Hydroxyurea is one of the most successfully used therapies for sickle cell disease. Results of many clinical trials point to hydroxyurea administration for patients with frequent painful crises and acute chest syndrome. Priapism is one of the complications that could be prevented by hydroxyurea, but there are few reports demonstrating the results. Since November 1993, hydroxyurea has been used in our clinic for preventing priapism in patients with stuttering or major attacks who are still capable of achieving intercourse on demand. Five patients were enrolled in the study, and 4 cases benefited by this treatment. After the initial treatment for the acute attack, all five patients developed stuttering priapism. Hydroxyurea was then introduced at the initial dose of 10 mg/kg, and as the hydroxyurea dosage increased, the number or length of priapism episodes decreased. One to two months after the maximal dose (20-35 mg/kg) was introduced, the episodes disappeared. In two patients, we were forced to administer over 30 mg hydroxyurea/kg to abort the episodes, and, in another patient, 25 mg/kg was necessary. All patients present normal sexual activity. Hydroxyurea was discontinued in two patients, but stuttering priapism reappeared. Hydroxyurea was then re-introduced, and priapism disappeared. One patient, using 20 mg hydroxyurea/kg, had a 6-year remission of priapism after hydroxyurea administration; however, he experienced stuttering priapism, 1 month before a major attack, that progressed to impotence. During that month, he did not seek medical attention. In conclusion, the data here presented suggests that hydroxyurea may prevent priapism attacks in sickle cell disease, probably at higher doses than usually prescribed for painful crisis prevention. Am.

BackgroundHealthcare-associated infections (HAI) are a common preventable complication of hospital care and represent a major threat to patient safety, especially in low- and middle-income countries. In June 2015, in partnership with IHI, a Brazilian health system launched a program to reduce HAI and improve patient safety in 13 intensive care units (ICUs) from 12 hospitals using a collaborative approach.ObjectivesTo reduce the rate of central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonias (VAP) and catheter-associated urinary tract infections (CAUTI) by 50% by December 2016.MethodsWe used an 18-month Breakthrough Collaborative Series (BTS) approach that promoted the adoption of bundles of care, coupled with leadership engagement, innovation and capacity building.Results13 ICUs participated in the collaborative. Gaps in infrastructure, staffing, and critical care knowledge were identified. Four learning sessions were held. Data from July 2016 shows a 49% reduction in the CLABSI rate, 33% in the VAP rate and 45% in the CAUTI rate.ConclusionsThe BTS approach proved to be effective in reducing HAI in ICUs in Brazil. Based on the results to date, our degree of belief that the Collaborative will achieve its goals for CLABSI and CAUTI is high, but not for VAP. Reducing VAP proved to be more challenging because it demands multidisciplinary teamwork and specific knowledge about certain elements of the bundle such as weaning and sedation. Future collaboratives in these settings might benefit from assessing and closing the gaps in clinical knowledge and infrastructure capacity, and from assessing teams' readiness for quality improvement prior to their implementation.Figure 1Figure 2Figure 3

Introduction:Mass gathering events (MGE), organized or unplanned, can attract sufficient attendees to strain the planning and response resources of the host community, state, or nation, thereby delaying the response to emergencies. MGEs also have the potential to cause a mass casualty incident. But MGE can also lead to improvements in the organization of local emergency medical services or public health that form the legacy of that MGE. Emergency medical teams (EMTs) could be deployed to ensure health security as a surge in MGE. But these EMTs should be built on guiding principles and core standards. However, to the best of our knowledge, there are no standards on medical planning and response during any type of MGE (e.g., sports, religious, or festivals).Method:A systematic review was performed in accordance with current guidelines, using six databases, namely Medline (via the PubMed interface), Scopus, Embase, Cochrane Library, ScienceDirect, and CINAHL, as well as literature sourced by Google Scholar and The Journal of Prehospital and Disaster Medicine. Studies published on minimum standards or medical planning and response during MGE from 2002-2022, written in English, were selected and assessed for eligibility by two reviewers.Results:From a total of 20,159 articles, 138 were screened, and 32 were assessed for eligibility. Two were only abstracts, and the others did not contain any description of minimal standards available for medical planning or response in different types of MGE.Conclusion:No studies were found that describe any form of standards for medical planning and the response of emergency medical teams in different types of mass gathering events (e.g., sports, religious, festivals). There is a need for minimum standards for emergency medical teams deploying as a surge in mass gathering events.

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