Management Of Severe Attacks Research Articles

Acute Pancreatitis and Pregnancy: A First Trimester Case and Review of the Literature

Acute pancreatitis associated with pregnancy occurs mostly in the 3rd trimester of pregnancy or during the immediate postpartum period, mainly caused by biliary lithiasis. Its incidence is approximately 1 in 1000 to 3000 pregnancies [1]. Maternal and fetal mortality due to acute pancreatitis occurring during pregnancy has fallen in recent years thanks to medico-technical advances in intensive care units with better management of severe attacks and better management of premature newborns. The clinical presentation is often atypical in pregnant women and the possibilities of imaging and surgery are limited. Acute pancreatitis can be treated medically but surgery becomes necessary if there is no improvement under medical treatment.

Specialist Advice Support for Management of Severe Hereditary Angioedema Attacks: A Multicenter Cluster-Randomized Controlled Trial

Hereditary angioedema is a rare disease associated with unpredictable, recurrent attacks of potentially life-threatening edema. Management of severe attacks is currently suboptimal because emergency medical teams are often unaware of new specific treatments. The objective of this trial is to test whether a dedicated national telephone care-management strategy would reduce resource use during severe hereditary angioedema attacks. We conducted a cluster-randomized multicenter prospective trial of patients with a documented diagnosis of hereditary angioedema (type I, II or FXII hereditary angioedema). Participants were enrolled between March 2013 and June 2014 at 8 participating reference centers. The randomized units were the reference centers (clusters). Patients in the intervention arm were given a national free telephone number to call in the event of a severe attack. Emergency physicians in the SOS-hereditary angiœdema (SOS-HAE) call center were trained to advise or prescribe specific treatments. The primary outcome was number of admissions for angioedema attacks. Economic evaluation was also performed. We included 100 patients in the SOS-HAE group and 100 in the control group. During the 2 years, there were 2,368 hereditary angioedema attacks among 169 patients (85%). Mean number of hospital admissions per patient in the 2-year period was significantly greater in the usual-practice group (mean 0.16 [range 0 to 2] versus 0.03 [range 0 to 1]); patient risk difference was significant: -0.13 (95% confidence interval -0.22 to -0.04; P=.02). Probabilistic sensitivity graphic analysis indicated a trend toward increased quality-adjusted life-years in the SOS-HAE group. A national dedicated call center for management of severe hereditary angioedema attacks is associated with a decrease in hospital admissions and may be cost-effective if facilities and staff are available to deliver the intervention alongside existing services.

Advice needed in use of home nebulisers.

Home nebulisers are valuable in childhood asthma but parents should be given written, as well as verbal, user- instructions, especially in the management of severe attacks.