Research Spotlight

Torres, V. A., J. E. Strack, S. Dolan, M. I. Kruse, M. L. Pennington, S. J. Synett, N. Kimbrel and S. B. Gulliver (2020). “Identifying Frequency of Mild Traumatic Brain Injury in Firefighters.” Workplace Health Saf Jun 11;2165079920922576. [Epub ahead of print.]. 2165079920922576.

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Background: Mild traumatic brain injury (mTBI) is a nationwide problem; yet, no firefighter mTBI data are available. Methods: In this cross-sectional study, we assessed retrospective head injuries using WHO guidelines. We captured mTBI frequency and examined firefighters’ symptoms (e.g., using Ohio State University Traumatic Brain Injury Identification method, Brief Traumatic Brain Injury Screen, Warrior Administered Retrospective Causality Assessment Tool). Findings: Of 1,112 firefighters contacted, 60 responses were included. Most participants were White (80%), male (90%), former athletes (75%). 62% met mTBI symptom criteria. 75% reported at least one lifetime head injury. Number of head injuries and depression symptoms were associated (r = .36, p < .05). Conclusion/application to practice: Overall, it appears most firefighters have sustained at least one lifetime mTBI. Those with multiple head injuries may be at increased risk of depression. Occupational health professionals should be aware of firefighters' mTBI risk. Further research is warranted given findings.

Shalowitz, D. I., C. Lefkowits, L. M. Landrum, V. E. von Gruenigen and M. A. Spillman (2020). “Principles of ethics and critical communication during the COVID-19 pandemic.” Gynecol Oncol Jun 25;S0090-8258(20)32320-9. [Epub ahead of print.].

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During the COVID-19 pandemic, the primary clinical emphasis has shifted to optimizing community health. Scarce resources should be allocated to maximize benefit without unfairly affecting any group. Healthcare systems should consider adopting a formal, tier-based response to COVID-19 related demand on resources. Clinicians should use principles of high-stakes communication to guide care planning during the pandemic.

Mistry, P., M. Balwani, D. Barbouth, T. A. Burrow, E. I. Ginns, O. Goker-Alpan, G. A. Grabowski, R. V. Kartha, P. S. Kishnani, H. Lau, C. U. Lee, G. Lopez, G. Maegawa, S. Packman, C. Prada, B. Rosenbloom, T. R. Lal, R. Schiffmann, N. Weinreb and E. Sidransky (2020). “Gaucher disease and SARS-CoV-2 infection: Emerging management challenges.” Mol Genet Metab 130(3): 164-169.

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Effective treatments for Gaucher disease are available that successfully reverse many of the systemic non-neurological manifestations of the disease. Administration of the two therapies, enzyme replacement therapy (ERT) and therapy preventing substrate accumulation (SRT) (for GD1) are widely used. Each has specific considerations that may be impacted by aspects of the COVID-19 pandemic. [No abstract available; excerpt from article.].

Sundaram, V., N. Mahmud, G. Perricone, D. Katarey, R. J. Wong, C. J. Karvellas, B. E. Fortune, R. S. Rahimi, H. Maddur, J. H. Jou, M. Kriss, L. L. Stein, M. Lee and R. Jalan (2020). “Long-term outcomes of patients undergoing liver transplantation for acute-on-chronic liver failure.” Liver Transpl Jun 23. [Epub ahead of print.].

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AIMS: Recent data have demonstrated greater than 80% one-year survival probability after liver transplantation (LT) for patients with severe acute on chronic liver failure (ACLF). However, long term outcomes and complications are still unknown for this population. Our aim was to compare long-term patient and graft survival among patients transplanted across all grades of ACLF. METHODS: We analyzed the UNOS database, years 2004-2017. Patients with ACLF were identified using the EASL-CLIF criteria. Kaplan-Meier and Cox regression methods were used to determine patient and graft survival and associated predictors of mortality in adjusted models. RESULTS: A total of 75,844 patients were transplanted of which 48,854 (64.4%) had no ACLF, 9,337 (12.3%) had ACLF-1, 9,386 (12.4%) had ACLF-2 and 8,267 (10.9%) had ACLF-3. Patients transplanted without ACLF had a greater proportion of hepatocellular carcinoma within (23.8%) and outside (12.7%) Milan criteria. Five-year patient survival after LT was lower in the ACLF-3 patients compared with the other groups (67.7%, p<0.001), although after year 1, the percentage decrease in survival was similar among all groups. Infection was the primary cause of death among all patient groups in the first year. After the first year, infection was the main cause of death in patients transplanted with ACLF-1 (31.1%), ACLF-2 (33.3%) and ACLF-3 (36.7%), whereas malignancy was the predominant cause of death in those transplanted with no ACLF (38.5%). Graft survival probability at 5 years was above 90% among all patient groups. CONCLUSION: Patients transplanted with ACLF-3 have lower 5-year survival as compared to ACLF 0-2 but mortality rates were not significantly different after the first year following LT. Graft survival was excellent across all ACLF groups.

Bajaj, J. S., M. Lauridsen, E. B. Tapper, A. Duarte-Rojo, R. S. Rahimi, P. Tandon, D. L. Shawcross, D. Thabut, R. K. Dhiman, M. Romero-Gomez, B. C. Sharma and S. Montagnese (2020). “Important Unresolved Questions in the Management of Hepatic Encephalopathy: An ISHEN Consensus.” Am J Gastroenterol 115(7): 989-1002.

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Management of hepatic encephalopathy (HE) remains challenging from a medical and psychosocial perspective. Members of the International Society for Hepatic Encephalopathy and Nitrogen Metabolism recognized 5 key unresolved questions in HE management focused on (i) driving, (ii) ammonia levels in clinical practice, (iii) testing strategies for covert or minimal HE, (iv) therapeutic options, and (v) nutrition and patient-reported outcomes. The consensus document addresses these topical issues with a succinct review of the literature and statements that critically evaluate the current science and practice, laying the groundwork for future investigations.