Background: Ventilator-associated pneumonia (VAP) is a hospital-acquired pneumonia that occurs more than 48 hours after mechanical ventilation. Studies showing temporal trends, predictors, and outcomes of VAP are very limited.Objective: We used the National database to delineate the trends and predictors of VAP from 2009 to 2017.Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) for adult hospitalizations who received mechanical ventilation (MV) by using ICD-9/10-CM procedures codes. We excluded hospitalizations with length of stay (LOS) less than two days. VAP and other diagnoses of interest were identified by ICD-9/10-CM diagnosis codes. We then utilized the Cochran Armitage trend test and multivariate survey logistic regression models to analyze the data.Results: Out of a total of 5,155,068 hospitalizations who received mechanical ventilation, 93,432 (1.81%) developed VAP. Incidence of VAP decreased from 20/1000 in 2008 to 17/1000 in 2017 with a 5% decrease. Patients who developed VAP had lower mean age (59 vs 61; p<0.001) and higher LOS (25 days vs. 12 days; p<0.001). In multivariable regression analysis, we identified that males, African Americans, teaching hospitals and co-morbidities like neurological disorders, pulmonary circulation disorders and electrolyte disorders are associated with the increased odds of developing VAP. VAP was also associated with higher rates of discharge to facilities and increased LOS.Conclusion: Our study identified the trends along with the risk predictors of VAP in MV patients. Our goal is to lay the foundation for further in-depth analysis of this trend for better risk stratification and development of preventive strategies to reduce the incidence of VAP among MV patients.

Trigeminal neuralgia (TN) is a chronic pain condition that affects the trigeminal nerve, the largest of the cranial nerves. It is characterized by severe, sudden, and recurrent facial pain, often triggered by light touch or a breeze. Treatment options for TN include medication, nerve blocks, and surgery, but radiofrequency ablation (RFA) has emerged as a promising alternative. RFA is a minimally invasive procedure that uses heat energy to destroy the small portion of the trigeminal nerve responsible for the pain. The procedure is performed under local anesthesia and can be done as an outpatient procedure. RFA has been shown to provide long-term pain relief for TN patients with a low complication rate. However, RFA is not suitable for all TN patients and may not be effective for those with multiple pain sites. Despite these limitations, RFA is a valuable option for TN patients who are not responding to other treatments. Furthermore, RFA is a good alternative for a patient unsuitable for surgery. Further research is needed to fully understand the long-term effectiveness of RFA and identify the best candidates for the procedure.

Brain and other CNS tumors are the eight most common cancers in adults older than 40. This article reviews the main methods used to assess residual brain tumors, such as conventional ultrasound, magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS). This opinion article points out the effectiveness of CEUS, compared to conventional ultrasound and MRI, as an intraoperative tool for residual brain tumors. Ultrasound (US) is a well-known imaging test that has been used for many years. This technology enables neurosurgeons to resect brain tumors more safely and preserve brain function without exposing the brain to ionizing radiation. Another vital tool frequently used is the MRI. This is a non-invasive imaging technology that produces three-dimensional detailed anatomical images. The most reliable imaging tool for brain tumors is gadolinium-enhanced resonance imaging. However, neurosurgeons have a postoperative time frame of 24-48 hours to perform an MRI with gadolinium enhancement; beyond that time frame, postoperative changes along the operative margins could be misinterpreted as residual enhancing tumors. Currently, the CEUS method is gaining popularity in the imaging field as a new radiological tool. CEUS has been effectively used to assess various organ afflictions, such as liver and renal tumors. However, there is limited evidence regarding its role in the central nervous system (CNS). The use of CEUS in brain tumors has shown to be more accurate in solid tumors when compared to cystic lesions. According to our research, contrast-enhanced ultrasound over conventional ultrasound in the US suggests a better outcome for patients undergoing neurosurgical procedures by reducing brain damage that could result from surgical removal of tumors. Therefore, CEUS should be considered in different operative stages for surgical brain tumor removal and postoperative clinical evaluation to ensure a better outcome for these patients.

Fat embolism syndrome is an uncommon but potentially fatal condition associated with trauma or long bone surgery, which presents predominantly with pulmonary symptoms. While medical advances have resulted in a reduction in mortality rates, the accurate diagnosis of the condition remains challenging due to its ability to mimic other causes of respiratory distress. Since the symptoms, laboratory tests, and imaging studies are often nonspecific, the identification of fat embolism must be based on a combination of these elements. The use of pulmonary imaging techniques, particularly chest computed tomography, is crucial to the assessment of this condition. When hypoxia occurs after surgery or trauma, the presence of diffuse and well-defined ground glass opacities or centrilobular nodules on CT are highly suggestive of fat embolism. As this disorder is mainly managed via supportive measures, prevention and early identification are essential to improving patient outcomes. This review describes the main clinical and imaging aspects of pulmonary fat embolism.