Sodium Valproate Versus Dopamine Antagonists for Acute Migraine in the Emergency Department: A Systematic Review.

BACKGROUND: Migraine is a common primary headache disorder diagnosed in the emergency department (ED). This systematic review sought to compare the efficacy of sodium valproate (SV) to dopamine antagonists (DA) in relieving pain due to acute migraine. METHODS: Two research librarians helped create a search strategy including Embase, Ovid Medline, and the Cochrane Database of Clinical Trials from inception to June 1, 2020, updated May 19, 2021. Two investigators identified randomized control trials (RCTs) including adult patients with acute migraine presenting to the ED or acute clinical setting comparing SV to a DA with the aim of relieving pain. Primary outcome was headache relief at 1 hour from treatment. Secondary outcomes included pain relief at 24 hours, relief of associated symptoms (e.g. nausea, photo-/phonophobia, etc.), and need for rescue analgesia. Meta-analysis was performed and presented as odds ratios. RESULTS: Four RCTs with 470 patients were identified from an initial pool of 454 titles. Two studies compared SV to a DA alone and two compared SV to a DA plus one other agent (sumatriptan or dihydroergotamine). Three studies were included for meta-analysis. Pain relief had a pooled odds ratio of 1.14 at 1 hour and 0.42 at 24 hours. Three articles reporting the need for rescue analgesia had pooled odds ratio of 2.76. CONCLUSIONS: Sodium valproate is not more effective than DA at reducing migraine headache pain at 1 hour and less effective at 24 hours. Dopamine antagonists should be used over SV for the management of patients with acute migraine.

The Yield of Computed Tomography of the Head Among Patients Presenting With Syncope: A Systematic Review.

BACKGROUND: Overuse of head computed tomography (CT) for syncope has been reported. However, there is no literature synthesis on this overuse. We undertook a systematic review to determine the use and yield of head CT and risk factors for serious intracranial conditions among syncope patients. METHODS: We searched Embase, Medline, and Cochrane databases from inception until June 2017. Studies including adult syncope patients with part or all of patients undergoing CT head were included. We excluded case reports, reviews, letters, and pediatric studies. Two independent reviewers screened the articles and collected data on CT head use, diagnostic yield (proportion with acute hemorrhage, tumors or infarct), and risk of bias. We report pooled percentages, I2 , and Cochran's Q-test. RESULTS: Seventeen articles with 3,361 syncope patients were included. In eight ED studies (n = 1,669), 54.4% (95% confidence interval [CI] = 34.9%-73.2%) received head CT with a 3.8% (95% CI = 2.6%-5.1%) diagnostic yield and considerable heterogeneity. In six in-hospital studies (n = 1,289), 44.8% (95% CI = 26.4%-64.1%) received head CT with a 1.2% (95% CI = 0.5%-2.2%) yield and no heterogeneity. In two articles, all patients had CT (yield 2.3%) and the third enrolled patients ≥ 65 years old (yield 7.7%). Abnormal neurologic findings, age ≥ 65 years, trauma, warfarin use, and seizure/stroke history were identified as risk factors. The quality of all articles referenced was strong. CONCLUSION: More than half of patients with syncope underwent CT head with a diagnostic yield of 1.1% to 3.8%. A future large prospective study is needed to develop a robust risk tool.

Two treatment methods for stormwater sediments--pilot plant and landfarming--and reuse of the treated sediments in civil engineering.

The aim of this research was to present a pilot plant for the treatment of stormwater sediments and to compare the decontamination rate to that obtained by landfarming. The possibilities for reuse of the treated sediments in civil engineering are also studied. Four sediments from retention/infiltration ponds or from street sweeping were studied. In each case organic matter (OM), total hydrocarbons (TH) and polycyclic aromatic hydrocarbons (PAH) were measured. Geotechnical tests were carried out to evaluate the reuse possibilities of the treated sediments. Treatment by means of the pilot plant was efficient at reducing TH and PAH concentrations: THs were reduced by 53-97% and PAHs were decreased by 60-95%. By comparison, a reduction of 45-75% in TH concentration is obtained with landfarming, whereas there is no significant decrease in PAHs. Furthermore, geotechnical tests showed that the treated fractions from the pilot plant can be reused as road embankments and as a capping layer. These results are most encouraging and show that stormwater sediments can valuably be reused after treatment in a pilot plant. Landfarming is less efficient but this technique could be used as a pretreatment in the case of high TH pollution.

Reduction of sediment micro-pollution by means of a pilot plant.

Solutions need to be found to manage polluted (organic matter, trace elements, hydrocarbons and PAHs) stormwater sediments while complying with stringent economic and environmental requirements. The cost of transport is a relatively large part of the treatment cost for such sediments, hence the development of a pilot unit that could provide their in situ treatment. Seven stormwater sediments were treated by means of the ATTRISED pilot plant, based on sieving and attrition. The objective is to apply a treatment procedure by which as much clean material as possible is recovered, while the pollutants are concentrated in a small volume ready for final destruction or isolation from the environment. Application of the attrition process serves to remove fine particles and contaminants from the surface of sediments and hydrocyclone separations allow to isolate fine contaminated particles (< 60 microm). The results show that particle size separations coupled to an attrition step allow decontamination efficiencies of 76% and 70% for street sweeping and pond sediments, respectively. Although the experiments were carried out on stormwater sediments, all kinds of sediments may be treated by the ATTRISED pilot plant if the mean particle size is greater than 60 microm.

Nursing research priorities for the care of the naval hospital patient: a Delphi survey.

The purpose of this study was to identify priorities for nursing research in a naval hospital using the Delphi technique. A general objective was to provide empirically based information to guide the development of a nursing research program at a regional medical treatment facility. Via a three-round Delphi survey, priority research questions were identified for the nursing department of a naval regional medical treatment facility. A serendipitous result was the identification of nursing research priorities within a deployed naval fleet hospital.

Safety profiles of the angiotensin converting enzyme inhibitors captopril and enalapril.

The safety profiles of the angiotensin converting enzyme inhibitors, captopril and enalapril, are the focus of this review. Adverse effects are reviewed as those associated with sulfhydryl compounds and as those considered class-specific adverse effects of angiotensin converting enzyme inhibitors. Specifically discussed are the incidences of the adverse effects of rash, taste disturbance, neutropenia, and proteinuria, which are characteristic of compounds containing sulfhydryl moieties, such as captopril. It is concluded from the review of these safety data that enalapril is well tolerated, has few class-specific adverse effects, and may offer a potential advantage over captopril by having fewer sulfhydryl-related adverse effects.