Hospitalized COVID-19 patients treated with convalescent plasma in a mid-size city in the Midwest

BACKGROUND

SARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge.

METHODS

Hospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively.

RESULTS

31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion.

CONCLUSION

Our results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.

Volatile anesthesia for a pediatric patient with very long-chain acyl-coenzyme A dehydrogenase deficiency: A case report

We report the case of a 3-year-old boy with very long-chain acyl-coenzyme A dehydrogenase deficiency presenting for adenotonsillectomy who was successfully and safely managed with a balanced anesthetic including sevoflurane. The anesthetic management is described, and the controversy surrounding volatile anesthetics in these patients is discussed.

Gender Diversity in Anesthesiology Programs: The Role of Current Residents and Department Leadership in the 2014 Match Results

BACKGROUND

Nearly half of graduates of American medical colleges are women, yet the percentage of women entering accredited anesthesiology programs remains less than 40%. There are obviously many factors that influence the choice of a residency training program, from geography to reputation to the atmosphere, composition and camaraderie of the department. We examined whether a greater number of current female residents, a female Chair, or a female Program Director were associated with a program matching a greater number of female candidates in the 2014 NRMP Match.

METHODS

An electronic questionnaire was sent to all 132 ACGME-accredited anesthesiology programs immediately following the 2014 Match seeking information on the gender mix of their current residents, the gender of the Chair and Program Director, and the gender composition of their newly-matched candidates.

RESULTS

The percentage of current female residents was significantly associated with the percentage of incoming female residents (p = 0.013). There was no association between the percentage of new female residents obtained in the Match and the presence of a female Chair or Program Director.

CONCLUSIONS

The results of the 2013 NRMP anesthesiology match indicate that programs with a higher proportion of female residents were able to sustain that diversity and successfully match a higher percentage of female candidates. No correlation was seen with Chair and Program Director gender, suggesting further work is needed to define the influence of female role models on female applicants' choice of anesthesiology residency programs.

Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients

We hypothesized that prior colonization with antibiotic-resistant Gram-negative bacteria is associated with increased risk of subsequent antibiotic-resistant Gram-negative bacteremia among cancer patients. We performed a matched case-control study. Cases were cancer patients with a blood culture positive for antibiotic-resistant Gram-negative bacteria. Controls were cancer patients with a blood culture not positive for antibiotic-resistant Gram-negative bacteria. Prior colonization was defined as any antibiotic-resistant Gram-negative bacteria in surveillance or non-sterile-site cultures obtained 2-365 days before the bacteremia. Thirty-two (37%) of 86 cases and 27 (8%) of 323 matched controls were previously colonized by any antibiotic-resistant Gram-negative bacteria. Prior colonization was strongly associated with antibiotic-resistant Gram-negative bacteremia (odds ratio [OR] 7.2, 95% confidence interval [CI] 3.5-14.7) after controlling for recent treatment with piperacillin-tazobactam (OR 2.5, 95% CI 1.3-4.8). In these patients with suspected bacteremia, prior cultures may predict increased risk of antibiotic-resistant Gram-negative bacteremia.