Campbell University

<h2>Abstract</h2><h3>Objectives</h3> This pilot study sought to examine the distribution of circulating adenovirus types among humans and other animals in Pakistan. <h3>Methods</h3> Patients with influenza-like illness or pneumonia at seven hospitals were enrolled and sampled (oropharyngeal or nasopharyngeal swabs), and their epidemiological data were collected. Concomitantly, livestock with respiratory symptoms in live bird markets and farms were also sampled. These specimens were screened for evidence of adenovirus infection. <h3>Results</h3> Of 1705 total samples, 96 (8.8%) of 1084 humans and 15 (4%) of 385 poultry had molecular evidence of adenovirus. Infection in humans was significantly associated with wheezing, coughing, fever, and sore throat, and prevalence was greatest among participants residing outside Punjab. Genetic sequencing identified co-circulation of human-like adenovirus (HAdV-7) and HAdV-3 strains among humans. Further sequencing identified HAdV-C1, HAdV-5, HAdV-89, HAdV-12, and HAdV-56. Bovine adenovirus 2 was unexpectedly detected in a human nasal swab. Among poultry, fowl aviadenovirus (FAdV)-4 and FAdV-11 were identified. <h3>Conclusions</h3> Compared with other studies, there was a relatively high prevalence of adenoviruses among sick humans and poultry, with the unusual discovery of bovine adenovirus in a sick human's airway. There was considerable diversity among detected adenovirus strains. Given periodic adenovirus outbreaks in Pakistan, monitoring types in respiratory illness is key.

Introduction: Available literature suggests albumin resuscitation in septic shock (SS) may reduce vasopressor requirements and cumulative fluid balance, but albumin timing varies. The purpose of this study was to assess optimal timing of albumin within 72 hours of initial SS crystalloid resuscitation. Methods: This retrospective study included SS patients that received guideline-recommended 30 mL/kg of crystalloid resuscitation. The primary objective was to assess the impact of albumin timing on vasopressor alive-and-free days. Secondary endpoints included vasopressor-free days, time to shock resolution, shock recurrence, need for new renal replacement therapy, ICU length of stay, hospital length of stay, and 28-day mortality. Results: Of patients included, 59 received albumin within 72 hours after initial crystalloid resuscitation, while 27 patients did not. Patients received a median of 31.9 mL/kg of initial crystalloid resuscitation that consisted mostly of lactated ringers (54.7%). For patients that received albumin, the median initial dose was 25 g at a concentration of 5% (79.7%). When albumin and no albumin groups were compared, results found no difference in vasopressor alive-and-free days, time to shock resolution, ICU and hospital length of stay (LOS), and 28-day mortality. However, there were significant differences in shock recurrence (13.6% vs 44.4%) and new renal replacement therapy (10.2% vs 0.0%). When albumin is given for SS, optimal timing was found to be 8.75 to 72 hours after initial crystalloid resuscitation for a perceived 6.92 day improvement in vasopressor alive-and-free days compared to those outside the perceived optimal timing. Conclusions: Patients that received albumin within 72 hours of initial SS crystalloid resuscitation had similar vasopressor alive-and-free days with reduced shock recurrence when compared to patients that did not receive albumin. Findings suggest optimal timing for albumin may be 8.75 to 72 hours after crystalloid resuscitation warranting further investigation.

The United States is experiencing a significant demographic shift characterized by an increasingly aging population, or "silver tsunami." These demographic changes have profound implications for spine surgery outcomes, as spinal surgery is one of the most frequent procedures performed annually by neurosurgeons and orthopedic spine surgeons. In current literature, two frailty indices, the Modified Frailty Index (mFI-5 or mFI-11) and the Risk Analysis Index (RAI), are the indices predominantly utilized to risk assess patients prior to surgical treatment. Utilizing a systematic search yielded ten studies. This study employs the area under the curve (AUC) from receiver operating characteristic (ROC) curves to develop a linear regression model aimed at evaluating the predictive performance of these indices for specific outcomes. This investigation focuses on the performance of the mFI and RAI in predicting three key postoperative outcomes in spine surgery patients: 30-day mortality, Clavien-Dindo IV complications, and non-home discharge (NHD). The results indicate that the RAI demonstrates superior predictive accuracy compared to the mFI for 30-day mortality (RAI AUC 0.82 [0.78-0.85] vs. mFI AUC 0.66 [0.62-0.70]) and Clavien-Dindo III-IV complications (RAI AUC 0.69 [0.66-0.72] vs. mFI AUC 0.63 [0.62-0.63]). However, no significant difference was observed in the ability to predict NHD (RAI AUC 0.81 [0.63, 0.91] vs. mFI AUC 0.71 [0.64, 0.77]). These findings suggest that the Risk Analysis Index is a more reliable predictor of 30-day mortality and Major complications (Clavien-Dindo III-IV) in patients undergoing spine surgery.

Major Depressive Disorder (MDD) is a leading cause of disability, and limitations of the monoamine hypothesis have driven the exploration of complementary models, including the inflammatory hypothesis. This hypothesis suggests that in a subset of patients, immune dysregulation, especially involving interleukins (ILs), contributes to depression. This review compares IL dysregulation in MDD and autoimmune diseases to identify common and unique inflammatory mechanisms for treatment. Some MDD patients exhibit chronic, low-grade inflammation both systemically (in blood) and centrally (in CSF and brain). They show elevated pro-inflammatory IL-6, IL-1β, and IL-18, with insufficient anti-inflammatory IL-10. This immune dysregulation affects key neurobiological processes (monoamine metabolism, HPA axis, neurogenesis), linking inflammation to depressive symptoms. MDD and autoimmune diseases share inflammatory mediators and signaling pathways, supporting these as therapeutic targets; however, MDD's inflammation is low-grade and innate driven, whereas autoimmune diseases have high-grade, adaptive immune responses to specific antigens. Successful anti-IL therapies in autoimmune conditions provide a roadmap for treating inflammation-driven depression. Translating these findings to practice requires a precision immune-psychiatry approach. Biomarkers like C-reactive protein and IL-6 can identify an inflammatory depression subtype, and patients may benefit from targeted immunomodulatory strategies, repurposed biologics, novel small molecules, or lifestyle interventions particularly if standard antidepressants fail.

There are two traditional binary ends of the spectrum that exist within the polarized secular discussion surrounding the issue of abortion. On one end, there are proponents of the position that a woman has unrestricted authority to choose to terminate a pregnancy. Conversely, on the other end of the spectrum, there are proponents of the position that each and every child maintains a fundamental right to live, and consequently, the state has a vested interest in preserving this right. The goal of this manuscript is to attempt to examine secular as well as theological considerations of both ends of the spectrum on abortion, before seeking to offer a mutual consensus based in Christian ethics, as supported by scripture, through examination of the ethical considerations of the pro-choice argument, examination of the ethical considerations of the pro-life argument, and ultimately, positing a common-ground alternative to this contentious issue by seeking to transcend the binary nature of the argument, and rather, focus on the mutual interests found in an ecumenical theological approach.

Subcritical bone has been shown to result in a higher rate of recurrent instability and inferior outcomes after an arthroscopic soft tissue Bankart procedure alone. The ideal surgery for patients with subcritical bone loss remains controversial, with options including arthroscopic Bankart alone, Bankart plus Remplissage (BRR), open Bankart, or a bone transfer procedure. The purpose of this study is to compare the outcomes between the arthroscopic BRR with an open Latarjet for the treatment of anterior shoulder instability in patients with glenoid bone loss (GBL) from 13.5% to 24% in an active-duty military population. It was hypothesized that there will be no difference in recurrence rate or patient-reported outcomes between the 2 procedures. Cohort study; Level of evidence, 3. A retrospective matched-cohort comparison of patients who underwent anterior glenohumeral instability procedures with subcritical bone loss was performed. Inclusion criteria included symptomatic anterior shoulder instability, subcritical GBL (13.5% to 24%), recurrent instability with ≥2 instability episodes, surgical treatment with arthroscopic BRR or open Latarjet, and minimum follow-up of 2 years. Outcomes assessed included recurrent instability (defined as postoperative dislocation or subjective subluxation), military physical restrictions, Western Ontario Shoulder Instability Index (WOSI) score, and Single Assessment Numeric Evaluation (SANE) score. In total, 50 patients were included, 25 of whom underwent an arthroscopic BRR and 25 patients who were treated with an open Latarjet. Mean bone loss was 16.1% and 19.3%, respectively. Five patients experienced recurrent instability, 3 in the arthroscopic BRR group and 2 in the open Latarjet group (P = .64). Mean postoperative SANE score for the arthroscopic BRR group was 81.6% and open Latarjet group was 84.2% (P = .42). Mean postoperative WOSI score for the arthroscopic BRR group was 64.6% and open Latarjet group was 67.9% (P = .44). There was no difference in the number of patients placed on permanent military physical restriction in the arthroscopic BRR group (n = 2) compared with open Latarjet (n = 3) (P = .64). In our small cohort of active-duty military patients with subcritical GBL, there was no difference in recurrent instability between arthroscopic BRR compared with open Latarjet. Additionally, there was no significant difference in postoperative SANE or WOSI scores, complications, or the number of patients placed on permanent military restriction.

Background: Traumatic amputations are morbid complications of blunt traumatic injury. Given the contaminated nature of these wounds, surgical site infections (SSIs) are frequent in this population. The natural history of these wounds following guillotine amputation is not well described. This study seeks to define the relation between operative technique, timing, and SSI. Patients and Methods: Using our institutional trauma registry, we obtained data for all patients with an admitting ICD-10 code for an amputation. Those that underwent amputation for non-traumatic indications were excluded. Results: Between 2013 and 2023, 100 patients with traumatic extremity wounds presented to our Level 1 Trauma Center and subsequently underwent completion amputation. Most patients were males (70%), and the mean age was 42.7. Of the 100 patients, 65 underwent guillotine amputation, 39 of which occurred within six hours of arrival. Of the studied population, SSI developed in 24% of them. The patients in the SSI group compared with the non-SSI group had a mean hospital length of stay (LOS) of 30.2 days (vs. 16.5, p = 0.007). Patients who did not undergo an attempt at salvage had a mean mangled extremity score of 8.25 (vs. 6.14, p < 0.001), a mean injury severity score of 19.4 (vs. 14.5, p = 0.014), mean lactate at presentation of 5.37 (vs. 3.18, p = 0.004), and mean ICU LOS of 8.4 days (vs. 4.2, p = 0.021). Patients who underwent guillotine within six hours had a lower risk of SSI (12.8% vs. 31.1%, p = 0.036). Conclusions: Understanding the impact of surgical timing and operative technique on SSI will inform surgeons about the best course of action when these difficult cases present to the trauma center. On the basis of these findings, early guillotine amputation in patients likely to undergo amputation was associated with a decrease in the rate of SSI.