Kernandreasen1190

The coronavirus disease 2019 (COVID-19) pandemic is placing extraordinary strains not only on hospital-wide systems but most especially on hospital medicine across the nation. The specific challenges faced by our hospitalist services are unfathomable. Hospitalist leaders are tasked to rapidly restructure clinical operations to accommodate the large surge in COVID-19 patients. In this perspective, we focus on the management strategies conducted by the Division of Hospital Medicine to tackle the major crisis that specifically impacted the general medicine services.Background There are limited reports describing critically ill COVID-19 patients in the state of New York. Methods We conducted a retrospective analysis of 32 adult critically ill patients admitted to a community hospital in upstate New York, between 14 March and 12 April 2020. We collected demographic, laboratory, ventilator and treatment data, which were analyzed and clinical outcomes tabulated. Results 32 patients admitted to the intensive care unit (ICU) were included, with mean (±SD) follow-up duration 21 ± 7 days. Mean (±SD) age was 62.2 ± 11.2 years, and 62.5% were men. 27 (84.4%) of patients had one or more medical co-morbidities. The mean (±SD) duration of symptoms was 6.6 (±4.4) days before presentation, with cough (81.3%), dyspnea (68.7%), and fever (65.6%) being the most common. 23 (71.9%) patients received invasive mechanical ventilation. 5 (15.6%) died, 11 (34.4%) were discharged home, and 16 (50%) remained hospitalized, 8 (25%) of which were still in ICU. Mean (±SD) length of ICU stay was 10.2 al Society of Thrombosis Hemostasis; NIV Non Invasive Ventilation; NY New York; PAI Plasminogen activator inhibitor; PaO2 partial pressure of arterial oxygen; PCV Pressure Control Ventilation; PEEP Positive End Expiratory Pressure; RGH Rochester General Hospital; RRH Rochester Regional Health; RT-PCR Reverse transcriptase polymerase chain reaction; RSV Respiratory Syncytial virus; SARS-CoV-2 Severe Acute Respiratory Syndrome Coronavirus 2; SD Standard Deviation; STEMI ST segment elevation myocardial infarction; TNF Tumor necrosis factor; USA USA; VTE Venous thromboembolism.Background In the oral and maxillofacial surgery, fixation plates are commonly used for the stabilization of bone fragments. Additive manufacturing has enabled us to design and create personalized fixation devices that would ideally fit any given fracture. Aim The aim of the present preliminary study was to assess the susceptibility of 3D-printed titanium fixation plates to biofilm formation. Methods Plates were manufactured using selective laser melting (SLM) from Ti-6Al-4 V. Reference strains of Streptococcus mutans, Staphyloccocus epidermidis, Staphylococcus aureus, Lactobacillus rhamnosus, and Candida albicans, were tested to evaluate the material's susceptibility to biofilm formation over 48 hours. Biofilm formations were quantified by a colorimetric method and colony-forming units (CFU) quantification. Scanning electron microscopy (SEM) visualized the structure of the biofilm. Results Surface analysis revealed the average roughness of 102.75 nm and irregular topography of the tested plates. They were susceptible to biofilm formation by all tested strains. The average CFUs were as follows S. mutans (11.91 x 107) > S.epidermidis (4.45 x 107) > S. aureus (2.3 x 107) > C.albicans (1.22 x 107) > L. rhamnosus (0.78 x 107). Conclusions The present preliminary study showed that rough surfaces of additively manufactured titanium plates are susceptible to microbial adhesion. The research should be continued in order to compare additively manufactured plates with other commercially available osteotomy plates. Therefore, we suggest caution when using this type of material.Bilateral asymmetric hip dislocations are rare injuries and associated vascular compromise is even rarer. We report a unique case of bilateral asymmetric hip dislocations with vascular compromise, due to mechanical arterial compression by the anteriorly dislocated femoral head on one side. Prompt closed reduction re-established the blood flow. Operative intervention was done subsequently to remove intra-articular loose bodies in the hip on the same side. At 6-month follow-up, patient had good functional outcome and no radiographic evidence of complications.Isolated, closed, conjoint bicondylar Hoffa fracture in a child is extremely rare with only three cases reported in literature till date. check details We report a complex variant of this very rare injury. An 11-year-old male child reported 2-week post-trauma with history of fall from a tree and injury to his right knee. Radiographs revealed a coronal plane fracture of the distal femur. The patient was operated using the swashbuckler approach, which revealed a sagittal split of the lateral femoral condyle along with a conjoint bicondylar Hoffa fracture. Fixation was done using multiple lag screws and fracture went on to uneventful union. Patient was followed up for 3 years and except for limb shortening of around 1.5 cm secondary to premature physeal closure as a consequence of the injury, he had excellent outcome with full range of motion at the knee, without any deformity.The chondral shear fracture is a rare sub-type of pediatric capitellum fractures, in which the fractured fragment is almost entirely cartilaginous. Since the fractured fragment is not visible on plain radiographs, these injuries are often missed on initial presentation resulting in delayed diagnosis and poor outcomes. To our knowledge, only eight such cases have been reported in the past. We report the cases of two adolescents with chondral shear fractures of the capitellum, that were initially missed. They both presented to us several months following trauma, with pain and restricted elbow range of motion. They were treated by excision of the intra-articular loose fragment, and one child also required radial head excision due to advanced radio-capitellar arthritis. Both had good outcomes at 1 year follow-up. We provide a review of literature on this injury and emphasize the need for having a high index of suspicion when dealing with elbow trauma in adolescents, so as to avoid missing this rare, but distinct fracture pattern.