scholarly journals Commencement of systemic corticosteroids in emergency Department versus in ward in management of acute adult asthma requiring hospitalization: a retrospective cohort study

2016 ◽  
Vol 15 (4) ◽  
pp. 608-614
Author(s):  
Suen Pao Yim

Introduction: Systemic corticosteroids are commonly used in management of acute asthma, sometimes started before admission in emergency department, sometimes in ward after admission. This study is to determine whether commencing systemic corticosteroids in emergency department compared to in ward for managing acute adult asthma requiring hospitalization can improve the outcome: shorter length of hospital stay.Methods: A retrospective cohort study was conducted in an emergency department in Hong Kong. Adults aged 18 to 65 years-old who presented to the emergency department with acute asthma and subsequently hospitalized with use of systemic corticosteroids were recruited and divided into two groups: a group with commencement of systemic corticosteroids in emergency department (Group A, n=139) and the other group with commencement of systemic corticosteroids in ward (Group B, n=209). The outcome measurement was length of hospital stay.Results: A total of 348 subjects were recruited in final analyses. We used Mann-Whitney U test to test the difference in ranking of length of hospital stay (days) between these two groups. The mean rank of length of hospital stay in Group A was 159, and that in Group B was 185 (p=0.014). The difference was statistically significant with commencement of systemic corticosteroids in emergency department resulting in higher ranking-shorter length of hospital stay.Conclusion: It may be possible to result in earlier discharge in acute adult asthma requiring hospitalization when systemic corticosteroids is started before admission in emergency department, instead of in ward after admission.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.608-614

2021 ◽  
pp. 219256822110088
Author(s):  
Kazunori Nomura ◽  
Munehito Yoshida ◽  
Motohiro Okada ◽  
Yosuke Nakamura ◽  
Kenichi Yawatari ◽  
...  

Study Design: Retrospective cohort study. Objectives: To investigate the effectiveness and safety of a gelatin–thrombin matrix sealant (GTMS) during microendoscopic laminectomy (MEL) for lumbar spinal canal stenosis (LSCS). Methods: This study included 158 LSCS cases on hemostasis-affecting medication who underwent MEL by a single surgeon between September 2016 and August 2020. Patients were divided into 2 groups depending on whether GTMS was used (37 cases, Group A) or not (121 cases, Group B). Perioperative data related to bleeding or postoperative spinal epidural hematoma (PSEH) was investigated. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score for low back pain. Results: The mean intraoperative blood loss per level was greater in Group A (26.0 ± 20.3 g) than in Group B (13.6 ± 9.0 g), whereas the postoperative drainage volume was smaller in Group A (79.1 ± 42.5 g) than in Group B (97.3 ± 55.6 g). No revision surgeries for PSEH were required in Group A, while 2 (1.7%) revisions were required in Group B ( P = .957). The median JOA score improved significantly from the preoperative period to 1-year postoperatively in both Group A and B (total score, 16.0-23.5 and 17.0-25.0 points, respectively). Conclusions: The use of GTMS during MEL for LSCS may be associated with a reduction in postoperative drainage volume. The revision rate for PSEH was not affected significantly by the use of GTMS. Clinical outcomes (represented by the JOA score) were significantly improved after the surgery, regardless of GTMS use during MEL.


2021 ◽  
Vol 70 (3) ◽  
pp. 146-155
Author(s):  
Václav Albrecht ◽  
Lukáš Školoudík ◽  
Peter Sila ◽  
Jan Mejzlík ◽  
Michal Janouch ◽  
...  

Summary Introduction: Acute vertigo ranks among the common reasons for visiting the emergency department. The aim of this study was to evaluate the rate of peripheral vestibular syndrome (PVS) in patients with acute vertigo examined at the ENT emergency department and to compare the agreement of physical ENT examination with video-assisted vestibular testing. Methods: Patients eamined at the ENT emergency department from January to December 2019 were evaluated retrospectively. The patients who underwent basic ENT examination without video-assisted vestibular testing form group A. The patients who underwent basic ENT examination which was followed by video head impulse test (vHIT) and videonystagmography in the next four days form group B. Results: A total of 117 patients with acute vertigo were included in group A, PVS was found in 31 patients (27%). In total, 50 patients were included in group B; PVS was found in 15 patients (30%), vestibular neuronitis was dia­gnosed most often (10 patients). The difference in the dia­gnosis of PVS by basic ENT examination (27 patients, 54%) and by video-assisted vestibular testing (15 patients, 30%) was statistically significant (P = 0.0030). The gain of the lateral (P = 0.0101) and superior (P = 0.0043) semicircular canal proved to be statistically significant, while vHIT was lower in PVS in comparison to other causes of vertigo. Conclusion: After basic ENT examination, PVS as a cause of acute vertigo was dia­gnosed in 27%. Video-assisted vestibular testing proved a statistically significant lower incidence of PVS in comparison to basic ENT examination. Accessibility of video- -assisted vestibular testing in the emergency department might allow for higher accuracy in the dia­gnosis of acute vertigo. Key words acute vertigo – vestibular function tests – video head impulse test – videonystagmography


Author(s):  
Jayendra R. Gohil ◽  
Atul M. Sheladiya ◽  
N. B. Adithya ◽  
Ratna D. Bhojak

Background and Objectives: There is no consensus over which drug best reduces symptoms in Bronchiolitis syndrome. The primary objective of our study is to establish comparative effect of adrenaline nebulisation alone and combination of adrenaline nebulisation plus injectable dexamethasone and adrenaline nebulisation plus fluticasone nebulisation in the treatment of clinical cases of bronchiolitis. Methods: 100 patients diagnosed clinically as bronchiolitis were enrolled in study from 1 month to 24 months of age. Patients were enrolled by purposive sampling. Patients with respiratory distress assessment instrument score [RDAI] of 4 to 15 were chosen, randomized into three groups and treatment given till patient fullfilled discharge criteria. Group A (n=33) were given nebulised adrenaline alone, Group B (n=34) were given nebulised adrenaline plus injectable dexamethasone and Group C (n=33) were given nebulised adrenaline plus nebulised fluticasone. Results: The mean reduction in clinical severity-RDAI score was 1.75 ±0.86 in Group A, 2.30 ± 0.68 in Group B and 1.42 ± 0.9 in Group C when measured in terms of difference in clinical scores between day 1 and 2 (p=0.0003). Mean duration of hospital stay in the group A was (4.93±1.95 days), Group C (4.78±1.83) and Group B (3.91 ±1.37 days). The difference of stay between the Groups A and B was 1.02±0.58 days vs 0.87± 0.46 days in groups B and C (p-0.0048). Reduction in the length of hospital stay in group B was 22% compared to Group A & 19% compared to Group C (p-0.0048). Side effects were tachycardia in six patients. Conclusion: Combination of adrenaline nebulization and injectable dexamethasone was found significantly better as compared to nebulised adrenaline plus nebulised fluticasone and nebulised adrenaline alone in patients of clinical bronchiolitis in reducing severity of clinical symptoms and duration of hospitalization.


2021 ◽  
Author(s):  
Yang Chen ◽  
Jianjun Jiang ◽  
Wei Peng ◽  
Chuan Zhang

Abstract Background: Palliative sedation is consciously reducing the patient's consciousness to alleviate the refractory symptoms. However, studies on palliative sedation for children are scarce. We aimed to survey the symptom control and risks for children with sedative therapy in end of life.Method: This study was a single center retrospective cohort study. Children who died in the Department of Palliative Medicine were divided into palliative sedation (Group A) and non-palliative sedation group (Group B). The symptoms relief, survival time, and last hospitalization time were compared between two groups. Results: From January 2012 to November 2019, 41 children died in department of palliative care. 24 children were sedated (Group A), meanwhile 17 children were not (Group B). The symptoms in Group A were more complex than Group B (p =0.013). Overall symptom relief in Group A was higher than that in Group B (24/24, 10/15 p =0.041). Pain relief rates(7/7, 20/21 p =0.714), maximum/pre-death opioid dose [30(20, 77.5), 18(9, 45) p =0.175, 30(20, 60), 18(9, 45) p =0.208]and pain intensity difference [5(4,6.5), 4(2,6) p =0.315] were not statistically significant difference in both group. After diagnosis, the survival time of the Group A was longer than the Group B (p =0.047). However, the length of hospitalization before death was similar in two groups (p =0.385).Conclusion: Palliative sedation controls complicated, painful symptoms at the end of life and does not shorten the hospitalization time in children.


1997 ◽  
Vol 4 (1) ◽  
pp. 41-44
Author(s):  
Douglas Sinclair ◽  
MG MacKenzie ◽  
Dennis M Bowie

STUDY OBJECTIVE: To compare two dosing regimens of salbutamol in acute asthma.DESIGN: Prospective randomized double-blind trial.SETTING: Urban emergency department.TYPE OF PARTICIPANTS: Patients who presented to the emergency department with moderate to severe asthma.INTERVENTIONS: All patients had pulmonary function testing and were randomized to group A (control; n=25) or group B (experimental; n=23). Group A (control) patients received salbutamol 2.5 mg delivered by wet aerosol at 0, 1 and 2 h (total dose 7.5 mg). At 20, 40, 80 and 100 mins a placebo aerosol was given. Group B patients received salbutamol 5 mg at 0 min and one-third the initial dose every 20 mins for a total of six doses by wet aerosol (total dose 15 mg).RESULTS: There were no differences in age, sex, preadmission medications or initial forced expiratory volume in 1 s (FEV1) between the groups. Forty-eight patients completed the study. Both groups of patients improved with mean absolute change in FEV1of 700 mL in group A and 590 mL in group B. There were no statistical differences between the two groups in terms of treatment response, admission rates or side effects.CONCLUSIONS: This study of patients presenting with acute asthma demonstrated no differences in improvement during the initial 3 h of treatment with a standard dose of aerosolized salbutamol given at hourly intervals (total dose 7.5 mg) compared with a higher total dose given at 20 min intervals (total dose 15 mg).


2020 ◽  
Vol 9 (3) ◽  
pp. 287-296
Author(s):  
Emmanuel Numfor ◽  
Nkengafac Nyiawung Fobellah ◽  
Joel Noutakdie Tochie ◽  
Tsi Njim ◽  
Sylvester Atanga Ndesso

Background: Post-partum hemorrhage (PPH) is a leading cause of maternal mortality. Its first-line of prevention often entails uterotonic drugs like oxytocin and misoprostol which constitute a core point of management in low-resource settings of sub-Saharan Africa. This study aimed to assess the effectiveness of oxytocin alone compared with oxytocin plus misoprostol in two different eras (before and after the advert of misoprostol) of a semi-urban Cameroonian hospital. Methods: This was a retrospective cohort study carried out between January 2015 to April 2015 and between January 2016 to April 2016 on a group of parturients (group A) who received only oxytocin and another administered oxytocin and misoprostol (group B), respectively. All participants delivered at the Bamenda Regional Hospital, Cameroon. The two different periods represent the era before and after the implementation of misoprostol in the prevention of PPH in this semi-urban hospital. Socio-demographic data, clinical characteristics and details of delivery as well as risk factors for PPH were studied from obstetric records. Results: We studied the obstetric records of 1778 parturients were studied; 857 in group A and 879 in group B. Their mean age was 26.3 ±5.2 years. Both groups were comparable in several baseline sociodemographic and clinical characteristics. The prevalence of PPH was 2.7% (3.4% vs 2.2%; p = 0.0744). The risk of PPH in the oxytocin only group was about 1.5 times higher than in the oxytocin plus misoprostol group. The estimated blood loss between the two groups was statistically significant (1100 ± 150 vs 800 ± 100 ml, p< 0.0001). The active management of the third stage of labor without misoprostol was the only risk factor for PPH. Conclusion and Global Health Implications: The implementation of misoprostol plus oxytocin in the prevention of PPH in this low-resource setting improved the obstetrical outcome by reducing the risk and the amount of blood loss during delivery. Keywords: • Misoprostol • Oxytocin • Postpartum Hemorrhage • Cameroon   Copyright © 2020 Numfor et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5106-5106 ◽  
Author(s):  
Evelyn Acuña Cruz ◽  
Jimena Cannata Ortiz ◽  
Ana García-Noblejas ◽  
Adrian Alegre ◽  
Reyes Arranz Sáez

Abstract Introduction: Anthracyclines plays a key role in the treatment of Diffuse Large B cell Lymphoma (DLBCL). There is a great concern about its cardiotoxicity, especially among elderly patients with raising age and related morbidities. Liposomal doxorubicin (LD) has proven to be efficacious and less cardiotoxic in combinations of neo-adjuvant chemotherapy regimes through phase II and III studies in breast cancer. There are some phase II studies in DLBCL but to our knowledge, controlled randomized studies are pending. Aim: To analyze the efficacy and toxicity of LD (Myocet¨) in DLBCL patients with cardiovascular/cardiopathy risk, in comparison with a control population who received the standard therapy during the same period of time. Methods: We conducted a retrospective cohort study in patients with de novo DLBCL treated with standard immunochemotherapy, comparing conventional Doxorubicin vs LD. Selection of a 3.3 vs 1 ratio was used to increase statistic power. Criteria to indicate LD therapy were any of the following: left heart ejection fraction < 50%, cardiovascular risk factors or prior history of cardiopathy. Overall response (OR), complete/uncertain response (CR/CRu), progression free survival (PFS) and overall survivall (OS) were analyzed. Toxicity was evaluated with CTCAE v.4.0. and the used statistical package was SPSS v18.0. Results: 78 patients (pts) treated between March 2006 and June 2012 were selected: 60 pts in the control group (group A) and 18 in the study arm (group B). Their characteristics are shown in table 1. Homogeneity was observed, except in LVEF < 50%, older age and hypertension in group B. Efficacy: 69 pts were evaluable for response, with similar OR rate and CR+CRu in both groups (see table 2). Response was consolidated in 17 pts: 22% in group A and 40% in group B. With a median follow up of 4.3 years for surviving pts (0.74 yrs - 8 yrs), actuarial OS and PFS for the whole series were 64% ±SD 13% and 55% ±SD 7%, respectively, without significant differences between both arms (OS: 64% vs 77%; p=0,7 and 56% vs 55%; p=0,9). Toxicity: Hematological toxicity was 43% vs 11%, grade 3 neutropenia 43% vs 6% and febrile neutropenia 37% vs 11%, all significantly different and favoring group B. These differences were probably due to the systematical use of Peg- GSF in group B. Four (5%) cardiac events were observed in group B: 1 heart failure and 3 arrhythmias. Currently, 16 (21%) pts have died, 11 due to lymphoma, 4 due to infection grade 5 during induction treatment and 1 suicide. Conclusion: In this study, the association of LD to immunochemotherapy showed the same efficacy as conventional Doxorubicin in fragile patients, without increased toxicity. Acknowledgment: We are grateful to TEVA for their contribution with the CRO for the statistical analysis. Disclosures Alegre: Celgene Corporation: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees.


2021 ◽  
Author(s):  
Yannan Chen ◽  
Xiaoling Gu ◽  
Xi Guan ◽  
Minyan Yu ◽  
Shuping Zhong ◽  
...  

Abstract Background Both anti-Mullerian hormone (AMH) and antral follicle count (AFC) predict ovarian reserve independently and have been shown to correlate well. However, it is quite common to encounter discordance between the two clinical indices. This objective of this study is to speculate which condition is favorable to patients and to decide what best to be done in cases of such discordance. Methods This retrospective cohort study analyzed the medical records of 714 women undergoing the first IVF cycle at the Center for Reproductive Medicine, the Affiliated Hospital of Nantong University, Nantong, Jiangsu between January 2017 and December 2020. All patients had their essential characteristics, baseline FSH, Estradiol, PRL, LH, Testosterone, CA125, AMH, and AFC recorded. Patients were classified into three groups according to whether their AMH and AFC values were in the lower quartile, upper quartile, or in between, namely Group A (Concordance, concordant in AMH and AFC), Group B (HTP, AMH concentration higher than predicted according to AFC) and Group C (LTP, AMH concentration lower than predicted according to AFC). SPSS 25.0 software package (SPSS, Inc., Chicago, IL, USA) was used for statistical analysis. Results The entire study population has a good concordance between AMH and AFC. 240 women (33.61%) had discordant AMH and AFC values, and the proportion in Group B(HTP) and Group C(LTP) seemed similar (16.67% VS 16.94%). The three cohorts had similar age, infertile duration, FSH, Estradiol, PRL, LH, Testosterone, and CA125 levels. BMI progressively increased from Group B to Group A and to Group C. The ratio of patients, who had completely mature oocytes (COM), rapidly decreased from Group C to Group A and to Group B. Although no significant difference in CMO rate was observed among Group A, B, and C when stratified according to BMI, CMO rate was the highest (72.31%) when BMI < 18.5 kg/m2 in all BMI categories. Conclusions Our analysis demonstrated a high frequency of clinical discordance between AMH and AFC in women undergoing IVF therapeutic regime. Patients’ BMI and completely mature oocytes ratio are significantly different among distinct grouping based on their AMH and AFC partition.


PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0249171
Author(s):  
Marie Burgard ◽  
Floryn Cherbanyk ◽  
Konstantinos Nassiopoulos ◽  
Sonaz Malekzadeh ◽  
François Pugin ◽  
...  

Aims of the study The novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID-19 pandemic. Methods We retrospectively analyzed all data collected from a multi-center database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre- and postoperative patient characteristics were evaluated. Results A total of 306 patients were included in this evaluation. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017–2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms (symptoms > 48h in 61% and 26%, p < 0,001), the intervention time (77 vs 61 minutes, p = 0,002), length of hospital stay (hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment (antibiotics > 3 days in 36% and 24% p = 0.001). Conclusions The COVID-19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.


2021 ◽  
Author(s):  
Marie Burgard ◽  
Floryn Cherbanyk ◽  
Konstantinos Nassiopoulos ◽  
Sonaz Malekzadeh ◽  
François Pugin ◽  
...  

AbstractAIMS OF THE STUDYThe novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID-19 pandemic.METHODSWe retrospectively analyzed all data collected from a multi-center database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre- and postoperative patient characteristics were evaluated.RESULTSA total of 306 patients were included in this evaluation. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017–2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms (symptoms > 48h in 61% and 26%, p < 0,001), the intervention time (77 vs 61 minutes, p = 0,002), length of hospital stay (hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment (antibiotics > 3 days in 36% and 24% p = 0.001).CONCLUSIONSThe COVID-19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.


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