Citations

Abstract The coronavirus disease-2019 (COVID-19) pandemic caused by SARS-CoV-2 has exacted an enormous toll on healthcare systems worldwide. The cytokine storm that follows pulmonary infection is causally linked to respiratory compromise and mortality in the majority of patients. The sparsity of viable treatment options for this viral infection and the sequelae of pulmonary complications have fueled the quest for new therapeutic considerations. One such option, the long-forgotten idea of using low-dose radiation therapy, has recently found renewed interest in many academic centers. We outline the scientific and logistical rationale for consideration of this option and the mechanistic underpinnings of any potential therapeutic value, particularly as viewed from an immunological perspective. We also discuss the preliminary and/or published results of prospective trials examining low-dose radiation therapy for COVID-19.

Abstract The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) Coronavirus Disease 2019 (COVID‐19) Nutrition Task Force was to examine nutrition research applicable to the COVID‐19 pandemic. The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID‐19 were reviewed and results mapped to the Population, Intervention, Comparator, Outcome, and Time (PICO‐T) questions. The aggregated data were analyzed by clinical stage: pre–COVID‐19, acute COVID‐19, and chronic/post–COVID‐19. Research gaps were discovered for all PICO‐T questions. Nutrition topics meriting urgent research included food insecurity/societal infrastructure and transcultural factors (pre–COVID‐19); cardiometabolic‐based chronic disease, pediatrics, nutrition support, and hospital infrastructure (acute COVID‐19); registered dietitian nutritionist counseling (chronic/post–COVID‐19); and malnutrition and management (all stages). The paucity of randomized controlled trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO‐T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (pre–COVID‐19); enteral nutrition, protein‐energy requirements, and glycemic control with nutrition (acute COVID‐19); and home enteral and parenteral nutrition support (chronic/post–COVID‐19). In conclusion, multiple critical areas for urgent nutrition research were identified, particularly using RCT design, to improve nutrition care for patients before, during, and after COVID‐19.

ObjectiveDeficiency of adenosine deaminase 2 (DADA2) is a monogenic form of vasculitis that can resemble polyarteritis nodosa (PAN). This study was undertaken to identify potential disease‐causing sequence variants in ADA2 in patients with idiopathic PAN, granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA).MethodsPatients with idiopathic PAN (n = 118) and patients with GPA or MPA (n = 1,107) were screened for rare nonsynonymous variants in ADA2 using DNA sequencing methods. ADA‐2 enzyme activity was assessed in selected serum samples.ResultsNine of 118 patients with PAN (7.6%) were identified as having rare nonsynonymous variants in ADA2. Four patients (3.4%) were biallelic for pathogenic or likely pathogenic variants, and 5 patients (4.2%) were monoallelic carriers for 3 variants of uncertain significance and 2 likely pathogenic variants. Serum samples from 2 patients with PAN with biallelic variants were available and showed markedly reduced ADA‐2 enzyme activity. ADA‐2 enzyme testing of 86 additional patients revealed 1 individual with strongly reduced ADA‐2 activity without detectable pathogenic variants. Patients with PAN and biallelic variants in ADA2 were younger at diagnosis than patients with 1 or no variant in ADA2, with no other clinical differences noted. None of the patients with GPA or MPA carried biallelic variants in ADA2.ConclusionA subset of patients with idiopathic PAN meet genetic criteria for DADA2. Given that tumor necrosis factor inhibition is efficacious in DADA2 but is not conventional therapy for PAN, these findings suggest that ADA‐2 testing should strongly be considered in patients with hepatitis B virus–negative idiopathic PAN.

AbstractInfection is a rare occurrence after revision anterior cruciate ligament reconstruction (rACLR). Because of the low rates of infection, it has been difficult to identify risk factors for infection in this patient population. The purpose of this study was to report the rate of infection following rACLR and assess whether infection is associated with patient‐ and surgeon‐dependent risk factors. We reviewed two large prospective cohorts to identify patients with postoperative infections following rACLR. Age, sex, body mass index (BMI), smoking status, history of diabetes, and graft choice were recorded for each patient. The association of these factors with postoperative infection following rACLR was assessed. There were 1423 rACLR cases in the combined cohort, with 9 (0.6%) reporting postoperative infections. Allografts had a higher risk of infection than autografts (odds ratio, 6.8; 95% CI, 0.9–54.5; p = .045). Diabetes (odds ratio, 28.6; 95% CI, 5.5–149.9; p = .004) was a risk factor for infection. Patient age, sex, BMI, and smoking status were not associated with risk of infection after rACLR.

Mycobacterium septicum is a rarely identified nontuberculous mycobacterium capable of causing infections in both healthy and immunocompromised individuals. Only a few cases of M. septicum infections have been reported, which makes recognizing corresponding clinical disease more challenging for clinicians. Antimicrobial susceptibility profiles for this organism are not well described, and corresponding optimal therapeutic regimens have not been established. We report a tertiary care center’s experience with M. septicum from 2014 to 2020.

Abstract BackgroundOur study aims to fill the vacancy of litigation studies related to trigeminal neuralgia management, and to give healthcare providers the necessary information needed to better understand the potential litigious outcomes that often follow certain treatment methods.MethodsWe queried the Westlaw Edge legal database to identify litigation cases related to the management of trigeminal neuralgia for the years 1985-2019 using the following search criteria: (trigeminal & neuralgia), (tic & douloureux) and (microvascular & decompression). Key variables extracted included the following: plaintiff medical complaints, trial outcome, payout, and demographic characteristics. Continuous variables were compared between cases in favor of defendant and cases in favor of plaintiff using t-test or Wilcoxon rank sum test. Categorical variables were compared using chi-square or Fischer’s exact test.Results49 cases met the inclusion criteria – for those cases surgical complication (42.9%) and failure to diagnose (32.7%) were cited as the most common alleged reasons for filing a malpractice claim. Cranial nerve deficits (34.7%) and loss of consortium (12.2%) were the most frequent post-operative complaints. Verdicts ruled in favor of the defendant in 61.2% of cases, and for the plaintiff in 26.5% of cases with a mean payout of $1,982,428.46. Dental specialists were included in the most cases, 63.3%, and the average payout was $415,908, while Neurosurgical specialists were involved in 20.4% of cases with an average payout of $618,775. Cases where the verdict was in favor of the plaintiff were more likely to be older than cases with a verdict in favor of the defendant (p=0.03). ConclusionsOver one-half of the cases resulted in a defendant’s verdict with surgical complications cited as the most common reason for litigation. Dentistry and neurosurgery were listed as the most common individual physician specialties for defendants, also contributing to the largest average payouts based on specialty (for specialties > 1 occurrence). Cranial nerve deficits and loss of consortium were the most common plaintiff post-operative complaints. A key implication of this study is the need for more extensive discussions between physician and patient regarding informed consent, especially when neurosurgical interventions are required.