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Spinal cord injury (SCI) is defined as physical damage that alters the function and structure of the spinal cord. Traumatic causes, such as vehicle accidents, falls, and violence, account for 90% of SCI cases. Recent evidence suggests that early intensive care unit (ICU) monitoring improves patient prognosis, highlighting the importance of prompt ICU admission and early decompression surgery. This review includes 50 publications selected based on specific criteria to gather evidence on the current management of SCI in acute settings. Pharmacological agents have been studied for their neuroprotective properties, offering hope for improved neurological outcomes. Several clinical trials are evaluating new pharmacological alternatives for SCI. In conclusion, the current management of acute SCI should focus on standardized treatments addressing ventilatory, cardiopulmonary, and hematologic complications, all of which directly impact long-term neurological and functional prognosis. New neuroprotective agents currently in clinical trials show promising results and should be further studied to determine their role in acute SCI management. [ABSTRACT FROM AUTHOR]

Abstract Anaphylaxis is an acute, potentially fatal systemic hypersensitivity reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients and healthcare professionals often fail to recognize and diagnose its early signs. Clinical manifestations vary widely, however, the most common signs are cutaneous symptoms, including urticaria and angioedema. Immediate intramuscular administration of epinephrine into the anterolateral thigh is first-line therapy, and is always safe even if the diagnosis is uncertain. The mainstays of long-term management include specialist assessment, allergen avoidance measures, and the provision of an epinephrine auto-injector with an individualized anaphylaxis emergency plan. This article provides an overview of the causes, clinical features, diagnosis, and acute as well as long-term management of anaphylaxis.

Anaphylaxis is an acute, potentially fatal systemic hypersensitivity reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients and healthcare professionals often fail to recognize and diagnose its early signs. Clinical manifestations vary widely, however, the most common signs are cutaneous symptoms, including urticaria and angioedema. Immediate intramuscular administration of epinephrine into the anterolateral thigh is first-line therapy, and is always safe even if the diagnosis is uncertain. The mainstays of long-term management include specialist assessment, allergen avoidance measures, and the provision of an epinephrine auto-injector with an individualized anaphylaxis emergency plan. This article provides an overview of the causes, clinical features, diagnosis, and acute as well as long-term management of anaphylaxis. Key take-home messages: • Anaphylaxis is the most severe form of a hypersensitivity reaction that is rapid in onset and potentially fatal. • Prompt recognition and treatment are critical in anaphylaxis. • The diagnosis is based primarily on clinical signs and symptoms. • The most common clinical manifestations are cutaneous symptoms, including urticaria, facial/lip swelling, erythema, and pruritus. • Referral to an allergist or immunologist should be considered for all persons who have experienced a previous anaphylactic episode. • Epinephrine is the drug of choice for anaphylaxis and should be given immediately, even if the diagnosis is uncertain; intramuscular administration into the anterolateral thigh is recommended. • There are no absolute contraindications to the use of epinephrine. • Up to 15% of anaphylaxis cases will have a biphasic response, with a second wave of symptomatology. • The mainstays of long-term treatment include: specialist assessment, avoidance measures, the provision of an epinephrine auto-injector and an individualized anaphylaxis emergency plan. [ABSTRACT FROM AUTHOR]

Introduction: After severe ischemic stroke (IS), circulating levels of symmetric dimethylarginine (SDMA) increase. We investigated the early dynamics of SDMA in stroke to potentially aid with prehospital identification of severe IS from hemorrhagic stroke (HS). Methods: We performed targeted mass spectrometry (MS) measurements of SDMA in two sequential acute plasma samples (early and secondary) of 50 IS patients with LVO and 49 HS patients. Secondary samples of 227 IS and 84 HS patients with moderate to severe symptoms (NIHSS ≥ 7) subsequently underwent ELISA validation. Results: The median (IQR) last-known-well (LKW) to sampling times were 43 min (35–67) for early samples in the MS analysis, and 83 min (65–113) for secondary samples in MS and ELISA analyses. No inter-group differences existed in early samples, but IS patients had significantly higher mean (IQR) SDMA levels in secondary samples in both analyses: 5.8 (5.3–6.9) vs. 5.1 (4.2–5.8) A.U. for HS, p < 0.001, with MS; and 0.82 (0.72–1.01) vs. 0.71 (0.58–0.85) nmol/mL for HS, p < 0.001, with ELISA. For IS patients, higher SDMA levels were associated with cardioembolic stroke: 0.84 (0.73–1.09) vs. 0.79 (0.71–0.91) nmol/mL for other etiologies, p = 0.042, and poor outcome: modified Rankin Scale (mRS) 4–6; 0.90 (0.73–1.06) vs. 0.80 (0.72–0.97) nmol/mL for mRS 0–3 (p = 0.045). Conclusion: In a large clinical cohort of stroke patients with moderate to severe symptoms, our data suggest that SDMA can assist in differentiation of IS and HS patients already 1 h and a half after symptom onset. SDMA may prove to have future value in a diagnostic stroke biomarker panel. [ABSTRACT FROM AUTHOR]

The information contained in this article is suitable for clinicians practicing in the United States desiring a general overview of the assessment and management of spinal cord injury (SCI), focusing on initial care, assessment, acute management, complications, prognostication, and future research directions. SCI presents significant challenges, affecting patients physically, emotionally, and financially, with variable recovery outcomes ranging from full functionality to lifelong dependence on caregivers. Initial care aims to minimize secondary injury through thorough neurological evaluations and imaging studies to assess the severity of the injury. Acute management prioritizes stabilizing respiratory and cardiovascular functions and maintaining proper spinal cord perfusion. Patients with unstable or progressive neurological decline benefit from timely surgical intervention to optimize neurological recovery. Subacute management focuses on addressing common complications affecting the respiratory, gastrointestinal, and genitourinary systems, emphasizing a holistic, multidisciplinary approach. Prognostication is currently based on neurological assessments and imaging findings, but emerging biomarkers offer the potential to refine outcome predictions further. Additionally, novel therapeutic interventions, such as hypothermia therapy and neuroprotective medications are being explored to mitigate secondary damage and enhance recovery. This paper serves as a high-yield refresher for clinicians for the assessment and management of acute spinal cord injury during index admission. [ABSTRACT FROM AUTHOR]

Background: The relationship between heart rate variability (HRV) changes potentially indicating autonomic dysregulation following spontaneous intracerebral hemorrhage (ICH) and functional outcome has not yet been fully elucidated. This study investigated the effects of HRV during the initial 96 h after admission on 90-day functional outcome in ICH patients. Methods: We included patients with spontaneous ICH in a prospective cohort single-center study. Continuous HR data were retrieved from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) and analyzed within the following time intervals: 0–2, 0–8, 0–12, 0–24, 0–48, 0–72, and 8–16, 16–24, 24–48, 48–72, 72–96 h after admission. HRV was determined from all available HR values by calculating the successive variability (SV), standard deviation (SD), and coefficient of variation (CV). Low HRV was set as SD ≤ 11.4 ms, and high HRV as SD > 11.4 ms. The clinical severity of ICH was assessed using the National Institutes of Health Stroke Scale (NIHSS) and functional outcome using the modified Rankin Scale (mRS). Good functional outcome was defined as mRS 0–2. Results: The cohort included 261 ICH patients (mean age ± SD 69.6 ± 16.5 years, 48.7% female, median NIHSS 6 (2, 12), median ICH score 1 (0, 2), of whom 106 (40.6%) had good functional outcome. All patients had the lowest HRV at admission, which increased during the first two days. Comparing ICH patients with low HRV (n = 141) and high HRV (n = 118), those with good outcome showed significantly lower HRV during the first three days (0–72 h: HRV SD good outcome 10.6 ± 3.5 ms vs. poor outcome 12.0 ± 4.0 ms; p = 0.004). Logistic regression revealed that advanced age, high premorbid mRS, and high NIHSS at admission were significant predictors of poor functional outcome, while reduced SD of HRV showed a non-significant trend towards good functional outcome (0–72 h: OR 0.898; CI 0.800–1.008; p = 0.067). Conclusions: Our results indicate autonomic dysfunction with sympathetic hyperactivity after spontaneous ICH, as reflected by the evidence of the lower HRV in the first days. Initially increased sympathetic tone appears to have a protective effect, as suggested by the comparatively lower HRV in patients with good functional outcome at the first days. [ABSTRACT FROM AUTHOR]

IntroductionAfter severe ischemic stroke (IS), circulating levels of symmetric dimethylarginine (SDMA) increase. We investigated the early dynamics of SDMA in stroke to potentially aid with prehospital identification of severe IS from hemorrhagic stroke (HS).MethodsWe performed targeted mass spectrometry (MS) measurements of SDMA in two sequential acute plasma samples (early and secondary) of 50 IS patients with LVO and 49 HS patients. Secondary samples of 227 IS and 84 HS patients with moderate to severe symptoms (NIHSS ≥ 7) subsequently underwent ELISA validation.ResultsThe median (IQR) last-known-well (LKW) to sampling times were 43 min (35–67) for early samples in the MS analysis, and 83 min (65–113) for secondary samples in MS and ELISA analyses. No inter-group differences existed in early samples, but IS patients had significantly higher mean (IQR) SDMA levels in secondary samples in both analyses: 5.8 (5.3–6.9) vs. 5.1 (4.2–5.8) A.U. for HS, p < 0.001, with MS; and 0.82 (0.72–1.01) vs. 0.71 (0.58–0.85) nmol/mL for HS, p < 0.001, with ELISA. For IS patients, higher SDMA levels were associated with cardioembolic stroke: 0.84 (0.73–1.09) vs. 0.79 (0.71–0.91) nmol/mL for other etiologies, p = 0.042, and poor outcome: modified Rankin Scale (mRS) 4–6; 0.90 (0.73–1.06) vs. 0.80 (0.72–0.97) nmol/mL for mRS 0–3 (p = 0.045).ConclusionIn a large clinical cohort of stroke patients with moderate to severe symptoms, our data suggest that SDMA can assist in differentiation of IS and HS patients already 1 h and a half after symptom onset. SDMA may prove to have future value in a diagnostic stroke biomarker panel.

Background: Spinal cord injuries have severe implications for public health all around the world. As a result, there is an urgent need to evaluate variables that influence the utilisation of the clinical practice guidelines for their acute care management. Objective: The study’s objective was to assess the determinants of the utilisation of the CPG in the acute management of patients with acute traumatic spinal cord injuries among healthcare workers at NSIH, Kenya. Material and methods: An analytical cross-sectional design was employed in this study. A census sampling with a sample size of 40 was employed in the study. A semi-structured research questionnaire was used to collect the quantitative data. The chi-square test was used for bivariate analysis and binomial logistic regression was used for multivariate analysis. The cutoff for statistical significance was p

A 58-year-old non-diabetic, non-hypertensive, non-dyslipidemic, euthyroid lady with a known case of migraine for last 10 years approached our hospital complaining of a severe right-sided throbbing headache in the temple area and behind the right ear for three days. She approached our hospital as she did not get any relief from painkillers. An intensity of 10 was recorded on Visual Analogue Scale (VAS) and 8 on the Global Assessment of Migraine Severity (GAMS) Scale. The case was diagnosed to be vatika shirashula on ardhavabhedaka, with no pitta-rakta association. She was posted for Agnikarma therapy [AGT]. Immediately, within 2 min of application of AGT on her right temple, her intense pain reduced, and within 5 min she had no pain [zero on VAS scale and one on GAMS scale]. Samyak mamsa dagdha lakshana was achieved. AGT was tolerable and did not produce any major discomforts. No adverse effects were reported. Patient experienced a mild burning sensation over the AGT, and the blackish discoloration due to AGT faded off within 41 days. AGT could be used as a potent, cheap, fast-acting, adverse effect free emergency treatment for acute attacks of migraine headache.

Deep periorbital burns are an important issue mainly due to the presence of the eyes in the region, and the crucial importance of preservation of vision. There is no consensus regarding their treatment. A retrospective analysis of the treatment and outcome of 446 patients with deep burns of the periorbital region admitted to the Department of Burns and Plastic Surgery of St George's University Hospital in Plovdiv, Bulgaria over 10 years was conducted. The study covers 446 patients, 162 female (36.5%) and 284 male (63.5%) aged from 5 months to 92 years. Deep periorbital burns accounted for 74.8% of hospitalized deep facial burns. Most frequent burn agents were hot liquids and flames. The mean total body surface area affected was 19.6% (min 0.5%, max 80.0%). Concomitant ocular pathology was diagnosed in 14% (n=63) of the patients. An early, staged and precise surgical approach was preferred, aimed at fast wound closure without sacrificing survived tissues. Follow up time ranged from 3 months to 5 years, median 37 months. Late ocular sequelae occurred in 7.4% (n=33) of the patients. There was no incidence of secondary corneal perforation or definitive loss of vision. Timely and adequate treatment during the acute period can minimize initial damage and late sequelae. Favor is given to the early, balanced surgical approach aimed at rapid wound closure between day 2 and 10 post burn. Preservation of vision is a determining factor for the significance of trauma and the effectiveness of treatment. [ABSTRACT FROM AUTHOR]

Background: In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See, patients with recent‐onset atrial fibrillation (AF) were randomized to either early or delayed cardioversion. Aim: This prespecified sub‐analysis aimed to evaluate heart rate during AF recurrences after an emergency department (ED) visit identified by an electrocardiogram (ECG)‐based handheld device. Methods: After the ED visit, included patients (n = 437) were asked to use an ECG‐based handheld device to monitor for recurrences during the 4‐week follow‐up period. 335 patients used the handheld device and were included in this analysis. Recordings from the device were collected and assessed for heart rhythm and rate. Optimal rate control was defined as a target resting heart rate of <110 beats per minute (bpm). Results: In 99 patients (29.6%, mean age 67 ± 10 years, 39.4% female, median 6 [3–12] AF recordings) a total of 314 AF recurrences (median 2 [1–3] per patient) were identified during follow‐up. The average median resting heart rate at recurrence was 100 ± 21 bpm in the delayed vs 112 ± 25 bpm in the early cardioversion group (p =.011). Optimal rate control was seen in 68.4% [21.3%–100%] and 33.3% [0%–77.5%] of recordings (p =.01), respectively. Randomization group [coefficient −12.09 (−20.55 to −3.63, p =.006) for delayed vs. early cardioversion] and heart rate on index ECG [coefficient 0.46 (0.29–0.63, p <.001) per bpm increase] were identified on multivariable analysis as factors associated with lower median heart rate during AF recurrences. Conclusion: A delayed cardioversion strategy translated into a favorable heart rate profile during AF recurrences. [ABSTRACT FROM AUTHOR]

Aim:To evaluate the knowledge levels and attitudes of physicians regarding acute management of seizures in pediatric patients.Materials and Methods:A self-administered questionnaire was distributed electronically to physicians. The participants were divided into 3 groups according to the estimated number of patients managed by the physician due to acute seizures per year; i) group 1: ≤10, ii) group 2: 11-50, iii) group 3: ≥51. Also, the participants were categorized whether they were pediatricians or not. Demographical features, and administration details regarding first- and second-line therapy were questioned. Rates of correct answers were compared between the groups.Results:A total of 400 physicians responded to the questionnaire. Precisely, 74.5% of participants were pediatricians. The time point t1 for tonic-clonic status epilepticus (SE) and focal SE with impaired consciousness were the least known details. Rates of correct answers to questions of the maximum number of benzodiazepines in case of ongoing seizures (p0.001), and prefer longer durations for phenytoin (p=0.003) in group 1 and group 2. Rates of correct answers to questions regarding the approach to patients who presented during the postictal period (p

Background: Sex-related differences in acute ischemic stroke may affect outcomes, yet evidence remains inconsistent. This large-scale study investigated sex-related differences in clinical presentation, peri-interventional parameters, and outcomes after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) using data from the German Stroke Registry-Endovascular Treatment (GSR-ET)., Methods: We analyzed 11.896 EVT patients (52.2% female) from the GSR-ET (June 2015-December 2021) comparing clinical characteristics, treatment details, and outcomes by sex. Two propensity score matchings (PSM) were applied: (1) logistic regression model with a caliper width of 0.1 on age, pre-stroke modified Rankin Scale (pmRS), and National Institutes of Health Stroke Scale at admission, and (2) 1:1 nearest neighbor matching with a caliper of 0.01. Primary outcomes were good (mRS 0-2) and excellent (mRS 0-1) outcomes at discharge and 90-day follow-up., Results: Women were older (76.3 ± 12.7 vs. 70.2 ± 12.9 years, p < 0.001) and had higher pre-stroke disability (median pmRS 0 (0, 2) vs. 0 (0, 1), p < 0.001). Cardioembolic strokes were more frequent in women, even after PSM. Despite this, women had better odds of achieving good outcomes at discharge (adjusted OR 1.20, 95% CI 1.04-1.38, p = 0.013), but not at follow-up (OR 0.91, 95% CI 0.78-1.05, p = 0.193). Both PSM analyses confirmed these findings., Conclusions: While women demonstrated better short-term functional outcomes after EVT, these benefits diminished in follow-up. The persistence of cardioembolic stroke in women suggests potential sex-specific mechanisms. Understanding and addressing sex-related differences in stroke is essential to optimize acute stroke care and improve outcomes. Future studies should explore biological and socio-economic factors influencing sex-related differences., Trial Registration: ClinicalTrials.gov identifier: NCT03356392., (© 2025 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Aim: To evaluate the knowledge levels and attitudes of physicians regarding acute management of seizures in pediatric patients. Materials and Methods: A self-administered questionnaire was distributed electronically to physicians. The participants were divided into 3 groups according to the estimated number of patients managed by the physician due to acute seizures per year; i) group 1: ≤10, ii) group 2: 11-50, iii) group 3: ≥51. Also, the participants were categorized whether they were pediatricians or not. Demographical features, and administration details regarding first- and second-line therapy were questioned. Rates of correct answers were compared between the groups. Results: A total of 400 physicians responded to the questionnaire. Precisely, 74.5% of participants were pediatricians. The time point t1 for tonicclonic status epilepticus (SE) and focal SE with impaired consciousness were the least known details. Rates of correct answers to questions of the maximum number of benzodiazepines in case of ongoing seizures (p<0.001), intravenous diazepam dose (p=0.017), and diazepam infusion time (p=0.034) were significantly higher in group 3. Also, there was a tendency to administer lower doses of levetiracetam (p=0.003) and phenytoin (p>0.001), and prefer longer durations for phenytoin (p=0.003) in group 1 and group 2. Rates of correct answers to questions regarding the approach to patients who presented during the postictal period (p<0.001), the time point t1 for tonic-clonic SE (p=0.07), the maximum number of benzodiazepines in case of ongoing seizures (p<0.001), diazepam infusion time (p<0.001), and co-administered liquid for phenytoin (p=0.043) were higher in pediatricians. Additionally, there was a significant tendency to administer lower doses of levetiracetam (p<0.001) and phenytoin (p<0.001), and prefer longer durations for levetiracetam (p<0.001) and phenytoin (p<0.001) in physicians other than pediatricians. Conclusion: There is a wide variation in knowledge levels and attitudes among physicians. Post-graduation education programs focusing on the least-known and important details are needed. [ABSTRACT FROM AUTHOR]

Acute and chronic heart failure with reduced ejection fraction (HFrEF) is a major public health problem, studies showing a 25% survival rate at 5 years after hospitalization. If left untreated, it is a common and potentially fatal disease. In recent years, the medical and device therapies of patients with HFrEF have significantly improved. The aim of our review is to provide an evidence-based update on new therapeutic strategies in acute and chronic settings, to prevent hospitalization and death in patients with HFrEF. We performed a systematic literature search on PubMed, EMBASE, and the Cochrane Database of Systemic Reviews, and we included a number of 23 randomized controlled trials published in the last 30 years. The benefit of beta-blockers and renin-angiotensin-aldosterone system inhibitors in patients with HFrEF is well known. Recent developments, such as sodium-glucose cotransporter 2 inhibitors, vericiguat, transcatheter mitral valve repair, wireless pulmonary artery pressure monitor and cardiac contractility modulation, have also proven effective in improving prognosis. In addition, other new therapeutic agents showed encouraging results, but they are currently being studied. The implementation of personalized disease management programs that directly target the cause of HFrEF is crucial in order to improve prognosis and quality of life for these patients.

Background: Primary adjunctive therapy with corticosteroids has been shown to reduce coronary artery (CA) abnormalities in high-risk Kawasaki disease (KD) patients in Japan (the randomized control trial to assess immunoglobulin plus steroid efficacy [RAISE] study). We evaluated their effect on outcomes in North American patients with high-risk KD., Methods: We performed a single-center retrospective review of high-risk KD patients between 2010 and 2023. From 2017 to 2023, adjunctive corticosteroids in a modified RAISE regimen (mRAISE) were given to high-risk patients as primary adjunctive therapy with intravenous gammaglobulin (IVIG) and aspirin. We compared CA outcomes in these patients and those presenting from 2010 to 2016, when mRAISE therapy was not administered., Results: A total of 221 high-risk KD patients were treated at our institution between 2010 and 2023. Among these, 83 received the mRAISE regimen and 138 did not (no corticosteroid, n = 82, corticosteroid in a non-mRAISE regimen, n = 56). There were no significant differences in CA outcomes in the mRAISE and non-mRAISE groups. Patients receiving the mRAISE regimen were significantly less likely to receive more than one dose of IVIG when compared to those who did not receive this regimen (11% vs 33%, p < .001)., Conclusions: Use of adjunctive primary therapy with corticosteroids in a mRAISE regimen in high-risk KD patients resulted in significantly decreased IVIG retreatment., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology. Although BAO accounts for only 1%-2% of all strokes, it has very poor natural outcome. We identified 10 relevant clinical situations and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions, based on which a systematic literature search and review was performed. The working group consisted of 10 voting members (five representing ESO and five ESMINT) and three non-voting junior members. The certainty of evidence was generally very low. In many PICOs, available data were scarce or lacking, hence, we provided expert consensus statements. First, we compared intravenous thrombolysis (IVT) to no IVT, but specific BAO-related data do not exist. Yet, historically, IVT was standard of care for BAO patients who were also included (albeit in small numbers) in IVT trials. Non-randomised studies of IVT-only cohorts showed high proportion of favourable outcomes. Expert Consensus suggests using IVT up to 24 h unless otherwise contraindicated. We further suggest IVT plus endovascular treatment (EVT) over direct EVT. EVT on top of best medical treatment (BMT) was compared to BMT alone within 6 and 6-24 h from last seen well. In both time windows, we observed a different effect of treatment depending on (a) the region where the patients were treated (Europe vs. Asia), (b) on the proportion of IVT in the BMT arm, and (c) on the initial stroke severity. In case of high proportion of IVT in the BMT group and in patients with NIHSS below 10, EVT plus BMT was not found better than BMT alone. Based on very low certainty of evidence, we suggest EVT + BMT over BMT alone (i.e. based on results of patients with at least 10 NIHSS points and a low proportion of IVT in BMT). For patients with an NIHSS below 10, we found no evidence to recommend EVT over BMT. In fact, BMT was non-significantly better and safer than EVT. Furthermore, we found a stronger treatment effect of EVT + BMT over BMT alone in proximal and middle locations of BAO compared to distal location. While recommendations for patients without extensive early ischaemic changes in the posterior fossa can, in general, follow those of other PICOs, we formulated an Expert Consensus Statement suggesting against reperfusion therapy in those with extensive bilateral and/or brainstem ischaemic changes. Another Expert Consensus suggests reperfusion therapy regardless of collateral scores. Based on limited evidence, we suggest direct aspiration over stent retriever as the first-line strategy of mechanical thrombectomy. As an Expert Consensus, we suggest rescue percutaneous transluminal angioplasty and/or stenting after a failed EVT procedure. Finally, based on very low certainty of evidence, we suggest add-on antithrombotic treatment during EVT or within 24 h after EVT in patients with no concomitant IVT and in whom EVT was complicated (defined as failed or imminent re-occlusion, or need for additional stenting or angioplasty)., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors have completed a declaration of competing interests and details are available in Supplemental Table 1.

Burns of the hand are prevalent and must be managed aggressively in the acute phase to prevent deformity and disability. Proper early wound management, achieving durable soft tissue coverage, and appropriate positioning in the acute period offer substantial benefits to patients long-term. When contractures occur, secondary procedures are often indicated, and they range from laser therapy to local/regional flap coverage; rarely free flaps are used. Boutonniere deformities are common, and unfortunately, at times finger amputation renders the hand more functional than further efforts at reconstruction., Competing Interests: Disclosure The authors have no financial relationships to disclose., (Published by Elsevier Inc.)

Even though cervical artery dissection is one of the main reasons for ischemic stroke in young patients, acute management and post-acute primary or secondary prevention of cerebral ischemia differ significantly in different centers and countries. These discrepancies are reflected by the differences in guideline recommendations of major stroke societies. Our narrative review aims to shed light on the different recommendations in guideline-statements of stroke societies and to give an overview of the current literature concerning acute management and post-acute treatment of cervical artery dissection patients. In general, intravenous thrombolysis and mechanical thrombectomy are recommended, irrespective of stroke etiology, if administered within the label. Secondary prevention of cerebral ischemia can be achieved by antiplatelet intake or anticoagulation, with, to date, neither treatment establishing superiority over the other. Duration of antithrombotic treatment, statin use as well as optimal endovascular approach are still up for debate and need further evaluation. Additionally, it is still unknown, whether the recommendations given in any of the guideline statements are similarly relevant in spontaneous and traumatic cervical artery dissection, as none of the stroke societies differentiates between the two. [ABSTRACT FROM AUTHOR]

Introduction: Blood pressure management in acute ischaemic stroke is crucial. Here we highlight uncertainties surrounding haemodynamic management in acute ischaemic stroke on the basis of current guidelines and the data available from recent studies. This review provides practical treatment options and suggestions for future research. State of the art: The U-shaped relationship between baseline blood pressure value and patients’ functional outcome or death is well established. Nonetheless, there is scant evidence for the benefits of early pharmacological intervention. Current guidelines differentiate blood pressure targets on the basis of implemented reperfusion treatment and allow blood pressure reduction in certain clinical situations. However, there is a substantial lack of evidence to guide management during acute stroke. Clinical implications: Taking into account several aspects of blood pressure management can improve stroke care, although they are not included in current guidelines. To make an optimal decision as to whether to intervene regarding blood pressure, it is important to consider dehydration, recanalisation status, blood pressure variability, and autoregulation state as measured by novel imaging techniques. Future directions: Further trials considering patient-specific factors with the use of continuous monitoring of blood pressure, as well as neurovascular imaging, are needed to resolve the current ambiguities. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to survey treatment practices used for preschool children with wheezing in emergency rooms (ER) focussing on inhalation device choice and handling, face mask use, salbutamol dosing and written instructions. We sought to assess whether current protocols are in line with published evidence and guidelines. Methods: This is a cross‐sectional survey done in paediatric ER units located in Finnish municipalities with more than 10 000 inhabitants. Results: Of the 100 units contacted, 50% responded. More than 50% of the units used nebulisers. Only 13% of the units administered salbutamol in single puffs. More than 30% of the units lacked criteria on face mask use. Poor co‐operation had no effect on the dose of salbutamol in 62% of the units. Ensuring tight mask‐to‐face seal was included in the training in 20% of the units. A written action plan was provided to the caregivers in 28% of the units. Conclusion: ER treatment guidelines for preschool children with wheezing are poorly endorsed. Research is needed to identify approaches to guideline implementation that are specific for primary care. Clinical research should focus on strengthening recommendations that are currently not embraced. ER treatment protocols need to be updated and adherence to guidelines should be re‐evaluated. [ABSTRACT FROM AUTHOR]

There have been marked improvements in the management of stroke in Australia over the past two decades. The greatest benefit has accrued from public health measures including reduced smoking rates and treatment of hypertension and hypercholesterolaemia. Recent advances in recanalisation therapy offer the chance of recovery to a subset of people who have a stroke. For many patients, stroke remains an illness with a devastating impact on their quality of life. Reducing the burden of stroke requires intervention across the health system from primary prevention through diagnosis, acute treatment, rehabilitation and secondary prevention. In this review, we will cover the changes in the epidemiology of stroke, public health measures in primary prevention of stroke, and acute management and secondary prevention of ischaemic stroke and primary intracerebral haemorrhage. [ABSTRACT FROM AUTHOR]

Abstract Anaphylaxis is an acute, potentially fatal systemic allergic reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients and healthcare professionals often fail to recognize and diagnose early signs and symptoms of the condition. Clinical manifestations vary widely; however, the most common signs are cutaneous symptoms, including urticaria, angioedema, erythema and pruritus. Immediate intramuscular administration of epinephrine into the anterolateral thigh is first-line therapy, even if the diagnosis is uncertain. The mainstays of long-term management include specialist assessment, avoidance measures, and the provision of an epinephrine auto-injector and an individualized anaphylaxis action plan. This article provides an overview of the causes, clinical features, diagnosis and acute and long-term management of this serious allergic reaction.

Even though cervical artery dissection is one of the main reasons for ischemic stroke in young patients, acute management and post-acute primary or secondary prevention of cerebral ischemia differ significantly in different centers and countries. These discrepancies are reflected by the differences in guideline recommendations of major stroke societies. Our narrative review aims to shed light on the different recommendations in guideline-statements of stroke societies and to give an overview of the current literature concerning acute management and post-acute treatment of cervical artery dissection patients. In general, intravenous thrombolysis and mechanical thrombectomy are recommended, irrespective of stroke etiology, if administered within the label. Secondary prevention of cerebral ischemia can be achieved by antiplatelet intake or anticoagulation, with, to date, neither treatment establishing superiority over the other. Duration of antithrombotic treatment, statin use as well as optimal endovascular approach are still up for debate and need further evaluation. Additionally, it is still unknown, whether the recommendations given in any of the guideline statements are similarly relevant in spontaneous and traumatic cervical artery dissection, as none of the stroke societies differentiates between the two.

Stroke is a medical emergency and expeditious treatment is critical to reducing permanent disability or death. Acute management of patients suffering from acute ischemic stroke (AIS) requires early recognition of symptoms, rapid assessment and stabilization (hyperacute workup), and appropriate selection of patients for reperfusion with intravenous alteplase and/or mechanical thrombectomy. Established stroke protocols which involve both prehospital emergency medical services and in-hospital multidisciplinary stroke teams have been shown to be crucial to reducing the long term, devastating effects of stroke. [ABSTRACT FROM AUTHOR]

Purpose of Review: The present manuscript examines the significance of blood pressure elevation in patients with acute ischemic stroke, the physiologic principles worthy of consideration during its treatment, and the recent empirical evidence that should guide management protocols. It also provides a sound and practical approach to treatment along the time continuum, with particular relevance to reperfusion strategies. Recent Findings: The existing evidence shows that both insufficient and excessive blood pressures are detrimental to the outcome of patients with acute ischemic stroke. This "U-shaped" relation, however, relates to measurements at the time of presentation, and clinical studies lack detail and specificity relative to differential measurements along the time continuum, particularly prior to and following reperfusion. Extrapolating from recent series, it is possible to construct treatment protocols balanced for effectiveness and safety. Summary: The management of blood pressure after acute ischemic stroke is an important, complex, and challenging aspect of care, requiring a thorough understanding of cerebrovascular physiology. Along the time continuum, the therapeutic priorities start with the preservation of penumbral tissue prior to reperfusion and then follow with the limitation of the damaging effects of excessive blood pressure readings after reperfusion, optimizing the chances of improved outcomes. [ABSTRACT FROM AUTHOR]

Purpose of the Review: Hyperkalemia is a common electrolyte abnormality that can lead to life-threatening cardiac arrhythmia. Medical management of acute hyperkalemia revolves around three strategies—stabilizing the myocardium, intracellular shifting of serum potassium, and enhancing elimination of total body potassium via urinary or fecal excretion. In this review, we outline the current evidence behind the acute medical management of hyperkalemia. Recent Findings: Two new oral potassium-binding agents, patiromer and sodium zirconium cyclosilicate, show promise in the management of hyperkalemia. Their role in the acute setting needs further investigation. Recent investigations also suggest that the optimal dosing of intravenous insulin may be lower than previously described. Summary: Despite its prevalence, there is wide variability in the medical management of hyperkalemia in the acute setting. High-quality evidence demonstrating efficacy is lacking for many medications, though novel oral potassium-binding agents show promise. Overall, more research is necessary to establish optimal dosing strategies to manage hyperkalemia in the acute setting. [ABSTRACT FROM AUTHOR]

Majid Alfadhel,1,2 Fuad Al Mutairi,1,2 Nawal Makhseed,3 Fatma Al Jasmi,4 Khalid Al-Thihli,5 Emtithal Al-Jishi,6 Moeenaldeen AlSayed,7 Zuhair N Al-Hassnan,7,8 Fathiya Al-Murshedi,5 Johannes Häberle,9 Tawfeg Ben-Omran10 Middle East Hyperammonemia and Urea Cycle Disorders Scientific Group (MHUSG) 1Department of Pediatrics, Division of Genetics, 2King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Department of Pediatrics, Jahra Hospital, Ministry of Health, Jahra City, Kuwait; 4Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates; 5Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman; 6Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain; 7Department of Medical Genetics, King Faisal Specialist Hospital & Research Center, 8The National Newborn Screening Program, Ministry of Health, Riyadh, Saudi Arabia; 9Department of Pediatrics, Division of Metabolism and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland; 10Division of Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar Background: Hyperammonemia is a life-threatening event that can occur at any age. If treated, the early symptoms in all age groups could be reversible. If untreated, hyperammonemia could be toxic and cause irreversible brain damage to the developing brain.Objective: There are major challenges that worsen the outcome of hyperammonemic individuals in the Middle East. These include: lack of awareness among emergency department physicians about proper management of hyperammonemia, strained communication between physicians at primary, secondary, and tertiary hospitals, and shortage of the medications used in the acute management of hyperammonemia. Therefore, the urge to develop regional guidelines is extremely obvious.Method: We searched PubMed and Embase databases to include published materials from 2011 to 2014 that were not covered by the European guidelines, which was published in 2012. We followed the process of a Delphi conference and involved one preliminary meeting and two follow-up meetings with email exchanges between the Middle East Hyperammonemia and Urea Cycle Disorders Scientific Group regarding each draft of the manuscript.Results and discussion: We have developed consensus guidelines based on the highest available level of evidence. The aim of these guidelines is to homogenize and harmonize the treatment protocols used for patients with acute hyperammonemia, and to provide a resource to not only metabolic physicians, but also physicians who may come in contact with individuals with acute hyperammonemia.Conclusion: These suggested guidelines aim to ease the challenges faced by physicians dealing with acute hyperammonemia in the region. In addition, guidelines have demonstrated useful collaboration between experts in the region, and provides information that will hopefully improve the outcomes of patients with acute hyperammonemia. Keywords: hyperammonemia, inborn errors of metabolism, urea cycle, acute management, ammonia, Middle East

Deep periorbital burns are an important issue mainly due to the presence of the eyes in the region, and the crucial importance of preservation of vision. There is no consensus regarding their treatment. A retrospective analysis of the treatment and outcome of 446 patients with deep burns of the periorbital region admitted to the Department of Burns and Plastic Surgery of St George's University Hospital in Plovdiv, Bulgaria over 10 years was conducted. The study covers 446 patients, 162 female (36.5%) and 284 male (63.5%) aged from 5 months to 92 years. Deep periorbital burns accounted for 74.8% of hospitalized deep facial burns. Most frequent burn agents were hot liquids and flames. The mean total body surface area affected was 19.6% (min 0.5%, max 80.0%). Concomitant ocular pathology was diagnosed in 14% (n=63) of the patients. An early, staged and precise surgical approach was preferred, aimed at fast wound closure without sacrificing survived tissues. Follow up time ranged from 3 months to 5 years, median 37 months. Late ocular sequelae occurred in 7.4% (n=33) of the patients. There was no incidence of secondary corneal perforation or definitive loss of vision. Timely and adequate treatment during the acute period can minimize initial damage and late sequelae. Favor is given to the early, balanced surgical approach aimed at rapid wound closure between day 2 and 10 post burn. Preservation of vision is a determining factor for the significance of trauma and the effectiveness of treatment., (© 2024 Euro-Mediterranean Council for Burns and Fire Disasters.)

Introduction: Takotsubo syndrome (TS) is an increasingly recognized acute heart failure syndrome which is self-limiting in most cases but can result in life-threatening complications. TS is difficult to distinguish from acute myocardial infarction (AMI) early in the disease course and currently lacks evidence-based treatment recommendations. Areas covered: Based on the available literature this systematic review discusses the clinical management of patients with TS during (i) the diagnostic workup; (ii) acutely after establishing the TS diagnosis; and (iii) after recovery of cardiac function. Expert commentary: Since TS is self-limiting in most cases it is recommended to refrain from unnecessary treatment (the do no harm principle) when managing patients with TS. The management of patients with TS should focus on careful monitoring of ECG and hemodynamics, and on preventing and treating complications. Because catecholamine-mediated inotropic overstimulation is implicated in the pathogenesis of TS, and because inotropic drugs have been associated with worse outcomes for patients with TS, we recommend the treating physician to avoid these drugs. Instead, mechanical assist devices should be considered early for patients with TS who develop cardiogenic shock with signs of end-organ hypo-perfusion. [ABSTRACT FROM AUTHOR]