Wilderhamilton3865

Exposure to acute, high-dose, high dose-rate whole-body ionizing radiations damages the bone marrow resulting in rapid decreases in concentrations of blood cells, especially lymphocytes, granulocytes and platelets with associated risks of infection and bleeding. In several experimental models including non-human primate radiation exposure models giving molecularly cloned haematopoietic growth factor including granulocyte/macrophage colony-stimulating factor (G/M-CSF; sargramostim) and granulocyte colony-stimulating factor (G-CSF; filgrastim and pegylated G-CSF [peg-filgrastim]) accelerates bone marrow recovery and increases survival. Based on these data these molecules are US FDA approved for treating victims of radiation and nuclear incidents, accident and events such as nuclear terrorism and are included in the US National Strategic Stockpile. We discuss the immediate medical response to these events including how to estimate radiation dose and uniformity and which interventions are appropriate in different radiation exposures settings. We also discuss similarities and differences between molecularly cloned haematopoietic growth factors. INTRODUCTION Due to an increase in life expectancy, onco-pulmonologists and thoracic surgeons are more frequently faced with octogenarian patients with lung cancer. In this age group, treatment modalities may need to be revised because of the increasing presence of comorbidities. Surgery remains the reference treatment for early stage disease, but mortality rates and postoperative complications are higher in this group of patients. One of the solutions to reduce the operative risk would be to develop videoassisted thoracoscopic pulmonary resection surgery. The aim of this study was to evaluate the results of this form of lung cancer surgery in octogenarians. METHODS All patients 80 years old or more who underwent videoassisted lung cancer surgery from 2014 to 2018 at Lyon University Hospital were included. Wedge resections and diagnostic procedures were excluded. RESULTS Nineteen patients (13 men, 6 women) were included. The median age was 82 years old. All patients had undergone videoassisted lobectomy. Three patients required conversion to thoracotomy (15.8%). All patients underwent complete resection (R0). One patient had N1 lymph node involvement, all others were N0. The postoperative complication rate was 68.4%, the majority of which were grade II of the Clavien classification. Perioperative mortality was 5.3%. CONCLUSIONS Videoassisted lung cancer resection in a selected population of octogenarians is associated with satisfactory short-term results. It is reasonable to favour minimally invasive techniques in this population, even if the proof of their superiority has not yet been firmly established. BACKGROUND Quantitative PCR to detect Pneumocystis jirovecii (Pj) is a new tool for the diagnosis of Pneumocystis jirovecii pneumonia (PJP). The yield of this technique, in cases of low fungal burden, when the standard technique using immunofluorescence (IF) is negative, needs to be evaluated. METHODS We retrospectively reviewed the charts of all patients with a positive PCR but negative IF test (PCR+/IF-) in bronchoalveolar lavage (BAL) fluid performed over one year. We used an algorithm based on underlying immunosuppression, clinical picture, thoracic CT scan appearances, existence of an alternative diagnosis and the patient's outcome on treatment. Using this, each case was classified as probable PJP, possible PJP or colonization. OSI-774 RESULTS Among the 416 BAL performed, 48 (12%) were PCR+/IF- and 43 patients were analyzed. Patients were mostly male (56%) with a median age of 60 years. Thirty-five (84%) were immunocompromised 4 (9%) HIV-infected patients, 26 (60%) with hematologic or solid organ cancer, 3 (7%) were renal transplant recipients. Seven (16%) were classified as probable PPJ and 9 (21%) as possible PJP. Patients with a probable or possible PJP were more frequently admitted to the ICU (P less then 0.02) and had higher risk of death (P less then 0.01) when compared to those with colonization. Median PCR levels were very low and were not different between PJP or colonized patients (P=0.23). CONCLUSIONS Among patients with a positive Pj PCR in BAL but with negative IF, only 37% had probable or possible PJP and PCR could not discriminate PJP from colonization. BACKGROUND/PURPOSE To assess the number of patients seen at the colorectal clinic of a low-to-middle income-country with emphasis on their social circumstances. METHODS Between January 2013 and December 2018 we recorded the number of visits to colorectal clinic. From February 2019 prospective data on patients with anorectal malformations (ARMs) focusing on their social conditions (type of housing and sanitation) and HIV-exposure were collected. RESULTS At the clinic 452 visits were recorded in 2013, 608 in 2014, 904 in 2016, 1392 in 2017, and 1968 in 2018. The ARM cohort included 100 patients at the time of delivery the HIV status of 74 mothers was negative, positive in 21, and unknown in 5. None of the HIV-exposed patients seroconverted to HIV positive (average follow-up39 months). Seventy-four patients live in formal settlements, 23 in informal, and 3 in unknown type. Forty-six patients have inside toilets, 39 outside flushing toilets, 10 outside pit latrines, 2 community toilets, and 3 an unknown sanitation. CONCLUSIONS The clinic work-load has increased during the past years. A significant proportion of our patients are HIV-exposed, do not live in formal houses and do not have inside toilets. Tailored strategies for a successful surgical plan and bowel management need to be implemented. LEVEL OF EVIDENCE II. INTRODUCTION Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. METHODS A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. RESULTS A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.