A Systematic Review of Complications from Pediatric Intraosseous Cannulation

“A Systematic Review of Complications from Pediatric Intraosseous Cannulation” Bouhamdan J, Polsinelli G, Akers KG, Paxton JH. Department of Emergency Medicine, Wayne State University School of Medicine (Detroit, MI) Introduction Intraosseous (IO) infusion is a commonly-used method for obtaining vascular access in emergency situations. It involves insertion of a needle into the marrow cavity of long bones, with subsequent infusion of medications and fluids to achieve resuscitation. This procedure is known to be associated with certain complications. Despite the widespread continued use of IO cannulation for pediatric subjects, a high-quality systematic review of the literature on pediatric IO complications remains lacking. Materials & Methods Several databases were searched for studies relating to IO infusion. Inclusion criteria included: English-language, original reports on the clinical treatment of human pediatric (old) patients, which reported the presence or absence of complications identified during the clinical care of the patient. Studies with IO cannulation performed under sterile operative settings were excluded. These studies were further processed on Covidence (www.covidence.org) systematic review software. Complications identified include, but are not limited to, pain, extravasation, compartment syndrome, local infections, osteomyelitis, embolism, fractures, and device failure. We are also collecting data on patient demographics, medications infused, injection site, and indication for cannulation. Results In total, 1,647 studies were imported for screening, with 762 duplicates removed. The remaining 885 studies were individually screened by abstract review, resulting in exclusion of 462 studies due to irrelevance. The remaining 423 studies are undergoing full-text review. Fifty-one studies have already been identified that appear to be suitable for inclusion and data extraction. Conclusions We anticipate this review to contribute to an improved understanding of complications associated with IO cannulation use in the pediatric population

the Cardiovascular Manifestations of COVID-19: A Review of the Literature and Institutional Experience

The cardiovascular health of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a major role in rates of hospitalization, mortality risk, and rates of mechanical ventilation. In patients with COVID-19, acute myocardial injury and history of cardiovascular disease are both independently established risk factors for poor patient prognosis. In addition to myocardial injury, numerous acute cardiovascular manifestations of COVID-19 disease have been identified. Previous work on this topic typically focused either upon a general description of the acute cardiovascular manifestations and sequalae of COVID-19, or upon broad-based clinical outcomes associated with COVID-19 in patients with history of cardiovascular and/or metabolic disease. However, the role of pre-existing cardiovascular and metabolic disease in predicting the development and severity of COVID-19-related cardiovascular complications remains unclear. We queried our institutional COVID-19 patient registry, extracting data on all patients who were tested for the presence of SARS-CoV-2 and myocardial injury from 3 March 2020 – 30 July 2020. We identified a total of 5,451 patients from our institutional COVID-19 registry who met our criteria, including 734 (13.5%) subjects ultimately confirmed to be COVID-19 positive, and 4,717 subjects confirmed to be COVID-19 negative. Those with a prior history of cardiovascular disease can have increased frequency of cardiovascular manifestations. Cardiovascular events in COVID-19 include acute myocardial injury, myocardial infarction, myocarditis, pericarditis, electrocardiogram abnormalities, acute thrombosis, and acute heart failure. Identifying underlying cardiovascular disease and evidence of myocardial injury may predict which patients should be prioritized or potentially require more aggressive management and treatment strategies

The Role of Leptin in Antipsychotic-Induced Weight Gain: Genetic and Non-Genetic Factors

Schizophrenia is a chronic and disabling mental illness affecting millions of people worldwide. A greater proportion of people with schizophrenia tends to be overweight. Antipsychotic medications have been considered the primary risk factor for obesity in schizophrenia, although the mechanisms by which they increase weight and produce metabolic disturbances are unclear. Several lines of research indicate that leptin could be a good candidate involved in pathways linking antipsychotic treatment and weight gain. Leptin is a circulating hormone released by adipocytes in response to increased fat deposition to regulate body weight, acting through receptors in the hypothalamus. In this work, we reviewed preclinical, clinical, and genetic data in order to infer the potential role played by leptin in antipsychotic-induced weight gain considering two main hypotheses: (1) leptin is an epiphenomenon of weight gain; (2) leptin is a consequence of antipsychotic-induced “leptin-resistance status,” causing weight gain

Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia

BACKGROUND: Evidence is mixed as to whether White Europeans are at a higher risk for suicide attempts or completions compared to other ethnic groups. The present analysis assessed whether risk for suicide attempt was associated with White European ethnicity in 907 subjects with schizophrenia or bipolar disorder. METHODS: Subjects were diagnosed using the Structured Clinical Interview for DSM-IV, and ethnicity was determined by self-report. Subjects were recruited from psychiatric care centers in Toronto, Canada. Logistic regression correcting for clinical covariates like age, gender and diagnosis, was used in this study. RESULTS: We found no difference in suicide attempter status in white and non-white subjects who were diagnosed with schizophrenia and bipolar disorder. CONCLUSION: Our study does not support the evidence that White-European patients in North America are at higher risk for suicide attempt compared to non-European descent subjects. However, this result has to be replicated in larger studies in patients with these disorders

Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia

Abstract Background Evidence is mixed as to whether White Europeans are at a higher risk for suicide attempts or completions compared to other ethnic groups. The present analysis assessed whether risk for suicide attempt was associated with White European ethnicity in 907 subjects with schizophrenia or bipolar disorder. Methods Subjects were diagnosed using the Structured Clinical Interview for DSM-IV, and ethnicity was determined by self-report. Subjects were recruited from psychiatric care centers in Toronto, Canada. Logistic regression correcting for clinical covariates like age, gender and diagnosis, was used in this study. Results We found no difference in suicide attempter status in white and non-white subjects who were diagnosed with schizophrenia and bipolar disorder. Conclusion Our study does not support the evidence that White-European patients in North America are at higher risk for suicide attempt compared to non-European descent subjects. However, this result has to be replicated in larger studies in patients with these disorders

Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia

BACKGROUND: Evidence is mixed as to whether White Europeans are at a higher risk for suicide attempts or completions compared to other ethnic groups. The present analysis assessed whether risk for suicide attempt was associated with White European ethnicity in 907 subjects with schizophrenia or bipolar disorder. METHODS: Subjects were diagnosed using the Structured Clinical Interview for DSM-IV, and ethnicity was determined by self-report. Subjects were recruited from psychiatric care centers in Toronto, Canada. Logistic regression correcting for clinical covariates like age, gender and diagnosis, was used in this study. RESULTS: We found no difference in suicide attempter status in white and non-white subjects who were diagnosed with schizophrenia and bipolar disorder. CONCLUSION: Our study does not support the evidence that White-European patients in North America are at higher risk for suicide attempt compared to non-European descent subjects. However, this result has to be replicated in larger studies in patients with these disorders