The disulfiram-like reaction (DLR) is a potentially life-threatening adverse drug reaction triggered by concomitant alcohol exposure during treatment with certain medications, particularly cephalosporins containing a methyltetrazolethiol (MTT) side chain such as cefoperazone-sulbactam. It is well-documented in adults, however pediatric cases are rarely reported. We report the case of a 4-year-old boy hospitalized with bronchopneumonia who received intravenous cefoperazone-sulbactam for 7 days with good clinical response. On the 8th day of hospitalization, approximately 10 min after accidentally consuming a small amount of an alcoholic beverage (RIO cocktail, 3%-8% vol), and during the subsequent cefoperazone-sulbactam infusion, the child suddenly developed generalized rash, facial flushing, drowsiness, dyspnea, hypotension (70/50 mmHg), tachycardia (180 beats/min), and prolonged capillary refill time (3 s), consistent with shock. Initially suspected as anaphylactic shock, cephalosporin-induced disulfiram-like reaction (CIDLR) was proposed after the parents revealed the accidental alcohol ingestion. The child was successfully resuscitated with immediate drug discontinuation, oxygen supplementation, fluid resuscitation, and dexamethasone administration. All symptoms resolved within hours, and the child was discharged home two days later with no sequelae at two-week follow-up. Although the clinical manifestations and temporal association with accidental alcohol ingestion in this case are most consistent with a disulfiram-like reaction, definitive diagnosis is limited by the lack of objective alcohol quantification, and a hypersensitivity reaction cannot be completely excluded. Clinicians should remain alert to both disulfiram-like reactions and hypersensitivity reactions in children receiving cefoperazone-sulbactam, and strict education regarding alcohol avoidance should be provided to caregivers to prevent life-threatening adverse events.
Stingray envenomation is a relatively common occurrence among water sports enthusiasts, including swimmers, scuba divers, and surfers, as well as among fishermen. However, there is a lack of medical literature on the pathophysiology of immediate and delayed hypersensitivity reactions and, more importantly, on the range of bacterial and mycobacterial infections that can result from these envenomation injuries. This paper aims to provide a general overview of the mechanisms, diagnostic challenges, and management of late hypersensitivity reactions and infections that can occur following stingray stings. A 63-year-old man with well-controlled hyperlipidemia presented to the Mayo Clinic with a 1-week-old injury from accidentally stepping on a stingray barb while walking on a beach in Ventura, California. Immediate pain was relieved with immersion in warm water. He did not take any over-the-counter or prescription medications, and over the following days, he returned to his usual activities of cycling, running, and swimming with minimal discomfort. There was no initial redness or swelling at the puncture site, but he reported intermittent sharp, localized pain with movement leading up to his hospital visit. A biopsy was performed due to concern for a developing necrotic infection, and he was diagnosed with a hypersensitivity reaction. He was initially treated with intravenous antibiotics, and steroids were added based on biopsy results. After completing his treatment course, his hypersensitivity reaction fully resolved over several weeks. This case underscores the importance of considering both immediate and delayed hypersensitivity reactions that can result from stingray envenomation. These reactions can be managed with conservative measures, such as warming the affected area in a water bath to denature heat-labile venom, as well as with conventional therapies, including topical or systemic antihistamines and steroids. It also highlights the need for early empiric antibiotic coverage and outlines the infectious agents implicated in early- and late-onset infections following stingray envenomation, including Pseudomonas aeruginosa, Vibrio vulnificus, and Mycobacterium fortuitum. Additionally, it emphasizes the need for tetanus vaccine updates, radiography, and a multidisciplinary approach to treating stingray injuries.
Home healthcare workers (HHWs) are frequently exposed to occupational safety hazards when servicing clients in their homes. These hazards may take different forms, many of which could be broadly categorized as "Electric, Fire and Burn," "Environmental," or "Slip, Trip, and Lift" hazards. To address this issue, a home healthcare virtual simulation training system (HH-VSTS) was developed. Although prior studies have assessed the usability, usefulness, and desirability of the system, there was a need to determine if the knowledge gained through this training process generalizes to a real-world setting. Sixteen study participants completed one of the three training modules in the HH-VSTS consistent with the hazard categories listed above. Participants were then asked to walk through a one-bedroom apartment with 15 simulated hazards (5 electric/fire/burn, 5 environmental, and 5 slip/trip/lift) that are addressed in the HH-VSTS. Each participant served as a control for the two hazard categories for which they were not trained. Participants were asked what they would do about the hazards they identified in the simulated apartment during their walk through. Hazard mitigation strategies were categorized as successful, partially successful, or failed. Overall, participants identified 85% of the hazards that were included in the one module in which they trained versus identifying only 46% of the hazards in the two modules in which they were not trained. When they identified hazards on which they were trained, participants were more likely to voice successful mitigation strategies than for hazards upon which they had not been trained. Thus, the data indicate the HH-VSTS training facilitated hazard identification and hazard mitigation strategies in a non-virtual, simulated home setting, suggesting that this training approach should be effective for real home care settings.
Frailty and falls are highly prevalent among community-dwelling older adults and are linked through a bidirectional relationship that increases the risk of injury, hospitalisation, functional decline and mortality. Community nurses play a central role in early identification and prevention. This article examines the relationship between frailty and falls, and outlines practical approaches to risk assessment and management in community nursing practice. The authors present a clinically focused synthesis of contemporary evidence and national guidance relating to frailty and falls in community-dwelling older adults. The evidence indicates that frailty is a modifiable and independent risk factor for falls and adverse outcomes. Integrating frailty assessment within multifactorial falls risk assessment, including assessment of orthostatic hypotension and medication-related risk, enables more targeted and person-centred interventions. Comprehensive Geriatric Assessment offers a practical framework for addressing shared risk factors. Addressing frailty should be regarded as a core strategy for effective falls prevention in community-dwelling older adults.
Over the last decades alcohol intake has decreased among the Swedish men but been on the rise among the women, thus leading to an increased risk of alcohol dependence (AD) and related consequences among the Swedish women. The aim of this study was therefore to compare the mortality between women with AD and population-matched controls. Data were retrieved from the medical records of 2,037 women with AD at the Addiction Centre in Malmö in 1970-2013 and followed up until 2019. They were matched by sex, age, and calendar year with a control group from the general population in Region Skåne. For persons who died during follow-up, death certificates were obtained from the national registers to obtain time and cause of death. The mortality was compared between the groups as observed vs. expected, cumulative survival was assessed by comparing the survival rates of the women with AD to those of the control group. The cumulative survival was calculated as observed compared to expected. The cumulative survival and standardized life expectancy were significantly reduced for the women with alcohol dependence compared to the matched controls; T1/2 = 21 vs. 11, p < 0.05 and OR 1.9 CI 1.73-2.02, respectively. More women with alcohol addiction passed away due to accidental and intended causes of death (15.5% vs. 2.8%, p < 0.05). Their cause-specific mortality was significantly increased for mental health disorders, respiratory and digestive diseases, but significantly lower for cardiovascular and cancer diseases. This study showed that the mortality among Swedish women with long term alcohol dependence was significantly increased, thereby suggesting a need for a special focus on this group.
The Nursing and Midwifery Council (NMC) updated the nursing and midwifery preregistration proficiencies in 2018 and 2019 respectively, and both contain requirements for safe staffing principles to be taught and assessed through academia and clinical placements of BSc degree programmes. To ascertain how higher educational institutions (HEIs) are preparing the 'future nurses' and 'future midwives' in terms of adequate knowledge on the principles of safer staffing, in line with four specific NMC proficiencies, ahead of entering the NMC register. A Freedom of Information request was made to 21 HEIs, complemented with an online survey of undergraduate preregistration students from five HEIs in England, to determine the level of safer staffing principles within the current curriculum. Reliance on clinical placements to support attainment of safer staffing knowledge was noted, with variation in curriculum content, acquisition of knowledge and assessment methods across HEIs; 86% of students declared that NMC proficiency 7.12, related to business case planning, was addressed the least. Implementing bespoke simulation learning, use of Chief Nursing Officer Safer Staffing Fellows, and integrating 'Fundamentals of Safer Staffing' e-learning will strengthen safer staffing knowledge related to four NMC proficiencies across HEIs and healthcare settings for future generations of nurses, midwives, practice and academic educators.
This study aimed to retrospectively evaluate sharp object injuries (SOIs) among healthcare workers (HCWs) and medical students in a 10-year period, from 2014 to 2023. A secondary aim was to assess the procedures and the prevalence of exposure to bloodborne pathogens. The data collection was retrieved from the hospital records for the examined period. All laboratory parameters had been determined by the electrochemiluminescence method and were performed using the Alinity instrument (Abbott Diagnostics, IL, USA). Statistical analysis was performed with IBM SPSS Statistics version 30.0. In total, 771 occupational accidents occurred, involving individuals with an average age of 34 years. Blood sampling was the most common procedure (n=360; 46.7%). Regarding the source, 61 (7.9%) cases involved abandoned sharps, while in 710 (92.1%) cases the source patient was identified. Laboratory analysis of the identified source patients showed that 31 (4.4%) were HBsAg-positive, 25 (3.5%) were anti-HCV positive only, 4 (0.6%) were HIV I/II positive, and 8 (1.1%) had screening tests for Treponema pallidum that were positive. Of note, two (0.3%) HCWs and two (0.9%) medical students were found to have pre-existing anti-hepatitis C antibodies at baseline testing; however, no true seroconversion occurred after exposure. This retrospective observational study underscores the persistent clinical risk of SOIs among HCWs and medical students.
Fall risk is associated with restricted exercise and increased morbidity and mortality. Outcomes of patients with high fall risk in cardiac rehabilitation (CR) are not well documented. This study describes the prevalence of high fall risk in CR, associated patient characteristics, CR engagement, and outcomes. Electronic records were examined from CR patients aged ≥65 years. An 11-variable checklist identified high (≥2 risk factors) versus low fall risk. Groups were compared on demographic, medical, and psychosocial variables, CR sessions completed, and pre-post-CR functional capacity change per maximum effort exercise tolerance test (metabolic equivalent of task) or 6-Minute Walk Test distance. The CR falls incident rate among 384 patients (70% male, mean age 74.2 ± 6.5) was 0.137/1000 visits. One quarter was identified as "high fall risk." Ten percent reported fear of falling. The most common risk factors included visual difficulty (41%), balance disturbance (24%), and gait disturbance (23%). Patients with high fall risk were older (78.03 ± 6.78, P < .001), reported lower physical and mental health-related quality of life (P ≤ .001), and attended slightly fewer CR sessions (23.80 ± 11.04 vs 26.47 ± 9.91; P = .18). There were no significant differences between groups in functional capacity (metabolic equivalent of task: P = .193; 6-Minute Walk Test: P = .141). Though patients with high fall risk share characteristics with known associations to lower CR referral (eg, older age and comorbidities), they are as likely to benefit from CR participation as patients with lower risk when supported by tailored exercise prescriptions and safety modifications.
Formaldehyde is a widely used fixative in medical practice. Accidental introduction into the human body can cause rapid protein coagulation, tissue necrosis, and severe systemic complications. We report the case of a 60-year-old woman who received an inadvertent injection of formaldehyde into the inner lower lip during a minor salivary gland biopsy. The patient developed severe pain, labiomental erythema, and mucosal necrosis. She was initially managed with oral antibiotics, but the development of labiomental cellulitis necessitated hospitalization and intravenous antibiotic therapy, followed by surgical necrosectomy and tissue repair. Postoperative care included pro-healing ointment and bicarbonate mouth rinses, leading to complete recovery. This rare case highlights that medical substance handling requires foolproof institutional safeguards. To prevent this severe complication, clinical facilities must ban the reuse of empty medication vials for chemical storage and enforce a strict dual-signature verification protocol prior to any local anesthetic infiltration.
Driving under the influence of drugs is a major cause of road traffic accidents, and alcohol markedly increases crash risk. A clinical test of impairment (CTI) is in some countries performed alongside blood sampling in apprehended drivers, yielding a conclusion of either "impaired" or "not impaired". While the relationship between CTI results and blood drug concentrations has been examined, no previous studies have evaluated CTI outcomes in relation to traffic accidents. This study assesses whether ethanol-positive drivers judged as "impaired" have a higher risk of traffic accident involvement than those assessed as "not impaired", and whether accident involvement increases with impairment severity and ethanol concentration. Drivers positive for ethanol alone were included if a valid CTI conclusion was available and blood sampling occurred 0.25-3 h after the incident. Cases were categorized as either traffic accident group or non-accident controls, the latter including police stops unrelated to accidents (e.g., routine checks, license issues, erratic driving). Age, sex, blood ethanol concentration and CTI results were compared between groups. Associations between impairment level and accident risk were analyzed using multivariable logistic regression. The accident included group 5,290 cases and the non-accident group included 17,596 cases. Accident-involved drivers were younger (median 30 vs. 34 years, p < 0.001), had higher ethanol concentrations (median [IQR] 1.60 g/kg [1.06, 2.05] vs. 1.29 g/kg [0.63, 1.89], p < 0.001) and were more often assessed as "impaired" (94.8% vs. 90.3%, p < 0.001) compared to non-accident drivers. After adjusting for age, sex, ethanol concentration and driving time, CTI-assessed impairment remained significantly associated with accident involvement (OR 1.47; 95% CI 1.28, 1.69). Accident odds increased progressively with both impairment severity and ethanol concentration (ptrend < 0.001). Ethanol-positive drivers assessed as "impaired" by the CTI had 47% higher odds of being involved in traffic accidents compared with drivers apprehended for other reasons, independent of ethanol concentration and demographic factors. Being assessed as "impaired" by the CTI therefore appear to be independently associated with accident risk among alcohol-positive drivers.
Patient safety culture is vital in healthcare for providing a quality care. Emotional intelligence plays a very important role in managing the emotions of the healthcare professionals. This study focuses on impact of emotional intelligence on patient safety culture and importance of balancing the emotions of healthcare professionals. To analyze the impact of patient safety culture factors on emotional intelligence factors . The study focused on implementation of patient safety cultures and its impact on emotional intelligence. Methodology adopted in the study was descriptive study and stratified random sampling is used for data collection. The study analyzed the impact of patient safety on emotional intelligence factors. Statistics tools like frequency, correlation, regression was used to test the hypothesis. It was observed from correlation and regression that the factors like self- awareness, relationship management has a positive association on patient safety culture. It was found that integrating data through influencing factors significantly <0.01) improves the quality of care through patient safety. The study highlights the factors of patient safety culture like report errors, near misses, and safety concerns, facilitating a culture of transparency and improvement and its impact on self-awareness, relationship management. The study recommends the continuous training for healthcare professionals on managing the emotions.
Introduction Falls continue to be among the leading causes of nonfatal injuries in the United States. Falls are common among the older population, and the Appalachian region is considered one with an aging population. Pet ownership is common and has even increased since 2020. Few studies exist on the topic of falls caused by dogs. Methods Data were retrospectively pulled from the trauma registry at a rural Appalachian Level 1 trauma center between January 1, 2017, and June 15, 2022. Patients ≥18 who presented to the facility due to falling or tripping caused by dogs were included. Injuries due to dog bites were excluded. Results A total of 94 patients were included in the study, all of whom sustained an injury. Patients ≥65 years represented 68.1% of the cohort population. Females represented most of the population with 73.4% (P<0.001).  Hip/pelvic fractures were the leading cause of injury and were a significant predictor of outcomes for the older population. Hip fractures were significantly higher in those aged ≥65 years compared to those <65 years of age (92% vs 7%, P<0.001). The ≥65-year group also had significantly longer hospital length of stay (4.5 vs 3.2 days, P=0.046). Patients aged ≥65 years were 10.3 times more likely to be discharged to a care facility and were discharged most often to skilled nursing (odds ratio (OR)=10.292, 95% confidence interval (CI)=3.194-33.161, P<0.001). Conclusion Females were more likely to experience trauma because of a dog-related trip or fall. Older people are more prone to falling due to dogs and experiencing hip/pelvic fractures. These patients are also more likely to be discharged to a care facility, most commonly skilled nursing.
Hypothermia is classically defined as a reduction in the body's core temperature below 95.0°F (35.0 °C). Most reported cases of hypothermia are due to environmental exposure to low ambient temperatures (accidental hypothermia). Other causes of hypothermia include sepsis, severe hypothyroidism (myxedema coma), acute spinal cord injury, diabetic ketoacidosis, multisystem trauma, and prolonged cardiac arrest. Frostbite, chillblain and trench foot all have specific therapies to prevent limb loss. There have been significant advances in these therapeutic options over the past decade which are detailed in this issue.
[This corrects the article DOI: 10.1002/ccr3.72901.].
Current epidemiological evidence on the association between air pollutants and non-accidental mortality remains limited, particularly in developing countries. This study aimed to investigate the short-term association between ambient air pollution and non-accidental mortality, and to quantify the attributable disease burden in Shantou, a subtropical coastal city in China. Daily data on non-accidental mortality, meteorological factors, and ambient air pollutants including PM2.5, PM10, SO2, NO2, CO, and O3 were collected in Shantou from 2016 to 2020. A Poisson generalized additive model (GAM) was applied to estimate the acute effects of air pollutants on non-accidental mortality, with stratification analyses by gender, age, and season. Attributable fractions (AFs) and attributable numbers (ANs) were further estimated based on the World Health Organization (WHO) air quality guidelines and Chinese air quality standards. Non-accidental mortality in Shantou was significantly associated with exposure to PM2.5, PM10, SO2, NO2 and O3, but not with CO. Per 10 μg/m3 increase in air pollutant concentration, the strongest relative risks (RRs) and 95% confidence intervals (CIs) for non-accidental mortality were 1.0199 (1.0106-1.0294) for PM2.5 at lag03 days, 1.0146 (1.0085-1.0209) for PM10 at lag 03 days, 1.1268 (1.0773-1.1786) for SO2 at lag 07 days, 1.0256 (1.0093-1.0422) for NO2 at lag 03 days, and 1.0048 (1.0013-1.0083) for O₃ at lag 04 days, respectively. Stratified analyses showed that individuals aged 65 years and older were more susceptible only to O₃. The significant adverse effect of O₃ was significantly stronger in the warm season than in the cold season, while no significant difference was found between males and females. Overall, 4.23% (5,576 cases) of non-accidental deaths were attributable to excess exposure to air pollution exceeding the WHO air quality guidelines. Short-term exposure to PM2.5, PM10, SO2, NO2 and O3 was significantly associated with elevated non-accidental mortality in Shantou, a coastal subtropical city, imposing a considerable disease burden. Our findings highlight the urgent need for effective air pollution control strategies to reduce the related disease burden.
Genital degloving injuries from motorcycle accidents are uncommon, with most reported cases involving complete devascularisation requiring skin grafting. We present a 70-year-old male who presented to a rural health center following a high-speed motorcycle accident with a unique distal pedicure circumferential penile skin avulsion. The penile skin sleeve remained viable through its distal attachment near the corona, while the proximal end was completely separated at the penoscrotal junction, exposing intact underlying corpora with confirmed urethral continuity. Management consisted of thorough wound irrigation, limited debridement, and simple anatomy reattachment of the viable avulsed skin using 4-0 Prolene sutures, completely avoiding the need for skin grafts. The postoperative course was completed by a superficial bacterial infection on day 3, which resolved with oral linezolid and adjunctive serratiopeptidases. Follow-up confirmed that vascular supply, normal sensation, unimpaired voiding, and preserved sexual function. This case demonstrates that in resource-limited settings, meticulous assessment to confirm tissue viability enables conservative surgical management with excellent outcomes, avoiding the need for advanced techniques or grafts.
Acute radiation-induced lung injury is a serious and potentially life-threatening complication of radiotherapy for thoracic malignancies or accidental radiation exposure, characterized by high incidence, limited treatment options, and substantial mortality. To address the lack of effective therapies for preventing and treating radiation-induced lung injury, we developed an engineered nanoplatform, BAT-exo@Au, generated by functionalizing exosomes derived from young brown adipose tissue (BAT) with 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-polyethylene glycol-thiol (DSPE-PEG-SH) and gold nanoparticles via chloroauric acid (HAuCl4) incubation. Our results show that BAT-exo@Au was efficiently internalized by irradiated lung tissue and exerted radioprotective effects by suppressing reactive oxygen species production and attenuating radiation-induced inflammatory responses. In addition, BAT-exo@Au mitigated radiation-induced epithelial-mesenchymal transition while enhancing tumor radiosensitivity, suggesting a dual therapeutic advantage. Mechanistically, BAT-exo@Au reduced apoptosis and preserved mitochondrial membrane potential after radiation in vitro. Transcriptomic analysis identified G protein-coupled receptor 183 (Gpr183) as a potential downstream target, showing upregulation after radiation but downregulation following BAT-exo@Au treatment. Further in vitro experiments demonstrated that BAT-exo@Au promoted the interaction between Gpr183 and the E3 ubiquitin ligase NEDD4, facilitating Gpr183 ubiquitination and proteasomal degradation. This study suggests that exosomes derived from young BAT may serve as a therapeutic strategy for the prevention of radiation-induced lung injury. In conclusion, BAT-exo@Au shows promise as a preventive approach for radiation-induced lung injury, potentially through modulation of Gpr183 via enhanced Gpr183-NEDD4 interaction and ubiquitination.
Foreign bodies embedded in the maxillofacial region following traumatic injuries pose a significant challenge to oral and maxillofacial surgeons. These retained objects may become a source of persistent pain, infection, and other complications. Early diagnosis can be achieved through the use of computed tomography (CT), which facilitates accurate localization of the foreign body. Once identified, prompt removal is recommended to prevent further morbidity. Here, we report a case in which early diagnosis of a foreign body embedded within the maxillofacial soft tissues enabled its successful retrieval without complications. Soft tissue impaction of orthodontic brackets following facial trauma is rarely reported in the literature, with only a few isolated case reports describing orthodontic appliances embedded within facial soft tissues after road traffic accidents or sports-related injuries.
Aesthetic nursing has rapidly expanded without standardized training to ensure provider competency, increasing the potential for adverse events (AEs). While most dermal filler AEs are minor, serious complications including vascular compromise, can occur. This quality improvement project aimed to reduce dermal filler AEs by implementing an evidence-based competency assessment program for aesthetic providers using the Quality and Safety Education for Nurses (QSEN) framework and Benner's Novice to Expert model. Our objective was to improve patient safety by decreasing dermal filler AEs through standardized evaluation of provider knowledge, skills, and attitudes (KSAs). To achieve this, we developed three assessment tools: a dermal filler knowledge self-assessment, a skills observation checklist, and a competency assessment tool structured around QSEN's KSAs, integrated with Benner's competency progression. Ten licensed aesthetic injectors participated across two clinical sites. Data were collected over 16 months: 6 months pre-intervention, a 4-month implementation phase, and 6 months postintervention. AEs were categorized as lumps, asymmetry, vascular events, or other complications. All providers demonstrated competence across assessed domains. Total AEs declined by 65%, from 97 to 34 events and vascular events dropped from four to zero. Implementation costs totaled $5,000, while estimated savings from reduced AE-related expenses exceeded $12,000 within 6 months. These results indicate that a structured competency program grounded in QSEN and Benner's framework can significantly improve injection safety and reduce complications. This model is replicable in other aesthetic practice settings and provides a foundation for competency-based training in high-risk, elective procedures, supporting both provider development and patient safety.
In 2022, the Swedish Women's Elite Ice Hockey League (SDHL) became the first women's league to introduce bodychecking. Using insurance data, this study examined injury incidence before and after the implementation of this rule. Since 2019, the SDHL has comprised 10 teams with 20-25 players on each. All players in SDHL have license insurance to take care of ice hockey injuries. All injuries that lead to contact with the insurance company are registered in a database. The insurance covers accidental injuries occurring during matches, organized team practices, hockey school sessions, and direct travel to and from these activities. Injury data from all seasons between 2019-2020 and 2024-2025 were analyzed. Injury rates (IR) per 1,000 player-game hours were calculated and compared across seasons and between pre-implementation (2019-2022) and post-implementation (2022-2025) periods. A total of 120 injuries were recorded among 92 players. IR per 1,000 player-game hours increased from 6.6 (95% CI 3.8-10.7) in season 2021-2022 to 16.7 (11.6-23.2) in 2022-2023, with moderately elevated rates remaining in subsequent seasons. When grouped by period before and after body checking implementation, IR increased from 6.0 (4.4-8.1) pre-implementation to 11.0 (8.6-13.7) post-implementation (p < 0.05). The injury incidence was highest during the first season with body checking and declined in subsequent seasons compared with this initial post-implementation peak. The introduction of body checking in the SDHL was associated with a significant increase in injuries recorded through the insurance system, indicating that this rule change may lead to a higher injury burden. More research on this topic is needed if body checking is to be widely incorporated into women's ice hockey.