Impact of sex, race and socioeconomic status on survival after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.

OBJECTIVES: Pulmonary thromboendarterectomy (PTE) is a definitive treatment for chronic thromboembolic pulmonary hypertension. Demographic-based disparities in PTE outcomes have not been well-studied. METHODS: We reviewed all patients who underwent PTE for chronic thromboembolic pulmonary hypertension between 2009 and 2019 at our institution, tracking demographic information including self-identified race, preoperative characteristics and 2-year survival. Socioeconomic status was assessed using the zip code-linked Distressed Communities Index, a validated holistic measure of community well-being. Survival was estimated using Kaplan-Meier method and factors associated with mortality were estimated using Cox regression. RESULTS: Of 235 PTE patients, 101 (42.9%) were white and 87 (37.0%) were black. White patients had a higher median age at surgery (57 vs 51 years, P = 0.035) and a lower degree of economic distress (33.6 vs 61.2 percentile, P < 0.001). Regarding sex, 106 (45.1%) patients were male and 129 (53.6%) were female. Male patients had a higher median age (59 vs 50 years, P = 0.004), greater rates of dyslipidaemia (34% vs 20.2%, P = 0.025), a lower ejection fraction (55% vs 57%, P = 0.046) and longer cross-clamp (77 vs 67.50 min, P = 0.004) and circulatory arrest times (42 vs 37.50 min, P = 0.007). No difference was observed in unadjusted 2-year survival after PTE between patients stratified by race and sex (P = 0.35). After adjustment for clinically relevant variables, neither socioeconomic status, sex nor race were associated with mortality in Cox proportional hazard analysis. CONCLUSIONS: Sex, socioeconomic status and race were not associated with adverse outcomes after PTE in our single-centre experience.

Longitudinal Outcomes for Multisystem Inflammatory Syndrome in Children.

BACKGROUND: In spring 2020, a novel hyperinflammatory process associated with severe acute respiratory syndrome coronavirus 2 multisystem inflammatory syndrome in children (MIS-C) was described. The long-term impact remains unknown. We report longitudinal outcomes from a New York interdisciplinary follow-up program. METHODS: All children <21 years of age, admitted to NewYork-Presbyterian with MIS-C in 2020, were included. Children were followed at 1 to 4 weeks, 1 to 4 months, and 4 to 9 months postdischarge. RESULTS: In total, 45 children were admitted with MIS-C. The median time to last follow-up was 5.8 months (interquartile range 1.3-6.7). Of those admitted, 76% required intensive care and 64% required vasopressors and/or inotropes. On admission, patients exhibited significant nonspecific inflammation, generalized lymphopenia, and thrombocytopenia. Soluble interleukin (IL) IL-2R, IL-6, IL-10, IL-17, IL-18, and C-X-C Motif Chemokine Ligand 9 were elevated. A total of 80% (n = 36) had at least mild and 44% (n = 20) had moderate-severe echocardiographic abnormalities including coronary abnormalities (9% had a z score of 2-2.5; 7% had a z score > 2.5). Whereas most inflammatory markers normalized by 1 to 4 weeks, 32% (n = 11 of 34) exhibited persistent lymphocytosis, with increased double-negative T cells in 96% of assessed patients (n = 23 of 24). By 1 to 4 weeks, only 18% (n = 7 of 39) had mild echocardiographic findings; all had normal coronaries. At 1 to 4 months, the proportion of double-negative T cells remained elevated in 92% (median 9%). At 4 to 9 months, only 1 child had persistent mild dysfunction. One had mild mitral and/or tricuspid regurgitation. CONCLUSIONS: Although the majority of children with MIS-C present critically ill, most inflammatory and cardiac manifestations in our cohort resolved rapidly.

National practice patterns for the care of the patient with total joint replacement.

PURPOSE: The purpose of this study was to determine national practice patterns for common nursing procedures related to the care of total hip and total knee patients. DESIGN: This was a comparative descriptive study utilizing a survey developed by the NAON Total Joint Special Interest Group. SAMPLE: Two hundred eight-seven valid surveys were completed by NAON members. FINDINGS: An average of 226 total knee replacements (TKR) and 183 total hip replacements (THR) were performed annually per facility. Data about perioperative practices, postoperative activity practices, use of equipment, anticoagulation practices, and discharge practices (including length of stay) were collected. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of national practice patterns and incorporation of the information into clinical practice can reduce the patient's risk of unsafe or ineffective care while promoting positive patient outcomes. Nurses can use these data to adjust clinical pathways and practice standards to improve patient outcomes.

Método sencillo para determinar la presencia de Toxoplasma gondii (Eucoccidia: Sarcocystidae) en carne / Simplifie method to determinated presence of Toxoplasma gondii in meat

Presence of T. gondii in meat from several sources was determined by traditional methods and by a new simplified method in wich animals are fed meat directly without any previous treatment with artificial gastric fluid. Tissues are ground and the animals ingest them naturally. Determination of Toxoplasma in lungs or brain (as well as by specific antibody test), showed no statistically significant differences between both methods.

Susceptibilidad de la rata Sigmodon hispidus (Rodentia: Cricetidae) al Toxoplasma gondii (Eucoccidia: Sarcocystidae) / Susceptibility of Sigmodon hispidus (Rodentia: Cricetidae) to Toxoplasma gondii (Eucoccidia: Sarcocystidae)

Sigmodon hispidus, a cotton rat, was inoculated with tachyzoites or oocysts of Costa Rican strains of Toxoplasma gondii to demonstrate the resistance to this parasite, as compared with mice, hamster and white rat infection. Susceptibility to tachyzoite inoculation was higher in this animal than in white rats but lower than in the other animals. Independent to the Toxoplasma strain studied, oocyst infection was less lethal for S. hispidus when compared with mice and hamsters; the results were similar to those observed for white rats. There is a probable participation of this wild animal in the natural Toxoplasma life cycle.

Age influence in the natural resistance of white rat and mice to the protozoan Toxoplasma gondii

Groups of 1, 5, 10, 15 and 30 day old rats (Sprague Dawley) and Wistar mice were infected per os with different inocula of Toxoplasma gondii oocysts from an avirulent strain. Infection pattern was followed by determination of survival time, tissue lesions, parasite presence and serology. Although all the animals survived the total experimental period (30 day), there were important differences between both rodents regarding to Toxoplasma natural resistance. Brain cysts, as well as tachyzoites in other organs were regularly present in mice but not in rats. On the other hand, most of the organs from mice presented characteristic T. gondii lesions, while in rats a normal tissues were observed, with the exception of an acute reaction found in the brain of a 15d old animal