Search

Traditional teaching has advocated for morphine in the treatment of acute coronary syndrome (ACS); however, recent data has called this into question. Previous data, though, has been riddled with bias. We sought to compare exposure to morphine versus other opioids and its effect on mortality and adverse outcomes in patients with ACS. We conducted a retrospective chart review of patients who presents to our emergency department for ACS and received a cardiac stent. Exposure of interest was receipt of narcotics and type, route, and dose of narcotics received prior to cardiac catheterization. Primary outcome was in-hospital mortality. Secondary outcome was a composite of in-hospital heart failure, hypotension, or dysrhythmia. We included 118 visits from 64 unique patients, of which 19 received morphine, 5 received fentanyl, 7 received oral opioids, and 88 received no opioids. There was no difference in mortality or adverse outcomes between patients receiving IV morphine (4.2%) or IV fentanyl (0%) but there was an increased mortality in patients receiving oral opioids (28.6%) compared to no opioids (4.5%) and an increase adverse outcome in patients receiving IV morphine (68.4%) versus no opioids (36.4%). Our limited-size study demonstrated that receipt of IV morphine is associated with an increased risk of adverse outcomes compared to not receiving opioids; however, there is no significant difference in adverse outcomes comparing morphine to other opioids. Our data adds evidence to the theory that prior reports of morphine-associated adverse outcomes are likely biased and not necessarily related to intrinsic properties of morphine.

Study Design: Systematic review of the literature. Objective: The goal of this study is to review the current literature on severe rhinophyma requiring operative management for significant cosmetic deformity or nasal obstruction. We aim to provide a treatment algorithm for the various surgical techniques employed in the treatment of severe rhinophyma. Methods: Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 2010 to 2020 were collected. All studies which described surgical treatment of severe rhinophyma using the Boolean method and relevant search term combinations, including “rhinophyma,” “severe,” “operative” and “surgery” were collected. Results: A total of 111 relevant unique articles met criteria for eligibility analysis. Of these, 85 articles were deemed inappropriate for the literature review due to exclusion criteria. The remaining 26 articles were included in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Conclusions: Severe rhinophyma may present a reconstructive challenge to reestablish normal contour and patent nasal airway. Significant deformity necessitates surgical correction. The present article reviews the current literature and provides a summary and stepwise explanation of established surgical techniques for addressing the cosmetic and functional deficits these patients encounter.

The infratemporal fossa is a complex space that both contains and is closely associated with vital neurovascular structures. As such, surgical access of the infratemporal fossa presents a definitive challenge requiring complete understanding of ventral skull base anatomy and expertise with both open craniofacial and endoscopic techniques. Anterior and lateral approaches to the infratemporal fossa vary greatly and may be individualized to each case in order to optimize visualization and instrumentation. Significant progress has been made in the development of surgical techniques for treatment of tumors involving the infratemporal fossa, including expanded endonasal approaches. Endoscopic, minimally invasive, and open approaches each provide distinct advantages and disadvantages. In the present article, we will review indications and limitations of the varied methodology for approaching the infratemporal fossa.

Human papillomavirus oral papilloma is often sexually transmitted, but non‐sexual modes of transmission should be considered, including autoinoculation from skin lesions. A patient‐centered multimodality approach should be utilized in the pediatric population.

The use of electronic vapor products (EVPs) has increased dramatically in the past decade. The objectives of our study were to examine the frequency of EVP use; to identify demographic characteristics, risk-taking behaviors, and beliefs about vaping; and to determine symptoms associated with EVPs among adolescents. A questionnaire addressing these objectives was administered to a convenience sample of subjects aged 12 to 23 years. Among 494 completed questionnaires, 80% of responders were considered experimenters/nonusers (never tried or tried one time) and 20% were considered frequent users (at least once a month). We identified demographic features and risk-taking behaviors associated with EVP use. In the previous 6 months, frequent users were more likely to report headache, cough, sleep disturbances, dehydration, weakness, racing heart, chest pain, and tremors. Our findings provide evidence to support efforts to decrease EVP use through screening, education, and preventative strategies.

Background/Purpose: Despite the increasing prevalence of the use of electronic vaping products (vapes) among adolescents and young adults, few studies have examined the clinical symptoms associated with vaping. The goal of this study was to examine the prevalence of vaping, to identify symptoms that may be associated with vaping, and to understand beliefs about vaping that may contribute to its growing prevalence. Methods: A questionnaire was administered to a convenience sample of subjects aged 12-23 years presenting for medical care to Penn State …

BACKGROUND/OBJECTIVES Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Pediatric sexual assault (SA) victims are a special population eligible for HPV vaccination at the age of 9 years. National clinical practice guidelines advise clinicians to address HPV during emergency department (ED)-based SA care and at follow-up. At our institution, addressing HPV among suspected SA victims was highly variable, and HPV counseling was subsequently recommended on an ED-based acute SA clinical pathway as standard care. The aim of this study was to determine the proportion of age-eligible SA victims who received HPV counseling, determine victim characteristics associated with addressing HPV during SA care, and identify barriers to addressing HPV in the ED. METHODS This study used a retrospective chart review of 448 pediatric SA victims presenting to the ED for acute postassault care. RESULTS HPV was discussed in 10 of 56 (18%) and 37 of 49 (76%) cases in the control versus intervention groups, respectively. To verify vaccination status, caregiver recall was relied upon for 32 of 56 patients in the control group (57%) and 24 of 49 patients in the intervention group (48.9%). Factors associated with failure to discuss HPV during postassault care were younger age at encounter (OR = 0.78, 95% CI [0.67, 0.90], p < 0.001), verbal report of vaccination status verification (OR = 2.98, 95% CI [1.51, 6.01]), and male gender of the victim (OR = 3.35, 95% CI [1.20, 11.94]). CONCLUSIONS Significant barriers to addressing HPV in the ED setting exist, most significantly reliance on caregiver recall to guide vaccination administration, raising concern for overvaccination and undervaccination.