Calvarial lytic lesions in neurosyphilis with ocular involvement

We report a case of calvarial lytic lesions in neurosyphilis with ocular involvement. A 42-year-old woman with a past medical history of polysubstance abuse presented with recent bilateral vision loss. CT revealed numerous calvarial lytic lesions and multiple myeloma was initially suspected. Syphilis screening with RPR and confirmative CSF studies were positive for active infection. The patient was treated with Penicillin G and demonstrated clinical improvement. The objective of this study was to provide insight into a rare manifestation of syphilis with osseous involvement and encourage further discourse into establishment of standards of care for syphilitic osteomyelitis. There exist no evidence-based guidelines regarding optimal treatment route and duration, role of bone biopsy, determination of therapeutic impact, and threshold for surgical intervention in the management of syphilitic osteomyelitis

Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub-Saharan experience

BACKGROUND: Patients with tetralogy of Fallot are now surviving to adulthood with timely surgical intervention. However, many patients in low-income countries have no access to surgical intervention. This paper reports the surgical access and perioperative mortality in a sub-Saharan center that was mainly dependent on visiting teams. METHODS: We reviewed records of patients operated from January 2009 to December 2014. We examined perioperative outcomes, primarily focusing on factors associated with perioperative mortality. RESULTS: During this period, 62 patients underwent surgery. Fifty-seven (91.9%) underwent primary repair, while 5 (6.5%) underwent palliative shunt surgery. Of the five patients with shunt surgery, four ultimately underwent total repair. Eight (12.9%) patients died during the perioperative period. Factors associated with perioperative mortality include repeated preoperative phlebotomy procedures (P \u3c .001), repeated runs and long cardiopulmonary bypass time (P \u3c .001), and aortic cross-clamp time (P \u3c .001), narrow pulmonary artery (PA) valve annulus diameter (P = .022), narrow distal main PA diameter (P = .039), narrow left branch PA diameter (P = .049), and narrow right PA diameter (P = .039). Of these factors, cardiopulmonary bypass time/aortic cross-clamp time and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality. CONCLUSION: In this series of consecutive patients operated by a variety of humanitarian surgical teams, cardiopulmonary bypass time/aortic cross-clamp time, and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality risk. As some of these factors are modifiable, we suggest that they should be considered during patient selection and at the time of surgical intervention

Clinical Characteristics, Risk Factors, and Outcomes Among a Large Midwestern U.S. Cohort of Patients Hospitalized With COVID-19 Prior to Vaccine Availability

Purpose: The COVID-19 pandemic posed unprecedented demands on health care. This study aimed to characterize COVID-19 inpatients and examine trends and risk factors associated with hospitalization duration, intensive care unit (ICU) admission, and in-hospital mortality. Methods: This retrospective study analyzed patients with SARS-CoV-2 infection hospitalized at an integrated health system between February 2, 2020, and December 12, 2020. Patient characteristics and clinical outcomes were obtained from medical records. Backward stepwise logistic regression analyses were used to identify independent risk factors of ICU admission and in-hospital mortality. Cox proportional hazards models were used to evaluate relationships between ICU admission and in-hospital mortality. Results: Overall, 9647 patients were analyzed. Mean age was 64.6 ± 18 years. A linear decrease was observed for hospitalization duration (0.13 days/week, R2 = 0.71; P \u3c 0.0001), ICU admissions (0.35%/week, R2 = 0.44; P \u3c 0.001), and hospital mortality (0.16%/week, R2 = 0.31; P \u3c 0.01). Bacterial co-infections, male sex, history of chronic lung and heart disease, diabetes, and Hispanic ethnicity were identified as independent predictors of ICU admission (P \u3c 0.001). ICU admission and age of ≥65 years were the strongest independent risk factors associated with in-hospital mortality (P \u3c 0.001). The in-hospital mortality rate was 8.3% (27.4% in ICU patients, 2.6% in non-ICU patients; P \u3c 0.001). Conclusions: Results indicate that, over the pandemic’s first 10 months, COVID-19 carried a heavy burden of morbidity and mortality in older patients (\u3e 65 years), males, Hispanics, and those with bacterial co-infections and chronic comorbidities. Although disease severity has steadily declined following administration of COVID-19 vaccines along with improved understanding of effective COVID-19 interventions, these study findings reflect a “natural history” for this novel infectious disease in the U.S. Midwest