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Rheumatoid arthritis is an autoimmune disease mediated by a widespread chronic systematic inflammatory process that causes joint deterioration, which leads to pain, disability, and poor quality of life. The increased use of disease-modifying antirheumatic drugs has been shown to markedly slow disease progression, which has translated into a decrease in the need for orthopaedic intervention in this population. However, a substantial percentage of patients with the disease fail optimal pharmacologic treatment and still require surgical intervention. A thorough understanding of medical considerations in these patients and improved knowledge of the medical complications caused by the disease process and the pharmacologic therapy used to treat it may lead to improved preoperative planning and medical clearance, which may ultimately improve the overall postoperative outcome.

Background: Delivery of therapeutic agents directly through the round window (RW) offers promise for treating sensorineural hearing loss. However, hearing loss can result from the surgical approach itself, and the reasons for this are poorly understood. We examined the hearing loss following the 3 major steps involved with the RW approach to access the mouse cochlea: bullostomy, RW puncture, and RW injection. Methods: Twenty-one adult CBA/J mice underwent bullostomy alone, 10 underwent RW puncture, and 8 underwent RW injection with PBS with 5% glycerol. Auditory brainstem responses (ABR) and otoscopy were performed preoperatively and up to 6 weeks postoperatively. Hair cells were stained, and survival was assessed using immunofluorescence. Results: One week postoperatively, mice in all groups showed significant threshold shifts. Otoscopy revealed approximately half of all mice had middle ear effusion (MEE), with a higher incidence of effusion in the RW puncture and RW injection groups. Those with MEE had significant ABR threshold shifts, whereas those without MEE had minimal hearing loss. MEE persisted through 6 weeks in a majority of cases, but in those mice with MEE resolution, there was at least partial improvement in hearing. Immunohistochemistry showed minimal loss of hair cells in all animals. Conclusion: MEE is highly correlated with hearing loss in mice undergoing RW surgery. Otoscopy is an important adjunct to consider after ear surgery in mice, as MEE may contribute to postsurgical hearing loss.

Open Access Opiniondeveloping countries. Although data on the burden of sepsis in developing countries is lacking in the published literature, the incidence and mortality are likely to be disproportionally high in developing countries compared to developed countries [4][5][6][7][8][9][10]. The Brazilian Sepsis Epidemiological Study has confirmed this conclusion by evaluating 1383 patients who were admitted to five different intensive care units. The investigators discovered that the incidence of sepsis, severe sepsis, and septic shock were 61.4, 35.6, and 30.0 per 1000 days, respectively [6]. The mortality of patients with sepsis, severe sepsis, and septic shock were 34.7%, 47.3%, and 52.2%, respectively [6]. These high incidences and mortalities of sepsis in developing countries may be caused by their quality of healthcare, lack of access to healthcare and educational efforts targeting sepsis, and shortage of resources.It is also important to note that severe sepsis is likely to complicate malnutrition, malaria, maternal conditions, and chronic illnesses, including HIV/AIDS, diabetes, and cancer in developing countries [4][5]8]. For instance, Bane et al. [7] Evaluated HIV-positive patients who were admitted to an Ethiopian hospital and noticed that sepsis and septic shock were among the most common causes of mortality due to their immunosuppressant [4,7]. Sani et al. [4,8]. Reviewed the causes of death among patients with AIDS over 4 years in a Nigerian hospital As a result of their calculations, 455 of 4574 patients (9.9%) were admitted due to their HIV/AIDS-related diagnoses, which caused 176 deaths (38.7%) over the period [4,8]. The most common causes of these deaths were tuberculosis (33.4%) and sepsis (23.8%). This indicates that immunosuppressant secondary to acute illnesses and chronic conditions in developing countries may thus potentially significantly increase the incidence and mortality of sepsis in developing countries [4].similarly, a large prospective study evaluating 1,235 Brazilian patients admitted to 90 Brazilian icus demonstrated that there was a clear association between infection and mortality [10]. Furthermore, the overall ICU mortality rate was 28.4% with the higher rate in the infected patients than in non-infected patients (37.6% vs 13.2%) [10]. Likewise, the in-hospital mortality rate was 34.2%, with 44.2% in the infected patients and 17.7% in non-infected patients. The authors performed a multivariate analysis and concluded that the significant factors associated with the incidence of infection were emergency surgery (OR 2.89), mechanical ventilation (OR AbstractSepsis is a major cause of morbidity and mortality in intensive care units. It affects millions of people worldwide annually, causing hundreds of thousands deaths and health-care expenditure of at least $16.7 billion per year. This highlights the significance of diagnosing and treating septic patients emergently. Unfortunately, developing countries are struggling with limited resources, lack of educational efforts targeting se...

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