Cause Of Emergency Admission Research Articles

Investigating the Efficacy of a Handheld Fan Intervention in Children With Dyspnea: A Randomized Controlled Study

IntroductionDyspnea associated with acute respiratory tract infections is a common cause of emergency admissions and can be distressing for children. This study aimed to evaluate the impact of a handheld fan intervention on physiological parameters in pediatric patients with dyspnea. MethodsA total of 59 children aged 2 to 12 years presenting to an emergency department for upper respiratory tract infection between March 2022 and March 2023 were assigned to the experimental group (n = 32) or control group (n = 27) by urn randomization. Both groups received the hospital’s standard care, including 3 doses of inhaled bronchodilator at 20-minute intervals. The fan intervention consisted of parents applying a handheld electric fan to the child’s face at a distance of 15 cm for 5 minutes after each inhaler treatment. Oxygen saturation, heart rate, and respiratory rate were recorded before treatment and after the 3 inhaler treatments. ResultsThere were no statistical differences in descriptive characteristics between the experimental and control groups (P > .05). Oxygen saturation values were significantly higher in the control group before treatment but showed greater increases in the intervention group after treatment (P < .001). The intervention group also exhibited greater reductions than the control group in both heart rate and respiratory rate after the third treatment than pretreatment values (P < .05). DiscussionThe handheld fan intervention effectively supports inhaler treatment for children with dyspnea. Further studies are recommended to assess its impact across different age groups and clinical conditions.

Self-Use of Aspirin Among Mothers in Management of Fever in Children Khartoum, Sudan 2022

Background: Fever is one of the most frequent symptoms of disease in childhood and a common cause of emergency admissions in infants and children. Aspirin is salicylic acid and is used to treat pain and fever. Aspirin should not be administrated to a child under 16 years old of age because it might lead to a serious and sometime fatal condition in children called Reye’s syndrome. Reye syndrome is a rare and potentially fatal pediatric illness defined as acute noninflammatory encephalopathy with fatty liver failure. Objective: To assess attitude and practice among mothers towards self-use of aspirin in management of fever in children under 5 years and its complication in Dar-alsalam almaghariba. Method: A descriptive, cross- sectional community-based study applied in sample size of 195 using non probability convenience sampling method, among mothers in Dar-alslam almaghariba area in February 2022. The data was collected by interview questionnaire. Which include sociodemographic data, close end questions contain 21 questions about knowledge, attitude and practice of self-use of aspirin, Data analysis was done by SPSS program and Microsoft excel. Results: the study report that (41.5%) of the respondents aged more than 40 years, (95,9%) of them were married, (75.4%) were housewife, (20%) were employee, (2.1%) were students and (2.6%) work, Majority of mother (87.2%) measured children’s temperature when felt subjectively rises by touch, irrespective to their beliefs about home management of fever (73.8%) used antipyretics. most of them know about complications of high-grade fever (93.8%) said high grade fever can cause convulsions. About (97.9%) of the participants know Aspirin and most of them (48.7%) get it from booth. Most of the participants (65.1%) used aspirin to lower temperature of their children, about (78.5%) of mothers know how to use aspirin. Majority of mothers (71.8%) don&amp;apos;t know the side effect of the irrational aspirin to the children, about (96.4%) don&amp;apos;t heard of Reye’s syndrome. Conclusion: Study concludes nearly all mothers used aspirin without prescription to reduce children’s body temperature, mothers’ awareness about hazardous use of aspirin and the Reye’s syndrome is extremely low, there is relation between low level of education and irrational use of aspirin by mothers. Ministry of health should increase the awareness of mothers about complications of aspirin aimed at eradication of the practice.

The Outcomes of Emergency Admissions and Associated Factors Among Children Admitted to the Pediatric Emergency Unit at Selected Public Hospitals in Addis Ababa, Ethiopia — A Retrospective Cross-Sectional Study

BACKGROUND: A pediatric emergency condition is a life-threatening process that, without timely and standard clinical intervention, may lead to death. Therefore, this study aimed to assess the outcomes of emergency admissions and associated factors among children admitted to the pediatric emergency of selected public hospitals. METHODS: An institutional-based retrospective cross-sectional study design was conducted on children admitted to the emergency unit/ward from January 02, 2020, to January 08, 2022, in the emergency units of randomly selected public hospitals. Data were extracted with prepared checklists from February 1 to March 1, 2022. RESULT: A total of 303 admitted children’s charts were reviewed with 100% coverage. The mean age of children was 37.47 months, and the male-to-female ratio was 1.16:1. The study revealed that the most common causes of emergency admission were pneumonia (22.4%), surgical emergencies (14.5%), and late-onset sepsis (9.2%), respectively. More than half (53.8%) of children were admitted to the Pediatric Emergency Department for less than 24 hours, and the mean length of stay was 2 days. 39.6% of children were discharged with clinical improvement. Known comorbidity (AOR=4.65, 95% CI (1.23-17.64)) and length of stay less than 24 hours (AOR=4.2, 95% CI (1.2-14.7)) were strongly associated with the outcome. CONCLUSION: Pneumonia is still the most common cause of pediatric emergency admission, and the mortality rate of children at the Pediatric Emergency Department is high, with known comorbidity showing a significant association with mortality. FMOH recommended developing national pediatric emergency care guidelines and providing skill gap training for healthcare workers.

Clinical study of 104 cases of hollow viscus perforation with peritonititis in gastric and duodenal perforation at rural tertiary centre

Acute abdomen with peptic ulcer perforation is a common cause of emergency admission and surgery. This is the study that documents the presentation and outcome of perforation management in DBVPRMC, Loni.This is a prospective study of patients operated upon for perforation peritonitis between March 1, 2021, and March 23, 2023. A structured recorded after questionnaire containing patients demographics, operative findings, and outcome was discharge or death.There were 104 patients. 81 males and 23 females (M : F = 3.5 : 1). The age range was between 18 years and 95 years. The mean age was 48.99 years ± SD 16.1 years. The ratio of gastric to duodenal perforation was 1.88 : 1. Perforation was the first sign of peptic ulcer disease in 62 (59.6%). Pneumoperitoneum was detectable with plain radiographs in 95 (91%) patients. 72 (69.2%) had Graham’s Omentopexy. Death rate was 17.3%.We note that gastric perforation is a more commoner disease in our environment. Perforation is often the first sign of peptic ulcer disease. We identify spicy food, alcoholism and NSAIDs intake amongst patient as a risk factor for perforation. Early presentation is associated with good prognosis.

Risk Stratification of Acute Upper Gastrointestinal Bleeding by AIMS65, Rockall, Glasgow Blatchford and Baylor Scores

Abstract Background Upper gastrointestinal bleeding (UGIB) is the most common cause of emergency admission in gastrointestinal disease. Despite the development of endoscopic therapies and pharmacological management, UGIB is still associated with considerable rates of mortality and morbidity, and high medical expenses. Different scoring systems have been suggested for diagnosing these patients. Aim of the Work In this study we aimed to compare the predictive value of three scoring systems Rockall, Glasgow Blatchfors scale (GBS) and AIMS65 in patients with UGIB. Patients and Methods This study was conducted on 120 adult Egyptian patients presented by UGIB at Emergency department of Ain Shams University Hospital in Cairo, Egypt at a period from October 2020 to June 2021. Patients underwent upper endoscopy within first day from an attack of UGIB. AIMS65, GBS, and PRS scores were calculated for each patient. The ability of these scores to predict clinical outcomes was determined. Area under the receiver-operating-characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values were calculated for rebleeding and mortality. Results GBS was superior to AIMS65, Rockall and Baylor scores in identifying the patients who are likely to need interventional endoscopy "cutoff ≥8.5, sensitivity 80.8%, specificity 54.4%", need blood transfusion "cutoff ≥11.5, sensitivity 54.2%, specificity 90.3%. While AIMS65 score was superior to GBS and other scores in prediction of unfavorable outcomes, namely risk of need for ICU admission "Cutoff ≥1.5, sensitivity 86.4% specificity 96.1%", need for rebleeding in hospital "cutoff ≥1.5, sensitivity 92.7%, specificity 96.2%" and death in hospital "cutoff ≥2.5, sensitivity 90.9%, specificity 98.2%. The reasons for differences in cutoff values compared to previous studies can including ethnicity, UGIB aetiology, period of follow up and number of patients. Conclusion Early risk stratification is recommended in patients presenting with acute UGIB to identify patients at higher risk of bleeding or death and guide management decisions regarding timing of endoscopy, triage to appropriate level of care, and disposition. The optimal cutoff of each scoring system should be specified for different population to maximize the power of identifying UGIB patients at high risk of death.

Prevalence of unfavorable outcome in acute poisoning and associated factors at the University of Gondar comprehensive specialized hospital, Gondar, Northwest Ethiopia: a hospital-based cross-sectional study.

Acute poisoning is a medical emergency in which the toxic effects occur almost immediately, usually within hours from the time of exposure, and can result from exposure to excessive doses of any chemical. It is the common cause of emergency admission, which may result in morbidity and mortality. There are a lot of factors that are associated with an increased magnitude of mortality and complication. Therefore, this study was carried out to assess the clinical characteristics of patients, unfavorable outcomes of acute poisoning, and associated factors to improve the quality of care, resource utilization, and decrease mortality. This study aimed to assess the outcome and associated factors among acute poisoning patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia (2021). A prospective follow-up study was conducted from January 2021 to September 2021 at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia. Data were collected using a comprehensively organized and pretested interviewer-administered questionnaire. The data were entered using EPI data version 4.6.0 statistical software and then exported to Stata 14 for analysis. The data were analyzed for descriptive statistics. Statistical analysis was performed using bivariate and multivariate logistic regression models to identify factors associated with the unfavorable outcome of acute poisoning. The result is presented in the form of tables, figures, and text using frequencies and summary statistics such as mean, SD, median, IQR, and percentage. A total of 233 patients were included in the study. The prevalence of unfavorable poisoning outcomes in acute poisoning was 17.6% (95% CI: 13.2, 23.1). In the multivariate logistic regression analysis, known chronic medical comorbidities [AOR: 3.846 (1.619, 9.574); value of p: 0.014] and hospital stay of less than 48 h [AOR: 6.57 (2.03, 21.273); value of p: 0.002] were found to be independent factors associated with unfavorable outcomes in acute poisoning. The magnitude of unfavorable poisoning outcomes was high in patients with acute poisoning. Having known medical comorbid illness and short hospital stay of less than 48 h were found to be associated with unfavorable outcomes.

Oral Anticoagulation in Patients with Chronic Liver Disease.

The administration of an anticoagulant in patients with liver disease (nonalcoholic steatohepatitis-NASH, nonalcoholic fatty liver disease-NAFLD, chronic hepatitis, or cirrhosis) who have an indication (atrial fibrillation, venous thrombosis, or pulmonary embolism) is challenging because there is an imbalance between thrombosis and bleeding. There is a need to focus our attention on preventing risk factors because diabetes, obesity, dyslipidemia, smoking, and sedentary behavior are risk factors for both NASH/NAFLD and AF, and these patients require anticoagulant treatment. Patients with advanced liver disease (Child-Pugh C) were excluded from studies, so vitamin K antagonists (VKAs) are still recommended. Currently, VKAs are recommended for other conditions (antiphospholipid syndrome, mitral valve stenosis, and mechanical valve prosthesis). Amongst the patients under chronic anticoagulant treatment, especially for the elderly, bleeding as a result of the improper use of warfarin is one of the important causes of emergency admissions due to adverse reactions. DOACs are considered to be efficient and safe, with apixaban offering superior protection against stroke and a good safety profile as far as major bleeding is concerned compared to warfarin. DOACs are safe in the Child-Pugh A and B classes (except rivaroxaban), and in the Child-Pugh C class are contraindicated. Given that there are certain and reliable data for chronic kidney disease regarding the recommendations, in liver function impairment more randomized studies must be carried out, as the current data are still uncertain. In particular, DOACs have a simple administration, minimal medication interactions, a high safety and effectiveness profile, and now a reversal agent is available (for dabigatran and idarucizumab). Patients are also statistically more compliant and do not require INR monitoring.

Prevalence of Attention Deficit Hyperactivity Disorder and Sluggish Cognitive Tempo Symptoms in Children Presenting with Foreign Body Ingestion: A Case-Control Study

Foreign body ingestion (FBI) is one of the common causes of emergency admissions in infancy and childhood. Although the large majority of children who present with the FBI have no psychiatric diagnosis, present studies demonstrate that attention deficit hyperactivity disorder (ADHD) and related psychiatric problems might be a risk factor for FBI. This study aimed to compare the demographic variables and attention deficit hyperactivity disorder levels and sluggish cognitive tempo symptoms (ADHD-SCT) in children who ingested foreign bodies with healthy children. Also, we aimed to address the relationship between ADHD-SCT symptoms and the age of FBI. The FBI group comprised 44 children (age 2-8, median age: 5, 68.2% boys) admitted to the emergency, pediatric surgery, and pediatric gastroenterology department after FBI, and the healthy control group comprised 30 children (age 3-8, median age: 6, 56.7% boys). We administered the sociodemographic information form, SNAP-IV ADHD rating scale, and Barkley’s child SCT ratings scale to both groups of parents. Our results demonstrated that maternal education level was significantly lower in the FBI group, although other demographic characteristics of the samples were similar (p=0.023). In addition, ADHD-hyperactivity/impulsivity scores were significantly higher in the FBI group (p=0.01). Still, there were no significant differences in ADHD-inattention, SCT-daydreaming, and SCT-sluggishness scores (for all, p&gt;0.05). We found positive-moderate relationships between SCT-daydreaming and sluggishness symptoms and FBI age (r=0.314, r=0.348, respectively). This means that higher SCT scores are related to an older FBI age. In conclusion, for the first time, we evaluated the ADHD and SCT symptoms in young children against FBI and found that ADHD-hyperactivity, but not ADHD-inattention symptoms, were significantly higher in the FBI group, and SCT symptoms increase the risk of FBI at an older age. In addition, we found that a lower maternal education level could be an additional risk factor for FBI. Despite the high hyperactivity in the FBI group, the low rate of child psychiatry evaluation should be considered when evaluating a child.

WE8.11 How has the management of acute biliary pathology changed as a result of the SARS CoV2 pandemic?

AimsGallbladder pathology is a common cause of emergency admission under general surgery - however management had to be drastically changed given the unexpected pressures of the SARS-CoV-2 pandemic. This study aimed to compare management strategies in patients presenting with biliary pathology pre and intra-SARS-CoV-2 pandemic in one NHS trust.MethodsA database of patients admitted to the acute surgical admissions ward in the months of November 2019 and 2021 was accessed, patients with biliary presentations were isolated and information about these admissions analysed.ResultsIn 2019 4 of 57 (8.7%) of patients admitted with biliary pathology had a laparoscopic cholecystectomy during that acute admission, compared to 8 of 65 (12.3%) in 2021. For all interventions (including ERCP and cholecystostomy) these values were 14 of 57 (25%) in 2019 and 24 of 65 (37%) in 2021. Of 54 patients in 2019 who did not have laparoscopic cholecystectomy on index admission, 9 were readmitted (16.7%).The median duration of admission for all biliary patients on index admission was 4 days in 2019 compared to 5.9 days in 2021.ConclusionsSARS CoV2 has precipitated a change in management of acute biliary patients. There is now an increased rate of intervention during the index admission and subsequent increase in admission duration. This is seen as an improvement in the pathway for patients in the long term, reducing the burden on the elective waiting list and reducing re-admission which will offset the modest increase in length of stay on the index admission.

The spectrum and outcome of paediatric emergency surgical admissions - a regional hospital analysis

BACKGROUND: Improving emergency surgical care for children requires information on the causes of admissions and the variables affecting outcome. There is a lack of such data in the South African context. METHODS: This retrospective study was conducted from January 2016 to December 2017. Data was collected on all children (&lt; 12 years of age) requiring admission with emergency surgical conditions. Infrastructure and staffing ratios were determined prior to data collection. Information was sourced from admission and discharge books, patient files and theatre registers. Variables of age, sex, referral source, diagnosis, length of stay, surgical treatment and outcome including death were collected. RESULTS: Four hundred and thirty-five of the 1 048 children (42%) admitted were in the 0-2-year age group. Trauma (258), sepsis (564) and burns (226) were the main causes. The median hospital stay was 3 days (IQR 2-5), however, for burns patients, the median stay was 4 days (IQR 2-9). Surgery was performed on 279 (27%) admissions. Eight (0.8%) died, six of which were due to burns. Clinical status prior to death was poorly documented. A dedicated high care unit and burns isolation rooms were lacking. Surgeon/population and child/nurse ratios were respectively 1.48/100 000 and 7-12/1. CONCLUSION: This study found that the emergency paediatric surgical burden is significant. Sepsis and trauma combined are the leading cause of emergency admissions. Burns had the highest mortality. Although mortality was low, improvements of staff to patient ratios and the institution of an early warning system could reduce mortality.

Aspectos epidemiológicos de 306 casos emergenciais em pequenos animais atendidos em um Hospital Escola Veterinário

The deficiencies in the screening protocols and the paucity of epidemiological studies aimed at emergency care contribute to a generalist emergency approach, without focusing on the most common causes and injuries of emergency admissions in veterinary practice. Thus, we aimed to retrospectively study the epidemiological aspects of emergency cases in dogs and cats under routine care at a veterinary school hospital at University X over 24 months (June 2012–June 2014). During this period, 328 cases were considered as emergencies, of which 306 were included in the study. The main causes of emergency admissions in both species were trauma, followed by hypovolemic shock. The third cause differed between species, the most common being neurological emergencies in dogs and urinary emergencies in cats. Knowledge of emergency epidemiological data in the pet clinic is essential for clinical surveillance, case screening, early diagnosis, rapid therapeutic intervention, and avoiding losses in the waiting rooms of veterinary emergency medicine.

Topical capsaicin versus topical ibuprofen in acute musculoskeletal injuries: A randomized, double-blind trial

Background: Acute musculoskeletal pain is one of the common causes of emergency admissions. Topical analgesics are an easily tolerated option in the treatment of these pains. Objective: This study aimed to compare the efficacy of topical capsaicin and topical non-steroidal anti-inflammatory drugs in acute musculoskeletal injuries. Methods: In this prospective, randomized, controlled, double-blinded study, patients were allocated to two groups—the topical non-steroidal anti-inflammatory drug (n = 60) and topical capsaicin (n = 59). For both groups, the first dose treatment was applied as a thin layer in the emergency department to a maximum area of 5 × 5 cm. The remaining doses were administered at home by the patients for 72 h. The initial visual analog scale scores were compared with the 60th and 120th minute as well as the 24th and 72nd hour values. Differences between the visual analog scale scores, clinical response to the treatment, and side effects were evaluated. Results: The proportional reduction in visual analog scale scores for topical capsaicin was significantly higher, especially at 36 and 72 h. These rates were 0.75 (95% confidence interval: 0.77–1.42; p = 0.029) and 9.08 (95% confidence interval: 1.02–17.14; p = 0.028) at 36 h, respectively. At 72 h, they were 1.27 (95% confidence interval: 0.48–2.05; p = 0.002) and 17.07 (95% confidence interval: 8.39–25.76; p &lt; 0.001), respectively. In the topical capsaicin group, the clinical response to treatment was significantly higher (p = 0.001). Treatment-related systemic side effects were experienced only in the topical non-steroidal anti-inflammatory drug group (1.7%). Conclusion: Topical capsaicin can be used safely in patients presenting to the emergency department with acute pain with its high analgesic efficacy and absence of systemic side effects.

Ultrasonographic measurement of the optic nerve sheath in the differential diagnosis and follow-up of migraine with and without aura: A pilot study

ObjectiveHeadache continues to be a common cause of emergency admissions. At first glance, primary headaches may not be distinguished from secondary headaches. This study aimed to evaluate the use of ultrasonic measurement of optic nerve sheath diameter (ONSD) in the clinical diagnosis of migraine patients during attack and during periods without attacks. Patients and MethodsThis prospective study was conducted at the emergency department and neurology outpatient clinic of a tertiary hospital between October 2019 and January 2020. Patients diagnosed with episodic migraine and between ages 18–60 were included in the study. Migraine diagnosis and classification were based on criteria from the 2018 International Classification of Headache Disorders. ONSD measurement was performed with ultrasonography. ONSD measurements of the same migraine patients during attack and attack-free periods were compared with measurements of healthy volunteers. ResultsA total of 82 participants consisting of 42 migraine patients and 40 control subjects were evaluated. In the control group, mean ONSD of the right eye was 4.88 ± 0.31 mm and mean ONSD of the left eye was 4.86 ± 0.31 mm. Mean ONSD measurement of the left eye was 4.80 ± 0.36 mm and mean ONSD of the right eye was 4.82 ± 0.37 during the attack period of the migraine patients. There was no significant difference between the migraine patients and the control group according to right and left eye ONSD measurements (attack-free period: p = 0.200, p = 0.448; attack period: p = 0.338, p = 0.660, respectively). There was no significant difference between ONSD measurements during the attack period and attack-free period in migraine patients (right eye p = 0.32; left eye p = 0.532). ConclusionThe results of our study indicate that ONSD measurements may provide clinical insight into differential diagnosis preceding neuroimaging in migraine patients. On the other hand, since our study is the first on this topic, it should be noted that further studies are needed to come to a conclusion.

The clinical and cost effectiveness of surgical interventions for stones in the lower pole of the kidney: the percutaneous nephrolithotomy, flexible ureterorenoscopy and extracorporeal shockwave lithotripsy for lower pole kidney stones randomised controlled trial (PUrE RCT) protocol

IntroductionRenal stones are common, with a lifetime prevalence of 10% in adults. Global incidence is increasing due to increases in obesity and diabetes, with these patient populations being more likely to suffer renal stone disease. Flank pain from stones (renal colic) is the most common cause of emergency admission to UK urology departments. Stones most commonly develop in the lower pole of the kidney (in ~35% of cases) and here are least likely to pass without intervention. Currently there are three technologies available within the UK National Health Service to remove lower pole kidney stones: extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureterorenoscopy (FURS) with laser lithotripsy. Current evidence indicates there is uncertainty regarding the management of lower pole stones, and each treatment has advantages and disadvantages. The aim of this trial is to determine the clinical and cost effectiveness of FURS compared with ESWL or PCNL in the treatment of lower pole kidney stones.MethodsThe PUrE (PCNL, FURS and ESWL for lower pole kidney stones) trial is a multi-centre, randomised controlled trial (RCT) evaluating FURS versus ESWL or PCNL for lower pole kidney stones. Patients aged ≥16 years with a stone(s) in the lower pole of either kidney confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) and requiring treatment for a stone ≤10 mm will be randomised to receive FURS or ESWL (RCT1), and those requiring treatment for a stone >10 mm to ≤25 mm will be randomised to receive FURS or PCNL (RCT2). Participants will undergo follow-up by questionnaires every week up to 12 weeks post-intervention and at 12 months post-randomisation. The primary clinical outcome is health status measured by the area under the curve calculated from multiple measurements of the EuroQol five dimensions five-level version (EQ-5D-5L) questionnaire up to 12 weeks post-intervention. The primary economic outcome is the incremental cost per quality-adjusted life year gained at 12 months post-randomisation.DiscussionThe PUrE trial aims to provide robust evidence on health status, quality of life, clinical outcomes and resource use to directly inform choice and National Health Service provision of the three treatment options.Trial registrationISRCTN: ISRCTN98970319. Registered on 11 November 2015.

Animal models to study the role of pulmonary intravascular macrophages in spontaneous and induced acute pancreatitis.

Acute necrotizing pancreatitis (ANP) is a common gastrointestinal cause of emergency admissions in dogs and humans and can lead to a systemic inflammatory response syndrome resulting in multiple organ dysfunction syndrome. Among the various complications associated with ANP, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) is a major contributor leading to high mortality rates associated with severe acute pancreatitis (AP) in human patients. The incidence of ALI/ARDS in ANP dogs is not well-characterized in spontaneous AP and there are no models to study it in rodent models. Most of the data related to AP comes from rodent models of AP, which may not always represent the true mechanisms occurring in the lungs of dogs or humans with ANP. Therefore, this manuscript provides a review of current and potential models to study the role of pulmonary intravascular macrophages (PIMs) in acute pancreatitis. Recently, we characterized lung inflammation in clinical cases of AP in dogs and found significant recruitment of PIMs which have been credited as pro-inflammatory cells in species such as cattle, horse, pigs, and sheep that normally have them. Considering the pro-inflammatory roles of constitutive or induced PIMs, we investigated whether a well-established mouse model of ANP has induced PIMs. We found induced PIMs in L-arginine-induced ANP in mouse and that MCP-1 is important in PIM induction in this model. Taken together, now we summarize information on spontaneous ANP in dog and a mouse model of induced ANP to study mechanisms of lung dysfunction and the role of PIMs during ANP.

Pediatric upper gastrointestinal bleeding in children: etiology and treatment approaches

Objective: Upper gastrointestinal bleeding (UGB) is one of the most important and serious cause of emergency admission in childhood. The aim of the study was to evaluate the etiological factors and the treatment approaches in patients with UGB. Methods: In this retrospective study, children with UGB admitted to emergency clinics of Istanbul Health Sciences University Kanuni Sultan Suleyman Research and Training Hospital, Istanbul Bakirkoy Sadi Konuk Research and Training Hospital and Diyarbakir Children’s Hospital were evaluated between January 2014 and August 2017. Results: Of the 198 children, 14.6% had non-steroid anti-inflammatory drug (NSAID) history, and 12.6% had chronic liver disease. We detected esophagitis, esophagus varices and peptic ulcer with upper gastrointestinal endoscopic evaluation (47%, 11.1%, 18.1%, respectively). Helicobacter pylori was found in 61.6% of patients. Endoscopic therapeutic procedures (band ligation therapy, sclerotherapy, and adrenaline injection) were appied in 11.1% of patients. Eighty-four (42.4%) patients were hospitalized, and erythrocyte transfusion (ET) was ordered in 29 (14.6%) patients. Conclusion: Approximately in 20% of the pediatric patients, the source of gastrointestinal bleeding is the upper gastrointestinal system. The cause of UGB varies with age. Appropriate diagnostic and therapeutic approaches are very important for management and to reduce mortality.

Prevalence of Head Injury of Patients Arriving in a Tertiary Care Center

Background and purpose: The prevalence of head injury is increasing with increasing number of automobiles, especially motorbike. With the objective to evaluate the prevalence of head injury and factors that could affect the severity of head injury, this study was performed in a tertiary hospital at far- eastern Nepal.&#x0D; Methodology: This is a cross-sectional study over the duration of one year. Association of age, gender, and mode of injury was checked with severity of injury using Chi-square test where P-value was kept significant at &lt;0.01.&#x0D; Result: Total numbers of patient admitted through the emergency department, during the study period, were 832. Mean age of patient in the study group was 34.59 (SD 18.92) years. Majority of them falls in the category of 20-29 years. Among the different categories of head injuries, mild head injury (76%) was the most common presentation followed by moderate head injury and severe head injury, which were 14% and 10% respectively.&#x0D; Conclusion: Head injury seems to be the major cause of emergency admission in for eastern part of Nepal. Among them road traffic accidents seems to be the major burden which is more common in young gentlemen with significant number of severe head injury.

Comparison of Glasgow Blatchford Score and AIMS65 in Predicting Mortality in Patients with Upper Gastrointestinal Bleeding

Introduction: Upper gastrointestinal bleeding (UGIB) is the most common cause of emergency admission in gastrointestinal disease. UGIB could accompany with adverse events if not treated timely. Different scoring systems have been suggested for diagnosing these patients, In this study we aimed to compare the predictive value of two scoring systems AIMS65 and Glasgow Blatchfors scale (GBS) in patients with UGIB. Methods: In this cross-sectional study, 153 patients (71.9% male with mean age of 56.72±21.64 years) with acute UGIB between April 2017 and September 2018 were included. Demographic findings, past medical history, laboratory findings, AMIS65 and GBS score, as well as, need for urgent endoscopy, transfusion and mortality were recorded. Both methods value in predicting the outcomes were measured using ROC curves. Results and Conclusion: Urgent endoscopy was performed in 44.4%. The most common finding was peptic ulcer with mostly clean base type. Rebleeding occurred in 15%, need for transfusion was in 44.4% and mortality rate was 5.2%. AIMS65 compared to GBS was superior in predicting mortality (AUC of 0.947 vs. 0.80) but was inferior compared to GBS in predicting need for transfusion (0.849 vs. 0.947). None of the systems could predict the need for urgent endoscopy. AIMS65 with cut off 2 and 0 and GBS with cut off of 12 and 8 could predict mortality and need for transfusion. GBS seems a better system in predicting the need for blood transfusion, while AIMS65 is better system for predicting in-hospital mortality in patients with UGIB.

Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s.

In the field of antithrombotics, precision medicine is of particular interest, as it may lower the incidence of potentially life-threatening side effects. Indeed, antiplatelet drugs such as P2Y12 inhibitors are one of the most common causes of emergency admissions for drug-related adverse events. The last ten years have seen a continuous debate on whether platelet function tests (PFTs) should be used to tailor antiplatelet drugs to cardiovascular patients. Large-scale randomized studies investigating the escalation of antiplatelet therapies according to the results of PFTs were mostly negative. Potent P2Y12 inhibitors are recommended as a first-line treatment in acute coronary syndrome patients, bringing the bleeding risk at the forefront. De-escalation from prasugrel or ticagrelor to clopidogrel is now considered, with or without the use of a PFT. This review covers recent advances in escalation and de-escalation strategies based on PFTs in various clinical settings. It also describes the main features of the most popular platelet function tests as well as the potential added value of genetic testing. Finally, we detail practical suggestions on how PFTs could be used in clinical practice.

Diabetic cardiomyopathy: Pathophysiology, theories and evidence to date.

The prevalence of type 2 diabetes (T2D) has increased worldwide and doubled over the last two decades. It features among the top 10 causes of mortality and morbidity in the world. Cardiovascular disease is the leading cause of complications in diabetes and within this, heart failure has been shown to be the leading cause of emergency admissions in the United Kingdom. There are many hypotheses and well-evidenced mechanisms by which diabetic cardiomyopathy as an entity develops. This review aims to give an overview of these mechanisms, with particular emphasis on metabolic inflexibility. T2D is associated with inefficient substrate utilisation, an inability to increase glucose metabolism and dependence on fatty acid oxidation within the diabetic heart resulting in mitochondrial uncoupling, glucotoxicity, lipotoxicity and initially subclinical cardiac dysfunction and finally in overt heart failure. The review also gives a concise update on developments within clinical imaging, specifically cardiac magnetic resonance studies to characterise and phenotype early cardiac dysfunction in T2D. A better understanding of the pathophysiology involved provides a platform for targeted therapy in diabetes to prevent the development of early heart failure with preserved ejection fraction.