Reading Hospital

Metronidazole-induced encephalopathy (MIE) is a rare adverse effect from long-term metronidazole use. We describe a patient with metastatic cancer and complicated abscesses on long-term antibiotics who presented to the emergency department with acute encephalopathic features including reported weakness and confusion. Physical examination was remarkable for chronic right-sided weakness from a previous stroke and reported abnormal right-sided finger-to-nose testing, which may have been due to weakness from his prior stroke. Head CT was non-contributory, and brain MRI showed bilateral edema in cerebellar dentate nuclei, suggestive of MIE. We recommend having a low threshold for brain MRI in patients on long-term metronidazole to rule out other diagnoses and, in patients with lasting neurologic deficits, early neurology and palliative care involvement to improve quality of life.

Lipoabdominoplasty has soared in popularity. Advancements in the procedure have led to improved abdominal contours. Despite improvements in surgical techniques, postoperative complications persist, especially seroma formation. Drains are commonly used to reduce the risk of seroma formation; however, drains are a nuisance for patients and may contribute to long-term complications. Many surgical strategies have been proposed to reduce seroma formation in lipoabdominoplasty, including progressive tension sutures (PTS), minimal cautery, and preservation of Scarpa's fascia; however, these strategies in combination remain underexplored. The objective of this study was to determine the postoperative seroma rate of lipoabdominoplasty with combined PTS, minimal cautery, and Scarpa's fascia preservation without postoperative drains. This is a review of 350 patients who underwent drainless lipoabdominoplasty performed by a single surgeon from January 2017 to December 2024 at a single surgery center. Patient demographics, operative characteristics, and postoperative outcomes were collected. Descriptive analysis was performed. Pearson's χ2 and Mann-Whitney U tests were used to compare groups. Multiple logistic regression analysis was performed. Statistical significance was set at P < .05. Among 350 cases, a total of 286 full abdominoplasties, 50 belt lipectomies, and 14 modified float abdominoplasties were performed. There was a total of 32 (9.1%) complications, with a 2% seroma rate. There were no mortalities. All patients who developed complications recovered without sequelae. The drainless lipoabdominoplasty can be performed safely with a low seroma rate using a multimodality approach that includes progressive tension sutures, minimal cautery, and preservation of Scarpa's fascia.

Background: Traumatic brain injury (TBI) is a major cause of morbidity, and concomitant acute kidney injury presents substantial management challenges. Continuous renal replacement therapy (CRRT) is thought to cause less hemodynamic instability than intermittent hemodialysis (IHD) after TBI, but factors associated with modality selection in TBI remain unclear. We sought to describe the clinical characteristics and outcomes of patients with TBI requiring renal replacement therapy and to test whether injury severity, Glasgow Coma Scale (GCS), and comorbidity burden were associated with the receipt of CRRT vs. IHD.Methods: This 10-year retrospective study at a level I trauma center included adult TBI patients requiring renal replacement therapy. Patients were grouped by modality (CRRT vs. IHD), and demographics, injury severity, and outcome variables were compared.Results: Eighty-one patients met the inclusion criteria; 52 received IHD and 29 received CRRT. Patients receiving IHD were older (69 vs. 58 years, p=0.006) and had higher Charlson Comorbidity Index scores (6.6 vs. 3.5, p<0.001). Patients receiving CRRT had lower presenting GCS (8.7 vs. 13.5, p<0.001) and higher injury severity scores (24.5 vs. 16.2, p=0.006). CRRT patients had higher mortality (62.1% vs. 30.8%, p<0.001), longer hospital stays (17 vs. 8.6 days, p=0.001), and were more commonly discharged with severe disability (17.2% vs. 3.8%, p=0.001).Conclusion: In this retrospective cohort, we found that CRRT was more frequently used in TBI patients with worse injuries and lower levels of consciousness on presentation, whereas patients with greater comorbid burden were more likely to receive IHD. These findings highlight the need for evidence-based guidelines to inform renal replacement modality selection in acute TBI.

BackgroundAcute myocardial infarction (AMI) remains a leading cause of mortality in the African American population, warranting an examination of regional and demographic trends to inform health policies.MethodsUtilizing the Centers for Disease Control and Prevention’s WONDER death certificate database, we conducted a comprehensive analysis of AMI mortality from 1999 to 2020 in African Americans and overall adults aged 25 and older. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, race, and geographic region. Joinpoint regression facilitated the assessment of mortality trends, revealing average annual percentage changes (AAPCs) with 95% confidence intervals (CIs).ResultsOver the study period (1999 - 2020), there were 3,015,339 total deaths due to AMI in adults aged 25 and older. African Americans had the highest AAMR, at 71.5, followed by Whites, at 63.5, and the lowest among Asians, at 32.6. Overall, AAMR decreased in the African American population from 128.5 in 1999 to 48.5 in 2020, with an AAPC of -5.29 (95% CI: -5.69 to -4.9). AAMR decreased from 109 in 1999 to 37.6 in 2020 in African American females. African American males experienced a decline from 157.8 to 63.4 in AAMR. African American males had a higher overall AAMR (88.6) than females (59.3). Regionally, AAMR was highest in the South (77.6) and lowest in the Northeast (57.6) among African Americans.ConclusionsWhile AMI mortality has declined, persistent differences persist in the African American community. African American males experience a higher mortality rate as compared to females. Regional variations, notably the higher AAMR in the Southern region, emphasize the need for targeted health policies to mitigate disparities and enhance healthcare access. These measures may include expanding insurance coverage and improving access to healthcare, education, food, and employment for African Americans.

Background: Chronic limb-threatening ischemia (CLTI) is clinically identified by the presence of a severe form of peripheral arterial disease that significantly affects the patient's quality of life. Despite improvements in medical and surgical interventions, social disparities in health care access remain a major determinant in clinical outcomes. We aim to explore the association between social determinants of health and hospital outcomes in CLTI among different socioeconomic groups. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2021. ICD 10 codes were used to identify and compare different interventions, including surgical bypass, endoscopic revascularization, and non-traumatic amputation among different socioeconomic groups. Major adverse limb events (MALE) and major adverse cardiovascular and cerebrovascular events (MACCE) were compared during the period of hospitalization. Multivariate regression adjusted for hypertension, diabetes, and hyperlipidemia. The trends of utilizing revascularization and amputation were examined within the six-year period. Results: The study reveals a rising prevalence of CLTI over the 6-year period. Meanwhile, the use of surgical bypass and amputation has been declining, while endovascular repair is increasingly utilized: as a treatment approach. There were 425,259 admissions, with the rate of admission in Caucasians, Blacks, Hispanics, and Asians being 60%, 20%, 12%, and 2%, respectively. Major comorbidities like hyperlipidemia, hypertension, cigarette use, and diabetes were similar across race. The prevalence of surgical bypass and endoscopic revascularization remains greater among Caucasians, while the prevalence of amputation is highest among Blacks and Hispanics. Using multivariate analysis comparing outcomes with the Caucasian population, the study shows Black patients were 18% (aOR 0.82, C.I.: 0.7- 0.8, P-value 0.00) less likely to undergo surgical bypass. Blacks and Hispanics were more likely to undergo amputation, with rates of 24% and 18%, respectively, both of which were statistically significant. Mortality was 30% more likely among Asians. Cardiac and ventricular arrhythmias were more likely among blacks. Conclusion: The study reveals that Blacks and Hispanics are at increased risk of adverse MALE and MACCE. This emphasizes the importance of understanding these disparities and their influence on management strategies, as it is crucial for improving patient care and ensuring equitable treatment.