Pain Management via Ultrasound-guided Nerve Block in Emergency Department; a Case Series Study

Introduction: Pain is the most common complaint of patients referring to emergency department (ED). Consideringthe importance of pain management in ED, this study aimed to investigate the efficacy and feasibility ofultrasound-guided nerve blocks in this setting. Methods: 46 patients who came to the ED with injured extremitieswere enrolled in the study and received either femoral, axillary or sciatic nerve block depending on theirsite of injury (1.5 mg Bupivacaine per kg of patient’s weight). Patients were asked about their level of pain beforeand after receiving the nerve block based on numerical rating scale. The difference between pre and post blockpain severity was measured. Both patients and physicians were asked about their satisfaction with the nerveblock in 5 tiered Likert scale. Results: 46 patients with the mean age of 37.5 § 12.5 years (8-82 years) receivedultrasound-guided nerve block (84.8% male). 6 Sciatic, 25 axillary, and 15 femoral nerve blocks were performed.Mean pain severity on NRS score at the time of admission was 8.1 § 1.4, which reduced to 2.04 § 2.06 after block.25 (54.3%) patients were highly satisfied (Likert scale 5), 15 (32.6%) were satisfied (Likert scale 4), 3 (6.5%) wereneutral and had no opinion (Likert scale 3), 1 (2.1%) was not satisfied (Likert scale 2), and 2 (4.3%) were highlyunsatisfied (Likert scale 1). There was no significant difference among the satisfaction scores within the threeblock locations (p = 0.8). There was no significant difference in physicians level of satisfaction between the threeblock locations either (p = 0.9). 1 (2.1%) case of agitation and tachycardia and 1 (2.1%) case of vomiting wereobserved after the procedure. Conclusion: Ultrasound-guided nerve block of extremities is a safe and effectivemethod that can be used for pain management in the ED. It results in high levels of satisfaction among bothpatients and physicians

Evaluating the effects of pod-based electronic cigarettes on human endothelial cell function

Pod-based electronic (e-) cigarettes more efficiently deliver nicotine using a protonated formulation. The cardiovascular effects associated with these devices are poorly understood. We evaluated whether pod-based e-liquids and their individual components impair endothelial cell function. We isolated endothelial cells from people who are pod users (n=10), tobacco never users (n=7), and combustible cigarette users (n=6). After a structured use, pod users had lower acetylcholine-mediated endothelial nitric oxide synthase (eNOS) activation compared with never users and was similar to levels from combustible cigarette users (overall P=0.008, P=0.01 pod vs never; P=0.96 pod vs combustible cigarette). The effects of pod-based e-cigarettes and their constituents on vascular cell function were further studied in commercially available human aortic endothelial cells (HAECs) incubated with flavored JUUL e-liquids or propylene glycol (PG):vegetable glycerol (VG) at 30:70 ratio with or without 60 mg/mL nicotine salt for 90 min. A progressive increase in cell death with JUUL e-liquid exposure was observed across 0.0001-1% dilutions; PG:VG vehicle with and without nicotine salt-induced cell death. A23187-stimulated nitric oxide production was decreased with all JUUL e-liquid flavors, PG:VG and nicotine salt exposures. Aerosols generated by JUUL e-liquid heating similarly decreased stimulated nitric oxide production. Only mint-flavored e-liquids increased inflammation and menthol-flavored e-liquids enhanced oxidative stress in HAECs. In conclusion, pod e-liquids and their individual components appear to impair endothelial cell function. These findings indicate the potential harm of pod-based devices on endothelial cell function and thus may be relevant to cardiovascular injury in pod-type e-cigarette users.Funding provided by: National Heart, Lung, and Blood InstituteCrossref Funder Registry ID: http://dx.doi.org/10.13039/100000050Award Number: 5P50HL120163Funding provided by: National Heart, Lung, and Blood InstituteCrossref Funder Registry ID: http://dx.doi.org/10.13039/100000050Award Number: U54HL120163Funding provided by: American Heart AssociationCrossref Funder Registry ID: http://dx.doi.org/10.13039/100000968Award Number: 20YVNR35500014Funding provided by: National Heart, Lung, and Blood InstituteCrossref Funder Registry ID: http://dx.doi.org/10.13039/100000050Award Number: K01 HL14314

Determination of oxidative stress using MitoSOX.

The representative images show two replicates for control, menthol, and mint treated HAECs for 90 minutes and loaded with MitoSOX. (TIF)</p

The JUUL e-liquid and its individual components induce cellular death.

The percentage of cells staining positive for TUNEL (terminal deoxynucleotidyl transferase dUTP nick-end labeling) were assessed with dilutions from 1 x 10−5 to 1% (n = 3). DNase was used as a positive control. The percentage of apoptosis for all dilutions of each e-liquid were compared to control (* indicates p<0.05, ** indicates p<0.01, and *** indicates p<0.005). Additionally, a dose-dependent nonparametric trend test was performed for each e-liquid type (indicated by horizontal line p-value). Data are plotted as mean and SEM.</p

Clinical characteristics.

Clinical characteristics.</p

International consensus (ICON) on: clinical consequences of mite hypersensitivity, a global problem

Since mite allergens are the most relevant inducers of allergic diseases worldwide, resulting in significant morbidity and increased burden on health services, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), formed by the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), the European Academy of Allergy and Clinical Immunology (EAACI), and the World Allergy Organization (WAO), has proposed to issue an International Consensus (ICON) on the clinical consequences of mite hypersensitivity. The objectives of this document are to highlight aspects of mite biology that are clinically relevant, to update the current knowledge on mite allergens, routes of sensitization, the genetics of IgE responses to mites, the epidemiologic aspects of mite hypersensitivity, the clinical pictures induced by mites, the diagnosis, specific immunotherapeutic approaches, and prevention