCH are confirmed by IR and a low grade inflammatory state in patients, and are associated with the predominance of sdLDL and Anti ox-LDL.

Estudio de la demencia Alzheimer en el área de salud del Policlínico Sur durante 2005-2006 / Study of Alzheimer dementia in the health area of South Polyclinic during 2005-2006

Se realizó un estudio observacional descriptivo con diseño transversal con el objetivo de determinar la prevalencia de la enfermedad de Alzheimer, así como factores asociados en pacientes mayores de 60 años en el área de salud del policlínico sur de Sancti-Spíritus durante los años 2005-2006, a través de la aplicación de una encuesta así como del test de Folstein y la escala de Hachinky; con un muestreo conglomerado monoetápico, efectuándose un examen mínimo a cada sujeto en el hogar. El 22,7 porciento de la muestra tenía deterioro cognitivo tipo Alzheimer y se encontraron con mayor relación a dicha enfermedad la edad, la baja escolaridad y la depresión, no así el hábito de fumar, la obesidad, el consumo de alcohol, los antecedentes familiares de demencia, el trauma craneoencefálico y el sexo aunque hubo un predominio de la representación femenina. La prevalencia de deterioro cognitivo tipo Alzheimer fue menor de un tercio(AU)

A descriptive observational study with cross design was made in order to determine the prevalence of Alzheimer's disease and associated factors in patients over 60 years in the health area of Sancti Spíritus South polyclinic during 2005-2006, through the application of a survey as well as Folstein test and Hachinky scale, with single-stage sampling conglomerate, being applied a minimum examination in each subject at home. 22.7% of the sample had cognitive impairment Alzheimer type and were found that age, low education and depression had a closer relation with this disease, not the cases of smoking, obesity, alcohol consumption, family history dementia, head trauma and sex although there was a predominance of female representation. The prevalence of cognitive impairment Alzheimer type was less than a third(AU)