St. John Hospital & Medical Center

BackgroundCesarean section is one of the most common major abdominal surgeries performed in the world. The American College of Obstetricians and Gynecologists (ACOG) states that untreated maternal pain after Cesarean delivery is associated with greater opioid use, postpartum depression, and the development of chronic pain. Enhanced Recovery After Cesarean (ERAC) is a multidisciplinary approach to managing postpartum pain. It is proven to not only reduce postpartum pain scores, but also decrease opioid consumption, shorten hospital stays, limit costs, increase postoperative mobilization, and improve maternal-infant bonding. We aimed to determine if the ERAC protocol with multimodal pain control initiated in the year 2021 significantly improved postpartum pain for women who underwent Cesarean section at Henry Ford St. John Hospital in Detroit, MI. We additionally investigated whether the ERAC protocol with multimodal pain control significantly decreased opioid usage for these patients.MethodsWe obtained demographic data, medical history, pain scores, and opioid usage measured in morphine milliequivalents (MME) through chart review for 100 women who underwent Cesarean section in 2020 and 100 women who underwent Cesarean section in 2022. Data were analyzed using Student’s t-test, chi-squared analysis, the Mann-Whitney U test, Pearson’s correlation, and linear regression.ResultsThere was no significant difference in pain scores between the two groups. There was, however, a significant difference in MME usage between the groups on postoperative days 1 and 2, which remained significant in the multivariable analyses after controlling for demographic and medical history variables.ConclusionsAt Henry Ford St. John Hospital, the ERAC protocol with multimodal pain control implemented in 2021 resulted in a significant decrease in MME usage on postoperative days 1 and 2, even though there was not a significant decrease in maternal pain scores.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-07607-y.

Limited evidence exists regarding the use of factor Xa inhibitors for the treatment of venous thromboembolism (VTE) in patients with severe renal impairment. Notably, these patients were excluded from clinical trials.The goal of this study was to examine the safety and effectiveness of apixaban versus warfarin for the treatment of acute VTE in patients with severe renal impairment.This retrospective cohort study was conducted across 36 Ascension Health sites between 2014 and 2024. Adult patients receiving apixaban or warfarin for VTE treatment with severe renal impairment were included. The primary outcome was time to composite bleeding event within six months.This study included 1200 patients receiving apixaban and 600 patients receiving warfarin. Overall, 23.4% of the study population had ESRD requiring renal replacement therapy. Among patients not requiring renal replacement therapy, stage IV CKD was most common (43.8%). No difference in time to composite bleeding events (HR 1.01; 95% CI 0.74-1.38, p = 0.97) or recurrent VTE (HR 1.24; 95% CI 0.70-2.18, p = 0.46) were noted after controlling for confounders. Furthermore, major bleeding (4.7% vs. 7.5%, p = 0.43) and clinically-relevant non-major bleeding (4.3% vs. 6.2%, p = 0.08) were similar between groups. Apixaban was associated with a significantly reduced incidence of anticoagulation-related ED admission (6.8% vs. 9.8%, p = 0.02) compared to warfarin. Anticoagulation-related readmission (7.4% vs. 8%, p = 0.66) and time to all-cause mortality (5.2% vs. 6.2%, p = 0.38) were similar between groups.No differences in safety or effectiveness were noted between apixaban and warfarin, providing encouraging evidence to support the use of apixaban for treatment of acute VTE in patients with severe renal impairment.

Post-traumatic stress (PTS) symptoms are highly comorbid with substance use (i.e., alcohol, tobacco, and cannabis). Few studies have investigated potential individual-, household-, and neighborhood-level socioeconomic effect modifiers of this comorbidity in longitudinal analyses. We aim to examine interactions between this multi-level environment and PTS symptoms on future substance use behaviors. Data were drawn from the Advancing Understanding of RecOvery afteR traumA (AURORA) study, including 2943 individuals who presented to the emergency department (ED) within 72 h of a traumatic event. Frequency of tobacco, alcohol, cannabis use, and PTS symptoms were reported at 6 timepoints. Mixed effect Poisson models, clustered by state, were used to generate incidence rate ratios (IRRs) substance use, both cross-sectionally and prospectively. Moderation analysis of PTS and substance use, stratified by household income and area deprivation index (ADI), was conducted using mixed effect models and parallel process growth curves. Significant associations were observed between PTS with tobacco, alcohol, and cannabis use frequency cross-sectionally, and for tobacco and alcohol and PTS exposure prospectively. Lower income (P < 0.001) and higher deprivation (P < 0.001) were associated with tobacco use, while higher income (P < 0.001) and less deprivation (P = 0.01) were associated with increased alcohol use. We found modest modification by household income for alcohol and tobacco, and little evidence of modification by neighborhood ADI. Household income had greater evidence of effect modification for substance use, compared to neighborhood-level ADI. Our findings demonstrate that household indicators of socioeconomic status likely modify the relationship between PTS and substance use.

A hepatic abscess is the collection of suppurative matter within the parenchyma of the liver. While most pyogenic liver abscesses (PLAs) are polymicrobial in nature, some rare cases are caused by methicillin-resistant Staphylococcus aureus (MRSA). We present a case of a 43 year-old male without evident exposures who presented with abdominal pain and via CT imaging was found to have monofocal MRSA hepatic abscess. An ultrasonography (US)-guided abscess drainage along with a pigtail catheter placement was performed along with antibiotic initiation. This article emphasizes the clinical manifestations of hepatic abscesses and employs literature reviews to offer a comprehensive approach to managing these patient populations.

Pericarditis and pericardial effusion related to COVID-19can lead to cardiac tamponade. Most case reports describe these complications in middle-aged or elderly patients. This case highlights a 29-year-old healthy patient who developed cardiac tamponade requiring an emergent pericardial window within one week of COVID-19 infection. This case also highlights the utility of point-of-care ultrasound in diagnosing serious COVID-19 complications.