The influence of the type of face mask used by healthcare providers during the SARS-CoV-2 pandemic on the report of pain: a cross-sectional study in a pediatric emergency department.

Background: During 4 months of the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic, nurses in a pediatric emergency department (ED) used surgical and clear face masks in triage. This study aimed to find out if the type of face mask influenced children's reports of pain. Methods: A retrospective cross-sectional analysis of the pain scores of all patients aged 3-15 years who visited the ED during the 4-month period was performed. Multivariate regression was used to control for the potential confounders of demographics, diagnosis (medical, trauma), nurse experience, ED time of arrival, and triage acuity level. Self-reports of pain ≥1/10 and pain ≥4/10 were the dependent variables. Results: Overall, 3,069 children attended the ED during the study period. Triage nurses wore surgical and clear face masks in 2,337 and 732 nurse-patient encounters, respectively. The two types of face masks were used in similar proportions of nurse-patient encounters. Compared with the clear face mask, wearing a surgical face mask was associated with a lower likelihood of reporting pain ≥1/10, and a lower likelihood of reporting pain ≥4/10; [adjusted odds ratio (aOR) =0.68; 95% confidence interval (CI): 0.56-0.82], and (aOR =0.71; 95% CI: 0.58-0.86), respectively. Conclusions: The findings suggest that the type of face mask used by the nurse influenced the report of pain. This study provides preliminary evidence that covered face masks worn by healthcare providers might have a negative impact on the child's report of pain.

Immunity waning after COVID vaccine booster vs. infection-better than expected.

BACKGROUND: Rapid decline in antibody-titres after BNT162b2 mRNA COVID-19 vaccine was reported; thus, a booster dose, and recently a second booster were approved. The study aims to discuss immunogenicity throughout the pandemic, especially after booster dose. METHODS: A prospective study conducted in EMMS-Nazareth hospital, Israel. Anti-SARS-CoV-2 IgG antibody titres were monitored every 5 weeks starting from the vaccine's second dose. To detect symptomatic and asymptomatic infections, nasopharyngeal swabs for COVID-19 PCR were obtained bi-weekly, and on suggestive symptoms. Third dose of the vaccine was suggested for all participants 5 months after the second one. A comparison was made between those who received three doses (booster-group), and those who were infected after having two doses (infection-group) or three doses (booster-infection) group. RESULTS: One-hundred participants were included; 66 finished 14 months of follow-up, out of whom 40 received a third dose, 10 received only two doses-all were infected (mean time for infection 5 ± 12.15 weeks before the designated booster), and 12 received three doses and were infected. The mean titres of these three groups 7 months after the designated booster dose (regardless of receiving it) were 1756 ± 2279; 3483 ± 3016 and 6925 ± 3720 BAU/mL, respectively. The booster group had high titres 7 months after the booster dose, comparable to two months after the second dose (p = .69); The booster-infected group had even higher titres. CONCLUSION: Immunogenicity decline rate after the booster dose is slower than the second dose. Timing of second booster in general population is still to be determined; neutralizing-antibody titres might be helpful.

Pediatric Intraosseous Access Performed by Emergency Department Nurses Using Semiautomatic Devices: A Randomized Crossover Simulation Study.

BACKGROUND: No study has examined the performance of emergency department (ED) nurses in establishing intraosseous access (IO) access. This study aimed to evaluate ED nurses' success rate in establishing pediatric IO access using semiautomatic devices. METHODS: A randomized crossover simulation study was conducted. The success rates of ED nurses were compared with those of paramedics with similar years of experience. The study instruments were the new spring-loaded injector (NIO) and the battery power drill (EZ-IO). Uncooked piglets' bones were used as the study model. All attempts were filmed by a video camera. Successful placement was defined as the visualization of flow from the marrow cavity. Participants recorded their ranking of the "ease of use" of each device. RESULTS: No differences in 1-attempt success rate was found between nurses and paramedics (27/34 [79.4%] vs 25/30 [83.3%], P = 0.68). Nurses and paramedics had similar success rates with the 2 semiautomatic IO devices (12/17 vs 12/15 with the spring-loaded injector, P = 0.69, and 15/17 vs 13/15 with the battery power drill, P = 0.9). The number of failed attempts and the causes for failure were equally distributed between nurses and paramedics. Median ease-of-use Likert-scale scores of the spring-loaded injector and the battery power drill were 4 (interquartile range [IQR] = 3-4) and 5 (IQR = 5-5) (P < 0.04) for the nurses and 5 (IQR = 4-5) and 5 (IQR = 4-5) (P = 0.44) for the paramedics, respectively. CONCLUSIONS: Emergency department nurses and paramedics had a similarly high insertion success rates on a pediatric bone model. This pilot study suggests that ED nurses can successfully perform this procedure.

Hospitalization and 1-year all-cause mortality in type 2 diabetic patients with chronic kidney disease at Stages 1 and 2: Effect of mild anemia.

BACKGROUND: The effect of anemia in advanced chronic kidney disease (CKD) on morbidity and mortality is known. The aim of the present study was to assess the effect of mild anemia on hospitalization and 1-year all-cause mortality in type 2 diabetes mellitus (T2DM) patients with Stage 1 and 2 CKD. METHODS: Hospitalized T2DM patients (n = 307) with a glomerular filtration rate ≥ 60 mL/min per 1.73 m(2) and urinary albumin excretion > 30 mg/24 h (Stage 1 and 2 CKD) were enrolled in the study and divided into two groups based on hemoglobin (Hb) concentrations: those with (mean [ ± SD] Hb 10.7 ± 0.7 g/dL) and without (mean Hb 13.3 ± 1.28 g/dL) anemia. RESULTS: There was no significant difference between patients with and without anemia in terms of age, gender, body mass index, HbA1c, and cardiovascular diseases. The mean length of hospitalization of the 130 anemic and 177 non-anemic patients was 4.3 ± 3.5 and 3.5 ± 1.9 days, respectively (P < 0.001). Twelve anemic patients died within 1 year, compared with three patients without anemia (9.2% vs 1.7%, respectively; P = 0.002). After adjusting for confounding variables, multivariate Cox regression analysis revealed that mild anemia was significantly associated with 1-year all-cause mortality (hazard ratio 2.15, 95% confidence interval 1.92-2.54; P = 0.033). CONCLUSIONS: Mild anemia may increase the length of hospitalization and was associated with 1-year all-cause mortality among hospitalized T2DM patients with Stage 1 and 2 CKD.

Torsion of undescended third testis, as rare cause of painful inguinal mass.

Twenty years old young was referred to our department due to painful inguinal mass. The mass was diagnosed as torsion of third testis which was treated by orchiectomy. Polyorchidism is a rare entity with increased risk for malignancy and torsion.