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Cyproheptadine for Serotonin Toxicity: an Updated Systematic Review and Grading of Evidence
AbstractPurpose of ReviewSerotonin toxicity (ST) is a serious clinical entity caused by drug-induced serotonin excess in the central nervous system. Animal studies and some human data indicate that activation of specific serotonin receptor subtypes, namely 5-HT1A and 5-HT2A, are involved in ST pathophysiology, suggesting that serotonin antagonists could be used to treat ST. However, to date, high-quality evidence for the clinical utility of the most commonly employed serotonin antagonist, cyproheptadine, is lacking. This systematic review provides a clinical update on the evidence regarding use cyproheptadine for treating ...
Source: Current Emergency and Hospital Medicine Reports - October 10, 2020 Category: Emergency Medicine Source Type: research

The Toxicity of Newer and Lesser-Known Anticonvulsant Drugs
AbstractPurpose of ReviewThis review describes newer and lesser-known anticonvulsant drugs. Due to increased diagnostic accuracy of seizure disorder subtypes, as well as escalating off-label and experimental usage, these agents are becoming more commonplace. Important mechanisms of action, pharmacokinetics/pharmacodynamics, critical medication interactions, adverse reactions, toxicities, and treatment strategies are discussed.Recent FindingsCenobamate, clobazam, eslicarbazepine, ethosuximide, everolimus, felbamate, lacosamide, perampanel, methsuximide, levetiracetam (and the related compound brivaracetam), rufinamide, stir...
Source: Current Emergency and Hospital Medicine Reports - August 21, 2020 Category: Emergency Medicine Source Type: research

Does Manganese Contribute to Methamphetamine-Induced Psychosis?
AbstractPurpose of ReviewThis review describes the increasing global problem of methamphetamine (MA) use and development of psychosis, the molecular and structural basis for this form of psychosis, and its treatment. The putative contribution of manganese (Mn), a common element found widely in nature and industry, to the development of MA-induced psychosis is discussed in relation to its shared toxicity with MA.Recent FindingsBoth MA and Mn cause damage to brain monoaminergic, glutaminergic, and GABAergic systems and to the blood brain barrier, leading to higher exposure to Mn. Iron (Fe) deficiency can also lead to Mn over...
Source: Current Emergency and Hospital Medicine Reports - August 17, 2020 Category: Emergency Medicine Source Type: research

Recent Developments in Infectious Disease Chemotherapy: Review for Emergency Department Practitioners 2020
This article provides Emergency Department clinicians with a useful summary with new information on antibiotic use and recent research into agents which may become available. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - June 15, 2020 Category: Emergency Medicine Source Type: research

Vaping Cardiovascular Health Risks: an Updated Umbrella Review
AbstractPurpose of ReviewModified risk products (MRP) such as electronic vaping cigarettes (EVC) and heat-not-burn cigarettes (HNBC) are alternatives to traditional combustion cigarettes (TCC) with an expanding consumer base. Yet, their cardiovascular health risks are still unclear. We aimed to summarize the evidence base on this topic by conducting an updated umbrella review.Recent FindingsWe identified 7 systematic reviews, totaling 183 studies and reports, ranging from in vitro and in animal studies to clinical studies in apparently healthy volunteers and patients at risk of cardiovascular disease. Overall, acute EVC us...
Source: Current Emergency and Hospital Medicine Reports - June 15, 2020 Category: Emergency Medicine Source Type: research

Importance of Selected Acute Flaccid Paralysis Diagnoses in an Emergency Department Setting for the Pediatric Population
AbstractPurpose of ReviewA review for the bedside practitioner of practical clinical exam, subtle differences, and diagnostic criteria for some of the difficult to distinguish acute flaccid paralysis diagnoses in the pediatric patient and to summarize the current findings of the evolving and elusive diagnosis termed acute flaccid myelitis.Recent FindingsSince the first public epidemiological reports in 2014 using the newly coined diagnosis of acute flaccid myelitis (AFM), emergency department clinicians and other frontline medical professionals have become primarily responsible for identifying patients who may become subse...
Source: Current Emergency and Hospital Medicine Reports - June 3, 2020 Category: Emergency Medicine Source Type: research

Pre-participation Cardiovascular Screening in Young Competitive Athletes
AbstractPurpose of ReviewThe purpose of this review was to highlight the current recommendations, data, and limitations for methods of cardiovascular screening in athletes.Recent FindingsWhile the history and physical (H&P) alone remains the cornerstone for pre-participation cardiovascular screening (PPCS) in athletes, the advent of modern electrocardiographic (ECG) screening criteria has drastically increased sensitivity and decreased false-positive rates for screening. Advanced imaging techniques remain an important component of secondary testing after an athlete has an abnormal initial screening exam; however, the u...
Source: Current Emergency and Hospital Medicine Reports - May 20, 2020 Category: Emergency Medicine Source Type: research

Acute Aortic Dissection: an Update
AbstractPurpose of ReviewThis review summarizes the pathophysiology of acute aortic dissection with recent findings and current strategies for diagnosis and treatment.Recent FindingsThe addition of clinical and laboratorial findings to radiologic classifications emerges as an approach to better stratify and treat patients with aortic dissection. Endovascular strategies grow in variety of treatment options, including for type A aortic dissection.SummaryAortic dissection is a wide spectrum syndrome, generally posing a life-threating risk. Early identification can be the difference between life and death. Better imaging diagn...
Source: Current Emergency and Hospital Medicine Reports - May 19, 2020 Category: Emergency Medicine Source Type: research

Triple Therapeutic Effects of Ketamine in Prehospital Settings: Systematic Review
AbstractPurpose of ReviewKetamine is a unique drug that, remarkably, provides three clinical benefits of analgesia, assisting intubation and sedation. It has minimal adverse events and may have major advantages for trauma patients and those with violent behaviours in prehospital environments. Twenty-one full-text articles were retrieved from 1119 journal abstracts in the databases PubMed, ScienceDirect and Taylor& Francis Group, and the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was used to assess their quality.Recent FindingsFindings clearly demonstrated signific...
Source: Current Emergency and Hospital Medicine Reports - May 18, 2020 Category: Emergency Medicine Source Type: research

Management of Travel-Related Infectious Diseases in the Emergency Department
AbstractPurpose of ReviewEmergency physicians generally have limited exposure to internationally acquired illnesses. However, travelers can present quite ill, and delays in recognition and treatment can lead to increased morbidity and mortality. This paper aims to summarize typical presentations of common international diseases and provide the emergency physician with a practical approach based on current guidelines.Recent FindingsIn the treatment of traveler ’s diarrhea, azithromycin has become the treatment of choice due to the growing antibiotic resistance. Intravenous artesunate was approved in 2019 under investigati...
Source: Current Emergency and Hospital Medicine Reports - May 5, 2020 Category: Emergency Medicine Source Type: research

Post Herpetic Neuralgia: Recent Advancements
AbstractPurpose of ReviewTo discuss updates and recommendations for the treatment of postherpetic neuralgia (PHN), a painful neuropathic condition caused by reactivation of the latent varicella-zoster virus (VZV). The focus of this review will include prevention, evaluation, diagnosis, and management.Recent FindingsUsing a multidisciplinary approach to management yields the best results, including oral and topical medication, physical therapy, psychotherapy, injections, complementary, and other procedural interventions, as well as neural stimulation.SummaryRecent advancements in the management of neuropathic pain condition...
Source: Current Emergency and Hospital Medicine Reports - March 25, 2020 Category: Emergency Medicine Source Type: research

Heart Failure and Comorbidities —Part 1
AbstractPurpose of ReviewThe main objective of the 1st part of this review is to demonstrate that a better understanding of comorbidities such as COPD, obstructive sleep apnea, thyroid dysfunction, cardiorenal syndrome, its pathophysiological and therapeutic implications, impact on the management of FH by interfering with its survival, and quality of life of patients.Recent FindingsThe prevalence of heart failure will increase 46% from 2012 to 2030, resulting in>  8 million people ≥ 18 years of age. This disease has a large burden of noncardiovascular comorbidities, which may increase the risk of mortality and de...
Source: Current Emergency and Hospital Medicine Reports - February 28, 2020 Category: Emergency Medicine Source Type: research

Heart Failure and Comorbidities —Part 2
AbstractPurpose of ReviewThe main objective in this 2nd part is to highlight comorbidities of great clinical importance such as diabetes, anemia, and chronic renal failure, either because of their high prevalence, or because of their relevance to impact on morbidity and mortality, and directly in the treatment of heart failure.Recent FindingsThe prevalence of heart failure will increase 46% from 2012 to 2030, resulting in>  8 million people ≥ 18 years of age. This disease have a large burden of noncardiovascular comorbidities, which may increase the risk of mortality and decrease quality of life. There is a perce...
Source: Current Emergency and Hospital Medicine Reports - February 23, 2020 Category: Emergency Medicine Source Type: research

Urinary Tract Infection Updates and Recent Developments
AbstractPurpose of ReviewThis review describes recent, relevant articles published regarding urinary tract infections (UTI). It reviews papers regarding the pathology, diagnosis, management, and prevention of urinary tract infections in addition to developments in the area of pediatric UTIs.Recent FindingsSeveral new papers demonstrated findings on antibiotic resistance of UTI pathogens. Diagnostic equipment and detection techniques were a significant area of focus in recent publications including one paper that reported a drastic reduction in time to identify bacteria compared with traditional culturing. A set of new guid...
Source: Current Emergency and Hospital Medicine Reports - February 21, 2020 Category: Emergency Medicine Source Type: research

Updates on Technology for Diabetes Mellitus
AbstractPurpose of ReviewTo update the medical community on the new and old technologies use for the control and management of diabetes mellitus.Recent FindingsDiabetes technology is defined as the different technology including hardware, devices, and software that are used by diabetic patients in order to help to manage blood glucose levels. This technology can be used in patients with any type of diabetes mellitus and, when applied appropriately, it can have a significant impact on these patients ’ health. They can be divided into different insulin delivery methods, blood glucose monitoring, and hybrid and implantable ...
Source: Current Emergency and Hospital Medicine Reports - February 9, 2020 Category: Emergency Medicine Source Type: research