Hamilton General Hospital

Background: Lemierre’s syndrome (LS), previously termed the “forgotten disease” after the introduction of modern antibiotics, is a rare and potentially fatal infection of the neck resulting in septic thrombophlebitis of the internal jugular and other neck veins. In recent years, there has been an increased resurgence of this disease, or at least in its detection, and it remains an important diagnosis with life-threatening potential to consider when presenting with multifocal cavitary pneumonia. Fusobacterium necrophorum, an obligate anaerobic Gram-negative bacterium, is the most isolated culprit organism involved in this condition; however, it is often fastidious and difficult to culture. The use of 16s rRNA gene sequencing can aid in this diagnosis when uncertainty exists. Methods: This case report describes an otherwise healthy 17-year-old male with a history of regular vaping presenting with upper respiratory infectious symptoms who was ultimately diagnosed with multifocal necrotizing pneumonia. In this case, there was initial diagnostic uncertainty as traditional microbiologic culture mechanisms failed to identify a causative organism for tailored antimicrobial treatment. This was despite direct empyema fluid analysis and pulmonary-bronchial biopsy. Novel gene sequencing was performed using 16s rRNA typing, a promising new way to identify a catalog of host organisms, detecting F. necrophorum. This diagnosis prompted further diagnostic imaging of the neck, confirming a small internal jugular clot and diagnosis of LS. Results: This case highlights the need for suspicion of LS in patients presenting with multifocal pneumonia. Furthermore, it re-iterates the idea of culture-negative infections, whereby fastidious organisms or tissue samples do not readily provide a diagnosis. Lastly, it further introduces hypotheses regarding the use of vaping as a possible associated factor for significant infection and lung injury. Conclusions: The use of 16s rRNA sequencing for the detection of fastidious, opportunistic organisms is another tool for physicians to ensure additional diagnostic clarity and appropriate treatment.

In a trauma setting, cricothyroidotomy is a life-saving procedure performed to secure a compromised airway. The rarity and high-stakes nature of the procedure drastically limit training opportunities. Existing models are expensive and inaccessible. Our objective was to design a low-cost, low-fidelity cricothyroidotomy simulator using universally available materials to ensure widespread access. Our technical report used an iterative design-based research methodology. A multidisciplinary team first determined the essential steps of a cricothyroidotomy. We then established the anatomical components required to perform the procedure: skin, subcutaneous tissue, trachea, thyroid cartilage, and cricothyroid membrane. Multiple prototypes built from a variety of materials were tested by performing simulated cricothyroidotomies. Our cricothyroidotomy simulator requires less than five minutes to construct and costs $0.53 USD. The trachea is made from a plastic water bottle. An egg carton mimics the thyroid cartilage. A nitrile glove slides onto the trachea to simulate the cricothyroid membrane. Slime, created using a mixture of glue, detergent, sodium bicarbonate, and cornstarch, is used for the skin and subcutaneous tissues. Each component can be used infinitely, except for the nitrile glove, which needs to be replaced after 10 uses. Our cricothyroidotomy simulator can be used to train healthcare providers in both well-resourced and resource-limited settings. In addition to making our design blueprints open access, we have intentionally chosen widely accessible and eco-friendly materials to make our simulator available worldwide.

Tranexamic acid (TXA) has been used in different orthopedicdepartments to reduce blood loss, transfusions, hemarthrosis, wound formation, infections, and other related complications. Nonetheless, the role or efficacy of Tranexamic acid (TXA) in total ankle arthroplasty (TAA) is not precisely depicted. This systematic review aims to report the role or efficacy of Tranexamic acid (TXA) in total ankle arthroplasty (TAA). This study conducted to find out the role or efficacy of Tranexamic acid (TXA) in total ankle arthroplasty (TAA). Database searches were conducted for eligible studies from 26thFebruary 2002 to 26th October 2022. Clinical studies on the use of Tranexamic acid in total ankle arthroplasty (TAA) were included. The outcomes were projected blood loss, hemarthrosis, change in hemoglobin, wound infections, and complications. Eight studies met the inclusion criteria. In six studies, Tranexamic acid (TXA) was found to be effective in reducing wound formations, infections, and complications in total ankle arthroplasty (TAA). However, two studies reported the use of Tranexamic acid (TXA) in total ankle arthroplasty (TAA) as non-effective. Six studies reported on blood loss, in which, in 4 studies there was no significant difference in blood loss between patients that received Tranexamic acid (TXA) during total ankle arthroplasty (TAA) and the control group. However, in twostudies Tranexamic acid (TXA) was found to be effective in reducing blood loss. In conclusion, Tranexamic acid (TXA) is associated with reduced wound formations, infections, and complications in total ankle arthroplasty (TAA). Additionally, TXA does not significantly reduce blood loss in total ankle arthroplasty.

After experiencing a hypertensive disorder of pregnancy, women are at increased risk of developing cardiovascular (CV) risk factors and premature CV disease. A dedicated postpartum clinic is 1 potential solution to educate patients on how to reduce their long-term health risks but there are limited data from the patient perspective regarding the utility and quality of such interventions. We performed a mixed-methods study using questionnaire data and focus group interviews to assess the patient's perspective regarding the timing, content, modality (virtual vs. in-person) and perceived effectiveness of the Postpartum CV Prevention Clinic in Ontario, Canada. Participants reported improved understanding of their health condition and healthy behaviours, as well as concrete behavioural changes because of their experience in the clinic. Participants reported a need for more mental health resources as part of their postpartum follow-up. A combination of in-person and virtual care was the preferred modality of follow-up. A dedicated Postpartum CV Prevention Clinic is an effective means to educate patients on health behaviours and the need for follow-up after pregnancy, but gaps remain in care, and future research is needed to determine the long-term health impacts.

Study DesignNarrative literature review.ObjectivesTo summarize the evidence for perioperative blood conservation for patients undergoing surgery for adult spine deformity.MethodsA systematic literature review with narrative analysis was conducted to describe the evidence for blood conservation strategies before, during and after surgery for adult spine deformity. The evidence is critically analyzed and recommendation drawn.ResultsThe evidence for iron supplementation, autologous blood donation, screening for diatheses, the constitution of the surgical team, hypotensive anaesthesia, osteotomy, patient positioning, antifibrinolytics, transfusion thresholds, cell salvage, surgical technique, topical hemostasis, postoperative drainage, postoperative tranexamic acid and the management of thromboprophylaxis and anticoagulants is critically evaluated. The management of haemorrhage in surgery for adult spine deformity is complex and multifaceted, requiring the surgeon to consider tactics in conservation at every stage of the process. There is a paucity of evidence for many techniques, whilst hypotensive anaesthesia, tranexamic acid, surgical team members and surgical duration have the most significant effects on blood loss and transfusion requirements.ConclusionsThe astute surgeon must consider strategies to prevent excessive haemorrhage in the pre- intra- and postoperative phases of care. Although some commonly used techniques have robust evidence, others may be at best poorly evidenced, and at worst ineffective. Surgeons should consider the members of the operative team, minimizing surgical time, preoperative correction of anemia, hypotensive anesthesia and the use of intravenous and topical tranexamic acid at a minimum.