Pneumothorax, pneumomediastinum, and subcutaneous emphysema in hospitalized COVID-19 patients: incidence, clinical characteristics, and outcomes.

BACKGROUND: Limited data is available on the incidence and outcomes of pneumothorax (PTX), pneumomediastinum (PNM), and subcutaneous emphysema (SCE) in COVID-19 patients. This study aimed to investigate the characteristics of these complications in hospitalized COVID-19 patients. RESEARCH DESIGN AND METHODS: A retrospective study was conducted, involving adult COVID-19 patients admitted to Mayo Clinic Florida from 03/2020-06/2022. Patients were divided into two groups based on the presence or absence of PTX/PNM/SCE. RESULTS: 1926 hospitalized patients with COVID-19 were included, of which 518 were admitted to the ICU. The incidence of PTX/PNM/SCE was 6.3%. Patients with these complications were more likely to be male, Asian, and unvaccinated. Conversely, they were less likely to have chronic obstructive pulmonary disease. Patients who developed PTX/PNM/SCE after 72 hours of admission were more likely to receive high-dose corticosteroids and for an extended duration. The affected group had an adjusted odds ratio for in-hospital mortality of 13.32 (95%CI, 8.19-21.59) and ICU admission of 9.14 (95%CI, 5.3-12.78) compared to the unaffected group. CONCLUSION: Although the occurrence of PTX/PNM/SCE in hospitalized COVID-19 patients was rare, it was associated with worse outcomes. Corticosteroids may contribute to the pathogenesis of these complications; however, further studies are needed to investigate this relationship in more detail.

Immunocytochemical localization of smooth muscle actin-containing cells in the trabecular meshwork of glaucomatous and nonglaucomatous dogs.

PURPOSE: It has been recently demonstrated that trabecular meshwork (TM) cells within the canine iridocorneal angle (ICA) contain smooth muscle actin (smA) and possess contractile abilities that probably alter aqueous outflow. As the number of trabecular meshwork cells in glaucomatous canine eyes have been found to be less than those in age-matched nonglaucomatous eyes, we hypothesize that the sub-population of TM cells that contain smooth muscle actin will also decline with age. We also hypothesize that a greater loss of these cells will be observed in glaucomatous eyes than in nonglaucomatous eyes of the same age. In the present study the ICA of 17 glaucomatous and eight nonglaucomatous eyes were examined for the presence of smA-containing TM cells. MATERIAL AND METHODS: Five-micron sagittal sections of each whole globe were immunolocalized for smooth muscle actin. Positive and negative controls were performed concomitantly. RESULTS: Labeling was observed in the meshwork of 10 out of the 17 glaucomatous eyes, distributed across all of the age groups represented, including eyes with primary and secondary glaucoma. Smooth muscle actin labeling was observed in the TM of 7 out of 14 eyes with closed-angle glaucoma. Positive immunoreaction was observed in 3/3 eyes with open ICAs. Labeling of smooth muscle actin was observed in the anterior part of the meshwork in only 4 of the 17 glaucomatous eyes, each having had secondary glaucoma. There were no eyes in which label was observed exclusively in the anterior portion of the meshwork. Labeling was most consistently observed in the outer, posterior uveal TM and the inner, posterior corneoscleral TM. All of the eight nonglaucomatous eyes showed greater labeling in both area and intensity than the glaucomatous eyes of the same age. CONCLUSION: It was concluded that smooth muscle actin-cell loss is associated with age in canine eyes and that this loss is more severe in glaucomatous eyes.

Optic nerve head morphology of the Eastern gray squirrel, Sciurus carolinensis.

The objective of this study was to characterize the morphology of the Eastern gray squirrel optic nerve head, using histochemical techniques and scanning electron microscopy, in order to make comparisons with other mammalian species. Eyes of three Eastern gray squirrels were enucleated, fixed in 10% neutral buffered formalin, and embedded in paraffin. Sections through the optic nerve head were made in the three different planes, and staining was accomplished with hematoxylin and eosin and Gomori's trichrome stain. Stained sections were examined using light microscopy. The surface of the optic nerve head and the peripapillary retina were evaluated using field emission scanning electron microscopy. The anterior optic nerve head of the Eastern gray squirrel was found to be horizontally elongated and tapers to a more conventional round shape after it exits the eye. Retinal nerve fiber axons converge on the optic nerve head from all directions. Anterior to the lamina cribrosa, the mean (+/- SD) optic nerve axon bundle diameter was 27 +/- 11 microm. The lamina cribrosa measured 363 microm dorsal to ventral and 3.60 mm nasal to temporal. The thickness of the lamina was 125 micro m anterior to posterior with a mean (+/- SD) laminar pore size of 45 +/- 12 microm. The optic nerve head measured 3.65 mm nasal to temporal and 330 microm dorsal to ventral. Trichrome staining indicated the presence of collagen in the lamina cribrosa. This is the first detailed description of the squirrel optic nerve head. It has an unusual shape among mammals with a dramatic horizontal elongation. The purpose of this shape is not apparent. The presence of collagen in the scleral lamina cribrosa indicates a similar extracellular matrix composition as in other species.

Structure and presumptive function of the iridocorneal angle of the West Indian manatee (Trichechus manatus), short-finned pilot whale (Globicephala macrorhynchus), hippopotamus (Hippopotamus amphibius), and African elephant (Loxodonta africana).

The iridocorneal angles of prepared eyes from the West Indian manatee, short-finned pilot whale, hippopotamus and African elephant were examined and compared using light microscopy. The manatee and pilot whale demonstrated capacity for a large amount of aqueous outflow, probably as part of a system compensating for lack of ciliary musculature, and possibly also related to environmental changes associated with life at varying depths. The elephant angle displayed many characteristics of large herbivores, but was found to have relatively low capacity for aqueous outflow via both primary and secondary routes. The hippopotamus shared characteristics with both land- and water-dwelling mammals; uveoscleral aqueous outflow may be substantial as in the marine mammals, but the angular aqueous plexus was less extensive and a robust pectinate ligament was present. The angles varied greatly in size and composition among the four species, and most structures were found to be uniquely suited to the habitat of each animal.