Reciprocal Abstracts

Abstract

Study objective: To determine the effectiveness of intranasal topical application of tranexamic acid in reducing the need for anterior nasal packing and determine the number of episodes of rebleeding in adult patients presenting with spontaneous atraumatic anterior epistaxis. Methods: This study was a double-blind randomized trial conducted from September to November 2021 in the ENT emergency department, Khalili Hospital, Shiraz, Iran. Cotton pledgets soaked in either phenylephrine and lidocaine (con-trol group) or tranexamic acid with phenylephrine and lidocaine (intervention group) were inserted into the patients’ nostrils for 15 min. The primary outcome was the need for anterior nasal packing. The secondary outcomes were stay-ing in the ED for more than 2 h, needing electrical cauteriza-tion, and rebleeding within 24 h and 1 to 7 days of the first referral to the ED. The trial was registered with the Iranian Registry of Clinical Trials (IRCT20210403050815 N1). Results: A total of 240 patients (120 in each group) were enrolled in this study. Tranexamic acid was associated with a lower rate of need for anterior nasal packing (50.0% versus 64.2%; odds ratio (OR), 0.56; 95% confidence interval (CI): 0.33–0.94). There were no significant differences between the 2 groups in terms of the need for electrical cau-terization and the rate of rebleeding within 1 to 7 days. Tranexamic acid was associated with a lower rate of stay in the ED for more than 2 Study objective: Drugs in emergency medical service (EMS) cars are often exposed to temperature variations that could affect the stability of these drugs. We aimed to study the influence of real-life temperature exposure on the stability of 5 drugs onboard an EMS vehicle. Methods: Concentrations of active principles of 5 emergency drugs (amiodarone, rocuronium, fentanyl, succinylcholine, and epinephrine) aboard an EMS vehicle were analyzed every 3 months up to 1 year. The samples were compared to the same drugs stored for 1 year either at room temperature or in a refrigerator in the pharmacy. Succinylcholine was additionally analyzed once a week for 4 weeks after being taken out of the refrigerator. The dosage of the active principle was measured using high-pressure Q5 liquid chromatography coupled with ultravi-olet detection. Results: After the 12-month period, all drugs from the EMS car, except succinylcholine, presented concentrations still above 90% of the concentrations measured at the start of the project. Concentrations ranged from 96.3% to 103%. For succinylcholine at 12 months, the remaining concentration was 89%. Temperatures in the EMS car ranged from 13.9 C to 33.9 C (median, 22.8 C (interquartile range: 20.5 C–25.8 C)). Conclusion: In real-life conditions, amiodarone, rocuro-nium, fentanyl, succinylcholine, and epinephrine onboard an EMS vehicle did not suffer pharmacologically relevant degradation from temperature variations. All concentrations measured remained in the specification intervals given by the manufacturers. Objective : Intra-abdominal injury (IAI) occurs in less than 15% of pediatric trauma activations but can be life-threat-ening. Computed tomography (CT) imaging is commonly ordered in pediatric trauma, even when IAI risk is low. We aimed to reduce abdominal/pelvic CT rates in children at very low risk for intra-abdominal injury requiring trauma activation at our pediatric trauma center. Methods : We implemented a quality improvement initiative using the Model for Improvement in children 0–15.99 years of age who activated a trauma response and were evaluated for intra-abdominal injury. Interventions included clinical decision support, institutional education, and individual audit and feedback. Our primary outcome was abdominal/pelvic CT rate in patients at very low risk for intra-abdominal injury. Balancing measures included CT scans ordered within 24 h of Emergency Department (ED) assessment and return to ED or hospitalization within 72 h for missed intra-abdominal injury. Statistical process control was used to evaluate rates over time. Results : The baseline period (1 April 2016 to 30 November 2017) included 359 trauma patients with a CT rate of 26.8% (95% CI: 20.5%–33.8%) in those at low risk for intra-abdominal injury. The intervention period (1 December 2017 to 31 December 2019) included 445 patients with a CT rate in low risk patients of 6.8% (95% CI: 3.2%–12.6%), demonstrating an absolute reduction of 20.0% (95% CI: 12.2%–27.7%, P < 0.05). Interventions resulted in a significant decrease in abdominal/pelvic CT imaging corre-sponding with special cause variation. No clinically significant intra-abdominal injuries were missed. Conclusions : This quality improvement initiative reduced abdominal/pelvic CT rates in pediatric trauma patients at low risk for intra-abdominal injury without any missed cases of significant injury. Leveraging standardized decision tools to reduce unnecessary CT imaging can be suc-cessfully accomplished without compromising care. The late-diagnosed human immunodeficiency are high. could offer a way to the number of Our aim to analyze whether is efficient. heterogene-ity statistic I2 was high, at 90.02% (P < .001). Estimates of prevalence based on studies were carried out in Europe, the United States, and Africa were, respectively, 0.48% (95% CI: 0.13%–1.03%), 0.54% (95% CI: 0.33%–0.40%), and 5.6% (95% CI: 3.37%–9.2%). The studies received quality ratings of moderate or strong. Conclusion: Although the reviewed studies applied vari-ous screening strategies to identify new HIV diagnoses, our findings support the conclusion that universal screening is efficient. Ability of and criteria defining sepsis to predict 30 day mortality, bacteremia, and microbiologically confirmed infection in patients with infection suspicion treated in Emergency Departments. 0.711–0.765 mmol/L) proved to be the best predictor of 30-day mortality, with an AUC of 0.890 (95% CI: 0.880– 0.901). The model that included the SIRS score ( > = 2) and procalcitonin concentration ( > = 0.51 ng/mL) proved to be the best predictor of true bacteremia and microbiologic confirmation, with an AUC of 0.713 (95% CI, 0.698–0.728). Conclusions: A qSOFA score of 2 or more plus lactate concentration ( > = 0.738 mmol/L) predict 30 day mortality bet-ter than the combination of a SIRS score of 2 or more and procalcitonin concentration. A SIRS score of 2 or more plus procalcitonin concentration ( > = 0.51 ng/mL) predict true bacteremia and microbiologic confirmation.