Anand Kumar

• Doctor of Medicine
• Pediatric Plastic Surgeon at Memorial University Medical Center

Objectives Refine the administrative data definition of sepsis in hospitalized patients, including less severe cases. Design and Setting For each of 1928 infection and 108 organ dysfunction codes used in Canadian hospital abstracts, experts reached consensus on the likelihood that it could relate to sepsis. We developed a new algorithm, called Alg...

Background Clinical trials suggest that therapeutic-dose heparin may prevent critical illness and vascular complications due to COVID-19, but knowledge gaps exist regarding the efficacy of therapeutic heparin including its comparative effect relative to intermediate-dose anticoagulation. Objectives The authors performed 2 complementary secondary a...

Rationale Acute respiratory distress syndrome (ARDS) is a life-threatening critical care syndrome commonly associated with infections such as COVID-19, influenza, and bacterial pneumonia. Ongoing research aims to improve our understanding of ARDS, including its molecular mechanisms, individualized treatment options, and potential interventions to r...

Background: The Physician Payments Sunshine Act (PPSA) was enacted to increase transparency regarding physician and industry financial interests. Consulting fee payments comprise a large proportion of these financial relationships. We hypothesized that there are discrepancies amongst industry-derived consulting payments to medical and surgical spe...

Objective: The aim of this study was to evaluate the volumetric airway changes using three-dimensional images following unilateral vertical mandibular distraction osteogenesis (uVMD) among patients with hemifacial microsomia (HFM). Design: This retrospective study analyzed cone-beam computed tomography (CBCT) scans of patients with HFM at three...

Opioid minimization in the acute postoperative phase is timely in the era of the opioid epidemic. The authors hypothesize that patients with facial trauma receiving multimodal, narcotic-minimizing pain management in the perioperative period will consume fewer morphine milligram equivalents (MMEs) while maintaining adequate pain control compared wit...

Reusable Antiviral Textiles In article number 2201338, Sarah Currie, and colleagues have synthesized a new quaternized N-chloramine (MAMPIP) featuring two quaternary ammonium groups to boost the chlorination efficiency of the piperidine amine and achieve excellent antiviral efficacy against SARS-CoV-2. The poly(MAMPIP) grafted cotton is highly effe...

Polymeric substrates can be endowed with antiviral properties by grafting N‐chloramine precursors to the surface. These surfaces bind oxidative chlorine from a dilute chlorine bleach solution and are similarly recharged after depletion for reuse. Previously, enhanced antibacterial efficacy of quaternized N‐chloramines compared to their neutral coun...

Although some adults infected with influenza 2009 A(H1N1)pdm09 viruses mounted high hemagglutination inhibition (HAI) antibody response, they still suffered from severe disease, or even death. Here, we analyzed antibody profiles in patients (n = 31, 17–65 years) admitted to intensive care units (ICUs) with lung failure and invasive mechanical venti...

Current treatment for volumetric muscle loss is limited to muscle transfer or acellular collagen scaffold (ACS) therapies that are associated with donor site morbidity and nonfunctional fibrosis, respectively. The aim of this study is to assess the utility of amniotic membrane scaffold (AMS) for volumetric muscle loss treatment. Methods: Murine q...

Early identification of surgical indication is critical to optimizing outcomes in orbital floor fracture management. However, identifying those at risk for delayed enophthalmos and requiring subsequent repair has remained a challenge. This study aimed to validate the Orbital Index, a prediction tool using computed tomography to stratify risk for de...

Purpose: Septic shock is associated with a mortality of 20-40%. The white blood cell count (WBC) at hospital admission correlates with prognosis in septic shock. Here, we explore whether the trajectory of WBC after admission provides further information about outcomes. We aimed to identify groups of patients with different WBC trajectories and the...

The maxilla forms the most central portion of the facial skeleton and contributes significantly to the overall aesthetics of the face. Deficiency or excess of the maxilla in the vertical or sagittal dimension can profoundly affect midface concavity/convexity, dental and gingival show during a smile, nasal dorsal prominence and tip position, rotatio...

Background: There is a pressing need to identify alternative mesenchymal stem cell sources for Schwann cell cellular replacement therapy, to improve peripheral nerve regeneration. This study assessed the efficacy of Schwann cell-like cells (induced muscle-derived stem cells) differentiated from muscle-derived stem cells (MDSCs) in augmenting nerve...

Background Few studies have quantified aerosol concentrations of SARS-CoV-2 in hospitals and long-term care homes, and fewer still have examined samples for viability. This information is needed to clarify transmission risks beyond close contact. Methods We deployed particulate air samplers in rooms with COVID-19 positive patients in hospital ward...

Shortages of personal protective equipment for use during the SARS-CoV-2 pandemic continue to be an issue among health-care workers globally. Extended and repeated use of N95 filtering facepiece respirators without adequate decontamination is of particular concern. Although several methods to decontaminate and re-use these masks have been proposed,...

Background: Thrombosis and inflammation may contribute to morbidity and mortality among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation would improve outcomes in critically ill patients with Covid-19. Methods: In an open-label, adaptive, multiplatform, randomized clinical trial, critically...

Purpose: Intravenous immune globulin (IVIG) may improve survival in people with septic shock. Current utilization patterns of IVIG are unknown. We sought to characterize adult patients with septic shock requiring vasopressors who received IVIG, describes IVIG regimens, and evaluate determinants of IVIG use in patients with septic shock. Methods:...

Purpose: Attention deficit hyperactivity disorder (ADHD) is a developmental disorder affecting the quality of life. The etiology of ADHD is unclear, yet it has been believed to be multifactorial. he aim of this Cone-beam computed tomography (CBCT) study was to assess the upper airway morphology in adolescents with ADHD compared to controls. Methods...

Learning objectives: After studying this article, the participant should be able to: 1. Describe the evolution of three-dimensional computer-aided reconstruction and its current applications in craniofacial surgery. 2. Recapitulate virtual surgical planning, or computer-assisted surgical simulation, workflow in craniofacial surgery. 3. Summarize t...

Background: Few studies have quantified aerosol concentrations of SARS-CoV-2 in hospitals and long-term care homes, and fewer still have examined samples for viability. This information is needed to clarify transmission risks beyond close contact. Methods: We deployed particulate air samplers in rooms with COVID-19 positive patients in hospital war...

Background Thrombo-inflammation may contribute to morbidity and mortality in Covid-19. We hypothesized that therapeutic-dose anticoagulation may improve outcomes in non-critically ill patients hospitalized for Covid-19. Methods In an open-label adaptive multiplatform randomized controlled trial, non-critically ill patients hospitalized for Covid-19...

Background Thrombosis may contribute to morbidity and mortality in Covid-19. We hypothesized that therapeutic anticoagulation would improve outcomes in critically ill patients with Covid-19. Methods We conducted an open-label, adaptive, multiplatform, randomized, clinical trial. Patients with severe Covid-19, defined as the requirement for organ su...

This article was updated to correct Alexis F. Turgeon’s name and affiliations.

Background: The 2014–2016 Ebola outbreak in West Africa recapitulated that nosocomial spread of Ebola virus could occur and that health care workers were at particular risk including notable cases in Europe and North America. These instances highlighted the need for centers to better prepare for potential Ebola virus cases; including understanding...

Shortages of personal protective equipment for use during the SARS-CoV-2 pandemic continue to be an issue among health-care workers globally. Extended and repeated use of N95 filtering facepiece respirators without adequate decontamination is of particular concern. Although several methods to decontaminate and re-use these masks have been proposed,...

PurposeThis national survey evaluated the perceived efficacy and safety of intravenous immune globulin (IVIG) in septic shock, self-reported utilization patterns, barriers to use, the population of interest for further trials and willingness to participate in future research of IVIG in septic shock.Methods We conducted a cross-sectional survey of c...

Cleft lip and Palate (CLP) is the most common craniofacial condition. Management of patients with clefts often requires multi-disciplinary rehabilitation of the orofacial structures. This case report demonstrates the multi-disciplinary management of an adult with a cleft lip and palate, highlighting the benefits of 3-Dimensional (3D) diagnosis, tre...

Aim of the study: Patients with Hemifacial Microsomia (HFM) exhibit highly variable skeletal and soft tissue asymmetries. The purpose of this study was to evaluate soft tissue discrepancies in patients with HFM and correlate them to the skeletal discrepancy. Case-series: Eight patients were selected and studied retrospectively using 3- Dimensional...

The response to the COVID-19 epidemic is generating severe shortages of personal protective equipment around the world. In particular, the supply of N95 respirator masks has become severely depleted, with supplies having to be rationed and health care workers having to use masks for prolonged periods in many countries. We sought to test the ability...

Objective The purpose of this study is to utilize cone-beam computed tomography (CBCT) to compare the bone mineral density (BMD) on the affected versus nonaffected side, among individuals with hemifacial microsomia (HFM). Methods This retrospective study included 9 patients with HFM. Pretreatment CBCT volumes were imported into Invivo5 software, w...

Zone 2 flexor tendon repair has been historically associated with poor outcomes, mainly due to stiffness. In an effort to minimize adhesions, accommodate flexor digitorum profundus and flexor digitorum superficialis bulk, and prevent bowstringing, we have developed a novel approach to flexor tendon repair that relies on aggressive flexor tendon pul...

Background Mortality from COVID-19 is high among hospitalized patients and effective therapeutics are lacking. Hypercoagulability, thrombosis and hyperinflammation occur in COVID-19 and may contribute to severe complications. Therapeutic anticoagulation may improve clinical outcomes through anti-thrombotic, anti-inflammatory and anti-viral mechanis...

Background: The optimal prevention and treatment of pain associated of iliac crest bone graft donor sites for the treatment of cleft alveolus defects has not been well characterized. The aim of this study is to assess the efficacy of minimal access bone graft techniques with or without regional anesthesia in iliac crest bone harvest and compare to...

Syndromic hypoplasia of the orbit and midface results in noticeable dysmorphology. Correction involves advancement of the orbito-facial complex either directly or by distraction osteogenesis. The surgery is challenging no matter where it is performed, however, the challenges are amplified on a surgical mission. Komedyplast Surgical Charity (Chicago...

The response to the COVID19 epidemic is generating severe shortages of personal protective equipment around the world. In particular, the supply of N95 respirator masks has become severely depleted with supplies having to be rationed and health care workers having to use masks for prolonged periods in many countries. We sought to test the ability o...

Purpose: To assess maxillary occlusal plane correction in patients with hemifacial microsomia (HFM) after vertical vector mandibular distraction osteogenesis (vMDO) without orthodontic appliances. Methods: A retrospective study was performed on consecutive patients with HFM and Kaban-Pruzansky type-II mandibular deformities who underwent unilate...

Background: Influenza infections produce a spectrum of disease severity, ranging from a mild respiratory illness to respiratory failure and death. The host-response pathways associated with the progression to severe influenza disease are not well understood. Methods: To gain insight into the disease mechanisms associated with progression to seve...

Background: Appropriate, progressive trainee autonomy is critical for training competent plastic surgeons who are adequately prepared to enter independent practice. Evaluation and reporting of meaningful operative autonomy among trainees in plastic surgery are understudied. Methods: Parallel survey instruments were developed using the Zwisch met...

Although much progress has been made in identifying the signaling pathways that mediate viral RNA-induced apoptosis and activation of interfe-ron-stimulated genes, the role that bacterial RNA plays in regulating these responses has remained undetermined. Herein, we identified bacterial RNA as a novel inducer of the apoptotic cell death. Unlike the...

Background: There are currently limited data for the use of specific antiviral therapies for the treatment of Ebola virus disease (EVD). While there is anecdotal evidence that supportive care may be effective, there is a paucity of direct experimental data to demonstrate a role for supportive care in EVD. We studied the impact of ICU-level support...

Please note that four authors (Logan Banadyga, Alixandra Albietz, Brad Pickering, and Gary Wong) have been erroneously omitted from the author list in the published original article [1].

Background Previous studies have investigated psychosocial adjustments among adolescents with cleft lip and/or palate (CL/P), but our understanding of other craniofacial conditions remains limited. The objective of this study is to compare psychosocial adjustments among 3 groups of adolescents: craniofacial conditions other than cleft lip and/or pa...

Introduction: Numerous studies have investigated psychosocial adjustment levels among adolescents with cleft lip and/or palate (CL/P), but our understanding of other craniofacial conditions remains limited. The primary purpose of the current study is to compare psychosocial adjustments among 3 groups of adolescents: (1) craniofacial conditions othe...

Severe influenza infection has no effective treatment available. One of the key barriers to developing host-directed therapy is a lack of reliable prognostic factors needed to guide such therapy. Here, we use a network analysis approach to identify host factors associated with severe influenza and fatal outcome. In influenza patients with moderate-...

Background: Cholecystitis-associated septic shock carries a significant mortality. Our aim was to determine whether timing of source control affects survival in cholecystitis patients with septic shock. Methods: We conducted a nested cohort study of all patients with cholecystitis-associated septic shock from an international, multicentre databa...

Adolescents with craniofacial conditions may face various psychosocial challenges. However, it is not completely understood why some affected teenagers may cope better than others. The objective of this study was to evaluate how may social factors predict the psychosocial well-being of teenagers with craniofacial conditions. The factors we examined...

Objectives: To characterize the prevalence, incidence, and temporal evolution of thrombocytopenia (platelets < 100 × 10/L) in septic shock and to investigate the independent association of thrombocytopenia on clinical outcomes. Design: Retrospective, propensity-matched, cohort study. Setting: Two academic ICUs in Winnipeg, Canada. Patients:...

Orthognathic surgery describes the surgical movement of the mandible and maxilla to correct dentofacial deformities that result from congenital or traumatic etiologies. Patients with dentofacial deformity often have malocclusion and functional problems related to breathing, chewing, or speech articulation. Furthermore, facial asymmetries or disprop...

Introduction: Correction of severe orbital and globe malposition from neurofibromatosis remains a significant clinical challenge. Current techniques including zygoma osteotomy, bone grafting, or placement of orbital implants do not adequately address aberrant anatomy, under-correct the deformity, and are prone to relapse. The authors have develope...

Background: Proper evaluation and analysis of speech surgery outcomes for cleft-related velopharyngeal incompetence in children and young adults performed on humanitarian missions is poorly characterized. The aim of this study is to examine the effect of using a multidisciplinary team on cleft-related humanitarian missions. The effect on patient s...

Background: Currently, there is a paucity of information on the presentation and proper management of pediatric nasoorbitoethmoid fractures. The purpose of this study was to examine the incidence, cause, associated injuries, and management of these fractures. Furthermore, the authors sought to assess outcomes after transnasal wiring or suture cant...

Background: Pneumonia complicated by septic shock is associated with significant morbidity and mortality. Classification and regression tree methodology is an intuitive method for predicting clinical outcomes using binary splits. We aimed to improve the prediction of in-hospital mortality in patients with pneumonia and septic shock using decision...

Background: Septic shock is among the most common causes of admission to medical intensive care units (ICU) and is associated with mortality of 20-40%. The white blood cell count (WBC) at time of admission correlates with prognosis in septic shock but it is not known if the change in WBC over time (i.e. the WBC trajectory) impacts survival. Hypothe...

Background: The effect of moderate caloric enteral intake in critically ill patients with hypercapnic acute respiratory failure (HCARF) is unclear. We studied the impact of permissive underfeeding (PUF) compared with standard feeding (SF) on various HCARF outcomes. Materials and methods: The PermiT trial randomized 894 patients to either PUF (40...

Background: Volumetric muscle loss secondary to traumatic or surgical causes can lead to functional and aesthetic impairments. The authors hypothesize that an implantable muscle-derived stem cell-enriched collagen scaffold could significantly augment muscle regeneration in a murine model of volumetric muscle loss. Methods: Murine muscle-derived...

Introduction: Stem cell therapy for peripheral nerve repair is a rapidly-evolving field in regenerative medicine. Although most studies to date have investigated stem cells originating from bone marrow or adipose, skeletal muscle has recently been recognized as an abundant and easily-accessible source of stem cells. Muscle-derived stem cells (MDSC...

Background and significance: Apert syndrome is a congenital disorder of patients who typically present with bilateral coronal craniosynostosis and varying degrees of complex syndactyly of the hands and feet, among other features. We describe a unique presentation of a rare Apert-like patient with unilateral coronal craniosynostosis and complex syn...

Background/Purpose:Numerous studies have investigated psychosocial adjustment levels among adolescents with cleft lip and/or palate (CL/P) but our understanding of other craniofacial conditions remains to be scarce. The primary purpose of the current study is to compare psychosocial adjustments among three groups of adolescents: 1-craniofacial cond...

Sepsis is a multi-factorial disease induced by an overwhelming inflammatory response to microbial infection. Sepsis and septic shock are the leading causes of death in intensive care units in the developed world. Approximately 800,000 cases of sepsis are reported annually in the United States and one quarter of patients will succumb to the disease....

Background: Adipofascial flaps (AFF) with acellular dermal matrix (ADM) have the potential to reconstruct neural tube defects without sacrificing muscle that may be critical for long-term function. Comparative studies between myocutaneous flap (MF) reconstruction, the accepted standard reconstructive technique, and AFF/ADM remain under-reported. T...

Background Shorter-duration antibiotic treatment is sufficient for a range of bacterial infections, but has not been adequately studied for bloodstream infections. Our systematic review, survey, and observational study indicated equipoise for a trial of 7 versus 14 days of antibiotic treatment for bloodstream infections; a pilot randomized clinical...

Removal of the fronto-orbital bandeau is one of the most critical components for procedures designed to correct anomalies of the craniofacial skeleton and remodel the anterior calvarial vault. It is also used to improve exposure of the anterior cranial fossa. It is arguably one of the more difficult portions of some craniofacial procedures. While t...

Background: The kinetics of the antibody response during severe influenza are not well documented. Methods: Critically ill patients with influenza A(H1N1)pdm09 virus infection, confirmed by RT-PCR or seroconversion (≥4-fold rise in titers), during 2009-2011 in Canada were prospectively studied. Antibody titers in serially collected sera were det...

The purpose of this study was to determine whether fungicidal versus fungistatic pharmacotherapy of invasive candidiasis/candidemia yields superior outcomes. Data sources included MEDLINE (1966–June 2017), EMBASE (1980–June 2017), PubMed (1966–June 2017), Global Health-Ovid (inception to June 2017), LILACS Virtual Health Library (inception to June...

Objectives: To determine the clinical characteristics and outcomes of culture-negative septic shock in comparison with culture-positive septic shock. Design: Retrospective nested cohort study. Setting: ICUs of 28 academic and community hospitals in three countries between 1997 and 2010. Subjects: Patients with culture-negative septic shock a...

Background Metabolomics is a tool that has been used for the diagnosis and prognosis of specific diseases. The purpose of this study was to examine if metabolomics could be used as a potential diagnostic and prognostic tool for H1N1 pneumonia. Our hypothesis was that metabolomics can potentially be used early for the diagnosis and prognosis of H1N1...

Background & aims: The prevalence of obesity in cirrhosis is rising. The impact of obesity in the critically-ill cirrhotic patient with sepsis/septic shock has not been evaluated. This study aimed to examine the relationship between obesity and mortality in cirrhotic patients admitted to the intensive care unit with septic shock. Methods: A retr...

Background: Both internal and external distraction devices have been used successfully in correcting midface hypoplasia. Although the indication for surgery and the osteotomy techniques may be similar, deciding when to use internal versus external devices has not been studied. The authors studied patient-reported outcomes with FACE-Q and functiona...

Background Preliminary studies suggested that Aboriginal Canadians had disproportionately higher rates of infection, hospitalization, and critical illness due to pandemic Influenza A(H1N1)pdm09. Methods We used a prospective cohort study of critically ill patients with laboratory confirmed or probable H1N1 infection in Canada between April 16 2009...

Temporal distribution of critically Ill patients with confirmed or probable 2009/2010 influenza A(H1N1) infection by month during 2009-2010, n = 660. (TIFF)

Kaplan-Meier curve of survival among aboriginal and non-aboriginal canadians with confirmed or probable 2009/2010 influenza A(H1N1) infection by month during 2009-2010 n = 647. (TIFF)

Purpose: To assess the two- and three-dimensional airway changes following unilateral vertical mandibular distraction osteogenesis (vMDO) in patients with hemifacial microsomia (HFM). Methods: A retrospective evaluation was performed for consecutive patients over an 18-month period with HFM and with Kaban-Pruzansky Type-II mandibular deformities...

Background: Stahl ear, a rare congenital auricular anomaly, occurs when a third crus crosses the scaphoid fossa. Optimal elimination of the third crus and reconstruction the superior crus in type 1 Stahl ear remain undercharacterized. We present a novel 3-step technique to reliably correct a type 1 Stahl ear as a case report. Methods: A 10-year-...

Abstract Background Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical...

Objective: Dynamic tests of fluid responsiveness have been developed and investigated in clinical trials of goal-directed therapy. The impact of this approach on clinically relevant outcomes is unknown. We performed a systematic review and meta-analysis to evaluate whether fluid therapy guided by dynamic assessment of fluid responsiveness compared...

Host response biomarkers can accurately distinguish between influenza and bacterial infection. However, published biomarkers require the measurement of many genes, thereby making it difficult to implement them in clinical practice. This study aims to identify a single-gene biomarker with a high diagnostic accuracy equivalent to multi-gene biomarker...

Background: Previous work by our group and other laboratories have revealed that muscle-derived stem cells (MDSCs) may contain both myogenic and endothelial progenitors, making MDSCs a promising option for skeletal muscle regeneration. The purpose of this study was to investigate the impact of vascular endothelial growth factor (VEGF) induction on...

Critical care needs have been rising in recent decades as populations age and comorbidities increase. Sepsis-related admissions to critical care contribute up to 50% of volume and septic shock carries a 35–54% fatality rate. Improvements in sepsis-related care and mortality would have a significant impact of a resource-intensive area of health care...