Association between Ambient Air Pollution and Outpatient Visits for Acute Bronchitis in a Chinese City

Objective To investigate the short-term association between outdoor air pollution and outpatient visits for acute bronchitis,which is a rare subject of research in the mainland of China.Methods A time-series analysis was conducted to examine the association of outdoor air pollutants with hospital outpatient visits in Shanghai by using two-year daily data（2010-2011）.Results Outdoor air pollution was found to be associated with an increased risk of outpatient visits for acute bronchitis in Shanghai.The effect estimates of air pollutants varied with the lag structures of the concentrations of the pollutants.For lag06,a 10 μg/m3 increase in the concentrations of PM10,SO2,and NO2 corresponded to 0.94%（95% CI：0.83%,1.05%）,11.12%（95% CI：10.76%,11.48%）,and 4.84%（95% CI：4.49%,5.18%） increases in hospital visits for acute bronchitis,respectively.These associations appeared to be stronger in females（P〈0.05）.Between-age differences were significant for SO2（P〈0.05）,and between-season differences were also significant for SO2（P〈0.05）.Conclusion Our analyses have provided the first evidence that the current air pollution level in China has an effect on acute bronchitis and that the rationale for further limiting air pollution levels in Shanghai should be strengthened.

Ambient Temperature and Outpatient Visits for Acute Exacerbation of Chronic Bronchitis in Shanghai: A Time Series Analysis

The association between ambient temperature and acute exacerbation of chronic bronchitis （AECB） was still unknown. Therefore, we performed an epidemiological study in a large hospital of Shanghai to explore the relationship about temperature and outpatient visit for AECB. We adopted a quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on AECB across multiple days. We found significant non-linear effects of cold temperature on hospital visits for AECB, and the potential effect of cold temperature might last more than 2 weeks. The relative risks of extreme cold （first percentiles of temperature throughout the study period） and cold （10th percentile of temperature） temperature over lags 0-14 d were 2.98 [95% confidence intervals （CI）： 1.77, 5.04] and 1.63 （95% Ch 1.21, 2.19）, compared with the 25th percentile of temperature. However, we found no positive association between hospital visits and hot weather. This study showed that exposure to both extreme cold and cold temperatures were associated with increased outpatient visits for AECB in a large hospital of Shanghai.

Study on the underlying mechanism of almond and platycodon in treating acute bronchitis based on network pharmacology

Objective:Network pharmacology method was adopted in this study to screen the target of almond and platycodon of the treatment to Acute Bronchitis and exploring its mechanism of treatment.Methods:Chemical components and selected targets related to almond and platycodon were searched through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP).Through GeneCards database,OMIM database,disease targets of Acute Bronchitis were searched.Venn diagram analysis was used to screen the common targets between drugs and disease,and then the interaction network diagram of the targets was constructed by String.Cytoscape3.7.0 was applied to construct the drugcomposition-target-disease interacted network.GO Enrichment and KEGG Enrichment Analysis of Targets were based on DAVID.Results:There are 25 active components such as luteolin,acacetin and Glabridin in the almond and platycodon,corresponding to 127 targets.81 targets are obtained by mapping with 1593 targets of acute bronchitis,including PTGS2,PTGS1,AKT1,TP53,etc.KEGG enrichment analysis mainly involves Apoptosis,PI3K-Akt signaling pathway,TNF signaling pathway,T cell receptor signaling pathway,etc.Conclusion:Based on the network pharmacology,the potential mechanism of almond and platycodon in the treatment of acute bronchitis was discussed,which provides ideas and directions for further experimental research.

Systematic review of Shufeng Jiedu capsules for acute attack of chronic bronchitis

Objective:To systematically evaluate the efficacy and safety of Shufeng Jiedu Capsules in the treatment of acute attacks of chronic bronchitis.Methods:CNKI,VIP,CBM,WanFang,PubMed,EMbase,Cochrane Library and ChiCTR were searched by computer,and randomized controlled trials of Shufeng Jiedu capsules in the treatment of AECB were integrated.The retrieval time was from the date of establishing the database to December 31,2020.Meta-analysis of outcome indicators[including effective rate,C-reactive protein(CRP),lung function[FEV1%and/or FEV1/FVC],interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)]were carried out by RevMan 5.3 software,and the effective rate was tested by sequential analysis(TSA),and the quality of evidence was evaluated according to GRADE standards.Results:A total of 680 cases in 8 articles were included.Shufeng Jiedu Capsules improved the effective rate of clinicaltreatment[RR=1.20,95%CI(1.13,1.28)],improved lung function[FEV1:MD=0.33,95%CI(0.22,0.45),FEV1/FVC:MD=10.17,95%CI(8.15,12.19)],reduced CRP[MD=-7.32,95%CI(-8.42,-6.22)],IL-8[MD=-63.39,95%CI(-73.49,-53.29)],TNF-α[MD=-7.44,95%CI(-8.35,-6.53)]levels.The above differences were statistically significant(P<0.05),and no serious adverse reactions were reported in all studies.The results of TSA analysis showed that the experimental group had definite evidence for improving the efficiency.According to the GRADE evaluation system,the efficiency,TNF-αwere medium-quality evidences,FEV1 was low-quality evidence,and FEV1/FVC,CRP,and IL-8 were extremely low-quality evidence.Conclusions:The curative effect of Shufeng Jiedu capsule combined with western medicine in the treatment of AECB was better than that of single western medicine.Nevertheless,considering the limited sample size and the quality of included articles,higher quality RCTs are still needed to further confirm its effectiveness and safety.

Treatment of Cough and Dyspnea due to Acute Bronchitis by Plaster for Cough and Dyspnea——A Report of 735 Cases

In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang [symbol: see text]-[symbol: see text]) was successfully applied to 735 cases of acute bronchitis (the treatment group), with the other 423 cases treated with routine western drugs as controls. The results showed that the cure rate in the treatment group was significantly higher than that in the control group (P

TCM aerosol inhalation treatment in acute exacerbations of chronic bronchitis： a meta-analysis

Objectives： To determine whether traditional Chinese medicine （TCM） aerosol inhalation treatment is effective inthe treatment of acute exacerbation of chronic bronchitis. Methods： Search double-blind randomised clinical trials（RCT） about the use of TCM aerosol inhalation in patient with acute exacerbation of chronic bronchitis via database including Chinese biomedicine literature database, Wanfang Data, CNKI, Pubmed, EMBASE and CochraneLibrary from the beginning to October 2016. Quality evaluation, data extraction and data analysis of these RCT wascarried out with reference to the Cochrane systematic review. Results： 16 studies with 738 patients in TCM aerosolinhalation group and 675 in control group were included. The results of meta-analysis showed, （1） TCM aerosolinhalation group could improve the total cure rate. （2） TCM aerosol inhalation could increase the expression of IL-2while decrease the expression of IL-8 and MDA in sputum and blood. （3） TCM aerosol inhalation could improvethe symptoms of cough, cough with sputum, cough with dyspnea and lung wet rales. It also improve the symptomsof cough, expectorate and lung wet rales. （4） Shorten the time of cough and lung rale. （5） The adverse reactionswere light only with 1 occurrence of nausea and vomiting. Conclusions： The use of TCM aerosol inhalation in thetreatment of acute exacerbation of chronic bronchitis was effective. However, the inclusion researches quality werenot very high, which only provided limited evidence for clinical application. Higher-quality randomized controlledtrials were needed for further study.

CLINICAL OBSERVATION ON TREATMENT OF ACUTE BRONCHITIS PRIMARILY WITH PRICKING-CUPPING ON BACK-SHU POINTS

To observe the clinical effect of treatment of acute bronchitis primarily with prickingcupping method on Back-shu points. Methods. The patients of acute bronchitis were randomly divided into 2 groups. In the observation group, there were 36 cases, who were treated with the integrated traditional Chinese and western medicine, primarily the pricking-cupping method on Back-shu points; while in the control group, there were 29 cases who were given the conventinal treatment of western medicine. All the 2 groups were treated for 7 days as one treating course. Results： The total effective rate of the observation group was 97.2% while that of the control group was 82,8%, so there is a significant difference between them. On the first and third days the clinical manifestations were more satisfactorily improved in the treatment group than in the control group （P 〈 0.01） and on the fifth and seventh days, the comparison showed no significant difference （P〉0.05）. Conclusion： The treatment of acute bronchitis by means of the integrated traditional Chinese and western medicine primarily with pricking-cupping method on Back-shu points is of marked therapeutic effect, simple manipulation, and little untoward effects, thus claiming the unique advantage.

Effects of montelukast sodium combined with pidotimod on acute phase protein and immune function in children with acute bronchitis

Objective: To observe the effects of montelukast sodium combined with pidotimod on acute phase protein (APP) and indexes of immunologic function in pediatric acute bronchitis treatment. Methods: A total of 180 cases children with acute bronchitis acted as research objects were randomly divided into control group (n=65) and observation group (n=63). On the basis of conventional therapy, control group was treated by plus pidotimod. On this base, observation group was treated with montelukast sodium. The changes of acute phase proteins (CRP, HP, a1-AAG and CER) and immune function (CD3+, CD4+, CD8+ and CD4+/CD8+) levels before and after treatment were observed after 2 months. Results: Before treatment, CRP, HP, a1-AAG, CER, CD3+, CD4+, CD8+ and CD4+/CD8+ levels of two groups had no statistically significant difference;CRP, HP, a1-AAG, CER, and CD8+ levels of control and observation groups decreased significantly after treatment, the decreases of observation group were more obvious than that of control group, and the levels after treatment were significantly lower than that of control groups. The levels of CD3+, CD4+ and CD4+/CD8+ in two groups after treatment were significantly higher than those before treatment. For observation group, the levels of CD3+, CD4+ and CD4+/CD8+ increased more significantly after treatment, which were significantly higher than that of the control group. Conclusion: Using Montelukast sodium combined with pidotimod can effectively reduce the children's acute phase protein levels, improve immune function, which has clinical value for the treatment of children with acute bronchitis.

Transient Macroamylasemia in a Severely Multiple-Handicapped Child Following the Development of Acute Bronchitis

Macroamylasemia is a condition of elevated serum amylase levels in which normal serum amylase form a complex with high molecular weight proteins such as immunoglobulins. This is a case report on a patient with macroamylasemia following acute asthmatic bronchitis. A 5-year-old male with cerebral palsy and developmental retardation was admitted to our hospital because of high fever and severe cough. Treatment of the respiratory symptoms provided symptomatic improvement, but the serum amylase levels became suddenly elevated. Although acute pancreatitis associated with respiratory infection was initially suspected, a predominant salivary isoamylase, normal serum lipase level, low urine amylase level, and low amylase-creatinine clearance ratio (ACCR) (0.58%) indicated macroamylasemia. The serum amylase level decreased, and the ACCR increased within normal range 2 weeks after discharge. Both of these indicators have been within normal range over the past year. Transient macroamylasemia can be misdiagnosed as acute pancreatitis, especially in a severely multiple-handicapped child who is unable to complain. The ACCR is useful in the diagnosis of macroamylasemia.

Acute suppurative terminal cholangitis:Clinical characteristics of a new subtype of acute cholangitis

Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Methods:We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020.We analyzed their clinical characteristics,including etiology,clinical manifestations,imaging features,treatment and prognosis.Results:A total of 32 ASTC patients were included in the analysis.The majority of the patients had a history of biliary operations,and clinical manifestations were occult and atypical.The positive rate of bacterial culture was 46.9%.All the patients had typical imaging features on computed tomography and magnetic resonance imaging.Treatment with effective antibiotics was provided as soon as diagnosis was established.After treatment,most patients had a good outcome.Elevated levels of total bilirubin,aspartate aminotransferase,procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis.Conclusions:Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis,and that earlier diagnosis and more personalized treatments are needed.

Acute Eosinophilic Pneumonia (AEP) Due to Daptomycin: Is Autoimmunity a Clinico-Pathophysiologic Bridge to AEP?

Daptomycin induced acute eosinophilic pneumonia is a rare and potentially life threatening condition characterized by rapid respiratory failure, pulmonary infiltrates and eosinophilia. Risk factors for acute eosinophilic pneumonia include smoking, environmental irritants or inhalants and certain medications such as Daptomycin [1]. In this review of literature, we aim to explore the potential triggers for developing acute eosinophilic pneumonia in patients exposed to Daptomycin. The exact immune mechanism for daptomycin induced AEP is unknown, however the current proposed mechanism describes a T helper 2 lymphocyte response to inactivated daptomycin in the pulmonary surfactant, which leads to eosinophilia. Disordered T regulatory cell function is seen in patients with certain cancers, allergies and autoimmune conditions. We propose that patients with these underlying risk factors may be at increased risk of developing AEP after becoming exposed to Daptomycin. Understanding potential risk factors is crucial for health care workers as it allows them to identify susceptible populations, explore preventative measures and treat accordingly.

Low skeletal muscle mass and high visceral adiposity are associated with recurrence of acute cholecystitis after conservative management:A propensity score-matched cohort study

Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity have various effects in several diseases.We aimed to clarify the relationship between RAC and body parameters.Methods:Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled.The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC.The areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI groups.We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC.Results:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)groups.In the propensity score-matched cohort there were 57 patients in each group.In Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),respectively.Conclusions:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.

Comparative transcriptomic analysis reveals the molecular changes of acute pancreatitis in experimental models

BACKGROUND Acute pancreatitis(AP)encompasses a spectrum of pancreatic inflammatory conditions,ranging from mild inflammation to severe pancreatic necrosis and multisystem organ failure.Given the challenges associated with obtaining human pancreatic samples,research on AP predominantly relies on animal models.In this study,we aimed to elucidate the fundamental molecular mechanisms underlying AP using various AP models.AIM To investigate the shared molecular changes underlying the development of AP across varying severity levels.METHODS AP was induced in animal models through treatment with caerulein alone or in combination with lipopolysaccharide(LPS).Additionally,using Ptf1αto drive the specific expression of the hM3 promoter in pancreatic acinar cells transgenic C57BL/6J-hM3/Ptf1α(cre)mice were administered Clozapine N-oxide to induce AP.Subsequently,we conducted RNA sequencing of pancreatic tissues and validated the expression of significantly different genes using the Gene Expression Omnibus(GEO)database.RESULTS Caerulein-induced AP showed severe inflammation and edema,which were exacerbated when combined with LPS and accompanied by partial pancreatic tissue necrosis.Compared with the control group,RNA sequencing analysis revealed 880 significantly differentially expressed genes in the caerulein model and 885 in the caerulein combined with the LPS model.Kyoto Encyclopedia of Genes and Genomes enrichment analysis and Gene Set Enrichment Analysis indicated substantial enrichment of the TLR and NOD-like receptor signaling pathway,TLR signaling pathway,and NF-κB signaling pathway,alongside elevated levels of apoptosis-related pathways,such as apoptosis,P53 pathway,and phagosome pathway.The significantly elevated genes in the TLR and NOD-like receptor signaling pathways,as well as in the apoptosis pathway,were validated through quantitative real-time PCR experiments in animal models.Validation from the GEO database revealed that only MYD88 concurred in both mouse pancreatic tissue and human AP peripheral blood,while TLR1,TLR7,RIPK3,and OAS2 genes exhibited marked elevation in human AP.The genes TUBA1A and GADD45A played significant roles in apoptosis within human AP.The transgenic mouse model hM3/Ptf1α(cre)successfully validated significant differential genes in the TLR and NOD-like receptor signaling pathways as well as the apoptosis pathway,indicating that these pathways represent shared pathological processes in AP across different models.CONCLUSION The TLR and NOD receptor signaling pathways play crucial roles in the inflammatory progression of AP,notably the MYD88 gene.Apoptosis holds a central position in the necrotic processes of AP,with TUBA1A and GADD45A genes exhibiting prominence in human AP.

Carrimycin in the treatment of acute promyelocytic leukemia combined with pulmonary tuberculosis: A case report

BACKGROUND Pulmonary tuberculosis(PTB)is prevalent in immunocompromised populations,including patients with hematologic malignancies,human immunodeficiency virus infections,and chronic diseases.Effective treatment for acute promyelocytic leukemia(APL)combined with PTB is lacking.These patients show an extremely poor prognosis.Therefore,studies should establish efficient treatment options to improve patient survival and prognosis.CASE SUMMARY A 60-year-old male with pain in the right side of his chest and a fever for 4 d visited the outpatient department of our hospital.Peripheral blood smear revealed 54%blasts.Following bone marrow examinations,variant APL with TNRC18-RARA fusion gene was diagnosed.Chest computed tomography scan showed bilateral pneumonitis with bilateral pleural effusions,partial atelectasis in the lower lobes of both lungs,and the bronchoalveolar lavage fluid gene X-Pert test was positive,indicative of PTB.Carrimycin,ethambutol(EMB),and isoniazid(INH)were administered since he could not receive chemotherapy as the WBC count decreased continuously.After one week of treatment with carrimycin,the patient recovered from fever and received chemotherapy.Chemotherapy was very effective and his white blood cells counts got back to normal.After being given five months with rifampin,EMB and INH and chemotherapy,the patient showed complete remission from pneumonia and APL.CONCLUSION We report a case of PTB treated successfully with carrimycin with APL that requires chemotherapy.

Acute coalescent mastoiditis in a 16-month-old child due to Streptococcus pneumoniae infection

Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone(acute coalescent mastoiditis).In addition,the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells,leading to subperiosteal abscesses.Patient’s Concern:A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis(swelling and redness of the skin).Diagnosis:Bilateral acute coalescent mastoiditis caused by S.pneumoniae infection.The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.Interventions:The patient underwent intravenous antibiotic therapy and surgical treatment.Outcomes:The patient was discharged 14 days after hospitalization with an improved condition.Lessons:Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications,sometimes serious and even life-threatening.Complications are prevalent in children under 2 years,in whom the disease progresses more rapidly and severely.The vaccination with a 13-valent vaccine may not result in sufficient immunity against S.pneumoniae,a predominant pathogen in children affected by acute coalescent mastoiditis.

Reliability of neutrophil gelatinase-associated lipocalin in detecting acute tubular necrosis in decompensated cirrhosis:Systematic review and meta-analysis

BACKGROUND Acute kidney injury(AKI)in cirrhosis is common.The diagnosis of AKI in cirrhosis patients depends on clinical presentation and laboratory tests like serum creatinine.However,urine biomarkers could also be used to assess the type of AKI and the severity of the disease.We performed a systematic review with metaanalysis to evaluate the association with urine neutrophil gelatinase-associated lipocalin(NGAL)marker in identifying acute tubular necrosis(ATN)in patients with cirrhosis.AIM To assess the reliability of urine NGAL in the detection of ATN in patients with cirrhosis.METHODS We systematically searched MEDLINE and PubMed using keywords including“urine biomarkers”,“NGAL”,“kidney dysfunction”,and“cirrhosis”to identify relevant studies.Data was screened and extracted.Included studies assessed hospitalized cirrhosis patients with AKI using the urine NGAL biomarker.We synthesized the data using diagnostic odds ratio(DOR),comparative and descriptive analyses,and Cochran Mantel-Haenszel(CMH)statistics to evaluate heterogeneity.RESULTS Three thousand seven hundred and one patients with cirrhosis were analyzed from a total of 21 cohort studies.The DOR of 14 of those studies[pooled DOR:22.150,(95%CI:17.58-27.89),P<0.0001]demonstrated a significant association between urine NGAL levels and its identification of ATN.Following stratification by cirrhosis status,heterogeneity was analyzed and showed a significant non-zero correlation between NGAL and AKI(CMH statistic=702.19,P<0.0001).CONCLUSION In patients with cirrhosis,the use of urine NGAL is a reliable biomarker for detecting ATN and identifying the etiology of AKI.

Successful emergency surgical intervention in acute non-STsegment elevation myocardial infarction with rupture:A case report

BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes:A retrospective cohort study

BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at home.AIMTo evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database.Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)groups.After applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical outcomes.RESULTS Following 1:1 propensity score matching,the analysis included 274 patients in each group.Notably,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon discharge.CONCLUSION Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications

BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few years.AIM The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:CRD42021279639.Medline and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in pain.RESULTS After full-text screening,we included 14 studies in the qualitative synthesis.Of these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients enrolled.There was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome explored.The MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an outcome.In 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not well-specified.The included studies were found to have a low-moderate risk of bias.CONCLUSION Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury.Intravenous ketamine may cause more adverse events than other routes of administration.

Acute macular neuroretinopathy following COVID-19 infection:Three case reports

BACKGROUND During the Coronavirus disease 2019(COVID-19)pandemic,a notable increase in acute macular neuroretinopathy(AMN)cases was observed.This study aimed to investigate the potential association between AMN and COVID-19 by examining 3 cases in China.CASE SUMMARY The first case involved a 30-year-old man who presented with progressive vision loss following a COVID-19 infection.Optical coherence tomography(OCT)and near-infrared imaging identified hallmark AMN lesions,hyperreflective disruptions within the outer plexiform layer,and hyporeflective anomalies in the ellipsoid zone,leading to an AMN diagnosis.Despite partial visual recovery,OCT angiography(OCTA)revealed persistent microvascular changes,specifically a decreased vascular density in the deep capillary plexus.The second case was a 24-year-old woman who experienced blurred vision and exhibited bilateral cottonwool spots on fundus examination post-COVID-19.Imaging confirmed the presence of AMN along with paracentral acute middle maculopathy(PAMM).Follow-up OCTA found a progressive reduction in vascular density,indicating ongoing microvascular compromise.The third case was a 28-year-old woman who reported sensations of occlusion in her right eye following a COVID-19 infection.Imaging confirmed both AMN and PAMM,revealing similar decreases of microvascular density on OCTA despite a significant improvement in visual acuity.We noted that all 3 patients had received the COVID-19 vaccine prior to the appearance of symptoms.CONCLUSION The findings highlight the diagnostic utility of advanced ocular imaging in detecting AMN in COVID-19 patients and the importance of comprehensive eye examinations.