Dr. Paul  Sasso   image

Dr. Paul Sasso

41 E Post Rd
White Plains NY 10601
914 811-1158
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: AN1865243-RI5
NPI: 1962651505
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Treating headache recurrence after emergency department discharge: a randomized controlled trial of naproxen versus sumatriptan. - Annals of emergency medicine
Multiple parenteral medications are used to treat migraine and other acute primary headaches in the emergency department (ED). Regardless of specific headache diagnosis, no medication eliminates the frequent recurrence of primary headache after ED discharge. It is uncertain which medication primary headache patients should be given on discharge from an ED. The aim of this study is to compare the efficacy of oral sumatriptan with naproxen for treatment of post-ED recurrent primary headache.This was a randomized, double-blind efficacy trial. We randomized patients to either naproxen 500 mg or sumatriptan 100 mg for headache recurrence after ED discharge. Patients were eligible if they received parenteral therapy for an acute exacerbation of a primary headache in the ED. Patients who met established criteria for migraine without aura were designated a priori as a homogenous subgroup of interest. We followed all patients by telephone 48 hours after ED discharge. The primary endpoint was the between-group difference in change in pain intensity during the 2-hour period after ingestion of either 500 mg naproxen or 100 mg sumatriptan. This difference was measured on a validated 11-point (0 to 10) verbal numeric rating scale (NRS). Satisfaction with the medication and adverse effects were also assessed. Patients who met criteria for migraine without aura were analyzed twice according to a priori design: once as a homogenous subgroup and then again combined with all other primary headaches.Of 410 patients randomized, 383 (93%) had outcome data available for analysis. Two hundred eighty (73%; 95% confidence interval [CI] 68% to 77%) reported headache post-ED discharge and 196 (51%; 95% CI 44% to 58%), including 88 with migraine, took the investigational medication provided to them. The naproxen group improved by a mean of 4.3 NRS points, whereas the sumatriptan group improved by 4.1 points (95% CI for difference of 0.2 points: -0.7 to 1.1 points). Findings were virtually identical among the migraine subset (4.3 versus 4.2 NRS points; 95% CI for difference of 0.1 points: -1.3 to 1.5 points). Seventy-one percent (95% CI 62% to 80%) of naproxen patients and 75% (95% CI 66% to 84%) of sumatriptan patients would want to take the same medication the next time. Adverse effect profiles were also comparable.In this trial, nearly three quarters of patients reported headache recurrence within 48 hours of ED discharge. Naproxen 500 mg and sumatriptan 100 mg taken orally relieve post-ED recurrent primary headache and migraine comparably. Clinicians should be guided by medication costs, contraindications, and a patient's previous experience with the medication.Copyright 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
Body mass index and pediatric asthma outcomes. - Pediatric emergency care
The purpose of this study was to determine the association between body mass index (BMI), a measure of obesity, with emergency department admission rate in children with asthma.This was a prospective study in a tertiary care, urban pediatric emergency department. Treating physicians and academic associates enrolled subjects during June 2005 to April 2008. Eligible subjects with documented weight and height were between ages 6 and 18 years with chief complaint of wheezing. We compared admission rates between overweight children (BMI, > or = 85% percentile) and nonoverweight children (BMI, < 85% percentile). Data were expressed as mean (SD). Group comparisons were made by Student t test or Fisher exact test, as appropriate. All tests were 2-tailed with an alpha set at 0.05.We studied 183 children, where 108 children were classified overweight. Demographic differences (mean age, male sex, and African-American race) between overweight and nonoverweight children were not statistically significant. In addition, changes in asthma outcome measures (inpatient admissions during the previous year, asthma visits in the last 30 days, and missed school days in the last 30 days) were not statistically significant. Only household tobacco use approached statistical significance (P = 0.07). The admission rate for nonoverweight children was 9.3% (95% confidence interval [CI], 4.3-18.3) compared with the 10.2% (95% CI, 5.6-17.5) for overweight children; a P = 1.0 was equivalent.Body mass index, a method to quantify overweight children, failed to predict admission of children with ambulatory asthma who presented to the pediatric emergency department.

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