Evaluating the Effectiveness of Pretreatment With Intravenous Fluid in Reducing the Risk of Developing Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis.

Contrast media administration to patients during cardiac events increases the risk of developing contrast-induced nephropathy (CIN). CIN is among some complications usually associated with the percutaneous coronary intervention and may result in acute renal failure. Several risk factors are associated with CIN. These risk factors include; age (elderly patients), pre-existing renal impairment, diabetes mellitus, and the use of high osmolar contrast media. Studies have shown that several measures such as using low osmolar contrast media, N-acetylcysteine, intravenous sodium bicarbonate, and hydration through oral or intravenous fluid administration play a significant role in CIN incidence reduction. Hydration using intravenous fluid, especially saline solution, has been critical in preventing CIN. Prehydration using the intravenous fluid before contrast media administration is vital. A systematic literature search with meta-analysis for relevant and original articles was carried out from 2000 to 2022 on databases such as PubMed, Cochrane Library, Google Scholar, ScienceDirect, Web of Science, and Embase. The search on the databases was based on various keywords related to intravenous fluid and CIN. The studies that met the inclusion criteria were critically analyzed, and data such as study design, interventions, participants, and outcomes of the research were retrieved. Out of the 784 results yielded during the initial search, ten articles met the eligibility criteria and were included in the study. The data analysis obtained from the included studies showed that pretreatment using intravenous fluid has conflicting results. Some studies showed that hydrating patients using intravenous fluid before contrast media administration significantly reduces the risk of CIN. In contrast, others claimed that intravenous fluid has minimal impact on preventing CIN. Despite the different investigations conducted on CIN, it remains insufficiently understood. From the analysis, most of the studies support that intravenous fluid administration decreases the occurrence of CIN in patients that receive contrast media. The analysis also has established that oral hydration is similar to intravenous fluid administration in reducing CIN incidence

An integrative comparative study between ultrasound-guided regional anesthesia versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: A systematic review and meta-analysis

BackgroundEmergency physicians play a major role in managing patients with hip fractures. The most commonly used pain management option is parenteral opioids. However, parenteral opioids are subjected to several adverse effects. New pain management techniques such as regional anesthesia are used as alternatives to parenteral opioids. Anatomical landmarks were used to administer regional anesthesia; however, ultrasound guidance has shown promising results with regional anesthesia. Objectiveof the Review: The present study compares the efficacy of ultrasound-guided regional anesthesia (USGRA) to parenteral opioids in analgesia of hip fractures patients. MethodsA literature search for original and relevant articles carried out through six electronic databases, yielded 710 articles which were then assessed using the eligibility criteria resulting in 8 studies eligible for inclusion. ResultsA Meta-analysis of the seven studies showed that ultrasound-guided femoral nerve block was more effective than parenteral opioids in relieving pain. Similarly, meta-analysis of data from two studies shows that US-guided FICB significantly reduced pain scores than parenteral opioids. A subgroup analysis of adverse events showed no significant difference in nausea/vomiting and respiratory complications. However, a subgroup analysis on hypotension showed that the incidence of hypotension was significantly lower in USGRA than parenteral opioids. The present study also revealed that patients in the USGRA group required less frequent rescue analgesia than the patients in the parenteral opioids group. ConclusionResults of the present study show that USGRA is superior to parenteral opioids in reducing pain and the need for rescue analgesia in patients with hip fractures.The publication of this article is funded by the Qatar National Library

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Test-Retest, Within-Visit Variability of Goldmann Visual Fields in Retinitis Pigmentosa

The authors have established test-retest reliability values for Goldmann visual fields (GVF) in retinitis pigmentosa. Under optimal conditions (single well-trained operator; same day retest) changes greater than 25% appear to rarely occur in patients with GVF radius greater than 7°

High flow nasal oxygen (HFNO) in the treatment of COVID-19 infection of adult patients from – An emergency perspective: A systematic review and meta-analysis

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2, which was first discovered in Wuhan, China. The disease has grown into a global pandemic causing mild to moderate symptoms in most people. The disease can also exhibit serious illnesses, especially for patients with other chronic diseases such as cardiovascular diseases, diabetes, chronic respiratory disease, or cancer. In such cases of severe illness, high flow nasal oxygen (HFNO) has been used to provide oxygenation to COVID-19 patients. However, the efficiency of HFNO remains uncertain, prompting the conduction of this systematic review to evaluate the effectiveness of the therapy.A thorough search for relevant and original articles was carried out on five electronic databases, including ScienceDirect, PubMed, Cochrane Library, Embase, and Google Scholar. No time limitation was placed during the search as it included all the articles related to COVID-19 from 2019 to 2022. The search strategy utilized in this systematic review yielded 504 articles, of which only 10 met the eligibility criteria and were included. Our meta-analysis reveals that HFNO success rate was higher than HFNO failure rates (0.52 (95% CI; 0.47, 0.56) and 0.48 (95% CI; 0.44, 0.53), respectively), however, the difference was statistically insignificant. HFNO was associated with a significant decrease in mortality and intubation rates (0.28 (95% CI; 0.19, 0.39) and 0.28 (95% CI; 0.18, 0.41), respectively). Our statistical analysis has shown that significantly lower ROX index (5.07 ± 1.66, p = 0.028) and PaO2/FiO2 (100 ± 27.51, p = 0.031) are associated with HFNO failure, while a significantly lower respiratory rate (RR) (23.17 ± 4.167, p = 0.006) is associated with HFNO success. No statistically significant difference was observed in SpO2/FiO2 ratio between the HFNO success and failure groups (154.23 ± 42.74 vs. 124.025 ± 28.50, p = 0.62, respectively).Based on the results from our meta-analysis, the success or failure of HFNO in treating COVID-19 adult patients remains uncertain. However, HFNO has been shown to be an effective treatment in reducing mortality and intubation rates. Therefore, HFNO can be recommended for COVID-19 patients but with close monitoring and should be carried out by experienced healthcare workers.Open Access funding provided by the Qatar National Library (QNL)

Friction stir welding of carbon black reinforced high-density polyethylene tube-to-tubesheet joints

Industrial heat exchanger applications dealing with highly corrosive fluids demand the use of thermoplastic heat exchangers because of the chemically inert and anti-fouling nature of the thermoplastics. A non-conventional joining framework, based on the friction stir welding (FSW) technique, is used to form high-quality thermoplastic tube-to-tubesheet joints (TTJs). The proposed technique has potential applications for thermoplastic shell-and-tube heat exchangers and piping industries (as flange-to-pipe joints). In this work, the tube and tubesheet materials made of carbon black reinforced high-density polyethylene were used. The effect of different FSW parameters (rotational speed, plunge depth, tube protrusion, dwell time) on the tube pull-out behavior was investigated. The FSW technique showed capabilities at a wide range of operating conditions. The highest load bearing capacity of 517 N was achieved using the FSW process, much higher than adhesive joints. Also, it provides higher extensions at maximum load than adhesive joints, with the highest extension of 5.161 mm. Two FSW cases provided high leak paths of 77% and 58% remaining sheet thickness (greater than tube thickness) along with high load bearing capacity and corresponding extensions. The macroscopic and SEM-based fractographic studies illustrated three types of failure behavior: ductile, brittle, or mixed depending on the FSW process conditions. The DSC results showed no significant crystallinity changes in the weld material. The TGA results showed no significant thermal degradation occurring in the weld material. Further, the FTIR analysis indicated possible oxidation of the weld material. The capability to form TTJs with high leak path, high load bearing capacity, and no significant material degradations makes the FSW technique suitable for thermoplastic shell-and-tube heat exchanger applications

A Comprehensive Review on Optimal Welding Conditions for Friction Stir Welding of Thermoplastic Polymers and Their Composites

Friction stir welding (FSW) and friction stir spot welding (FSSW) techniques are becoming widely popular joining techniques because of their increasing potential applications in automotive, aerospace, and other structural industries. These techniques have not only successfully joined similar and dissimilar metal and polymer parts but have also successfully developed polymer-metallic hybrid joints. This study classifies the literature available on the FSW and FSSW of thermoplastic polymers and polymer composites on the basis of joining materials (similar or dissimilar), joint configurations, tooling conditions, medium conditions, and study types. It provides a state-of-the-art and detailed review of the experimental studies available on the FSW and FSSW between similar thermoplastics. The mechanical properties of FSW (butt- and lap-joint configurations) and FSSW weld joints depend on various factors. These factors include the welding process parameters (tool rotational speed, tool traverse speed, tool tilt angle, etc.), base material, tool geometry (pin and shoulder size, pin profile, etc.) and tool material, and medium conditions (submerged, non-submerged, heat-assisted tooling, cooling-assisted tooling). Because of the dependence on many factors, it is difficult to optimize the welding conditions to obtain a high-quality weld joint with superior mechanical properties. The general guidelines are established by reviewing the available literature. These guidelines, if followed, will help to achieve high-quality weld joints with least defects and superior mechanical properties. Apart from parametric-based studies, the statistical-based studies (e.g., analysis of variance (ANOVA)-based studies) are covered, which helps with the determination of the influential parameters that affect the FSW and FSSW weld joint strength. Also, the optimal ranges of the most influential process parameters for different thermoplastic materials are established. The current work on the development of general guidelines and determination of influential parameters and their operating ranges from published literature can help with designing smart future experimental studies for obtaining the global optimum welding conditions. The gaps in the available literature and recommendations for future studies are also discussed

Clinical assessment and risk stratification for prehospital use of methoxyflurane versus standard analgesia in adult patients with trauma pain

Oligoanalgesia, the undertreatment of trauma-related pain using standard analgesics in prehospital and emergency departments, has been extensively documented as one of the major challenges affecting the effective treatment of trauma-related pain. When administered in low doses, methoxyflurane has been highlighted by numerous medical works of literature to provide an effective, nonopioid, nonnarcotic treatment alternative to standard analgesics for prehospital and emergency department use. Low-dose methoxyflurane has been associated with fast-pain relief in adult patients manifesting moderate-to-severe pain symptoms. This systematic review and meta-analysis aimed to assess the clinical implication of low-dose methoxyflurane use in prehospital and emergency departments in adult patients with moderate-to-severe trauma-related pain. Moreover, the review aimed at assessing the risk stratification associated with using low-dose methoxyflurane in prehospital and emergency departments. The systematic review and meta-analysis performed a comprehensive search for pertinent literature assessing the implications and risks of using low-dose methoxyflurane in adult patients exhibiting moderate-to-severe trauma-related pain in prehospital settings. A comparison between the use of low-dose methoxyflurane and standard-of-care analgesics, placebo, in prehospital settings was reported in four clinically conducted randomized controlled trials (RCTs). These RCTs included the STOP! trial, InMEDIATE, MEDIATA, and the PenASAP trials. A meta-analysis comparing the time taken to achieve first pain relief on initial treatment of patients with moderate-to-severe trauma-related pain favored the use of low-dose methoxyflurane to the standard-of-care analgesics (mean difference = -6.63, 95% confidence interval = -7.37, -5.09) on time taken to establish effective pain relief. Low-dose methoxyflurane has been associated with superior and faster pain relief in prehospital and emergency departments in adult patients exhibiting moderate-to-severe trauma-related pain compared to other standard analgesics

Accuracy of procalcitonin for diagnosing sepsis in adult patients admitted to the emergency department: a systematic review and meta-analysis

Background Differentiating sepsis from non-infectious systemic inflammatory response syndrome (SIRS) is challenging. Biomarkers like procalcitonin (PCT) aid early risk assessment and guide antibiotic use. This study aims to ascertain PCT's accuracy as a sepsis biomarker among adult emergency department admissions. Method The PRISMA guidelines were followed to search for relevant articles in five electronic databases between April 14th and August 4th, 2023: PubMed, Cochrane Library, ProQuest, EMBASEs, and ScienceDirect. Studies had to be published in English to avoid directly translating scientific terms. Besides, the inclusion criteria were based on the diagnosis of sepsis in adult patients admitted to an emergency department. QUADAS-2 tool provided by the Review Manager version 5.4.1 was utilized to assess the risk of bias in included studies. STATA (v. 16) software was used to perform the meta-analysis. Results Ten of 2457 studies were included. We sampled 2980 adult sepsis patients for the under-investigated role of PCT in ED sepsis diagnosis. PCT emerged as the primary early diagnostic biomarker with high levels (29.3 ± 85.3 ng/mL) in sepsis patients. Heterogeneity in outcomes, possibly due to bias in cohort and observational studies, was observed. Conclusion PCT tests offer moderate accuracy in diagnosing sepsis and stand out for rapidly and precisely distinguishing between viral and bacterial inflammations.Scopu