Need For Rescue Research Articles

Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery

<i>Background: </i>Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. <i>Methods: </i>Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient's sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o'clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. <i>Results: </i>35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). <i>Conclusions:</i>. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.

Sublingual sufentanil for patient-controlled analgesia during labor induction for pregnancy termination: an effective and well-tolerated approach

BackgroundEffective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy.MethodsWe conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating “not satisfied” to 5, denoting “completely satisfied”), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed.ResultsThe median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine.ConclusionsSublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.

Evaluating 900 Potentially Harming Fires in Germany: Is the Prescriptive Building Code Effective? German Fire Departments Assessed Fire Safety Measures in Buildings Through On-Site Inspections

Fire statistics mirror the outcome of fire prevention. Most fire statistics in Germany deal with the loss of life, value, and fire department actions (number of interventions, nozzles used, or alarm category like a false alarm). However, these results also represent the safety level the legislator has set through the prescriptive building regulations. The current statistics cannot evaluate the level of fire safety and the fulfillment or necessity of fire safety precautions. Today, expert judgment from firefighters is necessary to fill this gap. Here, we show the first evaluation of fire prevention and hazard protection measures by evaluating 900 potentially harming fires throughout Germany. In contrast to minor fires, these fires have advanced to the extent that they could potentially violate the protection objectives outlined in building regulations. The fire department association developed a questionnaire to evaluate the fire safety level and possibly reduce unnecessary fire safety regulations. One hundred twenty-three fire departments carried out the questionnaire, which are responsible for 25% of the German population. Fire prevention officers of the fire departments went to the scene after the fire was extinguished, and the fire safety concept of the building could be evaluated. We found a high rate of injuries, smoke spread, need for rescue by firefighters, and higher than expected firefighter response times after arrival at the scene. Surprisingly, smoke spread rates correlated with building height and not with building age. It was even possible to assess the risk of multiple casualties. Overall, the questionnaire results give insight into the current level of fire safety in existing buildings. Ways and rates for smoke and fire spread prove the importance of second escape routes and the influence of human misconduct. According to these results, current building code regulations are sufficient to prevent fire spread. On the other hand, smoke spreading is a severe threat to people’s safety. For example, the data shown can be applied in Bayes nets or other risk calculations to optimize individual building designs or even governmental building codes concerning fire safety engineering. Based on our observations, science, and building codes, authorities could in the future establish a performance-based building code instead of the current prescriptive code. This paper presents the first approach in Germany to quantify the expert judgment of fire departments and use it as a source of knowledge for fire prevention.

Mapping Tools for Flood Risk Rescue and Assistance Management

The assessment of vulnerability to the danger of flooding, with a focus on the need for rescue and assistance from the population, is still in an exploratory scientific phase. The main objective of this research is to propose a methodology based on the issues of rescue and assistance in the face of the risk of floods and to provide a tool for its management. A series of maps is presented, indicating those territorial elements that require rescue and surveillance in a prioritized manner in a visual and accessible way for public administration. Four methodological cartographic proposals have been designed as follows: (1) a map of territory sectors with special rescue needs (dependent population and/or buildings without shelter); a map of the impact on transportation infrastructure and vulnerable areas of buildings (2); a map of vulnerability to possible disorder and looting caused by flooding events (3); and a map of the increase in the cost of deployment for rescue and assistance systems (4). As an experimental zone to test the effectiveness of these proposals, a peri-urban area of the municipality of Málaga (Spain) is chosen, which has an extensive history of severe floods. The results confirm the applied and preventive nature of the tool, which can be incorporated into flood risk management plans and local flood risk action plans developed by public administrations. The main finding of the research is the technical advancement that comes with a precise understanding of vulnerability and its resulting issues for better flood risk management.

Single-use versus reusable metallic laryngoscopes for non-emergent intubation: A retrospective review of 72,672 intubations

Study objectiveIncreased regulatory requirements for sterilization in recent years have prompted a widespread transition from reusable to single-use laryngoscopes. The purpose of this study was to determine if the transition from metallic reusable to metallic single-use laryngoscopes impacted the performance of direct laryngoscopy at an academic medical center. DesignSingle-site retrospective cohort study. SettingGeneral anesthetic cases requiring tracheal intubation. PatientsAdult patients undergoing non-emergent procedures. InterventionsData were collected two years before and two years after a transition from metallic reusable to metallic single-use laryngoscopes. MeasurementsThe primary outcome was need for intubation rescue with an alternate device. Secondary outcomes were difficult laryngeal view (modified Cormack-Lehane grade ≥ 2b) and hypoxemia (SpO2 < 90% for >30 s) during direct laryngoscopy intubations. Subgroup analyses for rapid sequence induction, Macintosh blades, Miller blades, and patients with difficult airway risk factors (Obstructive Sleep Apnea, Mallampati ≥3, Body Mass Index >30 kg/m2) were performed. Main resultsIn total, 72,672 patients were included: 35,549 (48.9%) in the reusable laryngoscope cohort and 37,123 (51.1%) in the single-use laryngoscope cohort. Compared with reusable laryngoscopes, single-use laryngoscopes were associated with fewer rescue intubations with an alternate device (covariates-adjusted odds ratio [OR] 0.81 95% CI 0.66–0.99). Single-use laryngoscopes were also associated with lower odds of difficult laryngeal view (OR 0.86; 95% CI 0.80–0.93). Single use laryngoscopes were not associated with hypoxemia during the intubation attempt (OR 1.03; 95% CI 0.88–1.20). Similar results were observed for subgroup analyses including rapid sequence induction, Macintosh blades, Miller blades, and patients with difficult airway risk factors. ConclusionsMetallic single-use laryngoscopes were associated with less need for rescue intubation with alternate devices and lower incidence of poor laryngeal view compared to reusable metallic laryngoscopes.

Serotonergic agents and linezolid: Impact of exposure to more than one agent concomitantly on risk of adverse effects

Background: The off-target effects linezolid have the potential to cause serotonin syndrome when given in conjunction with serotonergic agents. Despite package insert labeling as a contraindication, several postmarketing studies have demonstrated a low incidence of serotonin syndrome with the concomitant use of linezolid and other serotonergic agents. Linezolid provides a convenient oral option for gram-positive infections. However, due to concerns for serotonin syndrome, the use of linezolid is sometimes avoided. Methods: We performed a single-center, retrospective, medical record review of all adult inpatients from September 2021 to September 2022. Patients included had 1 administration of linezolid and 1 inpatient administration of a selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI) within 14 days. The primary outcome was the incidence of serotonin syndrome as defined by the Hunter serotonin toxicity criteria, which were retrospectively applied to each patient based on medical-record documentation. We compared patients receiving 1 versus multiple serotonergic agents. Secondary outcomes included duration of hospitalization and adverse outcomes based on concerns for serotonin syndrome such as need for rescue, ICU admission, or change in medication. Results: Of the 50 included patients from a convenience sample, 27 (54%) were on linezolid and &gt;1 serotonergic agent. Patients had similar baseline characteristics (Table 1). The most common concomitant agent used was an SSRI. Other agents that predispose patients to serotonin syndrome included opioid analgesics and other classes of antidepressants (Fig. 1). Serotonin syndrome occurred within 48 hours in 1 patient on an SNRI and a continuous fentanyl drip. There was no need for rescue or ICU admission due to serotonin syndrome. No patients were readmitted due to serotonin syndrome, and no differences were observed in hospital lengths of stay. Conclusions: Exposure to a single serotonergic agent combined with receipt of linezolid was not associated with any cases of serotonin syndrome. Exposure to multiple serotonergic agents was not associated with a high incidence of serotonin syndrome. This small series supports previous reports demonstrating relative safety of linezolid given with serotonergic agents and encourages review of interruptive drug–drug interaction alerts for linezolid within the electronic ordering system.Disclosures: None

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis.

Patients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear. Five databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality. This meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016-0.55), shortened the time to tracheal extubation (MD = -181.55, 95% CI: -243.05 to -121.33) and the duration of hospital stay (MD = -0.73, 95% CI: -1.22 to -0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques. TEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia. https://www.crd.york.ac.uk/prospero/, ID: CRD42021276645.

The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided quadratus lumborum block for analgesia after cesarean delivery: a dose finding study

BackgroundQuadratus lumborum block was recently proposed as an alternative technique for post-cesarean delivery analgesia. However, there is not a definite optimum concentration of local anesthetics. A biased coin design up-and-down method was used to explore the minimum effective concentration of ropivacaine in quadratus lumborum block for satisfactory analgesia after cesarean delivery.MethodsFifty-six patients weighing 60–80 kg after cesarean section and with ages between 18 and 40 years were recruited. For the posterior quadratus lumborum block, a volume of 25 ml of the assigned concentration of ropivacaine was injected bilaterally.The concentration administered to each patient depended on the response to the previous dose. The first patient received 0.25%. If a successful block was observed, the next patient was randomized to receive the same ropivacaine concentration (with a probability of 0.89) or 0.025% less (with a probability of 0.11). After any block failure, the concentration was always increased by 0.025% for the next. The study ended when 45 successful blocks were obtained.We defined effective quadratus lumborum block as a resting visual analog score ≤ 3 and the absence of a need for rescue anesthetics.ResultsThe 90% minimum effective concentration of ropivacaine was 0.335% (95% CI 0.306 to 0.375%), and the 99% minimum effective concentration was 0.371% (95% CI 0.355 to 0.375%). The sufentanil consumption was 11 (11,13) and 24 (22,27) μg at 12 and 24 hours after quadratus lumborum block, respectively.ConclusionsThe optimum dosage of ropivacaine is a 25 ml volume of 0.335% for quadratus lumborum block after cesarean delivery.Trial registrationThe study was registered in the Chinese Clinical Trial Registry (No. ChiCTR2000040415).

Remote Patient Monitoring Effectively Assures Continuity of Care in Asthma Patients During the COVID-19 Pandemic

Background: Digital health tools to bridge gaps in managing infectious pandemics was a proposition grounded until recently more in the hypothetical than in reality. The last two years have exposed the extraordinary global need for robust digital solutions.&#x0D; Objective: The objective of this study was to determine the ability of remote patient monitoring (RPM) during the COVID-19 pandemic to improve clinical outcomes and assure continuity of care in patients with asthma.&#x0D; Methods and Findings:&#x0D; Design: The intervention combined health coaching telephone calls and remote telemonitoring.&#x0D; Participants: 102 patients with asthma were enrolled in a telemonitoring protocol at the beginning of the COVID-19 pandemic in the United States.&#x0D; Setting: A private, university affiliated, outpatient clinical adult and pediatric allergy/immunology and pulmonary practice.&#x0D; Intervention: Patients were enrolled with the primary rationale of maintaining continuity of care in the face of uncertain clinical care options. Enrollment and data collection proceeded in a fashion to allow detailed retrospective analysis. Telemonitoring included a pulse oximeter linked to a smart phone using the software platform Plan-it Med (PIM)®. A healthcare professional monitored data daily, and patients were contacted by providers due to vital sign abnormalities and treatment plan alterations. Patients were encouraged to remain on the platform daily during the first three months of the pandemic. After respiratory and or clinical stability was achieved and clinic visit opportunities were resumed, patients were encouraged to maintain engagement with the platform but were not expected to use the platform daily.&#x0D; Main Outcome measures: Asthma Control Test (ACT) scores were recorded before and after 6 months. Paired Wilcoxon signed-rank tests (dependent groups, before vs. after) and Wilcoxon rank-sum (Mann-Whitney) tests were performed for unpaired results (independent groups, RPM vs. Control). &#x0D; Results: 19 of 102 patients had physiological abnormalities detected (18.6%). Eight of these 19 patients had actionable changes in prescription regimens based on RPM findings (42.1%). In patients utilizing RPM, there was a reported decrease in shortness of breath episodes and a decreased need for rescue inhalers/nebulizer medications (P=0.005). Daily engagement in the first three months of the protocol was 61%. In a subset analysis, 48 study participants (47.1%) chose to continue to actively use the program for at least 14 months. 54 RPM patients were 99.1% compliant with RPM after 110 patient months. Of the patients that chose to discontinue the RPM program the reasons included: (1) symptom alleviation (41.7%); (2) out-of-pocket costs to patients (38.9%), and (3) difficulty using the RPM program (16.7%).&#x0D; Conclusions: A novel RPM technology positively impacted continuity of care, asthma outcomes, quality of life, and self-care.

Impact of opioid free Anaesthesia versus opioid Anaesthesia on the immediate postoperative oxygenation after bariatric surgery: a prospective observational study

Introduction: Opioid induced respiratory depression (OIRD) is a preventable aetiology of postoperative respiratory depression with 85% of the episodes taking place in the first 24 postoperative hours. Due to altered respiratory functional metrics and frequently coexisting comorbidities, obese patients are at a particularly higher risk for such complications. The present study aimed to assess if an opioid-free anesthesia (OFA) was associated with a reduced immediate postoperative OIRD when compared to Opiod-based anesthesia (OA). Methods: Obese patients presenting for bariatric surgery were consecutively included in a non-randomized fashion. Lung protective ventilation strategies applied in both groups. In the OA group, Sufentanil was used for intraoperative analgesia in a liberal fashion. In the OFA group, patients received a pre-induction dexmedetomidine loading, followed by a lidocaine, ketamine and dexmedetomidine bolus immediately before induction, further maintained throughout the intraoperative period. Plethysmographic saturations were obtained before induction as well as after extubation and in the Post-anesthesia care unit (PACU). Opioid requirement and Postoperative Nausea and Vomiting incidence were similarly registered. Results: Thirty-four patients were included in the OFA group, and 30 in the OA group. No significant anthropometric and comorbidity differences were found between both groups. OFA patients had significantly lower pre-induction saturations after dexmedetomidine loading. No difference was found for post-extubation saturations as well as well as pre-PACU discharge. The need for supplemental oxygen at the PACU was higher in the OA group. Opioid requirement and cumulative consumption (MEDs) were significantly higher with OA. Conclusion: OFA was not associated with significant postoperative saturation changes but led to a lower need of postoperative supplemental oxygen therapy. OA led to higher opioid rescue need. No fatal respiratory complications were registered in both groups in the immediate postoperative period.

Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy

BackgroundDirect aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration catheter internal diameter (ID) on aspiration thrombectomy efficacy is incompletely understood.MethodsA...

RESEARCH ON THE INNOVATIVE DESIGN OF TRADITIONAL LIGHTWEIGHT CLOTHING SILK FABRICS GUIDED BY THE CHANGE OF EMOTIONAL BEHAVIOR UNDER THE BACKGROUND OF GUANGDONG, HONG KONG AND MACAO

BackgroundThe construction and development of Dawan district has further promoted the innovative application of cultural resources, brought the long-standing Lingnan culture into the international stage, and become an important carrier and tool to strengthen international cultural exchanges and promote economic cooperation and development. Dawan district. Gauze, as a traditional and ancient manual weaving and dyeing process, has been listed in the national intangible cultural heritage list. It is on the verge of disappearing and in urgent need of rescue. Lightweight business wear is playing an increasingly important role in today's consumer market and has become a cultural image card to convey friendship and mutual assistance. This paper studies the innovative design of light and thin business clothing, and deeply integrates the two elements of shuisha and Lingnan culture, especially the changes of people's emotional behavior towards culture in the process of communication. At present, there is no relevant research report.Topics and MethodsTake water yarn as the carrier, transform Lingnan traditional culture into design elements, deeply integrate light and thin business clothing design, explore the new visual expression and process production of traditional water yarn in style, color and pattern, and give new artistic expression to traditional water yarn. The author studies the application status of gauze in related fields of cultural industry, including the advantages and limitations of gauze; Difficulties in design and production; Advantages and limitations of washing gauze clothing style types, styles and patterns. This paper will explain how to overcome the compatibility problem of the combination of light and thin business clothes and washed yarn, and put forward practical solutions from the aspects of fabric and technology. The research methods include creative practice, literature analysis, observation, field investigation and expert discussion. At the same time, the emotional behavior of water conservancy workers in various places was investigated. This study adopts the profile of mood states (POMS), which was compiled by Australian scholars grore and prapavessis in 1992 and revised by Professor Zhu Beili. It is considered to be a good tool to study emotional states. The average reliability of the scale is 0.71, which is in the standard value of 0.60 ~ 0.82. There are 40 adjectives in the questionnaire, which are divided into seven subscales: tension, anger, fatigue, depression, energy, panic and self-esteem. The corresponding score scale of 0-4 was used. The final result (TMD) of the total score of mood state is five negative emotion scores minus two negative emotion scores, plus a constant of 100 for correction.ResultsThe deep integration of “water yarn + Lingnan cultural elements + light business dress” will broaden the design field of water yarn and endow it with new artistic expression to meet the needs of the times. The combination of water yarn and other textile fabrics can improve the problems of single color, thin texture and high cost of water yarn. Through the summary of creative practice, it is found that there has been a new breakthrough in traditional technology and modern design, and found a new research perspective, which provides a theoretical basis for the application of traditional water yarn in fashion design.ConclusionThis study is not only conducive to revitalizing local culture, promoting the flow of innovative elements and continuously improving the value of urban culture, but also has practical application value for the inheritance and innovation of intangible cultural heritage, and is ready for transformation. From “China's garment industry” to “China's manufacturing industry”.AcknowledgementsThis paper is wrote by He Xiaochun and it is a research project of Guangdong Literary & Art Vocational College, Guangdong Province Education Science “13th Five-Year Plan” 2020. Project name: Research on Innovative Design of Traditional Watered Gauze in Light Business wear under the Background of Guangdong, Hong Kong, Macao Greater Bay Area Construction, Project Number: 2020GXJK313).

Expanding the Duty to Rescue to Climate Migration

Expanding the Duty to Rescue to Climate Migration

Mountain Emergency Medicine Review, 1st edition

Mountain Emergency Medicine Review, 1st edition

Assessing the Adequacy of the Emergency Assembly Points in Fuel Filling Stations in Ghana: The Perspective of the Public

There is the need for rescue in every emergency situation. Siting of the Emergency Assembly Point (EAP) is necessary to get people converge to facilitate the recue process. Truly, these points may seem appropriate and adequate in many institutions but is that the same for all? To find out the feeling of the public on the appropriateness of the EAP in fuel filling stations, this study, through a survey, was conducted in the Bono Region of Ghana. A sample size of 200 respondents was purposively and conveniently studied. These included customers, pump attendants and station managers. This descriptive study employed a structured questionnaire which was self – administered to pump attendants and station managers. Customer’s responds were gathered through Google forms. The gathered data were analysed and presented using Statistical Package for Social Sciences (SPSS). It was realised that people are generally aware of the EAP as well as its uses. However, they felt the point was not far enough to protect them from harm in certain emergencies. They were, therefore, not ready to converge in those points during emergencies. It is recommended that regulatory bodies should spell out emergency situations that are less dangerous for people to utilize these points. Also backup points should be allocated out of the filling station where people can go on their own when they are able to escape dangers from the stations or for serious emergencies.

Quail egg homogenate with zinc as adjunctive therapy in seasonal allergic rhinitis: a randomised, controlled trial.

Because most available treatments for managing seasonal allergic rhinitis show some side effects without reducing recurrence, natural anti-allergic products could represent an interesting treatment addition. This study aimed to analyse the efficacy and tolerance of quail egg as adjunctive therapy in seasonal allergic rhinitis. In a Consolidated Standards of Reporting Trials compliant framework, patients with seasonal allergic rhinitis were prospectively randomised to receive mometasone nasal spray for four weeks or the same topical corticosteroid therapy plus commercially available oral quail egg and zinc tablets. Forty patients were enrolled. The mometasone + quail egg and zinc tablets group showed a greater reduction in nasal itching, sneezing and total nasal symptom scores than the mometasone nasal spray only group. A higher proportion of participants in the mometasone + quail egg and zinc tablets group had good rhinitis control than in the mometasone nasal spray only group, with no need for rescue medications. Despite the need for a further larger study, quail egg preliminarily appears to be an effective adjunct to topical steroid therapy in seasonal allergic rhinitis.

Thrombopoietin receptor agonists and rituximab for treatment of pediatric immune thrombocytopenia: A systematic review and meta-analysis of prospective clinical trials.

Children with immune thrombocytopenia (ITP) may require second-line ITP therapies. The high remission rate in pediatric patients, need for extended-duration use of thrombopoietin receptor agonists (TPO-RAs), drug adherence, potential side effects, monitoring, and cost effectiveness are factors that should be considered in decision-making about second-line therapies. Rituximab (RTX) has been used off-label for years to treat ITP but there are limited studies about its efficacy and safety in children. To date, no studies have directly compared TPO-RAs with RTX for the treatment of childhood ITP. This systematic review analyzed the overall platelet response, durability of treatment effect, and safety for RTX use in comparison to TPO-RAs in pediatric ITP. MEDLINE/PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched through December 2020 and meta-analysis was conducted using proportions of success/failure for each intervention in the selected studies. The proportion of participants achieving the primary endpoint of a platelet response above 50,000 was similar for TPO-RAs (proportion=0.71, 95% CI: 0.63-0.78) and RTX (proportion=0.68, 95% CI: 0.53-0.82). However, considerable variation was found between the two groups with regards to the sustainability of the response and other secondary outcomes such as need for rescue and adverse events. RTX was associated with higher rates of rescue therapy. In this analysis of prospective pediatric ITP studies, RTX and TPO-RAs had similar rates of overall platelet response but differed in other important measures. Prospective comparative studies are needed to better characterize second-line treatments for pediatric ITP.

Comparison of Standard Technique, Ultrasonography, and Near-Infrared Light in Difficult Peripheral Vascular Access: A Randomized Controlled Trial

Successful placement of a peripheral intravenous catheter (PIVC) on the first attempt is an important outcome for difficult vascular access (DVA) patients. This study compared standard technique, ultrasonography (USG), and near-infrared light (NIR) in terms of success in the first attempt in patients with DVA. This was a prospective, randomized controlled study. The study was conducted in a tertiary care hospital. Emergency department patients who describe DVA history, have no visible or palpable veins, and were assessed by the nurse to have a difficult PIVC were included to study. The PIVC procedure was performed on patients by standard, USG, or NIR device techniques. For all approaches, the success of the first attempt was the primary aim. Total procedure time, the total number of attempts, and the need for rescue intervention were secondary aims. This study evaluated 270 patients. The first attempt success rates for USG, standard, and NIR methods were 78.9%, 62.2%, and 58.9%, respectively. The rate of first attempt success was higher in patients who underwent USG (USG versus standard, P = .014; USG versus NIR, P = .004; standard versus NIR, P = .648). The total median (IQR) procedure time for USG, standard, and NIR methods was 107 (69-228), 72 (47-134), and 82 (61-163) seconds, respectively. The total procedure time was longer in patients undergoing USG (standard versus USG, P <.001; NIR versus USG, P = .035; standard versus NIR, P = .055). The total median (IQR) number of attempts of USG, standard, and NIR methods were 1 (1-1), 1 (1-2), and 1 (1-2), respectively. A difference was found among the groups regarding the total number of attempts (USG versus NIR, P = .015; USG versus standard P = .108; standard versus NIR, P = .307). No difference was found among groups in terms of the need for rescue methods. It was found that USG increases the success of the first attempt compared with the standard method and NIR in patients with DVA.

A pilot randomized trial to study the success rate of early precut fistulotomy and its effect on radiation dose in patients with difficult biliary cannulation

Background: Role of precut fistulotomy in reducing fluoroscopy time and the radiation dose in difficult selective biliary cannulation is unknown. Methods: We performed a randomized trial where patients with difficult biliary cannulation were randomized into 2 groups: early precut fistulotomy (precut five minutes after failed standard biliary cannulation) or late precut fistulotomy (precut fifteen minutes after failed standard biliary cannulation). We compared the success rates of selective biliary cannulation, fluoroscopy time, radiation dose, complication rates, need for repeat endoscopic retrograde cholangiography (ERC) and need for other interventions Results: Of the 130 eligible patients screened, 40 patients were randomized. The technical success was comparable between early and late group. The fluoroscopy time and radiation dose were significantly less in the early group [4 minutes (3, 6) vs 15 minutes (8, 28), p=0.001] and [1.35 mGy (0.90, 1.63) vs 2.40 mGy (1.58, 3.25), p=0.010] respectively. In the late group, 60% required need for rescue precut fistulotomy. One patient from late group developed post ERC pancreatitis while 1 from early group developed perforation. Three needed other interventions due to failed second attempt. Conclusion: Early precut fistulotomy has comparable technical success and reduces the radiation dose as compared to late precut fistulotomy for difficult biliary cannulation.

Comparison of Postoperative Pain and Analgesic Requirements Between Laparoscopic and Open Hernia Repair in Children

BackgroundThis study analyses the impact of anaesthetic blockade and intraperitoneal local anaesthetic infiltration on paediatric laparoscopic inguinal hernia repair.MethodA retrospective review of paediatric laparoscopic hernia repairs versus open repairs. Anaesthetic blockade, analgesic consumption and postoperative pain scores were compared between groups.Results155 children underwent laparoscopic repair, 150 underwent open repairs. Median age was 7.2 months (16 days–14 years) in the laparoscopic group, 6 months (17 days–13 years) in the open group. Anaesthetic blockade varied significantly; 62.7% of open cases had caudal blockade compared to 21.6% laparoscopic (p < 0.001). A subset of laparoscopic patients had peritoneal local anaesthetic infiltration. 10.1% of laparoscopic cases required recovery analgesia, compared to 1.3% of open cases (p = 0.001). Postoperative analgesic consumption was significantly higher in the laparoscopic group. Peritoneal infiltration reduced analgesic consumption in the laparoscopic group (p = 0.038). Age < 2 was associated with use of caudal (p < 0.001), which reduced analgesic consumption.ConclusionsLaparoscopy was associated with increased use of recovery analgesia. Caudal reduced the need for rescue and postoperative analgesia. Intraperitoneal infiltration of local anaesthetic is associated with reduced postoperative analgesia in laparoscopy. In suitable patients undergoing laparoscopic surgery, combination caudal and peritoneal infiltration may prove a useful adjunctive analgesic strategy.