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Hypertrophic Pyloric Stenosis (HPS) is a common surgical disease in infants. Traditionally, patients present with projectile emesis and severe dehydration with metabolic alkalosis. We looked to assess if patients presenting as a transfer vs directly to our facility as well as race affected patients’ initial presentation and outcomes. We performed a retrospective analysis of 131 patients who presented to with a diagnosis of HPS from 2015 to 2021 assessing how transfer status and patient race affected presenting electrolyte levels and length of stay (LOS). We found no statistically significant difference in patients’ presenting electrolyte levels and hospital LOS based on transfer status or patient race. We believe this reflects availability and widespread utility of ultrasound. We suggest that this could be used as a model for standardizing care to equalize outcomes in other pediatric diseases which currently show large disparities in care based on race and geographical location.

Surgical stabilization of rib fractures in an effective technique for the management of bony thoracic trauma. However, rib fractures location or morphology may make the placement of the recommended 6 screws impossible. A retrospective analysis of patients receiving SSRF at our facility from 2009–2019 identified cases where less than the recommended screw placement was used. Respiratory complications and hardware integrity were analyzed using follow-up imaging and examinations when available. A total of 62 patients were identified that used less than the recommended number of screws. The majority of these were in the lateral and posterior chest wall positions. 1 pleural effusion, no pneumothoraces, deaths, or hardware dislodgments were identified. While the authors do not advocate for the routine deviation from manufacture recommendations, we concluded that in select circumstances, adequate fixation can be achieved with less than 6 screws across a plated fracture.

Few therapies exist to treat severe COVID-19 respiratory failure once it develops. Given known diffuse pulmonary microthrombi on autopsy studies of COVID-19 patients, we hypothesized that tissue plasminogen activator (tPA) may improve pulmonary function in COVID-19 respiratory failure.A multicenter, retrospective, observational study of patients with confirmed COVID-19 and severe respiratory failure who received systemic tPA (alteplase) was performed. Seventy-nine adults from seven medical centers were included in the final analysis after institutional review boards' approval; 23 were excluded from analysis because tPA was administered for pulmonary macroembolism or deep venous thrombosis. The primary outcome was improvement in the PaOtPA was associated with significant PaOThese data suggest tPA is associated with significant improvement in pulmonary function in severe COVID-19 respiratory failure, especially in patients whose pulmonary function is in decline, and has an acceptable safety profile in this patient population.