scholarly journals Barriers and Challenges Affecting Parents Use of Adrenaline Auto-Injector in Children at Risk of Anaphylaxis

2020 ◽  
Author(s):  
Ahmed Elghoudi ◽  
Klithem Al Dhaheri ◽  
Hassib Narchi
Keyword(s):  
United Arab Emirates ◽  
Medical Personnel ◽  
Drug Of Choice ◽  
Effective Interventions ◽  
Al Ain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Barriers And Challenges ◽  
Fear And Anxiety ◽  
Auto Injector

Abstract Background: Anaphylaxis is a life-threatening condition. As accidental exposure to the offending allergens usually happens in the community, in absence of medical personnel, adrenaline auto-injector (AAI), carried by parents, remains the first and only drug of choice. As studies have shown that AAI is commonly underused by parents, this study was undertaken to elucidate the causes of its underutilization in our community.Methods: A cohort of parents attending the paediatric allergy clinic at Al Ain hospital, in the United Arab Emirates (UAE), completed a questionnaire survey aimed to assess their understanding and knowledge of their child’s allergy management, including their aptitude with the use the AAI, as well as their competence and comfort to provide this treatment in an emergency. Results: A total of 47 parents, 83% of whom were Emirati, including 66% of mothers, participated in the study. Food allergy was the main indication for AAI prescription, with tree nuts 62%) and peanuts (38%) being the main culprits. The majority (94%) of parents were trained by a doctor on using the AAI, with most (79%) demonstrating a good knowledge of indications for administering the AAI. Although all parents expressed satisfaction with the training that they had received, they still admitted to a remaining lack of confidence with using an AAI. Conclusions: The continuous education and training of parents on how to use an AAI, still requires supplementary psychological support to overcome their fear and anxiety with using the device in an urgent situation. More research is needed to explore the reasons behind their fear and anxiety to plan effective interventions.

scholarly journals Considerations for Continuing Semielective and Emergency Otolaryngological Procedures During the COVID-19 Pandemic

2020 ◽  
Vol 100 (1) ◽  
pp. 19-25
Author(s):  
Sarina K. Mueller ◽  
Maximilian Traxdorf ◽  
Konstantinos Mantsopoulos ◽  
Antoniu-Oreste Gostian ◽  
Matti Sievert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Surgery ◽  
Transmission Rate ◽  
Medical Personnel ◽  
Human Beings ◽  
Threatening Condition ◽  
Long Time ◽  
Life Threatening

Introduction: During the COVID-19 pandemic, worldwide over 600,000 human beings died due to the cause of the disease. In order to deescalate the transmission rate and to avoid crush loading the countries medical health systems social distancing, face masks, and lockdowns have been considered essential by the majority of governments. Whereas some countries have highly reduced or completely stopped otorhinolaryngological procedures, other countries have continued selected surgeries. The objective of this study was to analyze procedures and outcomes of continuing semielective and emergency surgeries during the COVID-19 pandemic. Methods: Retrospective analysis of n = 750 patients who received semi-elective or emergency surgery between March 26 and June 16, 2020, in the Otolaryngology Department of the Friedrich-Alexander-University of Erlangen-Nürnberg. All patients were screened for COVID symptoms and swabbed for SARS-CoV-2 prior to surgery. Results: Of the n = 750 patients, n = 699 patients received semielective surgery and n = 51 emergency surgery. For 27 patients, the swab result could not be awaited due to a life-threatening condition. In these cases, surgery was performed in full protective equipment. No patient was tested positive during or after the surgery (follow-up 45 to 127 days). No member of the medical personnel showed symptoms or was tested positive after contact with patients. Due to the continuation of surgeries, patients’ lives were saved and improvement of long-term quality-of-life and outcomes is anticipated. Conclusions: Continuing selected otorhinolaryngological surgeries is crucial for patients’ health, survival, and long-time quality of life, yet, the protection of the medical personnel has to be granted.

scholarly journals An Evaluation of the Drone Delivery of Adrenaline Auto-Injectors for Anaphylaxis: Pharmacists’ Perceptions, Acceptance, and Concerns

Drones ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 66
Author(s):  
September Beck ◽  
Tam T. Bui ◽  
Andrew Davies ◽  
Patrick Courtney ◽  
Alex Brown ◽  
...  
Keyword(s):  
Threatening Condition ◽  
Life Threatening ◽  
Relevant Group ◽  
Chemical Purity ◽  
Vitro Model ◽  
The Stability ◽  
The Uk ◽  
Auto Injector ◽  
Temperature Storage

Anaphylaxis is a life-threatening condition where delays in medical treatment can be fatal. Such situations would benefit from the drone delivery of an adrenaline auto-injector such as EpiPen®. This study evaluates the potential risk, reward, and impact of drone transportation on the stability of adrenaline during episodes of anaphylaxis. Further, this study examines pharmacists’ perceptions on drone delivery—pharmacists approved the use of drones to deliver EpiPen® during emergencies but had concerns with drone safety and supply chain security. Laboratory simulated onboard drone conditions reflected typical missions. In these experiments, in vitro model and pharmaceutical equivalent formulations were subjected independently to 30 min vibrations at 5, 8.43, and 13.33 Hz, and temperature storage at 4, 25, 40, and 65 °C for 0, 0.5, 3, and 24 h. The chiral composition (an indicator of chemical purity that relates to molecular structure) and concentration of these adrenaline formulations were determined using ultraviolet (UV) and circular dichroism spectroscopy (CD). Adrenaline intrinsic stability was also explored by edge-of-failure experimentation to signpost the uppermost limits for safe transportation. During drone flight with EpiPen®, the temperature and vibration g-force were 10.7 °C and 1.8 g, respectively. No adverse impact on adrenaline was observed during drone flight and laboratory-simulated conditions shown by conformation to the British Pharmacopeia standards (p > 0.05 for CD and UV). This study showed that drone delivery of EpiPen® is feasible. There are more than 15,000 community pharmacies and ≈9000 GP surgeries spanning the UK, which are likely to provide achievable ranges and distances for the direct drone delivery of EpiPen®. The authors recommend that when designing future missions, in addition to medicine stability testing that models the stresses imposed by drone flight, one must conduct a perceptions survey on the relevant group of medical professionals, because their insights, acceptance, and concerns are extremely valuable for the design and evaluation of the mission.

Laryngeal Papillomatosis

2013 ◽  
Author(s):  
Elizabeth Prentice
Keyword(s):  
Human Papilloma Virus ◽  
Nursing Staff ◽  
Preoperative Assessment ◽  
Medical Personnel ◽  
Respiratory Obstruction ◽  
Laryngeal Papillomatosis ◽  
Papilloma Virus ◽  
Laryngeal Papilloma ◽  
Threatening Condition ◽  
Life Threatening

The incidence of recurrent juvenile laryngeal papilloma caused by human papilloma virus has been rising (Dalmeida et al., 1996). A child with this potentially life-threatening condition requires surgical resection to avoid respiratory obstruction; this surgery may need to be repeated regularly for many years. Laser therapy to the airway provides specific challenges to the anesthesiologist. In particular, the risks of a shared compromised airway as well as the hazards of the laser itself must be appreciated by all medical personnel. The key to success is thorough preoperative assessment, good continuous communication with surgical and nursing staff, preparation for the management of critical incidents, and familiarity with the surgical and anesthetic equipment.

scholarly journals Camel-related Major Vascular Injuries: A 20-years’ Experience

2021 ◽  
Author(s):  
Fikri M. Abu-Zidan ◽  
Saleh Abdel-Kader ◽  
Hussam Mousa ◽  
Ahmad Al Aiyan ◽  
Mohamed S. Baguneid ◽  
...  
Keyword(s):  
United Arab Emirates ◽  
Surgical Care ◽  
Iliac Vein ◽  
Vascular Injuries ◽  
Web Based ◽  
Al Ain ◽  
Life Threatening ◽  
The One ◽  
And Behavior ◽  
Masseter Muscles

Abstract Background: Majority of animal-related injuries in United Arab Emirates are caused by camels. We aimed to study the anatomy, biomechanism and outcome of major camel-related human vascular injuries and correlate them to the camel anatomy and behavior.Methods: We retrospectively studied all patients who were admitted to Al-Ain Hospital with camel-related major vascular injury during January 2001 to January 2020. A special protocol was designed to collect the data. An adult 7-year-old male camel skull was prepared and web-based video clips of camel bites to humans were analysed to have an in-depth understanding of the biomechanism of injury.Results: Seven patients were studied, all were males having a median age of 26 years. Five out of six bite injuries (83%) occured during the camel rutting season. The injuries were severe and life threatening. Four involved the carotid artery, one the femoral artery and vein, one the external iliac vein and one the aorta which was due to a fall from a camel. Although the standard of surgical care was high, the outcome was poor. Six patients were admitted to the ICU for a median of 5 days. One patient died, one was vegetative, and one had arm paralysis. The elongated jaws of the camel having its biting component at the front, and the strong masseter muscles at the back increases the strength of its bite grip. Each bite causes four small elliptical wounds of the canine teeth which resembles two stab wounds of 8 cm long, penetrating deeply and injuring major vessels. Aggressive camels bite repeatedly to kill their victims.Conclusions: Camel-related vascular injuries have a poor clinical outcome. Although the basis of their surgical management is similar to other vascular injuries, their poor outcome is related to the aggressiveness of the attacking camel, the anatomy of its jaw, and its intention to kill. Neck wounds of camel bites can be closed primarily after debridement. Studying these unusual injuries gives an insight into the “one globe one health approach” in which humans interacts with the animals and the environment around them. It important to understand the camel behavior for injury prevention.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Psychological influences on wound healing

2019 ◽  
Vol 98 (8) ◽  
pp. 312-314
Keyword(s):  
Wound Healing ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Wound Complications ◽  
State Of Mind ◽  
Life Threatening ◽  
Psychological Influences ◽  
Fear And Anxiety ◽  
Care Costs

Surgical wound complications remain a major cause of morbidity; although usually not life threatening, they reduce the quality of life. They are also associated with excessive health care costs. Wound healing is affected by many factors – wound characteristics, infection, comorbidities and nutritional status of the patient. In addition, though, psychological stress and depression may decrease the inflammatory response required for bacterial clearance and so delay wound healing, as well. Although the patient´s state of mind can be influenced only to a certain extent, we should nevertheless stick to ERAS (Enhanced Recovery After Surgery) guidelines and try to diminish fear and anxiety by providing enough information preoperatively, pay due attention to postoperative analgesia and seek to provide an agreeable environment.

Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

2016 ◽  
Vol 25 (4) ◽  
pp. 555-558
Author(s):  
Alina Popp
Keyword(s):  
Celiac Disease ◽  
International Normalized Ratio ◽  
Gluten Free Diet ◽  
Alveolar Hemorrhage ◽  
Severe Anemia ◽  
Gluten Free ◽  
Pulmonary Infiltrates ◽  
Pulmonary Hemosiderosis ◽  
Threatening Condition ◽  
Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

Sophistry and Circumstance at the End of Life

2008 ◽  
Vol 5 (1) ◽  
pp. 81-88
Author(s):  
Philip Berry
Keyword(s):  
Liver Failure ◽  
Medical Personnel ◽  
Medical Decision ◽  
Loss Of Consciousness ◽  
Supportive Treatment ◽  
Medical Decisions ◽  
Life Threatening Illness ◽  
Two Factors ◽  
Life Threatening ◽  
Counselling Process

When life-threatening illness robs a patient of the ability to express their desires, medical personnel must work through the issues of management and prognosis with relatives. Management decisions are guided by medical judgement and the relatives’ account of the patient’s wishes, but difficulties occur when distance grows between these two factors. In these circumstances the counselling process may turn into a doctor-led justification of the medical decision. This article presents two strands of dialogue, in which a doctor, counselling for and against continuation of supportive treatment in two patients with liver failure, demonstrates selectivity and inconsistency in constructing an argument. The specific issues of loss of consciousness (with obscuration of personal identity), statistical ‘futility’ and removal of autonomy are explored and used to bolster diametrically opposed medical decisions. By examining the doctor’s ability to interpret these issues according to circumstance, the author demonstrates how it is possible to shade medical facts depending on the desired outcome.

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Critical View Of Safety ◽  
Recent Onset ◽  
Conversion To Open Cholecystectomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Collections ◽  
A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

PRO–CF–MED, Clinical Proof of concept for a RNA–targeting Oligonucleotide for a Cystic fibrosis–F508del MEDication, Horizon2020

Impact ◽  
2018 ◽  
Vol 2018 (3) ◽  
pp. 52-54
Author(s):  
Nicolas Lamontagne
Keyword(s):  
Cystic Fibrosis ◽  
Transmembrane Conductance Regulator ◽  
Transmembrane Conductance ◽  
Rna Targeting ◽  
Threatening Condition ◽  
Life Threatening ◽  
Cftr Protein ◽  
Disease Modifying ◽  
Cystic Fibrosis Transmembrane ◽  
Specific Challenge

Cystic fibrosis (CF) is a progressive life–shortening disease caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene leading to a dysfunctional CFTR protein. The disease affects over 70,000 patients worldwide and while many mutations are known, the F508del mutation affects 90% of all patients. The absence of CFTR in the plasma membrane leads to a dramatic decrease in chloride efflux, resulting in viscous mucus that causes severe symptoms in vital organs like the lungs and intestines. For CF patients that suffer from the life threatening F508del mutation only palliative treatment exist. PRO–CF–MED addresses the specific challenge of this call by introducing the first disease modifying medication for the treatment of the CF patients with F508del mutation. The PRO–CF–MED project has been designed to assess the potential clinical efficacy of QR–010, an innovative disease modifying oligonucleotide–based treatment for F508del patients. Partners within PRO–CF–MED have generated very promising preclinical evidence for QR–010 which allows for further clinical assessment of QR–010 in clinical trials. PRO–CF–MED will enable the fast translation of QR–010 towards clinical practice and market authorisation. PRO–CF–MED has the potential to transform this life–threatening condition into a manageable one.

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