Report of the ASFA apheresis registry on muscle specific kinase antibody positive myasthenia gravis

Background : Anti‐muscle specific kinase antibody positive (MuSK Ab) myasthenia gravis (MG) patients are known to have different clinical course compared to anti‐acetylcholine receptor Ab positive MG patients. Therapeutic plasma exchange (TPE) has been reported to be effective; however, little is known of the response and of TPE procedural information. An ASFA Apheresis Registry was developed to analyze those data. Methods : The study collected detailed de‐identified patient data, TPE procedures, and treatment outcome/complications. Collected data was described in aggregate. Results : A total of 15 MuSK Ab MG patients with exacerbation of MG symptoms, 13 females/2 males, median age 44, were investigated. Thirty TPE courses (median 5 procedures/course, total 145 procedures) were evaluated. All TPE procedures were performed with citrate anticoagulation, 1 − 1.25 plasma volume exchange in 100% fluid balance, and 90% of courses used only albumin as replacement. Calcium was added to albumin or given orally as needed. TPE was performed every other day in 55% of courses. Adverse events occurred in 3.4% of procedures. Ten patients (67%) experienced relapses within a median of 7 weeks. Objective symptoms were resolved in more than 75% of courses. Overall subjective improvement rates were 94.1%/93.3% after 3/4 TPE procedures, respectively. Thirty‐one percent of patients responded poorly with minimal recovery. Conclusion : Overall subjective improvement was seen up to 94% of patients after one course of TPE. Some patients were poor‐responders. Five TPE may be adequate for initial course with additional TPE as needed. Based upon this preliminary data, we will modify our future data collection. J. Clin. Apheresis 32:5–11, 2017. © 2016 Wiley Periodicals, Inc.     

Concerns of an Itinerant Surgeon: Results of a Guatemalan Surgical Aid Trip

Over the past decade the popularity of foreign medical aid has increased and gained notoriety. Operation Walk is a philanthropic organization dedicated to improving the ambulatory potential of patients in developing countries by providing free surgical treatment for patients who otherwise lack access to care of debilitating bone and joint conditions. During Operation Walk Mooresville's 2013 trip to Guatemala 40 patients prospectively completed a Likert Scale style survey. The 63-question survey assessed patient impressions and concerns regarding the care they receive as part of itinerant surgical aid trips. Mean scores were calculated and then concerns were ranked accordingly. We are aware of no other investigation assessing these sorts of patient centered perspectives for international surgical aid trips.     

Wrestling Injuries in North Carolina High Schools

In brief: Using data on 1,091 North Carolina high school wrestlers during 49 team-seasons, the authors attempted to relate the number, type, and severity of wrestling injuries to factors such as mat surfaces, endurance exercises, weight- reducing methods, protective equipment, and coaching experience. Most of the 248 injuries were minor, causing little time loss, but 57 (23%) were so severe that athletes missed an entire season. Possible contributory factors were inappropriate endurance training shoes, infrequent headgear use during practice, less than optimum wrestler-to-coach ratios, and potentially dangerous weight-reduction methods.     

Can Bariatric Surgery be Performed Safely in Patients with Severe Treatment-Resistant Asthma?

Obesity-associated severe asthma is a distinct phenotype characterised by resistance to standard asthma therapies. Bariatric surgery appears to be a viable alternative for those who have failed trials of traditional weight loss methods. However, anaesthetic and surgical risks are potential barriers. We describe three patients with treatment-resistant obesity-associated severe asthma who underwent bariatric surgery without complications due to the multidisciplinary perioperative planning and care involved in these complex cases. All three patients showed improvements in asthma control and reduction in maintenance medication use post-surgery.