Emergency Treatment Research Articles

Prehospital lactate analysis in suspected sepsis improves detection of patients with increased mortality risk: an observational study

BackgroundRapid, adequate treatment is crucial to reduce mortality in sepsis. Risk stratification scores used at emergency departments (ED) are limited in detecting all septic patients with increased mortality risk. We assessed whether the addition of prehospital lactate analysis to clinical risk stratification tools improves detection of patients with increased risk for rapid deterioration and death in sepsis.MethodsA10-month observational study with consecutive, prospective prehospital inclusion of adult patients with suspected sepsis. Prehospital lactate was used as a continuous variable and in intervals. Analyses of patient subgroups with high and lower priorities according to Rapid Emergency Triage and Treatment System (RETTS) and National Early Warning Score 2 (NEWS2) were performed. Primary outcome was 30-day mortality, secondary outcomes were sepsis at the ED and in-hospital mortality.ResultsIn all, 714 patients were included with a 30-day mortality of 10%. Among the 322 cases (45%) fulfilling Sepsis-3 criteria, the 30-day mortality was 14%. Prehospital lactate was higher among non-survivors (2.6 vs 2.0 mmol/L, p < 0.001). Mortality at different lactate intervals were: 6.7%, at 0–2 mmol/l; 10.0% at > 2–3 mmol/l; 19.2% at > 3–4 mmol/l; and 17.0% at levels > 4 mmol/l. The highest RETTS priority (red) group had higher lactate levels than the lower (non-red) priority group (2.5 vs 1.9 mmol/L, p < 0.001). In the non-red group, prehospital lactate was higher among non-survivors (2.4 vs 1.8 mmol/L, p = 0.002). In the multivariable regression analysis, prehospital lactate > 3 mmol/l was a predictor of 30-day mortality (OR 2.20, p = 0.009) This association was even stronger in the lower priority RETTS non-red group (OR 3.02, p = 0.009). Adding prehospital lactate > 3 mmol/l increased identification of non-survivors from 48 to 68% in the RETTS red group and from 77 to 85% for the NEWS2 ≥ 7 group.ConclusionThe addition of a prehospital lactate level > 3 mmol/l improved early recognition of individuals with increased mortality risk in a cohort with suspected sepsis admitted to the ED. This was particularly evident in patients whose risk stratification scores did not indicate severe illness. We suggest that the addition of prehospital lactate analysis could improve recognition of subjects with suspected sepsis and increased mortality risk.Graphical

Basic Medical Emergency Treatment for Maxillofacial Injuries

Introduction: Maxillofacial trauma presents unique challenges due to the complex anatomy of the face, encompassing vital structures. Beyond physical injuries, these cases significantly impact a patient's appearance and function, necessitating a multidisciplinary approach. Challenges: Maxillofacial trauma often co-occurs with other injuries, particularly head, chest, and extremity trauma. This increases complexity, with head injuries observed in 7.6-8.9% of facial fracture cases, frequently associated with lower Glasgow Coma Scores. Cervical spine injuries and airway obstruction are significant concerns. Management: While trauma management has significantly improved mortality rates, maxillofacial injuries in polytrauma patients remain a challenge. Their proximity to the brain, spine, and airway necessitates modifications to standard ABC assessments. These modifications often incorporate DRSABCDE, a comprehensive evaluation that includes airway clearance with C-spine control, breathing, ventilation, oxygenation, circulation, disability-neurologic status, exposure-environment, and body temperature. Each component of DRSABCDE is crucial in the initial management of maxillofacial trauma. Conclusion: Continuous education and training in triage, communication, and advanced life support (e.g., BLS-AED, ACLS, PHTLS, BTLS, ATLS) are crucial and empowering for healthcare professionals managing maxillofacial trauma in polytrauma patients. This ongoing learning equips them with the necessary skills and knowledge to handle these complex cases effectively.

Using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in a community setting: does it facilitate best interests decision-making?

In the UK, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a widely used process, designed to facilitate shared decision-making between a clinician and a patient or,...

The Immune-Genomics of Cholangiocarcinoma: A Biological Footprint to Develop Novel Immunotherapies.

Cholangiocarcinoma (CCA) represents approximately 3% of all gastrointestinal cancers and is a highly heterogeneous and aggressive malignancy originating from the epithelial cells of the biliary tree. CCA is classified by anatomical location into intrahepatic (iCCA), extrahepatic (eCCA), gallbladder cancer (GBC), and ampullary cancers. Although considered a rare tumor, CCA incidence has risen globally, particularly due to the increased diagnosis of iCCA. Genomic and immune profiling studies have revealed significant heterogeneity within CCA, leading to the identification of molecular subtypes and actionable genetic alterations in 40-60% of cases, particularly in iCCA. Among these, FGFR2 rearrangements or fusions (7-15%) and IDH1 mutations (10-20%) are common in iCCA, while HER2 amplifications/overexpression are more frequent in eCCA and GBC. The tumor-immune microenvironment (TIME) of CCAs plays an active role in the pathogenesis and progression of the disease, creating a complex and plastic environment dominated by immune-suppressive populations. Among these, cancer-associated fibroblasts (CAFs) are a key component of the TIME and are associated with worse survival due to their role in maintaining a poorly immunogenic landscape through the deposition of stiff extracellular matrix and release of pro-tumor soluble factors. Improved understanding of CCA tumor biology has driven the development of novel treatments. Combination therapies of cisplatin and gemcitabine with immune checkpoint inhibitors (ICIs) have replaced the decade-long standard doublet chemotherapy, becoming the new standard of care in patients with advanced CCA. However, the survival improvements remain modest prompting research into more effective ways to target the TIME of CCAs. As key mechanisms of immune evasion in CCA are uncovered, novel immune molecules emerge as potential therapeutic targets. Current studies are exploring strategies targeting multiple immune checkpoints, angiogenesis, and tumor-specific antigens that contribute to immune escape. Additionally, the success of ICIs in advanced CCA has led to interest in their application in earlier stages of the disease, such as in adjuvant and neoadjuvant settings. This review offers a comprehensive overview of the immune biology of CCAs and examines how this knowledge has guided clinical drug development, with a focus on both approved and emergent treatment strategies.

Special Robotic Stylet for Assisting Endotracheal Intubation Based on Multisegment Continuum Mechanism

Endotracheal intubation (ETI) is a critical procedure in anesthesia and emergency medicine, which requires professional personnel for operations and has a high risk of occupational exposure. Herein, a special robotic stylet is developed based on a multisegment continuum mechanism for specialized assisting ETI, which needs to be inserted into the endotracheal tube and bends the tube to accommodate the airway lumen during insertion. Geometric parameters of the ETI route are measured, and design requirements of the robot are clarified based on medical images. Kinematic models which reflect the motion coupling of multisegment bending are derived. A prototype is designed and fabricated. Five bending phases of three segments are designed for kinematic validation, and results illustrate that the kinematic models present the same features with actual motions of the robotic stylet captured by optical tracking system. An airway model is built based on medical images and a simulated ETI experiment is conducted. Accomplishing this experiment, the design concept of the robotic stylet is approved, which is bending the tube by the multisegment continuum mechanism for guiding the ETI procedure. This study significantly contributes to specialized robot‐aided ETI system, which can strengthen accurate, timely, and safe ETI in anesthesia and emergency treatment.

Treatment quality with and without an electronic cognitive aid for emergencies in anaesthesia (eGENA) : The DANGER pilot study part 2 in randomized controlled in-situ emergency simulations

The electronic cognitive aid for emergencies in anesthesia (eGENA) is an app that offers digital support in anesthesiological emergency situations as a cognitive aid tool via checklists for memory and making decisions. The eGENA was published by the German Society of Anesthesiology and has been implemented in the emergency management of the anesthesiological team of the clinic in Potsdam, Germany. The primary endpoint was to observe the influence of eGENA on the anesthesiological emergency management on the subjective feeling of assurance as well as on quality of treatment and, therefore, patient safety. All employees in the anesthesia department (nursing staff and physicians) took part in the initial implementation of eGENA. The implementation phase covered crew resource management (CRM) principles and eGENA use as well as 10case studies that were discussed with help from eGENA. Afterwards in arandomized controlled simulation study, realistic case studies were processed and evaluated. In this, 18cases were handled by 9groups with 4persons in each group. Treatment during these simulations was assessed using apredetermined 20-point evaluation form and 10resuscitation-related and 10case-related points were awarded. Significance tests were carried out using the Wilcoxon-test (significance levelp < 0.05) and two evaluations were completed by the attendees at the beginning and the end of the eGENA implementation process. Scenarios1 and2 showed comparable overall scores (14.9vs. 16.3points out of 20, not significant). Higher case-associated scores (7.6 vs.5.6out of 10, p = 0.03) and higher total scores were achieved with the help of eGENA (16.9 vs. 14.3 out of 20, p = 0.02). Resuscitation-associated scores did not differ significantly (9.3vs.8.8 of 10, p = 0.1). During eGENA use for cases the execution of the algorithm-based resuscitation measures was not delayed or accelerated. With eGENA, however, differential diagnoses were discussed significantly more frequently and expanded treatment and diagnostic measures were implemented. During simulation cases eGENA was mainly used by physicians. The initially very positive responses of the evaluations toned down over time. Planned eGENA use for self-study was less frequent (p = 0.006) and there was less approval of the quality of treatment by eGENA than in the first survey (p = 0.002). The cooperation between doctors and nurses in emergency treatment showed an improvement (p < 0.001). The questions about self-assessed safety in emergency treatment on ascale from 0to 10showed higher values in all categories at the second survey (except only circulatory emergencies and 'other' emergencies). The respondents were more likely to be involved in emergency treatment at the second time of the survey (p = 0.03) after a median of 20months. The sense of security and emergency involvement increased significantly over the observation period. The initial need to use eGENA in everyday life has diminished over time; however, these results cannot be causally associated with eGENA. The use of eGENA does not improve resuscitation efforts but does not delay them either. With the use of eGENA better case-associated results are achieved and advanced diagnostics and treatment are implemented more frequently in complex emergency situations. This increases the quality of treatment. Further studies should be carried out with alarger number of cases to confirm the shown effects.

Single-Cell Multi-omics Assessment of Spinal Cord Injury Blocking via Cerium-doped Upconversion Antioxidant Nanoenzymes.

Spinal cord injury (SCI) impairs the central nervous system and induces the myelin-sheath-deterioration because of reactive oxygen species (ROS), further hindering the recovery of function. Herein, the simultaneously emergency treatment and dynamic luminescence severity assessment (SETLSA) strategy is designed for SCI based on cerium (Ce)-doped upconversion antioxidant nanoenzymes (Ce@UCNP-BCH). Ce@UCNP-BCH can not only efficiently eliminate the SCI localized ROS, but dynamically monitor the oxidative state in the SCI repair process using a ratiometric luminescence signal. Moreover, the classic basso mouse scale score and immunofluorescence analysis together exhibit that Ce@UCNP-BCH effectively facilitates the regeneration of spinal cord including myelin sheath, and promotes the functional recovery of SCI mice. Particularly, the study combines snATAC-eq and snRNA-seq to reveal the heterogeneity of spinal cord tissue following Ce@UCNP-BCH treatment. The findings reveal a significant increase in myelinating oligodendrocytes, as well as higher expression of myelination-related genes, and the study also reveals the gene regulatory dynamics of remyelination after treatment. Besides, the ETLSA strategy synergistically boosts ROS consumption through the superoxide dismutase (SOD)-related pathways after SOD-siRNA treatment. In conclusion, this SETLSA strategy with simultaneously blocking and dynamic monitoring oxidative stress has enriched the toolkit for promoting SCI repair.

Emergency Treatment and Management Strategies for 79 Patients Involved in a School Mass Bee Sting Incident

Emergency Treatment and Management Strategies for 79 Patients Involved in a School Mass Bee Sting Incident

Emborrhoid technique in hemorrhoidal disease: Retrospective analysis of data from a single center.

This study evaluates the safety and effectiveness of coil embolization of the superior rectal artery for both emergency and elective treatment of rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated. Between 2019 and 2024, 18 patients (11 males, 7 females) with a mean age of 65±10.3 years were included in the study. Hemorrhoid grading was performed according to the Goligher classification, and rectal bleeding grading was assessed using the Paris bleeding severity score. Femoral artery access was utilized for embolization in all patients, and superior rectal artery branches were embolized exclusively with coils. All patients were treated electively except one who developed hemodynamic instability due to massive rectal bleeding while monitored in the intensive care unit. Follow-up was conducted via clinical examination and rectoscopy at 1, 3, and 6 months. All patients underwent successful treatment with 100% technical success. No procedure-related ischemic complications or femoral artery puncture-related complications were observed in any patient. All patients were classified as grade 4 according to the Goligher classification prior to treatment. The mean Paris bleeding severity score was 6.6±1.1 before treatment, 3.4±1.5 at the first month, 3.8±1.61 at the third month, and 3.6±1.29 at the sixth month. Recurrence occurred in one patient at the first month and in another at the third month. Clinical success was 95% at the first month and 85% at the third and sixth months. Re-embolization was not performed in patients with recurrence. In conclusion, this study demonstrates that coil embolization of the superior rectal artery branches is a safe and effective minimally invasive procedure for both the emergency treatment of bleeding due to grade 4 hemorrhoidal disease and the elective treatment of patients unsuitable for surgical intervention.

Anaphylaxis in infancy: An area that needs to be highlighted.

Anaphylaxis, the most severe end of the spectrum of allergic reactions, has shown increasing incidence globally over recent years. This hypersensitivity reaction can occur at any age, including infancy. Recent data, although scarce, show that anaphylaxis is increasingly reported in infancy, with food identified as the leading cause of anaphylaxis cases in this age group. Infants constitute a unique subgroup with specific challenges regarding diagnosis of anaphylaxis due to a variety of factors, such as lack of age-specific diagnostic criteria, inability of infants to describe their symptoms, and the broad spectrum of clinical manifestations that may be mistaken as normal findings. Additionally, there are special issues in reference to the treatment of anaphylaxis during infancy, such as the limited availability of weight-appropriate epinephrine autoinjectors for infants weighing <15 kg. In this study, we review the current literature regarding specific characteristics of anaphylaxis in infants as well as unique challenges in terms of diagnosis, acute treatment, and long-term management of this medical emergency in this vulnerable age group.

Selenoprotein P predicting mortallity in acute ill patients with dyspnea.

Good Selenium (Se) status predicts favorable prognoses for various diseases and a reduced overall mortality. The primary objective of the study was to determine whether Selenium status, i.e. Selenoprotein P (SeP) levels, is associated with risk of 90-day mortality in elderly patients with acute dyspnea at the Emergency Department (ED). Patients presenting with dyspnea were enrolled from the ED at the University Hospital in Malmö between 2013 and 2018. Cox regression analyses were conducted to evaluate hazard ratios (HRs) for 90-day mortality. This analysis was performed in two steps. Model A included adjustments for age and sex with 95 % confidence intervals (95 % CI) for individual factors such as SeP levels, the Medical Emergency Triage and Treatment System - Adult (METTS-A), BMI levels, comorbidities, and smoking status. Model B was a multivariate analysis with 99 % confidence intervals (99 % CI), incorporating age, sex, and statistically significant factors from Model A, including SeP levels, BMI, heart failure, anemia, and stroke. A lower concentration of SeP was independently associated with a higher risk of death within 90 days. In the continuous model of SeP, the HR was 0.798 (99 % CI 0.678-0.940). When comparing the lowest quartile to the highest quartile of SeP, the HR was 2.462 (99 % CI 1.240-4.891). Low SeP concentrations were found to predict 90-day mortality in ED patients presenting with dyspnea. The assessment of SeP levels could serve as a valuable tool in the initial evaluation of elderly patients in the ED.

Impact of Sex on Clinical Outcomes of Tandem Occlusion in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy. A Propensity-Matched Analysis.

Although mechanical thrombectomy (MT) represents the standard of care for ischemic stroke due to large-vessel occlusion (LVO), the impact of sex on outcomes in tandem occlusions remains unclear. We investigated sex-based differences in outcomes after MT for tandem occlusions. This multicenter observational study included consecutive patients with tandem occlusion treated with MT across three stroke centers (2021-2023). Propensity score matching was performed. Primary outcomes were the 90-day favorable functional outcome (mRS 0-2) and mRS score shift. Secondary outcomes included favorable recanalization, 24-h early neurological improvement, and NIHSS median score. Safety outcomes were post-MT intracerebral hemorrhage and 90-day mortality. Of 635 patients (46.8% women), 289 women were matched to 289 men. There were no significant differences in primary, secondary, or safety outcomes between sexes. Subgroup analysis showed a lower rate of favorable 90-day mRS scores in women with diabetes compared to men. Women not receiving emergent carotid treatment had higher rates of favourable outcomes. No significant sex differences were found in other subgroups. Women with anterior circulation tandem occlusions treated with MT have similar outcomes to men. However, women with diabetes and those treated with intracranial MT alone exhibited sex-specific differences. Further studies are needed to explore underlying mechanisms.

The health effects of poor air quality.

Smoke, particularly from wildfires and other combustion sources, is a significant contributor to air pollution, comprising a complex mixture of particulate matter and gaseous pollutants. Prolonged exposure to smoke can exacerbate respiratory diseases, such as asthma and chronic obstructive pulmonary disease, leading to increased ED visits and hospitalizations. This article examines the significant health risks associated with air pollution, particularly chronic diseases and acute respiratory conditions, and discusses the emergency treatment of acute respiratory distress from exposure.

The Conditions and Improvement Plan for 119 EMS Activities with Anaphylactic Reaction Patients: Focused on Daejeon Metropolitan City

This study examined the current state of emergency services (EMS) provided to patients experiencing anaphylactic reactions based on 119 EMS activity reports and proposed improvement measures. From January 1, 2021, to December 31, 2021, a total of 106 individuals with anaphylactic reactions in a metropolitan city were analyzed. The results showed that the most frequent locations for anaphylaxis were homes, mountains, and fields, with bee stings identified as the leading cause. Among the individuals with anaphylactic reactions, 26.4% were classified as severe, 36.8% as moderate, and 36.8% as mild reactions. Severe anaphylactic reactions were associated with increased cardiovascular and respiratory clinical manifestations. Implementation rates for cardiac rhythm monitoring and oxygen, fluid therapy, antihistamine, and epinephrine administration were 21.4%, 46.3%, 28.6%, 3.6%, and 7.1%, respectively. It is crucial to identify the suspected causative agent through accurate medical history taking to improve outcomes. Early prediction of severe anaphylaxis based on a patient’s clinical manifestations and vital signs after exposure is essential to ensure intensive monitoring and appropriate emergency treatment.

Appraise the anesthetic efficacy in emergency pulpotomy versus complete pulp extirpation during endodontic treatment: a randomized clinical trial

Background and objectives. Symptomatic irreversible pulpitis (SIP) is one of the main reasons people seek emergency dental care, an extremely painful inflammatory condition of the dental pulp. In endodontics, efficient pain management is a sign of superior clinical practice. An appropriate local anesthesia combined with adequate emergency intervention is mandatory. The aim of the present study was to compare local anesthetic success during pulp extirpation versus emergency pulpotomy in endodontic treatment of mandibular molars teeth with symptomatic irreversible pulpitis. Materials and methods. Seventy-eight patients with mandibular molar having vital pulps with symptomatic irreversible pulpitis were included in the study. After confirming the diagnosis clinically and radiographically, patients were randomly assigned into two groups (n=39) for each group. The control group treated by complete pulp extirpation and the intervention group treated by emergency pulpotomy. Every patient received 4% artiacine as inferior alveolar nerve block (IANB). Endodontic access was initiated after 10 minutes of anesthesia, lip numbness and electric pulp tester (EPT) reading. Pain during endodontic access cavity preparation for both groups and during pulp extirpation or pulpotomy according to each group was recorded by verbal rating scale (VRS). When patients needed, they received buccal infiltration or intraligamentary or intra-pulpal anesthesia of the same anesthetic solution as supplemental. Data were collected through verbal rating scales (VRS) during the intervention to assess the anesthetic success. The second visit was scheduled after one week to complete the treatment for both groups. All the data were collected and tabulated. Statistical analysis was performed by mean, standard deviation for each group, Kolmogorov-Smirnov, Shapiro-Wilk tests, Independent-sample t-test, Mann Whitney test. and the significance level was set to (P≤0.05). Results. There was no statistically significant difference between pulp extirpation group and pulpotomy group (p=0.795) in success of pain control during access cavity preparation and during pulp extirpation or pulpotomy according to each group. 49% of patients in the control group and 43.5% of patients in the intervention group required supplemental anesthesia to effectively complete the treatment without pain. Conclusion. The present study demonstrated that pulpotomy was highly effective as pulp extirpation in rate of anesthetic success upon emergency treatment for mandibular molars with symptomatic irreversible pulpitis. Clinical significance: pulpotomy offers more effective care in less time and with less discomfort than complete pulp extraction.

Awareness of anaphylaxis among public in Al-Ahsa City of Saudi Arabia: A cross-sectional study.

Anaphylaxis is a severe, life-threatening allergic reaction requiring prompt treatment with epinephrine. However, gaps in public understanding exist globally. To guide future education efforts, this study assessed anaphylaxis awareness among adults in Al-Ahsa, Saudi Arabia. A cross-sectional survey assessed knowledge among 380 adults using a validated questionnaire. Convenience sampling was used with data collected via online platforms. Descriptive statistics were calculated, and associations were tested. We analyzed the data using SPSS software. Knowledge was suboptimal, with a mean score of 34.5/60. Most identified the anaphylaxis definition (76.1%) and rapid symptom onset (78.9% within minutes). But just 37.9% recognized epinephrine as a first-line treatment and only 17.4% had auto-injector training. Nearly half (48.4%) needed to learn the proper EpiPen injection site. Under half understood the need for long-term allergen avoidance. Older age, more education, and Job status were associated with higher scores. This study reveals critical gaps in anaphylaxis knowledge among adults in Al-Ahsa, Saudi Arabia. Poor understanding of emergency treatment and long-term management highlights the urgent need for improved public awareness. Targeted educational initiatives must emphasize prompt epinephrine administration, proper auto-injector use, and allergen avoidance. Collaborative efforts engaging healthcare professionals, schools, and policymakers are essential to enhance anaphylaxis preparedness through focused training and tailored awareness campaigns. This will empower the Saudi public to recognize symptoms quickly and respond effectively, saving lives from this dangerous allergic reaction.

Local anesthetic systemic toxicity after brachial plexus block with ropivacaine: a case report

The aim of this article is presentation of clinical case of local anesthetic systemic toxicity (LAST). Local anesthetic systemic toxicity is a rare but life-threatening complication. Ropivacaine is widely used for the regional blocks and rarely leads to the development of LAST. LAST may develop due to intravascular injection or high dose of ropivacaine. We present the case of 48-year-old-female (ASA I, 56 kg, and 165 cm), who underwent surgery on the right shoulder under brachial plexus block. Brachial plexus nerve block was performed by interscalene access with introduction of 40 ml of 0.75% ropivacaine (300 mg). Twenty minutes after the injection, complete sensory/motor block was achieved. Twenty-five minutes after the injection, the patient complained of numbness in the tongue, tinnitus and dizziness. During this time, her blood pressure was 132/83 mmHg, heart rate 82 beats/min. oxygen saturation 97%. No changes were observed on the ECG. Suspecting ropivacaine-induced toxicity, 50 mg of thiopental sodium followed by 2 mg of midazolam were administered for seizure prophylaxis, and supplemental oxygen was given via face mask. Patient’s state improved in 10 minutes. Ten minutes later 20% intralipid emulsion bolus during 2-3 min was administered followed by continuous infusion at a dose of0.25 ml/kg/min. Against clinical stablility and consciousness of the patient, decision was made to proceed with surgery, which was uneventful. Implementation of preventive measures can decrease the possibility for development of complication and emergency treatment can safe patient’s health and life. Preventive measures should include implementation of ultrasound nerve location guidance, individual calculation of local anesthetic dose, taking into account sex, weight, and physical status of a patient.

Evaluation of dentists’ clinical practices and antibiotic use in managing endodontic emergencies in Karachi, Pakistan: a cross-sectional survey

BackgroundEndodontic emergencies, often presented as acute pain or swelling, constitute a substantial challenge in dental practice. While effective management emphasizes prompt intervention, antibiotics are typically indicated only when systemic signs and symptoms are present. There is limited research exists on evaluating the knowledge and clinical approach of dental practitioners in managing endodontic emergencies from our region of the world. Therefore, this study aims to evaluate dentists' knowledge, attitude, and practices regarding clinical management and the prescription of antibiotics in endodontic emergency cases.Materials and methodsA web-based questionnaire was distributed to working dentists in secondary and tertiary care hospitals and clinics. Eligible participants included dental practitioners, postgraduate trainees, and consultants. The questionnaire included demographic information and inquiries about endodontic emergency treatment approaches, antibiotic prescribing habits, and awareness of guidelines. Statistical analysis was performed Stata software version 17 (StataCorp, College Station, Texas, USA), employing a χ2 test.ResultsOf the 527 dentists approached, 409 completed the survey (response rate: 77.6%). The majority of respondents were female (68%) and general dental practitioners (60.32%) with up to 5 years of experience (80.93%). Survey findings highlighted varied treatment approaches, favoring root canal treatment in multiple visits for cases of both irreversible pulpitis (73.59%) as well as with necrotic pulps/periapical lesions (79.95%). Similarly, 45.48% and 37.9% of the respondents favored pulpectomy combined with analgesics and antibiotics in managing irreversible pulpitis and acute apical periodontitis respectively. Moreover, antibiotics were frequently prescribed for acute apical abscess, with amoxicillin-clavulanate being the most common choice (83.6%). Most practitioners (69%) recommended a minimum of 5-day antibiotic course.ConclusionsThis study highlights Pakistani dentists' preferences in managing endodontic emergencies and prescribing antibiotics. Despite awareness of guidelines and the consequences of overuse, there's a tendency towards antibiotic overprescription, indicating a need for educational interventions to promote rational antibiotic use and mitigate antibiotic resistance.

Endodontic emergency patients’ profile and treatment outcome – a prospective cohort study

BackgroundToothache is a debilitating condition, often with mild to excruciating pain, swelling, eating difficulties and insomnia. This study aims to delineate the profiles of patients seeking emergency dental care, focusing on the diagnosis, treatment, and outcomes following non-surgical root canal treatment.MethodsThis prospective cohort study was conducted from 2012 to 2021 at the Section for Endodontics, Department of Clinical Dentistry, University of Bergen, Norway. A total of 281 emergency patient forms were analyzed. Data registered included patient demographics, dental history, chief complaints, medications used, diagnostic results, treatments provided and outcome.ResultsA total of 272 patients (272 teeth) were included in the study. Pain was the predominant complaint (98.5%), where only 57.4% of the patients managed to localize pain to a specific tooth. The mean age of patients was 51.2 years with no significant gender differences. The maxillary right first molar (15.4%) was the most frequent tooth needing treatment. The majority of the patients had experienced pain for three days before they attended the emergency appointment. The most frequently used drug for pain management was paracetamol which was stated to have little effect. Teeth that needed endodontic treatment often had restorations rather than caries. The most frequent diagnoses were pulpitis (26.8%) followed by necrotic pulp (25.4%) and previously root filled teeth (22.8%). Root canal treatment was performed on 60% of the teeth and a success rate of 95% was registered at one-year recall.ConclusionsThere was no singular diagnostic cause leading patients to seek an emergency appointment, highlighting the necessity of a thorough diagnostic procedure. Over the counter pain medications have little effect on alleviating dental pain, often resulting in desperate measures of self-medication. 60% of the teeth needing emergency treatment had previous coronal restorations such as fillings or crowns, indicating that conservative treatment does not appear to fully protect against future pulpal disease. The good prognosis of root canal treatment for teeth with acute symptoms supports recommending dentists to attempt root canal treatment rather than opting for tooth extraction.

STUDY OF DRUG RESISTANCE OF MALARIA PLASMODIA

Malaria is the main cause of death in tropical and subtropical countries, killing more than 1 million people worldwide each year. Although there are now effective methods to control malaria, the number of malaria cases is still increasing due to several factors. In this emergency, prompt and effec-tive diagnostic and treatment methods are essential for fighting and controlling malaria.Two groups were used for the purpose of research. The standard treatment was held in the first group (3 days), and the prolonged treatment (5 days) - in the second group. All cases with severe malaria course ended by recovery, while besides chemical therapy 33 (94.3%) patients received intravenous desintoxication therapy. Fever duration at the stationary was 3.80±0.42 days, which was longer than chemical therapy. Subfebrilitet duration was observed up to 4 days at the post-fever period in 3 (8.6%) patients. Most of all, asthenic syndrome was observed on average for 17.20±1.49 days in 30 (85.7%) patients during discharging from stationary. The duration of intoxication, complication development, and asthenic syndrome was a reason for a longer period of hospitalization - 18.30±1.39 days. The main treatment of malaria vivax is still chloroquine, which was received by 98.2% of patients. The extension of the treatment course with chloroquine up to 5 days allowed for avoiding the development of earlier re-lapse in the control group.