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Health Calling Report

Lactated Ringer's: A Clear Winner for Pancreatitis Resuscitation

Summary

Pancreatitis is a challenging condition often seen in emergency departments, affecting approximately 34 out of 100,000 adults annually. The traditional approach to fluid resuscitation involved the use of normal saline (NS). However, emerging research now favors Lactated Ringer's (LR) due to its balanced electrolyte composition and anti-inflammatory properties.

Why Lactated Ringer's?

LR more closely resembles human plasma, reducing complications such as hyperchloremic acidosis and metabolic imbalances often caused by NS. Studies show that LR lowers levels of inflammatory markers like CRP and IL-6, reduces organ dysfunction, and decreases the risk of severe pancreatitis complications, including systemic inflammatory response syndrome (SIRS).

Key Study Findings

A pivotal study across 22 international sites revealed significant benefits for patients receiving LR within the first 24 hours of hospitalization:

Lower incidence of severe pancreatitis and complications
Reduced rates of ICU admission and shorter hospital stays
Decreased systemic inflammation and risk of fluid overload

Comparative Outcomes: LR vs. NS

Outcome	Lactated Ringer's (LR)	Normal Saline (NS)
Electrolyte composition	Balanced, similar to plasma	High chloride content
Risk of hyperchloremic acidosis	Lower risk	Higher risk
Impact on CRP & IL-6	Reduces CRP, IL-6	No effect
SIRS incidence	Reduced	Higher
Risk of necrotizing pancreatitis	Lower risk	Higher risk
ICU admission	Fewer	More
Length of hospital stay	Shorter	Longer
One-year mortality	Lower	Higher

Future Insights

Ongoing studies like the WATERLAND trial aim to confirm LR's advantages through randomized controlled trials. These studies focus on inflammatory markers like CRP and SIRS to determine LR's role in mitigating severe outcomes. Until these results are available, the evidence strongly supports the use of LR as a safe and effective choice for early pancreatitis resuscitation.

Conclusion

The shift from NS to LR reflects growing recognition of LR's superiority in managing pancreatitis. By reducing inflammation, complications, and ICU admissions, LR offers better outcomes for patients. Emergency physicians are encouraged to adopt LR for fluid resuscitation in pancreatitis while awaiting further research results.

For more information, visit the journal Emergency Medicine Research.

The Rise of Mpox in a Post-Smallpox World

Summary

The rise of mpox, a disease caused by the monkeypox virus (MPXV), has been increasing in both endemic regions like Africa and new areas globally. The 2022 outbreak highlighted the pandemic potential of the disease, primarily affecting men who have sex with men (MSM). Factors contributing to its rise include waning immunity after smallpox vaccination cessation, human-to-human transmission, and zoonotic exposure to wildlife reservoirs.

Key Factors Driving Mpox Spread

Decline in Population Immunity: The cessation of smallpox vaccination in 1979 led to a significant reduction in immunity to MPXV, contributing to more cases of mpox.
Zoonotic Transmission: Increased human exposure to wildlife, combined with habitat encroachment and reliance on wild animals for food, has driven the rise of mpox in endemic regions.
Human-to-Human Transmission: The virus has spread efficiently through sexual contact, with rapid geographic spread due to migration and travel.

Vaccination and Control Efforts

The article emphasizes vaccination as a key tool for controlling mpox. The JYNNEOS vaccine is effective against clade II mpox and safer for immunocompromised individuals. The WHO's recent approval of the vaccine should facilitate better access to it in endemic regions, though logistical and cost challenges remain.

Research and Future Preparedness

Genomic Mutations: MPXV is showing evidence of genetic mutations that could impact diagnostics, treatment, or virulence, but these changes are not yet significant.
Medical Countermeasures: There is a need for further research into antiviral treatments and more effective vaccines, particularly those with temperature stability for global use.

Conclusion

Mpox poses a growing global health threat, necessitating a multi-faceted approach, including enhanced vaccination programs, research, improved diagnostics, and international collaboration to prevent future outbreaks and manage the disease effectively.

Firearm Injuries in North Carolina: Research Insights

Research by the Emergency Medicine & Injury Prevention Research Center shows firearm injuries in North Carolina are pervasive and increasing, but preventable. Findings highlight the impact of social determinants of health, geographic disparities, and the importance of evidence-based prevention strategies.

Key Findings

In 2022, 1,782 people were killed by firearm violence in North Carolina—approximately five deaths per day.
N.C. EMS responded to 3,379 firearm-related incidents, including fatal and nonfatal injuries.
Firearm injuries often cluster in areas with higher poverty, unemployment, and other adverse social determinants of health.

Prevention Strategies

Safe storage of firearms prevents access by children and at-risk individuals.
Community and hospital-based programs address the root causes of firearm violence by improving social determinants of health.
Interventions should account for geographic and demographic differences in firearm violence.

Data Visualization and Research Tools

UNC researchers developed an interactive “StoryMap” featuring county-by-county visualizations of firearm injuries, including assaults, self-inflicted injuries, and unintentional firearm injuries. These tools aim to help policymakers, community leaders, and the public understand firearm violence and implement tailored interventions.

“Firearm violence is preventable through measures such as safe storage of firearms. We aim to support public health and violence prevention partners with tools that inform their work,” said Dr. Katie Harmon, Principal Investigator.

Research Team and Support

The research team included experts from UNC’s Emergency Medicine, Epidemiology, and Health Informatics departments. The project was funded by the American Public Health Association.

Acetaminophen in Pregnancy: Safe or Not?

Summary

Acetaminophen (APAP) is widely used during pregnancy and is considered "probably safe" by the FDA. It is commonly recommended for fever, pain, and viral illnesses, as untreated fever can lead to serious risks such as neurodevelopmental disorders and neural tube defects.

Potential Risks

Observational studies have suggested a link between prenatal acetaminophen exposure and conditions like ADHD, autism, asthma, and lower IQ. However, these associations do not prove causation, as other health factors may be involved.

Scientific Findings

A Swedish study of 2.5 million children found slightly higher rates of neurodevelopmental disorders among those exposed to acetaminophen in utero, but a sibling-controlled analysis found no significant connection. Animal studies have raised concerns, but they often involve unrealistically high doses.

Should Pregnant Women Take Acetaminophen?

While more research is needed, experts agree that treating fever and severe illness in pregnancy is crucial. Physicians should encourage judicious use of acetaminophen for minor pain but emphasize the importance of managing fevers during pregnancy.

Conclusion

Acetaminophen is likely safe for short-term use in pregnancy, especially for treating fever and viral illnesses. However, its use should be carefully considered for non-essential pain relief. More rigorous studies are needed to settle this debate definitively.