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Objectives: 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. [ABSTRACT FROM AUTHOR]

The article discusses the importance of choosing appropriate outcome indicators in clinical research, particularly in the context of COVID-19 disease. While mortality rates and Intensive Care Unit (ICU) admission are commonly used as objective criteria, the study acknowledges the influence of vaccination and the potential role of antiviral drugs like remdesivir. The use of steroids and concerns about zinc dosage and adverse effects are also addressed.

Background: Short‐acting β2‐agonists are the mainstay of treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department (ED). It is still unclear whether the addition of short‐acting anticholinergics is clinically more effective care compared to treatment with β2‐agonists alone in patients with hypercapnic AECOPD. Objective: The objective was to evaluate whether combining ipratropium bromide (IB) to terbutaline reduces hospital and intensive care unit (ICU) admission rates compared to terbutaline alone in AECOPD hypercapnic patients. Methods: In this double‐blind controlled trial, patients who were admitted to the ED for AECOPD requiring noninvasive ventilation (NIV) were randomized to receive either 5 mg of nebulized terbutaline combined to 0.5 mg of IB (terbutaline/IB group, n = 115) or 5 mg of terbutaline sulfate (terbutaline group, n = 117). Nebulization was repeated every 20 minutes for the first hour and every 4 hours within the first day. Primary outcomes were the rate of hospital admission and need for endotracheal intubation within the first 24 hours of the start of the experimental treatment. Secondary outcomes included changes from baseline of dyspnea, physiologic variables, length of hospital stay, ICU admission rate, and 7‐day mortality. Results: The two groups were similar regarding baseline demographic and clinical characteristics. Hospital admission was observed in 70 patients (59.8%) in the terbutaline/IB group and in 75 patients (65.2%) in the terbutaline group (respiratory rate [RR] = 1.09, 95% confidence interval [CI] = 0.93 to 1.27, p = 0.39). ICU admission was required in 37 (32.2%) patients in the terbutaline/IB group and 30 patients (25.6%) in terbutaline group (RR = 1.25, 95% CI = 1.02 to 1.54, p = 0.27). There were no significant differences in dyspnea score, blood gas parameters changes, vital signs improvement, and 7‐day death rate between both groups. Conclusion: In patients admitted to the ED for AECOPD requiring NIV, combination of nebulized IB and terbutaline did not reduce hospital admission and need to ICU care. [ABSTRACT FROM AUTHOR]

The article addresses the impact of zinc supplementation on Covid-19 outcomes, emphasizing its significance despite modest effects. Topics covered include zinc's potential for reducing hard outcomes, its affordability, and the importance of clear ICU admission criteria; and offers concerns about the fragility index, indicating its limitations, and acknowledge uncertainties regarding the study's applicability to different Covid-19 variants and vaccination rates.

AbstractIntroductionObjectiveMethodsResultsConclusionThe assessment of Volatile Organic Compounds (VOCs) in exhaled breath or sweat represents a potential non-invasive and rapid diagnostic tool for respiratory diseases.To determine if trained dogs can reliably identify the odour associated with COVID19.This is a monocentric prospective study carried out in the Emergency Department (ED) of a university hospital fromJulyto November 2021.Axillary sweat samples from all patients were collected bytwo trained health care professionals. The samples were collected in the form of sterile gauze swabs placed under the armpits for at least 4 h for each patient.Then, Tubes wereshiftedto the double-blind dog training centre for VOC detection by two individuals.Dogs were tested using a total of 129 axillary sweat samples; 69 of the 107 patients who tested positive for COVID-19 based on their odours had a positive PCR/Antigen test and 19 of the 22 patients who were tested negative for COVID-19 by the dogs had a negative PCR test. The sniffer dog infection detection method had a sensitivity of 95.83% and a specificity of 33.33%. The PPV was 64.49% and the NPVwas 86.36%. The measurement of the intensity of the connection between the two variables (disease/sign) was very strong (Q = 0.84). This link is statistically significant (X2 = 19.13) with a probability p ≤ 0.001.Overall, the use of trained detection dogs as a screening method for SARS-CoV-2 is an interesting avenue of research that warrants further exploration and validation. [ABSTRACT FROM AUTHOR]

Objective: Renal colic (RC) is a common urologic emergency often leading to significant pain and recurrent hospital visits. This study aimed to compare the efficacy and safety of piroxicam versus paracetamol in preventing pain recurrence and hospital readmission in patients treated for RC and discharged from the emergency department (ED)., Methods: A prospective, randomized, single-blind trial was conducted in four EDs. Eligible adults with RC were randomized to receive oral piroxicam, paracetamol, or placebo for 5 days post-ED discharge. Primary outcomes included pain recurrence and ED readmission within 7 days. Secondary outcomes included time to recurrence and treatment-related side effects., Results: Of 1383 enrolled patients, no significant differences were observed among the groups regarding baseline characteristics. Pain recurrence rates within 7 days were 29% (95% confidence interval [CI] 24.9%-33.2%) for piroxicam, 30.3% (95% CI 26.1%-34.5%) for paracetamol, and 30.8% (95% CI 26.6%-35.0%) for placebo, with no significant between-group differences (p = 0.84). Among patients experiencing recurrence, the majority encounter it within the initial 2 days following their discharge (86% in the piroxicam group, 84.1% in the paracetamol group, and 86% in the placebo group, respectively). ED readmission rates were similar across groups: 20.8% (95% CI 17.1%-24.5%) in the piroxicam group, 23.8% (95% CI 19.9%-27.7%) in the paracetamol group, and 22.9% (95% CI 19.1%-26.8%) in the placebo group (p = 0.52). The piroxicam group reported significantly higher adverse effects compared to others., Conclusions: Piroxicam and paracetamol did not demonstrate efficacy in preventing pain recurrence or ED readmission within the first week following RC treatment., (© 2024 The Author(s). Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

Study Objective: We wished to determine whether the addition of magnesium sulfate (MgSO 4 ) or lidocaine to diclofenac could improve the analgesic efficacy in emergency department (ED) patients with acute renal colic., Methods: In this prospective, double-blinded, randomized controlled trial of patients aged 18 to 65 years with suspected acute renal colic, we randomized them to receive 75 mg intramuscular (IM) diclofenac and then intravenous (IV) MgSO 4, lidocaine, or saline solution control. Subjects reported their pain using a numerical rating scale (NRS) before drug administration and then 5, 10, 20, 30, 60, and 90 minutes afterwards. Our primary outcome was the proportion of participants achieving at least a 50% reduction in the NRS score 30 minutes after drug administration., Results: We enrolled 280 patients in each group. A 50% or greater reduction in the NRS score at 30 minutes occurred in 227 (81.7%) patients in the MgSO 4 group, 204 (72.9%) in the lidocaine group, and 201 (71.8%) in the control group, with significant differences between MgSO 4 and lidocaine (8.8%, 95% confidence interval [CI] [1.89 to 15.7], P=.013) and between MgSO 4 and control (9.9%, 95% CI [2.95 to 16.84], P=.004). Despite this, differences between all groups at every time point were below the accepted 1.3 threshold for clinical importance. There were no observed differences between groups in the frequency of rescue analgesics and return visits to the ED for renal colic. There were more adverse events, although minor, in the MgSO 4 group., Conclusion: Adding intravenous MgSO 4 , but not lidocaine, to IM diclofenac offered superior pain relief but at levels below accepted thresholds for clinical importance., (Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background: The diagnosis of the post polio syndrome is purely clinic. It occurs few decade after poliomyelitis. It associates recent appearance or progressive worsening of muscular weakness, pain, muscular fatigue or atrophy. It remains not recognized in Tunisia., Aim: of our study is to identify the socio-medical profile of the postpolio population in the Tunisian east central region through a check of the risk factors and the clinical characteristics of these patients., Methods: Descriptive study analyzing 32 files (medical expertise) of post polio syndrome patients, Results: The risk factors of post polio syndrome such us female gender, obesity, low educational level, early age of poliomyelitis appearance and the importance of physical effort at work, were observed in our study and are in agreement with the literature data. Average delay of post polio syndrome occurrence was 40 years. Most Disturbing symptom was the muscular pain. All our patients indicated negative impact on their everyday life and their work. They all asked for their right for incapacity or long-term disease beside the National health insurance fund (CNAM)., Conclusion: Recognition of patients affected by the Post polio syndrome and their social and medical needs are necessary.