1
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Ali K, Cho NY, Tran Z, Kim S, Sakowitz S, Curry J, Balian J, Benharash P. Trends and associated outcomes of fat embolism after trauma surgery. Surgery 2024; 176:492-498. [PMID: 38811327 DOI: 10.1016/j.surg.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Fat embolism is a life-threatening complication often occurring in patients with traumatic injuries. However, temporal trends and perioperative outcomes of fat embolism remain understudied. Using a nationally representative cohort, we aimed to characterize temporal trends of fat embolism and its associated resource utilization in operatively managed trauma patients. METHODS All patients (≥18 years) undergoing any major operations after traumatic injuries were tabulated using the 2005 to 2020 National Inpatient Sample. Patients were stratified into those with fat embolism and those without. Multivariable logistic and linear regressions were developed to assess the association between fat embolism and outcomes of interest. RESULTS Of an estimated 10,600,000 hospitalizations, 7,479 (0.07%) patients had fat embolism. Compared to the non-fat embolism cohort, the fat embolism cohort was younger (55 [26-79] vs 69 [49-82] years, standard mean difference = 0.46) and more likely to receive treatment at a high-volume trauma center (42.9 vs 33.7%, standard mean difference = 0.19). Over the study period, there was an increase in annual mortality and hospitalization costs among the fat embolism group (nptrend <0.001). After risk adjustment, fat embolism was associated with greater odds of mortality (adjusted odds ratio: 2.65, 95% confidence interval: 2.24-3.14) compared to others. Additionally, fat embolism was associated with increased odds of cerebrovascular, infectious, and renal complications. CONCLUSION Among all operatively managed trauma patients, those who developed fat embolism had increased mortality, rates of complications, length of stay, and costs. Optimization of early and accurate identification of fat embolism is warranted to mitigate complications and improve resource allocation among trauma patients.
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Affiliation(s)
- Konmal Ali
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Nam Yong Cho
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Zachary Tran
- Department of Surgery, Loma Linda University Health, Loma Linda, CA
| | - Shineui Kim
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sara Sakowitz
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joanna Curry
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jeffrey Balian
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Peyman Benharash
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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2
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Owattanapanich N, Lewis M, Biswas S, Benjamin ER, Demetriades D. Epidemiology and risk factors for fat embolism in isolated lower extremity long bone fractures. Eur J Trauma Emerg Surg 2024; 50:1775-1781. [PMID: 38630127 DOI: 10.1007/s00068-024-02516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/30/2024] [Indexed: 10/08/2024]
Abstract
PURPOSE Fat embolism syndrome (FES) is a serious complication after orthopedic trauma. The aim of this study was to identify risk factors for FES in isolated lower extremity long bone fractures. METHODS The National Trauma Data Bank "NTDB" study included patients with isolated femoral and tibial fractures. A total of 344 patients with FES were propensity score matched with 981 patients without FES. Multivariate logistical regression was used to identify independent risk factors for FES. RESULTS FES was diagnosed in 344 (0.03%) out of the 1,251,143 patients in the study populations. In the two matched groups, the mortality was 7% in the FES group and 1% in the No FES group (p < 0.001). FES was associated with an increased risk of ARDS, VTE, pneumonia, AKI, and stroke. Younger age, femur fractures, obesity, and diabetes mellitus were independent predictors of FES. Early operative fixation (≤ 48 h) was protective against FES. CONCLUSION FES increases mortality by seven times. Young age, obesity, and diabetes mellitus are significant independent risk factors for FES. Early fixation is independently associated with a reduced risk of FES. LEVEL OF EVIDENCE Level III. STUDY TYPE Prognostic study.
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Affiliation(s)
- Natthida Owattanapanich
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, University of Southern California, Los Angeles, CA, USA
- Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Meghan Lewis
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Subarna Biswas
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth R Benjamin
- Department of Surgery, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, University of Southern California, Los Angeles, CA, USA.
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Takagi K, Saitoh D, Nakagawa K, Inoue H, Takeuchi H, Takyu H, Tanaka H. Alcohol-Intoxicated Patients With Blunt Trauma and Head Injuries Have Better Outcomes Than Sober Patients. Cureus 2024; 16:e63044. [PMID: 39050351 PMCID: PMC11268456 DOI: 10.7759/cureus.63044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Although alcohol-intoxicated patients have difficulties evaluating their consciousness level and being transported prehospital, there is some evidence that the survival outcomes for alcohol-intoxicated patients with head injuries are better. The present study evaluated whether the survival and brain function outcomes in alcohol-intoxicated trauma patients with head injuries were better than those in sober patients using the Japan Trauma Data Bank (JTDB), a nationwide trauma registry in Japan. METHODS The 17,823 patients with blunt trauma, including head injuries, who were registered in the JTDB database between January 2019 and December 2021 were retrospectively analyzed. Logistic regression analyses were performed for in-hospital survival in patients with blunt trauma, including those with head injuries, and for good brain function based on the Glasgow outcome scale (GOS) in patients with only head injuries. Survival rates by head injury score using the abbreviated injury scale (AIS) 2008 or injury severity score (ISS) categories were compared between drinking and nondrinking groups. RESULTS Drinking significantly affected survival (odds ratio 1.800, p<0.001) and good brain function (odds ratio 1.546, p<0.001), as indicated by logistic regression analysis using head injuries alone or blunt multisite trauma (including head injuries), respectively. According to analyses by the ISS category or head AIS score, there were significant differences between the drinking and non-drinking groups in several categories (ISS 9-15, 16-24, and 25-40 and AIS 3 and 5) regarding survival rates with blunt trauma, including head injuries, or good GOS rates with head injuries alone. CONCLUSIONS The survival rates for blunt trauma, including head injuries, and the prognosis for brain function based on the GOS were better in the drinking group than in the control group for cases with head injuries alone. A multivariate analysis also showed that alcohol consumption was significantly associated with better outcomes.
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Affiliation(s)
- Kazuhiko Takagi
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, JPN
- Department of Paramedicine, Shinjuku Fire Station, Tokyo Fire Department, Tokyo, JPN
| | - Daizoh Saitoh
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, JPN
| | - Koshi Nakagawa
- Department of Integrated Science and Engineering for Sustainable Societies, Faculty of Science and Engineering, Chuo University, Tokyo, JPN
| | - Hironori Inoue
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, JPN
| | - Hidekazu Takeuchi
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, JPN
| | - Hiroshi Takyu
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, JPN
| | - Hideharu Tanaka
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, JPN
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4
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Bentaleb M, Abdulrahman M, Ribeiro-Junior MAF. Fat embolism: the hidden murder for trauma patients! Rev Col Bras Cir 2024; 51:e20243690. [PMID: 38716918 PMCID: PMC11185067 DOI: 10.1590/0100-6991e-20243690-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/08/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations. METHODS we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma. RESULTS the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community. CONCLUSION to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.
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Affiliation(s)
- Malak Bentaleb
- - College of Medicine and Health Sciences, Khalifa University, Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
| | - Mohammed Abdulrahman
- - College of Medicine and Health Sciences, Khalifa University, Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
| | - Marcelo Augusto Fontenelle Ribeiro-Junior
- - College of Medicine and Health Sciences, Khalifa University, Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
- - Sheikh Shakhbout Medical City, Division of Trauma, Critical Care and Acute Care Surgery - Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
- - PUC-Sorocaba, Disciplina de Cirurgia Geral e do Trauma - Sorocaba - SP - Brasil
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5
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Cruz-Kan K, Jelic T. Maintaining screen awareness: the identification of fat embolism with point-of-care ultrasound while performing a nerve block. CAN J EMERG MED 2024; 26:359-361. [PMID: 38143249 DOI: 10.1007/s43678-023-00635-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Kanisha Cruz-Kan
- Department of Emergency Medicine, University of Manitoba (Bannatyne Campus), S203 Medical Services Building, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W2, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba (Bannatyne Campus), S203 Medical Services Building, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W2, Canada.
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Tzilas V, Roussis I, Sakellaropoulou K, Chrysikos S, Hillas G, Ryu JH. A 68-Year-Old Patient With Dyspnea and Hypoxemia After Total Hip Arthroplasty. Chest 2023; 164:e107-e110. [PMID: 37805247 DOI: 10.1016/j.chest.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/09/2023] [Accepted: 04/29/2023] [Indexed: 10/09/2023] Open
Abstract
CASE PRESENTATION A 68-year-old patient with obesity (BMI, 4 7 kg/m2) was transferred to the ED of our hospital because of dyspnea and pronounced hypoxemia. The patient underwent total right hip arthroplasty in an outside hospital because of osteoarthritis; there was no history of trauma. After 48 h, she experienced dyspnea with severe hypoxemia. The next day she was transferred to our hospital. Her history was notable for arterial hypertension and depression, but not heart failure. Her medications included candesartan (16 mg once daily) and sertraline (100 mg once daily). Perioperatively, she received enoxaparin 4.000 International Units subcutaneously once daily. There was no family history of respiratory diseases. The patient currently smokes (50 pack-years) with no recent increase in her habit and denied vaping, alcohol consumption, illicit drug use, and any home or occupational exposures. Prior to surgery, the family of the patient reported that she maintained modest mobility despite her osteoarthritis and was able to fulfill her daily activities. Interestingly, she reported a similar event of severe dyspnea and hypoxemia after total knee arthroplasty 3 years earlier; however, no further details were available.
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Affiliation(s)
- Vasilios Tzilas
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria," Athens Greece.
| | - Ioannis Roussis
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria," Athens Greece
| | | | - Serafeim Chrysikos
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria," Athens Greece
| | - Georgios Hillas
- 5th Respiratory Department, Chest Diseases Hospital "Sotiria," Athens Greece
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Komori A, Iriyama H, Kainoh T, Aoki M, Abe T. Association between intra-abdominal injured organs and abdominal compartment syndrome in patients with severe blunt trauma: A propensity score matched study using nationwide trauma registry in Japan. PLoS One 2023; 18:e0286124. [PMID: 37220117 DOI: 10.1371/journal.pone.0286124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Abdominal compartment syndrome (ACS) after blunt abdominal trauma is a rare complication that requires early recognition and subsequent surgical intervention for optimal outcome. We aimed to investigate how differences in injured abdominal organs affect ACS development in patients with severe blunt abdominal trauma. METHODS This nested case-control study used a nationwide registry of trauma patients, namely, the Japan Trauma Data Bank (JTDB), and only included patients aged ≥ 18 years with blunt severe abdominal trauma, defined as an AIS score of abdomen ≥ 3, sustained between 2004 and 2017. Patients without ACS were used as control subjects and identified using propensity score (PS) matching. Characteristics and outcomes between patients with and without ACS were compared and logistic regression was used to identify specific risk factors for ACS. RESULTS Among 294,274 patients in the JTDB, 11,220 were eligible for inclusion before PS matching, and 150 (1.3%) developed ACS after trauma. PS matching led to the inclusion of 131 and 655 patients with and without ACS, respectively. Compared to controls, patients with ACS had higher number of injured organs in the abdomen and displayed a greater frequency of vascular and pancreatic injuries, need for blood transfusion, and disseminated intravascular coagulopathy, a complication of ACS. In-hospital mortality was higher in patients with ACS than those without ACS (51.1% vs. 26.0%, p < 0.01). Logistic regression analysis revealed that a higher number of injured organs in the abdomen [odds ratio (OR) (95% confidence interval [CI]): 1.76 (1.23-2.53)] and pancreatic injury [OR (95% CI): 1.53 (1.03-2.27)] were independently associated with ACS. CONCLUSIONS Greater number of injured organs in abdomen and pancreatic injury are independent risk factors for the development of ACS.
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Affiliation(s)
- Akira Komori
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroki Iriyama
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takako Kainoh
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Makoto Aoki
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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8
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Bassell-Hawkins J, Suresh NE, Mahoney D, Van Hentenryck M, Csortan A, Pena D, Cornfield DN. Fat Embolism Syndrome After Knee Arthroscopy in a Pediatric Patient. Chest 2023; 163:e107-e110. [PMID: 36894263 PMCID: PMC10154858 DOI: 10.1016/j.chest.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 03/09/2023] Open
Abstract
Fat embolism syndrome describes a constellation of symptoms that follow an insult and that results in a triad of respiratory distress, neurologic symptoms, and petechia. The antecedent insult usually entails trauma or orthopedic procedure, most frequently involving long bone (especially the femur) and pelvic fractures. The underlying mechanism of injury remains unknown but entails biphasic vascular injury with vascular obstruction from fat emboli followed by an inflammatory response. We present an unusual case of a pediatric patient with acute onset of altered mental status, respiratory distress, hypoxemia, and subsequent retinal vascular occlusions after knee arthroscopy and lysis of adhesions. Diagnostic findings most supportive of the fat embolism syndrome included anemia, thrombocytopenia, pulmonary parenchymal, and cerebral pathologic findings on imaging studies. This case highlights the importance of fat embolism syndrome as a diagnostic consideration after an orthopedic procedure, even absent major trauma or long bone fracture.
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Affiliation(s)
| | - Nina E Suresh
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - David Mahoney
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | | | - Alexandra Csortan
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Diana Pena
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - David N Cornfield
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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9
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Gearhart S, Nguyen A, Vance AZ. Cerebral Fat Embolism Syndrome in a Patient With an Aortic Dissection and Orthopedic Injuries: A Case Report. Cureus 2023; 15:e34500. [PMID: 36874307 PMCID: PMC9981479 DOI: 10.7759/cureus.34500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/22/2023] [Indexed: 02/04/2023] Open
Abstract
Traumatic brain injury is a significant cause of morbidity and mortality in adults and can be associated with severe secondary complications, including post-traumatic cerebral infarction. One potential cause of post-traumatic cerebral infarction is cerebral fat embolism syndrome (FES). We present a case in which a male in his twenties was involved in a motorcycle collision with a truck. He sustained numerous injuries, including bilateral femur fractures, left acetabular, open left tibial and fibular fractures, and a type A aortic dissection. Before orthopedic fixation, his Glasgow Coma Score (GCS) was 10. Following open reduction and internal fixation, his GCS was noted to be 4, with a stable computed tomography scan of the head. The differential included embolic strokes related to his dissection, an unrecognized cervical spine injury, and cerebral FES. Stat magnetic resonance imaging of the head demonstrated a starfield pattern of restricted diffusion consistent with cerebral FES. An intracranial pressure (ICP) monitor was placed, and his ICP acutely spiked to over 100 mmHg despite maximal medical management. This case highlights several key learning points, namely, that cerebral FES should remain in the mind of any physician treating high-energy multisystem traumas. While it is a rare syndrome, its effects can lead to significant morbidity and mortality as treatment is controversial and can conflict with the treatment of other systemic injuries. Further research into prevention and treatment is warranted to continue optimizing outcomes following cerebral FES.
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Affiliation(s)
- Samuel Gearhart
- Neurosurgery, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Anthony Nguyen
- Neurosurgery, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Awais Z Vance
- Neurosurgery, Baylor Scott & White Medical Center - Temple, Temple, USA
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10
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Guo P, Rao T, Han W, Liang L, Ji H, Liu H, Lu Q. Use of VA-ECMO successfully rescued a trauma patient with fat embolism syndrome complicated with acute heart failure and acute respiratory distress syndrome. World J Emerg Med 2023; 14:332-334. [PMID: 37425078 PMCID: PMC10323504 DOI: 10.5847/wjem.j.1920-8642.2023.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/03/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Pengchao Guo
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Taiwen Rao
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wen Han
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Licai Liang
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Hongjue Ji
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Hong Liu
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Qin Lu
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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11
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Martens S, De Wit M, De Grim L. Dyspnea after endomedullary nailing: Fat embolism. Clin Case Rep 2022; 10:e6788. [PMID: 36583198 PMCID: PMC9792644 DOI: 10.1002/ccr3.6788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/28/2022] Open
Abstract
Fat embolism is a well-known and life-threatening condition that can develop after long bone fractures and lower limb orthopedic surgery. It presents in a wide range of respiratory, hematological, neurological, and cutaneous symptoms and signs of varying severity, resulting from embolic showering. It is important for clinicians to have a high index of suspicion for fat embolism in patients with respiratory compromise postoperatively. Rapid recognition and supportive treatment are key in improving the outcome of these patients. The prognosis is usually good, except in fulminant fat embolism syndrome.
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Affiliation(s)
| | - Marcia De Wit
- Department of emergency MedicineHospital AZ VoorkempenMalleBelgium
| | - Laurens De Grim
- Department of emergency MedicineHospital AZ VoorkempenMalleBelgium
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12
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Ding YJ, Zhang L, Sun XW, Lin YN, Li QY. Rapid recovery of fat embolism syndrome with acute respiratory failure due to liposuction. Respirol Case Rep 2022; 10:e01047. [PMID: 36213214 PMCID: PMC9527506 DOI: 10.1002/rcr2.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/19/2022] [Indexed: 11/11/2022] Open
Abstract
Liposuction is not a risk-free procedure and potentially fatal complications may occur, especially liposuction-induced fat embolism syndrome (FES). Here we report the case of a 29-year-old woman who developed FES suddenly during a liposuction operation in a cosmetic medical clinic. She was transferred to the hospital and achieved complete recovery within 11 days by comprehensive therapeutic strategies, including noninvasive ventilation (NIV), corticosteroids, albumin, diuretics and anticoagulation. Liposuction-induced FES is a life-threatening condition, which can be treated with complate recovery by comprehensive therapeutic strategies according to its pathophysiologic mechanism.
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Affiliation(s)
- Yong Jie Ding
- Department of Respiratory and Critical Care MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Respiratory DiseasesShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious DiseasesShanghaiChina
| | - Liu Zhang
- Department of Respiratory and Critical Care MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Respiratory DiseasesShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious DiseasesShanghaiChina
| | - Xian Wen Sun
- Department of Respiratory and Critical Care MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Respiratory DiseasesShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious DiseasesShanghaiChina
| | - Ying Ni Lin
- Department of Respiratory and Critical Care MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Respiratory DiseasesShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious DiseasesShanghaiChina
| | - Qing Yun Li
- Department of Respiratory and Critical Care MedicineRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Respiratory DiseasesShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious DiseasesShanghaiChina
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13
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Ibekwe SO, Potluri V, Palvadi R, Best GT. Use of Point-of-Care Ultrasound and Focus-Assessed Transthoracic Echocardiography to Diagnose Acute Right Heart Failure Due to Fat Emboli in a Parturient. Cureus 2022; 14:e28585. [PMID: 36185894 PMCID: PMC9521511 DOI: 10.7759/cureus.28585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
Fat embolism syndrome (FES), causing right heart dysfunction, is a rare disease that is often difficult to diagnose with imaging modalities such as computed tomography (CT). FES is the clinical presentation that follows the entry of fat globules into the systemic circulation, which typically results in respiratory failure, scattered petechiae, cardiovascular collapse, and neurological sequelae. It is mostly observed in the cases of orthopedic trauma but may occur in any circumstance where fat can enter the circulatory system. In this case report, the authors describe an atypical presentation of FES in a 24-week parturient. The use of bedside point-of-care ultrasonography (POCUS) and the focus-assessed transthoracic echocardiography (FATE) protocol aided in the prompt diagnosis of right heart failure and helped to confirm the diagnosis of FES with more advanced imaging technology.
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14
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Tsai SHL, Chen CH, Tischler EH, Kurian SJ, Lin TY, Su CY, Osgood GM, Mehmood A, Fu TS. Fat Embolism Syndrome and in-Hospital Mortality Rates According to Patient Age: A Large Nationwide Retrospective Study. Clin Epidemiol 2022; 14:985-996. [PMID: 36017328 PMCID: PMC9397531 DOI: 10.2147/clep.s371670] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Fat embolism syndrome (FES) is a rare life-threatening condition that can develop after traumatic orthopedic injuries. Controversy remains concerning the epidemiology in the elderly population. Therefore, this study aims to report FES related to in-hospital mortality stratified by age. Methods A retrospective trauma cohort study was conducted using data from the National Trauma Data Bank (NTDB) from 2007 to 2014. All FES cases were included in the study with the diagnosis of FES (ICD9 958.1). Death on arrival cases were excluded. Patients were stratified by age cohort: less than 40 (G1), 40–64 (G2), and greater than 65 (G3) years of age. The primary outcome evaluated was in-hospital mortality. Multivariable regression models were performed to adjust for potential confounders. Results Between 2007 and 2014, 451 people from a total of 5,836,499 trauma patients in the NTDB met the inclusion criteria. The incidence rate was 8 out of 100,000. The inpatient mortality rate was 11.8% for all subjects with the highest mortality rate of 17.6% in patients over 65. Multivariable analyses demonstrated that age greater than 65 years was an independent predictor of mortality (aOR 24.16, 95% CI 3.73, 156.59, p=0.001), despite higher incidence and injury severity of FES among patients less than 40. No significant association with length of hospital stay, length of intensive unit care, or length of ventilation use was found between the groups. Subgroup analysis of the elderly population also showed a higher mortality rate for FES in femoral neck fracture patients (18%) than other femoral fractures (14%). Conclusion In this retrospective cohort analysis, old age (≥ 65 years) was found to be an independent risk factor for in-hospital mortality among fat embolism syndrome patients. Elderly patients specifically with femoral neck fractures should be monitored for the development of FES.
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Affiliation(s)
- Sung Huang Laurent Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung, 204, Taiwan.,School of medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chien-Hao Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung, 204, Taiwan.,School of medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Eric H Tischler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Shyam J Kurian
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Tung-Yi Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung, 204, Taiwan.,School of medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chun-Yi Su
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung, 204, Taiwan.,School of medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Greg Michael Osgood
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amber Mehmood
- University of South Florida College of Public Health,Tampa, FL, USA
| | - Tsai-Sheng Fu
- School of medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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15
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Sekine Y, Saitoh D, Terayama T, Nakamura T, Nemoto M. The survival rate of patients with burns induced by explosions was significantly higher than that of common burn cases: A nationwide observational study using the Japan Trauma Data Bank. Burns 2022:S0305-4179(22)00203-0. [DOI: 10.1016/j.burns.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
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16
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Chen CH, Wu YC, Li YC, Tsai FA, Li JY, Wang JS, Lee CH. Factors Associated with Postoperative Lipiduria and Hypoxemia in Patients Undergoing Surgery for Orthopedic Fractures. Front Surg 2022; 9:814229. [PMID: 35574529 PMCID: PMC9096020 DOI: 10.3389/fsurg.2022.814229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
We investigated factors associated with postoperative lipiduria and hypoxemia in patients undergoing surgery for orthopedic fractures. We enrolled patients who presented to our emergency department due to traumatic fractures between 2016 and 2017. We collected urine samples within 24 h after the patients had undergone surgery to determine the presence of lipiduria. Hypoxemia was defined as an SpO2 <95% determined with a pulse oximeter during the hospitalization. Patients’ anthropometric data, medical history, and laboratory test results were collected from the electronic medical record. Logistic regression analyses were used to determine the associations of clinical factors with postoperative lipiduria and hypoxemia with multivariate adjustments. A total of 144 patients were analyzed (mean age 51.3 ± 22.9 years, male 50.7%). Diabetes (odd ratio 3.684, 95% CI, 1.256–10.810, p = 0.018) and operation time (odd ratio 1.005, 95% CI, 1.000–1.009, p = 0.029) were independently associated with postoperative lipiduria, while age (odd ratio 1.034, 95% CI, 1.003–1.066, p = 0.029), body mass index (odd ratio 1.100, 95% CI, 1.007–1.203, p = 0.035), and operation time (odd ratio 1.005, 95% CI, 1.000–1.010, p = 0.033) were independently associated with postoperative hypoxemia. We identified several factors independently associated with postoperative lipiduria and hypoxemia in patients with fracture undergoing surgical intervention. Operation time was associated with both postoperative lipiduria and hypoxemia, and we recommend that patients with prolonged operation for fractures should be carefully monitored for clinical signs related to fat embolism syndrome.
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Affiliation(s)
- Chih-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopedic surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yun-Che Wu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Li
- Department of Pathology & Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Feng-An Tsai
- Department of Pathology & Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jen-Ying Li
- Department of Pathology & Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Sing Wang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Correspondence: Jun-Sing Wang Cheng-Hung Lee
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan
- Correspondence: Jun-Sing Wang Cheng-Hung Lee
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17
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Cibulas MA, Carrillo EH, Lee SK, Rosenthal AA. Cerebral Fat Embolism via a Patent Foramen Ovale. Am Surg 2022; 88:1534-1536. [PMID: 35333625 DOI: 10.1177/00031348221082270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fat embolism syndrome (FES) is a multisystem process predominantly secondary to long bone/pelvic fractures and orthopedic procedures. A 19-year-old man presents after motor vehicle collision with trace right pneumothorax, right grade 3 kidney laceration, left pubic rami, and right femoral shaft fractures. Right femur closed reduction ensued and he underwent intramedullary nailing; his other injuries were managed nonoperatively. Upon awakening in recovery, he was newly aphasic. Despite negative repeat CT brain, he continued to worsen and became tachycardic and hypoxemic. MRI/MRA brain demonstrated innumerable bilateral frontal, parietal, and occipital acute ischemic infarcts in a starfield pattern. Echocardiogram revealed a PFO. With supportive care, he improved and was discharged with planned outpatient PFO closure. One month later, he had complete symptom resolution with return to neurologic baseline. FES is a potentially devastating condition which may include cerebral fat embolism (CFE) with outcomes varying widely from mortality to complete recovery.
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Affiliation(s)
- Megan A Cibulas
- Department of Surgery, 3932Memorial Healthcare System General Surgery Residency Program, Hollywood, FL, USA
| | - Eddy H Carrillo
- Division of Trauma and Acute Care Surgery, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Seong K Lee
- Division of Trauma and Acute Care Surgery, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Andrew A Rosenthal
- Division of Trauma and Acute Care Surgery, 3933Memorial Healthcare System, Hollywood, FL, USA
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18
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Cunha AAD, Nazima MTST, Castilho-Martins EA. Covid-19 among the Brazilian Amazon indigenous people: factors associated with death. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210368en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This case-control study paired by gender and age analyzes factors associated with the death of indigenous people from COVID-19 in the state of Amapá, Brazil. Data were collected from a public secondary database produced by the Amapá State Department of Health. Cases (n=29) were deaths of indigenous people from COVID-19 and controls were cures of the disease (n=87), recorded between April 2020 and January 2021. Data from individuals with active disease were excluded. Univariate analysis followed by multiple logistic regression were performed to study the independent variables associated with death. Most cases of death were women (51.7%), without comorbidities (62.1%), residing in cities of the Metropolitan Region of Macapá (RMM) (65.5%) and in urban areas (89.7%). Median age of the death group was 72 years (interquartile range=21.5). The final multiple model showed that indigenous individuals with cardiovascular comorbidity had a 4.01 times greater chance (95% confidence interval - 95% CI=1.05-15.36) of death by COVID-19 when compared with indigenous people without comorbidities. And that indigenous people residing in the RMM had a 2.90 times greater chance (95%CI = 1.10-7.67) of death when compared with indigenous residing in the countryside.
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Affiliation(s)
- Arthur Arantes da Cunha
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil
| | - Maira Tiyomi Sacata Tongu Nazima
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil
| | - Emerson Augusto Castilho-Martins
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil
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19
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Cunha AAD, Nazima MTST, Castilho-Martins EA. Covid-19 entre indígenas na Amazônia brasileira: fatores associados ao óbito. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210368pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo objetiva analisar fatores associados ao óbito de indígenas pela covid-19 no estado do Amapá, Brasil. Trata-se de um estudo caso-controle emparelhado por sexo e idade, que utilizou um banco de dados secundários público, produzido pela Secretaria de Estado da Saúde do Amapá. Os casos (n=29) foram óbitos de indígenas pela covid-19 e os controles foram curas da doença (n=87), registrados entre abril de 2020 e janeiro de 2021. Dados de indivíduos com doença ativa foram excluídos da análise. Foram realizadas análises univariadas seguidas por regressão logística múltipla para estudo das variáveis independentes associadas ao desfecho de óbito. A maioria dos casos de óbito era do sexo feminino (51,7%), sem comorbidades (62,1%), residentes em municípios da Região Metropolitana de Macapá (RMM) (65,5%) e em área urbana (89,7%). A mediana das idades do grupo de óbitos foi de 72 anos (intervalo interquartil= 21,5). O modelo múltiplo final demonstrou que indígenas com comorbidade cardiovascular apresentaram chance 4,01 vezes (intervalo de confiança de 95% - IC 95%= 1,05-15,36) maior de óbito pela covid-19 quando comparados a indígenas sem comorbidades. E que indígenas residentes na RMM apresentaram chance 2,90 vezes (IC 95%= 1,10-7,67) maior de óbito quando comparados aos indígenas residentes no interior do estado Amapá.
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Affiliation(s)
- Arthur Arantes da Cunha
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil
| | - Maira Tiyomi Sacata Tongu Nazima
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil
| | - Emerson Augusto Castilho-Martins
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil
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20
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Kadar A, Shah VS, Mendoza DP, Lai PS, Aghajan Y, Piazza G, Camargo EC, Viswanathan K. Case 39-2021: A 26-Year-Old Woman with Respiratory Failure and Altered Mental Status. N Engl J Med 2021; 385:2464-2474. [PMID: 34936743 DOI: 10.1056/nejmcpc2107355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Aran Kadar
- From the Department of Pulmonary and Critical Care Medicine, Newton-Wellesley Hospital, Newton (A.K.), and the Department of Pulmonary and Critical Care Medicine, Tufts Medical School (A.K.), the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Massachusetts General Hospital, the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Harvard Medical School, and the Department of Medicine, Brigham and Women's Hospital (G.P.), Boston - all in Massachusetts
| | - Viral S Shah
- From the Department of Pulmonary and Critical Care Medicine, Newton-Wellesley Hospital, Newton (A.K.), and the Department of Pulmonary and Critical Care Medicine, Tufts Medical School (A.K.), the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Massachusetts General Hospital, the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Harvard Medical School, and the Department of Medicine, Brigham and Women's Hospital (G.P.), Boston - all in Massachusetts
| | - Dexter P Mendoza
- From the Department of Pulmonary and Critical Care Medicine, Newton-Wellesley Hospital, Newton (A.K.), and the Department of Pulmonary and Critical Care Medicine, Tufts Medical School (A.K.), the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Massachusetts General Hospital, the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Harvard Medical School, and the Department of Medicine, Brigham and Women's Hospital (G.P.), Boston - all in Massachusetts
| | - Peggy S Lai
- From the Department of Pulmonary and Critical Care Medicine, Newton-Wellesley Hospital, Newton (A.K.), and the Department of Pulmonary and Critical Care Medicine, Tufts Medical School (A.K.), the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Massachusetts General Hospital, the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Harvard Medical School, and the Department of Medicine, Brigham and Women's Hospital (G.P.), Boston - all in Massachusetts
| | - Yasmin Aghajan
- From the Department of Pulmonary and Critical Care Medicine, Newton-Wellesley Hospital, Newton (A.K.), and the Department of Pulmonary and Critical Care Medicine, Tufts Medical School (A.K.), the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Massachusetts General Hospital, the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Harvard Medical School, and the Department of Medicine, Brigham and Women's Hospital (G.P.), Boston - all in Massachusetts
| | - Gregory Piazza
- From the Department of Pulmonary and Critical Care Medicine, Newton-Wellesley Hospital, Newton (A.K.), and the Department of Pulmonary and Critical Care Medicine, Tufts Medical School (A.K.), the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Massachusetts General Hospital, the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Harvard Medical School, and the Department of Medicine, Brigham and Women's Hospital (G.P.), Boston - all in Massachusetts
| | - Erica C Camargo
- From the Department of Pulmonary and Critical Care Medicine, Newton-Wellesley Hospital, Newton (A.K.), and the Department of Pulmonary and Critical Care Medicine, Tufts Medical School (A.K.), the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Massachusetts General Hospital, the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Harvard Medical School, and the Department of Medicine, Brigham and Women's Hospital (G.P.), Boston - all in Massachusetts
| | - Kartik Viswanathan
- From the Department of Pulmonary and Critical Care Medicine, Newton-Wellesley Hospital, Newton (A.K.), and the Department of Pulmonary and Critical Care Medicine, Tufts Medical School (A.K.), the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Massachusetts General Hospital, the Departments of Pulmonary and Critical Care Medicine (V.S.S.), Radiology (D.P.M.), Medicine (P.S.L., G.P.), Neurology (Y.A., E.C.C.), and Pathology (K.V.), Harvard Medical School, and the Department of Medicine, Brigham and Women's Hospital (G.P.), Boston - all in Massachusetts
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21
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He Z, Shi Z, Li C, Ni L, Sun Y, Arioli F, Wang Y, Ammirati E, Wang DW. Single-case metanalysis of fat embolism syndrome. Int J Cardiol 2021; 345:111-117. [PMID: 34743891 DOI: 10.1016/j.ijcard.2021.10.151] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Only one large series has been reported on fat embolism syndrome (FES), a condition caused by fat globules release into the circulation, primarily as consequence of bone fracture. Thus, more data on clinical features, therapies, and prognosis are needed. METHODS AND RESULTS The study screened 1090 manuscripts in PubMed and Web of Science on cases of FES published from June 2010 to June 2020. The authors identified 124 studies and included in the pooled-analysis 135 patients (>14 years), plus one additional unpublished case managed in Tongji hospital. All had confirmed diagnosis of FES with complete clinical data. The median age at presentation was 39 years, and 82 (61.8%) were men. FES was predominantly associated with bone fractures (78, 57.4%), particularly femur fracture (59, 43.4%). The most common clinical finding at the onset was respiratory abnormalities in 34.6% of all clinical presentations. Therapies included respiratory supportive care in 127 (93.4%) patients, application of corticosteroids in 22 (16.2%) and anticoagulant in 5 (3.7%) cases. Overall mortality was 30.2% (N = 41), and logistic regression analysis showed that corticosteroid therapy was significantly associated with reduced mortality with an OR of 0.143 (95%CI 0.029-0.711), while age ≥ 65 years and non-orthopedic conditions were significantly associated with increased mortality with an OR of 4.816 (95%CI 1.638-14.160) and 4.785 (95%CI 1.019-22.474). CONCLUSIONS FES has been associated with a larger mortality rate than previously observed, although publication bias can have led to overestimation of mortality. Finally, a potential protective effect of corticosteroid therapy has been suggested by the current analysis.
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Affiliation(s)
- Zuowen He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China
| | - Zeqi Shi
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China
| | - Chenze Li
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China
| | - Li Ni
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China
| | - Yang Sun
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China
| | - Francesco Arioli
- Department of Cardiology, Fatebenefratelli Hospital, Milano, Italy
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy.
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China.
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