Percutaneous mechanical thrombectomy in acute pulmonary embolism: Outcomes from a safety-net hospital.

BACKGROUND: Our study aims to present clinical outcomes of mechanical thrombectomy (MT) in a safety-net hospital. METHODS: This is a retrospective study of intermediate or high-risk pulmonary embolism (PE) patients who underwent MT between October 2020 and May 2023. The primary outcome was 30-day mortality. RESULTS: Among 61 patients (mean age 57.6 years, 47% women, 57% Black) analyzed, 12 (19.7%) were classified as high-risk PE, and 49 (80.3%) were intermediate-risk PE. Of these patients, 62.3% had Medicaid or were uninsured, 50.8% lived in a high poverty zip code. The prevalence of normotensive shock in intermediate-risk PE patients was 62%. Immediate hemodynamic improvements included 7.4 mmHg mean drop in mean pulmonary artery pressure (-21.7%, p < 0.001) and 93% had normalization of their cardiac index postprocedure. Thirty-day mortality for the entire cohort was 5% (3 patients) and 0% when restricted to the intermediate-risk group. All 3 patients who died at 30 days presented with cardiac arrest. There were no differences in short-term mortality based on race, insurance type, citizenship status, or socioeconomic status. All-cause mortality at most recent follow up was 13.1% (mean follow up time of 13.4 ± 8.5 months). CONCLUSION: We extend the findings from prior studies that MT demonstrates a favorable safety profile with immediate improvement in hemodynamics and a low 30-day mortality in patients with acute PE, holding true even with relatively higher risk and more vulnerable population within a safety-net hospital.

A case report of Enterobacter cloacae endocarditis in a patient with a history of cotton fever.

Background: Cotton fever is a self-limited, febrile syndrome occurring after the injection of trace amounts of drugs, in particular heroin, extracted from reused cotton filters. It is characterized by non-specific findings, such as fever, tachycardia, and leucocytosis. The leading pathophysiologic explanation suggests it is the result of direct inoculation of the bloodstream with endotoxins from Gram-negative bacilli of the genus Enterobacter, known to colonize all parts of the cotton plant. Only one prior case report has suggested cotton fever as a potential risk factor of infective endocarditis (IE). Case summary: We describe a case of a 57-year-old patient with a history of intravenous heroin use complicated by self-reported episodes of cotton fever. His presentation was notable for Enterobacter cloacae IE with bilateral septic pulmonary emboli. Transthoracic echocardiography findings included new tricuspid regurgitation and two mobile echodensities on the right atrial implantable cardioverter defibrillator (ICD) lead. Despite broad antibiotic coverage and extraction of the ICD leads, the patient passed away from septic shock. Discussion: The present case report is only the second published report of endocarditis in a patient with a history of cotton fever. In both cases, bacteria of the Enterobacter genus were isolated in patients' blood cultures. This evidence supports the endotoxin theory as the leading pathophysiologic explanation for cotton fever and suggests cotton fever as a risk factor for Gram-negative IE. In the inpatient setting it informs proper antibiotic coverage, whereas in the outpatient setting it supports harm reduction interventions in the form of sterile cotton balls.

Impact of Social Support and Pain Coping Abilityon Length of Stay and Discharge Disposition following Hip and Knee Arthroplasty A Prospective Study.

INTRODUCTION: While there are many factors known to predict the outcomes of hip and knee arthroplasty procedures, there is a growing interest in predictors that take into consideration the social and psychological preparedness of patients prior to surgery. This study's aim was to determine whether patients' preoperative social support and pain catastrophizing characteristics are independently associated with the outcomes of postoperative length of stay or discharge disposition following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Data on a prospective sample of 189 THA and TKA adult patients using the pain catastrophizing scale and the medical outcomes study social support expectation score were analyzed. Demographic characteristics, such as age, gender, and race (Caucasian versus non-Caucasian), which served as covariates, were also collected. Bivariate associations between our outcome variables and covariates using Pearson's and Spearman's rank correlation coefficients and Mann Whitney U test for continuous variables (age, MOS-SSS) and Chi-squared tests for categorical variables (gender, race, ethnicity, procedure, catastrophizing) were employed. Statistical significance was set at p ≤ 0.05. Data are presented as median with range values, frequencies with percentages, or adjusted odds ratios (OR) and betas (ß) with 95% confidence intervals (CI). RESULTS: There were 73 (38.6%) patients categorized as catastrophizers. Median score for social support was 90.8 (range: 3.9 to 100). No statistically significant associations between pain catastrophizing or social support were observed for length of stay (ß: 0.03, 95% CI: - 0.24-0.31, p = 0.81; ß: - 0.002, 95% CI: - 0.010-- 0.006, p = 0.58) and discharge disposition (OR: 1.15, 95% CI: 0.51-2.55, p = 0.74; OR: 0.99, 95% CI: 0.97-1.01, p = 0.37). Significant associations with discharge to a rehabilitation facility included non-Caucasian (OR: 5.4, 95% CI: 2.4-11.8, p < 0.001) and longer length of stay (OR: 1.6, 95% CI: 1.01-2.4, p = 0.04). Female gender and non-Caucasian were associated with longer length of stay (ß: 0.3, 95% CI: 0.03-0.6, p = 0.03; and ß: 0.4, 95% CI: 0.1-0.6, p=0.008, respectively). CONCLUSION: We did not find a significant association between pain catastrophizing behavior and level of social support with length of stay or discharge disposition.