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  • 1
    Online Resource
    Online Resource
    Effect on Opioids Requirement of Early Administration of Intranasal Ketamine for Acute Traumatic Pain
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  The Clinical Journal of Pain Vol. 36, No. 6 ( 2020-06), p. 458-462
    Details
    In: The Clinical Journal of Pain, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 6 ( 2020-06), p. 458-462
    Abstract: To evaluate the efficacy and safety of early administration of low-dose intranasal ketamine on reducing the need for opioid and nonopioid analgesic agents in emergency department (ED) patients with acute moderate to severe acute limbs’ trauma pain. Patients and Methods: This is a double-blind, randomized, prospective, controlled study conducted in the ED. The included patients were randomly assigned to intranasal pulverization of ketamine or placebo. Protocol treatment was given at the triage. The primary outcome is the need for opioids during ED stay. Secondary outcome included the requirement of nonopioid analgesic agents and the percentage of patients discharged from the ED with a visual analog scale (VAS) 〈 30. A combined outcome score including the 3 outcome items was constructed. Results: The authors included 1102 patients, 550 patients in the placebo group, and 552 in the intranasal ketamine group. The groups were similar regarding demographics, clinical characteristics, and baseline VAS. The need for opioids was decreased in the intranasal ketamine group compared with the placebo group (17.2% vs. 26.5%; P 〈 0.001). The need for nonopioid analgesics was significantly lower in the intranasal ketamine group compared with the placebo group (31.1% vs. 39.6%; P =0.003). The percentage of patients discharged with a VAS score 〈 30 was significantly higher in the intranasal ketamine group ( P 〈 0.001). The mean combined outcome score was 0.97 in the placebo group and 0.67 in the intranasal ketamine group ( P 〈 0.001). Conclusion: Intranasal ketamine administered early in the triage was associated with a decrease in opioids and nonopioid analgesics need in patients with acute limb trauma-related pain.
    Type of Medium: Online Resource
    ISSN: 0749-8047
    URL: Article
    DOI: 10.1097/AJP.0000000000000821
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1497640-7
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  • 2
    Online Resource
    Online Resource
    Acetaminophen, Nonsteroidal Anti‐inflammatory Drugs, or Combination of Both Analgesics in Acute Posttrauma Pain: A Randomized Controlled Trial
    Wiley ; 2021
    In:  Academic Emergency Medicine Vol. 28, No. 2 ( 2021-02), p. 155-163
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 28, No. 2 ( 2021-02), p. 155-163
    Abstract: Nonsteroidal anti‐inflammatory drugs (NSAIDs) and acetaminophen (also called paracetamol) are the most frequent analgesics used to relieve posttrauma pain in the emergency department (ED). However, the utility of combining both treatments is still controversial. We sought to explore the benefits of combining an NSAID with acetaminophen compared to acetaminophen alone, or NSAID alone, in the treatment of posttraumatic pain of the extremity after discharge from the ED. Methods This is a prospective, randomized controlled trial, carried out in a single ED from March 2017 to November 2018. The included patients were randomly assigned to receive paracetamol alone, high‐dose NSAID (piroxicam) alone, or a combination of paracetamol and high‐dose NSAID for 7 days after ED discharge. The primary outcome was need for additional oral analgesics. Secondary outcomes included the change of the visual numeric scale (VNS) between ED discharge (VNS D0) and 7 days later (VNS D7), ED revisits for residual pain, side effects, and patient satisfaction as assessed by a Likert satisfaction scale. Results The need for additional oral analgesics was comparable between the paracetamol–NSAID combination group (9.8%) and the paracetamol group (11.4%; p = 0.43). ED readmission rate was also comparable between the two groups at 5.6 and 5.8%, respectively (p = 0.86). In contrast, need for new analgesics and ED revisit rates were both more frequent in the high‐dose NSAID group. Mean VNS decreases on day 7 compared to day 0 were 66, 63, and 67%, respectively, in the paracetamol, NSAID, and paracetamol–NSAID combination groups (p = 0.32). Frequency of dissatisfaction was higher in the NSAID group. Side effects were more frequent in the NSAID and paracetamol–NSAID combination groups. Conclusion This study found that the combination of a high‐dose NSAID with paracetamol does not increase the analgesic effect compared to paracetamol alone. We also found that paracetamol alone is superior to high‐dose NSAID alone for posttraumatic extremity pain.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.v28.2
    DOI: 10.1111/acem.14169
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2029751-8
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  • 3
    Online Resource
    Online Resource
    Twice-Daily Oral Zinc in the Treatment of Patients With Coronavirus Disease 2019: A Randomized Double-Blind Controlled Trial
    Oxford University Press (OUP) ; 2023
    In:  Clinical Infectious Diseases Vol. 76, No. 2 ( 2023-01-13), p. 185-191
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 76, No. 2 ( 2023-01-13), p. 185-191
    Abstract: Zinc supplementation has been considered a potential therapy for coronavirus disease 2019 (COVID-19). We aimed to examine zinc efficacy in adult patients with COVID-19 infection. Methods We conducted a prospective, randomized, double-blind, placebo-controlled multicenter trial. Patients who were tested positive for COVID-19 without end-organ failure were randomized to oral zinc (n = 231) or matching placebo (n = 239) for 15 days. The primary combined outcome was death due to COVID-19 or intensive care unit (ICU) admission ≤30 days after randomization. Secondary outcomes included length of hospital stay for inpatients and duration of COVID-19 symptoms with COVID-19–related hospitalization for outpatients. Results 190 patients (40.4%) were ambulatory and 280 patients (59.6%) were hospitalized. Mortality at 30 days was 6.5% in the zinc group and 9.2% in the placebo group (OR: .68; 95% CI .34–1.35); ICU admission rates were, respectively, 5.2% and 11.3% (OR: .43; 95% CI .21–.87). Combined outcome was lower in the zinc group versus the placebo group (OR: .58; 95% CI .33–.99). Consistent results were observed in prespecified subgroups of patients aged & lt;65 years, those with comorbidity, and those who needed oxygen therapy at baseline. Length of hospital stay was shorter in the zinc group versus the placebo group (difference: 3.5 days; 95% CI 2.76–4.23) in the inpatient group; duration of COVID-19 symptoms decreased with zinc treatment versus placebo in outpatients (difference: 1.9 days; 95% CI .62–2.6). No severe adverse events were observed during the study. Conclusions Our results showed that, in COVID-19 patients, oral zinc can decrease 30-day death, ICU admission rate and can shorten symptom duration. Clinical Trials Registration. ClinicalTrials.gov, NCT05212480.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciac807
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2002229-3
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  • 4
    Online Resource
    Online Resource
    Two-day versus seven-day course of levofloxacin in acute COPD exacerbation: a randomized controlled trial
    SAGE Publications ; 2022
    In:  Therapeutic Advances in Respiratory Disease Vol. 16 ( 2022-01), p. 175346662210997-
    Details
    In: Therapeutic Advances in Respiratory Disease, SAGE Publications, Vol. 16 ( 2022-01), p. 175346662210997-
    Abstract: Duration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Typical administration periods range from 5 to 7 days. A 2-day course with levofloxacin was not previously assessed. We performed a randomized clinical trial to evaluate the efficacy of 2-day versus 7-day treatment with levofloxacin in patients with AECOPD. Methods and analysis: Patients with AECOPD were randomized to receive levofloxacin for 2 days and 5 days placebo ( n = 155) or levofloxacin for 7 days ( n = 155). All patients received a common dose of intravenous prednisone daily for 5 days. The primary outcome measure was cure rate, and secondary outcomes included need for additional antibiotics, ICU admission rate, re-exacerbation rate, death rate, and exacerbation-free interval (EFI) within 1-year follow-up. The study protocol has been prepared in accordance with the revised Helsinki Declaration for Biomedical Research Involving Human Subjects and Guidelines for Good Clinical Practice. The study was approved by ethics committees of all participating centers prior to implementation (Monastir and Sousse Universities). Results: 310 patients were randomized to receive 2-day course of levofloxacin ( n = 155) or 7-day course ( n = 155). Cure rate was 79.3% ( n = 123) and 74.2% ( n = 115), respectively, in 2-day and 7-day groups [OR 1.3; 95% CI 0.78–2.2 ( p = 0.28)]. Need for additional antibiotics rate was 3.2% and 1.9% in the 2-day group and 7-day group, respectively; ( p = 0.43). ICU admission rate was not significantly different between both groups. One-year re-exacerbation rate was 34.8% ( n = 54) in 2-day group versus 29% ( n = 45) in 7-day group ( p = 0.19); the EFI was 121 days (interquartile range, 99–149) versus 110 days (interquartile range, 89–132) in 2-day and 7-day treatment groups, respectively; ( p = 0.73). One-year death rate was not significantly different between the 2 groups, 5.2% versus 7.1% in the 2-day group and 7-day group, respectively; ( p = 0.26). No difference in adverse effects was detected. Conclusion: Levofloxacin once daily for 2 days is not inferior to 7 days with respect to cure rate, need for additional antibiotics and hospital readmission in AECOPD. Our findings would improve patient compliance and reduce the incidence of bacterial resistance and adverse effects.
    Type of Medium: Online Resource
    ISSN: 1753-4666 , 1753-4666
    URL: Article
    DOI: 10.1177/17534666221099729
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2387506-9
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  • 5
    Online Resource
    Online Resource
    Reply to Swindells et al
    Oxford University Press (OUP) ; 2023
    In:  Clinical Infectious Diseases Vol. 77, No. 4 ( 2023-08-22), p. 662-663
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 77, No. 4 ( 2023-08-22), p. 662-663
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciad228
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2002229-3
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  • 6
    Online Resource
    Online Resource
    Bedside lung ultrasonography by emergency department residents as an aid for identifying heart failure in patients with acute dyspnea after a 2-h training course
    Springer Science and Business Media LLC ; 2021
    In:  The Ultrasound Journal Vol. 13, No. 1 ( 2021-12)
    Details
    In: The Ultrasound Journal, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2021-12)
    Abstract: Ultrasonographic B-lines have recently emerged as a bedside imaging tool for the differential diagnosis of acute dyspnea in the Emergency Department (ED). However, despite its simplicity, LUS has not fully penetrated emergency department. This study aimed to assess the accuracy and reproducibility of ultrasonographic B-lines performed by emergency medicine (EM) residents for the diagnosis of congestive heart failure (CHF) in patients admitted to ED for acute dyspnea. Patients and methods This is a cross-sectional prospective study conducted between January 2016 and October 2017 including patients aged over 18 years admitted to ED for acute dyspnea. At admission, two consecutive bedside LUS study were performed by a pair of EM residents who received a 2-h course for recognition of sonographic B-lines to determine independently B-lines score and B-profile pattern. All participating sonographers were blinded to patients’ clinical data. B-lines score ≥ 15 or a B-profile pattern was considered as suggestive of CHF. The final leading diagnosis was assessed by two expert sonographers, who were blinded to the residents’ interpretations, based on clinical findings, chest X-ray, brain natriuretic peptide, cardiac and lung ultrasound testing. Accuracy and agreement of B-lines score and B-profile pattern were calculated. Results We included 700 patients with a mean age of 68 ± 12.6 years and a sex ratio (M/F) of 1.43. The diagnosis of CHF was recorded in 371 patients (53%). The diagnostic performance of B-lines score at a cut-off 15 and B-profile pattern was, respectively, 88% and 82.5% for sensitivity, 75% and 84% for specificity, 80% and 85% for positive predictive value, 84% and 81% for negative predictive value. The area under receiver operating characteristic curve was 0.86 [0.83–0.89] and 0.83 [0.80–0.86] , respectively, for B-lines score and B-profile pattern. There was an excellent agreement between residents for the diagnosis of CHF using both scores (kappa = 0.81 and 0.85, respectively, for ordinal scale B-lines score and B-profile pattern). Conclusion Lung ultrasound B-lines assessment has a good accuracy and an excellent reproducibility in the diagnosis of CHF in the hand of EM residents following a short training program. Trial registration Name of the registry: clinicaltrials.gov; Trial registration number: NCT03717779; Date of registration: October 24, 2018 ‘Retrospectively registered’; URL of trial registry record: clinicaltrials.gov
    Type of Medium: Online Resource
    ISSN: 2524-8987
    URL: Article
    DOI: 10.1186/s13089-021-00207-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2965029-X
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