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https://www.readbyqxmd.com/read/28334467/revisiting-the-paradigm-shift-in-opioid-use-developments-and-implications-10%C3%A2-years-later
#1
Benedikt Fischer, Jürgen Rehm
A decade ago, we queried the unfolding of a 'paradigm shift' in illicit opioid use in North America, specifically involving a shift away from heroin to prescription opioid (PO) use. Today, this situation is more acute than ever, with prescription opioid misuse, morbidity and mortality amounting to one of the most severe substance use-related public health crises ever, now even impacting life expectancy in key population segments. Despite medical system-based PO dispensing and practices being recognised as core drivers of the PO crisis, effective policy measures have been long absent or limited-including those to reduce medical PO use to levels supported by best evidence for pain care...
March 23, 2017: Drug and Alcohol Review
https://www.readbyqxmd.com/read/28333667/effect-of-penetration-enhancers-on-the-percutaneous-delivery-of-pain-management-actives
#2
John Trimble, Bob Light
Transdermal compositions for pain management are comprised of nonsteroidal anti-inflammatory drugs, opioid drugs, and adjuvant drugs acting on: voltage-gated channels, gamma-aminobutyric acid receptors, acute musculoskeletal pain, and as an antidepressant. In this work, baclofen, bupivacaine, cyclobenzaprine, diclofenac, gabapentin, ibuprofen, ketamine, and pentoxifylline were loaded in transdermal compositions, prepared using a mixture of lipids (isopropyl palmitate and mineral oil) and one of two selected penetration enhancer mixtures: alkyl dimethicone, phenyl trimethicone, and polyoxyethylene sorbitan monostearate; and cetostearyl polyoxyethylene ether and ethylene oxide/propylene oxide copolymer...
May 2016: International Journal of Pharmaceutical Compounding
https://www.readbyqxmd.com/read/28333326/new-high-dose-pulsed-hyaluronidase-protocol-for-hyaluronic-acid-filler-vascular-adverse-events
#3
Claudio DeLorenzi
The purpose of this article is to update the changes to the author's protocols used to manage acute filler related vascular events from those previously published in this journal. For lack of a better term, this new protocol has been called the High Dose Pulsed Hyaluronidase (HDPH) protocol for vascular embolic events with hyaluronic acid (HA) fillers. The initial protocol used involved many different modalities of treatment. The current protocol is exceedingly simple and involves solely the use of hyaluronidase in repeated high doses...
March 17, 2017: Aesthetic Surgery Journal
https://www.readbyqxmd.com/read/28332005/levetiracetam-synergizes-with-gabapentin-pregabalin-duloxetine-and-selected-antioxidants-in-a-mouse-diabetic-painful-neuropathy-model
#4
Radica Stepanović-Petrović, Ana Micov, Maja Tomić, Uroš Pecikoza
RATIONALE: We have reported that levetiracetam, a novel anticonvulsant with analgesic properties, synergizes with ibuprofen/aspirin/paracetamol in a model of diabetic painful neuropathy (DPN). Most guidelines recommend gabapentin, pregabalin, and duloxetine as first- or second-line agents for DPN. OBJECTIVE: We examined the effects of combination treatment of first-/second-line analgesics with levetiracetam in a model of DPN. Additionally, the levetiracetam's combinations with antioxidants, low dose of aspirin, coenzyme Q10, or α-lipoic acid were evaluated...
March 22, 2017: Psychopharmacology
https://www.readbyqxmd.com/read/28331979/clinical-and-radiological-factors-related-to-the-presence-of-motor-deficit-in-lumbar-disc-prolapse-a-prospective-analysis-of-70-consecutive-cases-with-neurological-deficit
#5
Vibhu Krishnan, Shanmuganathan Rajasekaran, Siddharth N Aiyer, Rishi Kanna, Ajoy Prasad Shetty
PURPOSE: To analyse the clinic-radiological factors associated with neurological deficit following lumbar disc herniation. METHODS: A prospective, cross-sectional study was performed in 140 cases of micro-discectomy following lumbar disc herniation. Group 1 included 70 consecutive patients with motor deficit and group 2 (controls) included 70 patients with intact neurology. Motor deficit was defined as the occurrence of motor power ≤3/5 in L2-S1 myotomes. Multiple clinical and radiological parameters were studied between the two groups...
March 22, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28331873/rapid-corneal-thinning-and-perforated-ulcerative-keratitis-in-a-patient-with-relapsing-polychondritis
#6
Tracy Hiu Ting Lai, Nikki Far, Alvin Lerrmann Young, Vishal Jhanji
BACKGROUND: To report rapid corneal thinning and perforation in a case with relapsing polychondritis. CASE PRESENTATION: A 43 year-old male diagnosed with relapsing polychondritis suffered from bilateral scleritis, bilateral swelling of pinna, saddle nose and tracheal stenosis. The patient presented with right eye pain and redness for one month. Slit lamp examination of the right eye showed 80% peripheral corneal thinning between 3 and 7 o'clock. The best-corrected visual acuity (BCVA) was 1...
2017: Eye and Vision (London, England)
https://www.readbyqxmd.com/read/28331489/reversible-atrial-fibrillation-following-crotalinae-envenomation
#7
Dan Quan, Kenneth Zurcher
BACKGROUND: Cardiotoxicity is a documented complication of Crotalinae envenomation. Reported cardiac complications following snake envenomation have included acute myocardial infarction, electrocardiogram abnormalities and arrhythmias. Few reports exist describing arrhythmia induced by viper envenomation and to our knowledge none describe arrhythmia induced by Crotalinae envenomation. This report concerns the first known case of atrial fibrillation precipitated by rattlesnake bite. CASE PRESENTATION: A 73-year-old Caucasian man with a past medical history of hypertension, hyperlipidemia, type 1 diabetes mellitus, and a baseline first-degree atrioventricular block presented to the emergency department following a rattlesnake bite to his left lower leg...
2017: Journal of Venomous Animals and Toxins Including Tropical Diseases
https://www.readbyqxmd.com/read/28331103/two-cases-of-young-children-with-acute-severe-asthma-treated-by-noninvasive-positive-pressure-ventilation-via-a-helmet
#8
Yuko Amimoto, Naoko Tamura, Natsuki Kitaura, Osamu Hirata, Osamu Arashin, Masakuni Wago
We used noninvasive positive pressure ventilation (NPPV) with a helmet-type mask in two young children with acute severe bronchial asthma. The intervention was well-tolerated, because the helmet-type mask caused no pain or discomfort, as compared to the face mask. Tracheal intubation can be avoided by the start of the NPPV. Thus, the respiratory symptoms improved by the use of NPPV in children with acute severe asthma with respiratory muscle fatigue and failure of medical treatment.
2017: Arerugī, [Allergy]
https://www.readbyqxmd.com/read/28331027/malignant-hypercalcaemia-related-to-parathyroid-hormone-related-peptide-pthrp-secretion-from-a-metastatic-pancreatic-neuroendocrine-tumour-net
#9
Megan Symington, Louise Davies, Gregory Kaltsas, Martin O Weickert
A 54-year-old woman presented to our centre with acute abdominal pain and vomiting. Routine blood tests showed severe hypercalcaemia (>4 mmol/L). Serum parathyroid hormone (PTH) was suppressed. CT scan detected a pancreatic mass and some liver lesions, initially suspicious for metastatic pancreatic adenocarcinoma. Liver biopsy however revealed the presence of a well-differentiated, grade 1, metastatic neuroendocrine tumour (NET) where prognosis is considerably better. Serum PTHrP was raised, indicating paraneoplastic hypercalcaemia, most likely secondary to the pancreatic NET...
March 22, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28331010/presynaptic-and-extrasynaptic-regulation-of-posterior-nucleus-of-thalamus
#10
Anthony Park, Ying Li, Radi Masri, Asaf Keller
The posterior nucleus of thalamus (PO) is a higher-order nucleus involved in sensorimotor processing, including nociception. An important characteristic of PO is its wide range of activity profiles that vary across states of arousal, thought to underlie differences in somatosensory perception subject to attention and degree of consciousness. Further, PO loses the ability to down-regulate its activity level in some forms of chronic pain, suggesting that regulatory mechanisms underlying the normal modulation of PO activity may be pathologically altered...
March 22, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/28329922/recurrent-abdominal-pain-after-laparoscopic-appendectomy
#11
Kwang Il Seo, Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Jung Gu Park
Laparoscopic surgical approaches, compared with open surgical approaches, provide comparable clinical outcomes, but lower complications. Unfortunately, a rare complication-portomesenteric vein thrombosis-had been reported after laparoscopic surgery. A 42-year-old woman was referred our hospital for recurrent abdominal pain after laparoscopic appendectomy from acute appendicitis. It was determined that abdominal pain was due to postoperative superior mesenteric vein thrombus. A six-month anticoagulation therapy is an excellent treatment for superior mesenteric vein thrombus ...
March 25, 2017: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/28329905/-acute-abdominal-pain
#12
Peter Becker, Knut A Böttcher, Dieter Schilling
Acute abdominal pain is a potentially life-threatening condition that requires a concise and quick workup. Patient history, physical examination and laboratory studies help to establish a working diagnosis. If abdominal Ultrasound is not conclusive, contrast-enhanced Computertomography should be performed. Every patient should be treated aggressively for pain control and fluid substitution independent of the diagnostic workflow. In cases of severe disease, initiation of broad spectrum antibiotic therapy should be considered early...
March 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28329274/trichinella-nativa-outbreak-with-rare-thrombotic-complications-associated-with-meat-from-a-black-bear-hunted-in-northern-ontario
#13
Daniel Dalcin, Dante S Zarlenga, Nicholas C Larter, Eric Hoberg, Daniel A Boucher, Samuel Merrifield, Rachel Lau, Filip Ralevski, Karamjit Cheema, Kevin L Schwartz, Andrea K Boggild
Background: Although trichinellosis is known to cause thrombotic disease, serious thrombotic events are rare and have not been previously associated with Trichinella nativa infection. Methods: Patient interviews and medical chart reviews were conducted on 10 men who became ill following consumption of a common source of black bear meat. Trichinella serology on patient sera as well as PCR and larval identification of the meat samples was conducted. Results: All 10 exposed individuals developed an acute illness clinically compatible with trichinellosis, characterized by fever, abdominal pain, and diarrhea, along with eosinophilia ranging from 0...
February 22, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28328700/lumbar-tactile-acuity-in-patients-with-low-back-pain-and-healthy-controls-systematic-review-and-meta-analysis
#14
Wacław Adamczyk, Kerstin Luedtke, Edward Saulicz
OBJECTIVE: Diminished tactile acuity in chronic non-neuropathic pain syndromes has been attributed to central pain processing and cortical reorganization. The latter was recently targeted in clinical trials that demonstrated no clear advantages over traditional approaches for the reduction of nonspecific low back pain (LBP). The aim of this systematic review and meta-analysis was to summarize the current evidence on tactile acuity in LBP and pain-free controls. METHODS: Six databases were independently searched by 2 researchers...
March 21, 2017: Clinical Journal of Pain
https://www.readbyqxmd.com/read/28328689/adult-chest-pain-in-the-pediatric-emergency-department-treatment-and-timeliness-from-door-in-to-door-out
#15
Jeffrey H Sacks, Peter B Flueckiger, Philip R Spandorfer, William T Mahle, Brian E Costello
OBJECTIVES: The American College of Cardiology Foundation/American Heart Association guidelines for acute coronary syndrome (ACS) recommend immediate aspirin (ASA) administration, an electrocardiogram (ECG) in less than 10 minutes, and a door-in to door-out (DIDO) time less than 30 minutes for interfacility transfer. We sought to determine if compliance is hindered when adults with suspected ACS present to pediatric facilities. METHODS: Visits to the 2 tertiary care emergency departments of a pediatric healthcare system using an adult chest pain protocol were examined from October 2006 to September 2012...
March 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28328653/somatosensory-functions-in-survivors-of-critical-illness
#16
Philipp Baumbach, Theresa Götz, Albrecht Günther, Thomas Weiss, Winfried Meissner
OBJECTIVES: There is growing evidence for increased levels of pain and reduced health-related quality of life in survivors of critical illness. Recent studies showed marked small nerve fiber pathology in critically ill patients, which may contribute to chronic pain states and reduced physical recovery after ICU discharge. Primary objective of this study was the comparison of somatosensory functions between survivors of critical illness 6 months after ICU discharge and controls. In post hoc analyses, we aimed to identify associations between small fiber deficits, pain, health-related quality of life, and clinical data...
March 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28328595/hemorrhage-and-infarction-of-the-conjunctiva-and-orbit-in-essential-thrombocythemia
#17
Jaehoon Na, Soo Youn Choi, Sehyun Baek, Hwa Lee
An 82-year-old woman who had a history of essential thrombocythemia presented with ocular pain, bleeding, and decreased visual acuity of the left eye. Orbital computed tomography revealed a relatively well-defined homogenous mass-like lesion in the left subconjunctival and intraconal space. Conjunctival biopsy showed acute inflammation with necrosis, vascular ectasia with thrombosis and hemorrhage. After the treatment with hydroxyurea and anagrelide, her symptom and lesion were markedly improved. Hematologic disorders like essential thrombocythemia should be considered in patients with severe spontaneous bleeding around the eye...
March 21, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28328324/trial-of-pregabalin-for-acute-and-chronic-sciatica
#18
Stephanie Mathieson, Christopher G Maher, Andrew J McLachlan, Jane Latimer, Bart W Koes, Mark J Hancock, Ian Harris, Richard O Day, Laurent Billot, Justin Pik, Stephen Jan, C-W Christine Lin
Background Sciatica can be disabling, and evidence regarding medical treatments is limited. Pregabalin is effective in the treatment of some types of neuropathic pain. This study examined whether pregabalin may reduce the intensity of sciatica. Methods We conducted a randomized, double-blind, placebo-controlled trial of pregabalin in patients with sciatica. Patients were randomly assigned to receive either pregabalin at a dose of 150 mg per day that was adjusted to a maximum dose of 600 mg per day or matching placebo for up to 8 weeks...
March 23, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28327442/immune-cells-and-mediators-involved-in-the-inflammatory-responses-induced-by-a-p-i-metalloprotease-and-a-phospholipase-a2-from-bothrops-atrox-venom
#19
Danilo L Menaldo, Carolina P Bernardes, Karina F Zoccal, Anna L Jacob-Ferreira, Tássia R Costa, Maria P F M Del Lama, Rose M Z G Naal, Fabiani G Frantz, Lúcia H Faccioli, Suely V Sampaio
Bothrops envenomations can promote severe inflammatory responses by inducing edema, pain, leukocyte recruitment and release of chemical mediators by local cells. In the present study, two toxins from Bothrops atrox venom (the P-I metalloprotease Batroxase and the acidic phospholipase A2 BatroxPLA2) were evaluated in relation to their inflammatory effects induced in vivo and in vitro, mainly focusing on the participation of different immune cells and inflammatory mediators. Both toxins mainly promoted acute inflammatory responses with significant recruitment of neutrophils in the early hours (1-4h) after administration into the peritoneal cavity of C57BL/6 mice, and increased infiltration of mononuclear cells especially after 24h...
March 16, 2017: Molecular Immunology
https://www.readbyqxmd.com/read/28327167/optimal-release-timing-of-temporary-drain-clamping-after-total-knee-arthroplasty
#20
Yoon Sang Jeon, Jun Sung Park, Myung Ku Kim
BACKGROUND: Bleeding control is critical after total knee arthroplasty (TKA). The purpose of this study was to evaluate the optimal time to release the clamped drain after TKA. METHODS: We performed unilateral TKA in 120 patients using three methods of drainage. Group A (N = 40) had a 3-hour clamp applied, and group B (N = 40) had a 4-hour clamp applied. Group C (N = 40) underwent conventional negative drainage. We evaluated the drainage volume, as well as the hemodynamic markers, transfusion volume, visual analog scale (VAS) scores, and range of motion (ROM)...
March 21, 2017: Journal of Orthopaedic Surgery and Research
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