Aspiration Risk Factors in Hospitalized Patients Following Trauma

Introduction. Risk factors for aspiration are not well characterized in the trauma patient population.  Improved understanding is important due to features of this patient population that place them at high risk for morbidity and mortality with aspiration.  Methods. In a retrospective analysis of a select group of patients who suffered a traumatic injury, candidate and significant associations were identified for aspiration events. Results. Of the 146 patients analyzed, 57 (39%) had at least one documented aspiration event while 89 (60.9%) patients had none.  Multivariate logistic regression found a significant association between impaired consciousness and aspiration events (p = 0.012). Conclusions. To our knowledge, this study is a novel characterization of trauma patients likely to have experienced an aspiration event while hospitalized.  Our results suggest candidate risk factors for aspiration exist in a trauma-specific population.  Impaired consciousness is likely to show a significant association with aspiration in trauma patients in future studies

Long standing biliary colic masking chylous ascites in laparoscopic roux-en-Y gastric bypass; a case report

Abstract Background Chylous ascites is considered to be an intra-abdominal collection of creamy colored fluid with triglyceride content of > 110 mg/dL. Chylous ascites is an uncommon but serious complication of numerous surgical interventions. However, it is a rare complication of LRYGB. An internal hernia limb defect is thought to be the underlying etiology, where the hernia will cause lymphatic vessel engorgement and lymphatic extravasation. Case presentation We report a case of a 29 years old male with a 9 year history of laparoscopic Roux en y gastric bypass (LRGYB), presenting with recurrent abdominal pain for 2 months radiating to the right shoulder. Ultrasound examination revealed gallstones and the patient was subsequently admitted for laparoscopic cholecystectomy. Intraoperatively, whitish colored fluid, high in triglycerides content was aspirated. During exploration, an internal hernia limb defect was found and corrected. Conclusion Post LRGYB patients with symptoms of recurrent abdominal pain should be suspected for chylous ascites reflecting an internal hernia

Empowering the Affected – Informing Community-Based Solutions through Interviews with Survivors of Interpersonal Firearm Violence

Firearm violence remains epidemic in the United States, with interpersonal gun violence leading to significant morbidity and mortality. Interpersonal violence has strong associations with social determinants of health, and community-specific solutions are needed to address root causes. We hypothesized that open-ended interviews with survivors of interpersonal firearm violence would identify themes in individual and community-level factors that contribute to ongoing violence. Between July 2017 and November 2019, we performed a mixed-methods study in which qualitative and quantitative data were obtained from survivors of interpersonal firearm violence admitted to our urban level I trauma center. Qualitative data were obtained through semistructured, open-ended interviews with survivors. Quantitative data were obtained via survey responses provided to these same individuals. Qualitative and quantitative data were then used to triangulate and strengthen results. During the study period, 51 survivors were enrolled in the study. The most common cause of firearm violence reported by survivors was increased gang and drug activity (n = 40, 78%). The most common solution expressed was to reduce drug and gang lifestyle by offering jobs and educational opportunities to afflicted communities to improve opportunities (n = 35, 69%). Nearly half of the survivors (n = 23, 45%) believe that firearm violence should be dealt with by the affected community itself, and another group of survivors believe that it should be through partnership between the community and trauma centers (n = 19, 37%). Interviews with survivors of firearm violence at our urban level I trauma center suggest that drug and gang lifestyle perpetuate ongoing violence and that this would best be overcome by improving access to quality education and job opportunities. To address endemic firearm violence in their communities, trauma centers should identify opportunities to partner in developing programs that provide improved education, job access, and conflict mediation. Prognostic and epidemiological, level I