Effects of Serum Vitamin D and Efficacy of Subcutaneous Immunotherapy in Adult Patients With Allergic Rhinitis

Immunotherapy is the standard of treatment for long-life relief of symptoms of allergic rhinitis. Vitamin D may affect the outcomes of treatment. This study evaluated the clinical efficacy of subcutaneous allergen immunotherapy in adult patients with allergic rhinitis based on the serum level of vitamin D. Patients with persistent allergic rhinitis and positivity for skin prick test were evaluated by Sino-nasal Outcome Test (SNOT-22) and Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) before subcutaneous allergen immunotherapy and during the maintenance phase to assess the relation of the serum level of vitamin D and the clinical efficacy of immunotherapy. After immunotherapy, the greatest reduction in SNOT-22 scores were reported in patients with vitamin D sufficiency (39.0 ± 9.2), followed by vitamin D suboptimal provision (35.1 ± 12.1), insufficiency (25.0 ± 7.5), and deficiency (18.3 ± 6.0) (P < 0.001). The MiniRQLQ reduction in patients with vitamin D sufficiency, suboptimal provision, insufficiency, or deficiency was 30.7 ± 8.7, 27.1 ± 8.7, 20.0 ± 8.6, or 17.4 ± 7.1, respectively (P < 0.001). Both of SNOT-22 and MiniRQLQ scores decreased significantly following immunotherapy in patients with different levels of vitamin D. However, these effects were more pronounced when the level of vitamin D was sufficient.

Assessment of pain management in pediatric emergency department in Mashhad-Iran

Pain may be described as a sensation of hurt or strong discomfort and is the body's way of sending message to the brain that an injury has occurred. Pain medicines block these messages or reduce their effect on the brain. Accurate administration of analgesia have a long -lasting effect on children whole experience of medical care and affects parents' and children's future reaction to pediatrics emergency departments. The purpose of this study was to evaluate pain management on children in our emergency department. In this study we evaluated the relief of pain and anxiety on 100 children who referred to our pediatric Emergency Department [ED] in Imam Reza Hospital- Mashhad .The patients were assessed based on the American Academy of Pediatrics [AAP] recommendations about pain. Patients were gone under IV Line 97%, Intubation 5% and Lumbar Puncture 28%. Training had been provided to 70% participants in the Emergency Department. Nonpharmacologic stress reduction was used in 35% of cases. Family presence was allowed only in 5%. Prehospital pain controlling was began on 20% of patients and continued in ED on 40%. At the time of discharge 40% prescribed analgesics. Sedation and pain prophylaxis was provided for 10% of patients undergoing painful procedures in ED. According to results, pain management in our Pediatric Emergency Department was inadequate. Physicians and prehospital EMS providers should be justified about the importance of pain relieving and trained how to use all available analgesic and sedative options