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https://www.readbyqxmd.com/read/28742770/role-of-the-perioperative-surgical-home-in-optimizing-the-perioperative-use-of-opioids
#1
Thomas R Vetter, Zeev N Kain
Several federal agencies have recently noted that the United States is in the midst of an unprecedented "opioid epidemic," with an increasing number of opioid-related overdoses and deaths. Providers currently face 3 population-level, public health challenges in providing optimal perioperative pain care: (1) the continued lack of overall improvement in the excessive incidence of inadequately treated postoperative pain, (2) minimizing or preventing postoperative opioid-related side effects, and (3) addressing current opioid prescribing patterns, and the accompanying problematic surge in prescription opioid diversion, misuse, abuse, addiction, and overdose...
July 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28742643/sensitive-troponin-i-and-stress-testing-in-the-emergency-department-for-the-early-management-of-chest-pain-using-2-hour-protocol
#2
Shahriar Dadkhah, Zakaria Almuwaqqat, Samian Sulaiman, Husein Husein, Quang Nguyen, Saad Ali, Tuncay Taskesen
BACKGROUND: Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742515/do-exercises-improve-back-pain-in-pregnancy
#3
Muhammad Azrai Abu, Nur Azurah Abdul Ghani, Lim Pei Shan, Aqmar Suraya Sulaiman, Mohd Hashim Omar, Mohd Hisam Muhamad Ariffin, Azmi Baharuddin, Shuhaila Shohaimi, Zuraidah Che Man
Objective To assess the efficacy of an exercise program towards reducing back pain in pregnant women. Methods In this prospective control study, 145 low risk pregnant women who scored more than 20 for functional limitation assessment were recruited. The severity of back pain was assessed using the visual analoque scale (VAS) and the functional limitation was assessed using the Oswestry disability questionnaire (ODQ). All participants were informed of back care measures and provided with Paracetamol as an adjunct analgesia...
July 25, 2017: Hormone Molecular Biology and Clinical Investigation
https://www.readbyqxmd.com/read/28742435/the-role-of-transversus-abdominis-plane-blocks-in-eras-pathways-for-open-and-laparoscopic-colorectal-surgery
#4
Alexander J Kim, Robert Jason Yong, Richard D Urman
INTRODUCTION: The concepts of Enhanced Recovery After Surgery (ERAS(®)) have steadily increased in usage, with benefits in patient outcomes and hospital length of stay. One important component of successful implementation of ERAS protocol is optimized pain control, via the multimodal approach, which includes neuraxial or regional anesthesia techniques and reduction of opioid use as the primary analgesic. Transversus abdominis plane (TAP) block is one such regional anesthesia technique, and it has been widely studied in abdominal surgery...
July 25, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28742282/med-resulting-from-recessively-inherited-mutations-in-the-gene-encoding-calcium-activated-nucleotidase-cant1
#5
Karthika Balasubramanian, Bing Li, Deborah Krakow, Lisette Nevarez, Patric J Ho, Julia A Ainsworth, Deborah A Nickerson, Michael J Bamshad, LaDonna Immken, Ralph S Lachman, Daniel H Cohn
Multiple Epiphyseal Dysplasia (MED) is a relatively mild skeletal dysplasia characterized by mild short stature, joint pain, and early-onset osteoarthropathy. Dominantly inherited mutations in COMP, MATN3, COL9A1, COL9A2, and COL9A3, and recessively inherited mutations in SLC26A2, account for the molecular basis of disease in about 80-85% of the cases. In two families with recurrent MED of an unknown molecular basis, we used exome sequencing and candidate gene analysis to identify homozygosity for recessively inherited missense mutations in CANT1, which encodes calcium-activated nucleotidase 1...
July 25, 2017: American Journal of Medical Genetics. Part A
https://www.readbyqxmd.com/read/28742099/variants-of-acan-are-associated-with-severity-of-lumbar-disc-herniation-in-patients-with-chronic-low-back-pain
#6
Romain Shanil Perera, Poruwalage Harsha Dissanayake, Upul Senarath, Lalith Sirimevan Wijayaratne, Aranjan Lional Karunanayake, Vajira Harshadeva Weerabaddana Dissanayake
INTRODUCTION: Disc herniation is a complex spinal disorder associated with disability and high healthcare cost. Lumbar disc herniation is strongly associated with disc degeneration. Candidate genes of the aggrecan metabolic pathway may associate with the severity of lumbar disc herniation. OBJECTIVES: This study evaluated the association of single nucleotide variants (SNVs) of the candidate genes of the aggrecan metabolic pathway with the severity of lumbar disc herniation in patients with chronic mechanical low back pain...
2017: PloS One
https://www.readbyqxmd.com/read/28741675/pharmacokinetics-of-dinalbuphine-sebacate-and-nalbuphine-in-human-after-intramuscular-injection-of-dinalbuphine-sebacate-in-an-extended-release-formulation
#7
Yu En Tien, Wen-Chuan Huang, Hui-Yuan Kuo, Lily Tai, Yow-Shieng Uang, Wendy H Chern, Jin-Ding Huang
Nalbuphine is a semi-synthetic opioid indicated for the relief of moderate to severe pain. Its short half-life requires frequent injections in clinical practices, resulting in greater incidences of adverse events. We have developed a prodrug of nalbuphine, dinalbuphine sebacate (DNS), dissolved in a simple oil-based injectable formulation, which could deliver and maintain effective blood nalbuphine level. An open-label, prospective, two-period study was performed in healthy volunteers to verify the extended blood concentration profile of nalbuphine...
July 25, 2017: Biopharmaceutics & Drug Disposition
https://www.readbyqxmd.com/read/28741278/italian-intersociety-consensus-on-prevention-diagnosis-and-treatment-of-delirium-in-hospitalized-older-persons
#8
Giuseppe Bellelli, Alessandro Morandi, Marco Trabucchi, Guido Caironi, Daniele Coen, Carlo Fraticelli, Ciro Paolillo, Carolina Prevaldi, Angela Riccardi, Gianfranco Cervellin, Corrado Carabellese, Salvatore Putignano, Stefania Maggi, Antonio Cherubini, Paola Gnerre, Andrea Fontanella, Nicola Latronico, Concezione Tommasino, Antonio Corcione, Giovanni Ricevuti, Nicola Ferrara, Francesco De Filippi, Alberto Ferrari, Mario Guarino, Maria Pia Ruggieri, Pietro Amedeo Modesti, Carlo Locatelli, Patrizia Hrelia, Marco Otto Toscano, Emi Bondi, Antonio Tarasconi, Luca Ansaloni, Francesco Perticone
Delirium is a severe neuropsychiatric syndrome characterized by inattention and global cognitive dysfunction in the setting of an acute medical illness, medical complication, drug intoxication, or drug withdrawal. The most important risk factors are advanced age and dementia, whereas pain, dehydration, infections, stroke, metabolic disturbances, and surgery are the most common triggering factors. Although delirium is a common clinical syndrome in different settings of care (acute care hospitals, inpatient rehabilitation facilities, nursing homes, and hospices), it often remains under-recognized, poorly understood, and inadequately managed...
July 24, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28741218/asymmetric-pedicle-subtractionosteotomy-apso-guided-by-a-3d-printed-model-to-correct-a-combined-fixed-sagittal-and-coronal-imbalance
#9
Pierre-Pascal Girod, S Hartmann, P Kavakebi, J Obernauer, M Verius, C Thomé
Surgical correction of fixed thoracolumbar deformity is usually achieved by estimating the preoperatively planned correction angles during surgery and is therefore prone to inaccuracy. This is particularly problematic in biplanar deformities. To overcome these difficulties, 3D model for planning, preparation, and simulation of an asymmetric pedicle subtraction osteotomy (aPSO) was printed and used to realign coronal and sagittal balance in case of rigid degenerative kyphoscoliosis. A 59-year-old woman presented with severe back pain and spinal claudication and was diagnosed with a rigid kyphoscoliosis with multilevel spinal stenosis...
July 24, 2017: Neurosurgical Review
https://www.readbyqxmd.com/read/28741118/strategies-to-decrease-injection-site-pain-in-botulinum-toxin-therapy
#10
Lejla Paracka, Katja Kollewe, Florian Wegner, Dirk Dressler
Botulinum toxin is now used for numerous indications including dystonias, spasticity, cerebral palsy, hyperhidrosis, cosmetics and chronic migraine. It has to be injected into its target tissues thus causing injection site pain. We wanted to compare the efficacy of various analgesic interventions suggested for reduction of injection site pain. In 13 healthy controls, pain thresholds in the fingertips II and III bilaterally were determined by the Mechanical Pain Threshold Test and the Repetitive Pain Stimulation Test at baseline and under nitrous oxide/oxygen, ice spray, local anaesthetic cream and forearm ischaemia...
July 24, 2017: Journal of Neural Transmission
https://www.readbyqxmd.com/read/28740935/effects-of-vertebral-body-sparing-proton-craniospinal-irradiation-on-the-spine-of-young-pediatric-patients-with-medulloblastoma
#11
Iain MacEwan, Brian Chou, Jeremy Moretz, Lilia Loredo, David Bush, Jerry D Slater
PURPOSE: To investigate the long-term effects of vertebral-body-sparing proton craniospinal irradiation (CSI) on the spine of young patients with medulloblastoma. METHODS AND MATERIALS: Six children between the ages of 3 and 5 years with medulloblastoma were treated with vertebral-body-sparing proton CSI after maximal safe resection. Radiation therapy was delivered in the supine position with posterior beams targeting the craniospinal axis, and the proton beam was stopped anterior to the thecal sac...
April 2017: Advances in Radiation Oncology
https://www.readbyqxmd.com/read/28740925/characterization-of-efficacy-and-toxicity-after-high-dose-pelvic-reirradiation-with-palliative-intent-for-genitourinary-second-malignant-neoplasms-or-local-recurrences-after-full-dose-radiation-therapy-in-the-pelvis-a-high-volume-cancer-center-experience
#12
Sophia C Kamran, Lauren C Harshman, Mandar S Bhagwat, Vinayak Muralidhar, Paul L Nguyen, Neil E Martin, Stephanie La Follette, Sarah Faso, Akila N Viswanathan, Jason A Efstathiou, Clair J Beard
PURPOSE: The use of large-field external beam reirradiation (re-RT) after pelvic radiation therapy (RT) for genitourinary (GU) cancers has not been reported. We report the results of such treatment in patients with either symptomatic GU second malignant neoplasms or locally recurrent pelvic tumors after initial RT for whom surgery or further systemic therapy was not an option. METHODS AND MATERIALS: The records of 28 consecutive patients with advanced, bulky GU malignancies treated with high-dose, large-field re-RT with palliative intent between 2008 and 2014 were retrospectively reviewed...
April 2017: Advances in Radiation Oncology
https://www.readbyqxmd.com/read/28740840/bicytopenia-and-leukoerythroblastosis-a-rare-initial-presentation-of-signet-ring-cell-gastric-adenocarcinoma
#13
REVIEW
Vilma Takayasu, Edna Harumi Goto, Mayra Zanon Casagrande, Paulo Guilherme de Arruda Miranda, Gabriela Bezerra de Freitas Diniz, Micaela Frasson Monteiro, Aloisio Felipe-Silva
Gastric adenocarcinoma is a common neoplasia and is responsible for up to 30% of the overall deaths due to cancer. Advanced disease is mostly characterized by peritoneum, liver, and lung involvement. The spread of the disease to the bone is rare, and bone marrow dissemination is even rarer. In this setting, leukoerythroblastosis may be the initial manifestation of the disease. The authors report the case of a 64-year-old Caucasian man who sought medical care complaining of back pain, weakness, and weight loss...
April 2017: Autopsy & case reports
https://www.readbyqxmd.com/read/28740693/disease-flare-after-discontinuing-gefitinib-in-a-patient-with-lung-adenocarcinoma-and-concomitant-epithelial-growth-factor-receptor-mutation-and-anaplastic-lymphoma-kinase-translocation
#14
Eun Hye Park, Hwa Young Lee, Jin Woo Kim, Chang Dong Yeo
We report on a patient with lung adenocarcinoma and a concomitant epithelial growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation who developed a disease flare after discontinuing gefitinib. A 63-year-old woman with lung adenocarcinoma and a concomitant activating EGFR mutation and ALK translocation was treated with first-line gefitinib. After 4 months, she discontinued the gefitinib due to disease progression. She was admitted to the emergency room complaining of severe dyspnea and back pain 22 days after discontinuing gefitinib...
June 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28740682/combined-analgesic-treatment-of-epidural-and-paravertebral-block-after-thoracic-surgery
#15
Yujiro Yokoyama, Takahiro Nakagomi, Daichi Shikata, Taichiro Goto
In pulmonary surgical practice, appropriate pain management after thoracotomy is essential for patient recovery and the prevention of complications. Although epidural analgesia (EPI) has been established for chest surgery, it has some limitations and contraindications. Recently, paravertebral block (PVB) was reported as a good alternative method with fewer side effects. Despite the significant effects of these two treatments, postoperative pain remains among the greatest patient burdens. In our institution, we apply a combination of epidural and PVBs after thoracic surgery to reduce pain more effectively...
June 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28740442/techniques-used-for-the-screening-of-hemoglobin-levels-in-blood-donors-current-insights-and-future-directions
#16
REVIEW
Rajendra Chaudhary, Anju Dubey, Atul Sonker
Blood donor hemoglobin (Hb) estimation is an important donation test that is performed prior to blood donation. It serves the dual purpose of protecting the donors' health against anemia and ensuring good quality of blood components, which has an implication on recipients' health. Diverse cutoff criteria have been defined world over depending on population characteristics; however, no testing methodology and sample requirement have been specified for Hb screening. Besides the technique, there are several physiological and methodological factors that affect accuracy and reliability of Hb estimation...
2017: Journal of Blood Medicine
https://www.readbyqxmd.com/read/28740427/vulvodynia-is-not-created-equally-empirical-classification-of-women-with-vulvodynia
#17
Meryl Alappattu, Georgine Lamvu, Jessica Feranec, Kathryn Witzeman, Michael Robinson, Andrea Rapkin
BACKGROUND: Vulvodynia classification is based on the sensory dimensions of pain and does not include psychological factors associated with the pain experience and treatment outcomes. Previous work has shown that individuals with chronic pain can be classified into subgroups based on pain sensitivity, psychological distress, mood, and symptom severity. OBJECTIVE: The aim of this study was to identify distinct subgroups of women with vulvodynia enrolled in the National Vulvodynia Registry...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28740426/efficacy-of-flurbiprofen-8-75-mg-delivered-as-a-spray-or-lozenge-in-patients-with-sore-throat-due-to-upper-respiratory-tract-infection-a-randomized-non-inferiority-trial-in-the-russian-federation
#18
Eugenia Radkova, Natalia Burova, Valeria Bychkova, Robert DeVito
OBJECTIVE: To assess the efficacy of flurbiprofen 8.75 mg delivered as a spray or lozenge in patients with sore throat due to upper respiratory tract infection (URTI). MATERIALS AND METHODS: This multicenter, double-blind, double-dummy, non-inferiority study randomized 440 adults with recent-onset, moderate-to-severe sore throat due to URTI to a single dose of either flurbiprofen 8.75 mg spray (n=218) or flurbiprofen 8.75 mg lozenge (n=222). The presence or absence of beta-hemolytic streptococci (A or C) was confirmed by culture tests (throat swab)...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28740423/antinociceptive-tolerance-to-nsaids-in-the-agranular-insular-cortex-is-mediated-by-opioid-mechanism
#19
Natia Pirkulashvili, Nana Tsiklauri, Marina Nebieridze, Merab G Tsagareli
Several lines of investigations have shown that in some brain areas, in particular, in the midbrain periaqueductal gray matter, rostral ventromedial medulla, central nucleus of amygdala, nucleus raphe magnus, and dorsal hippocampus, microinjections of nonsteroidal anti-inflammatory drugs (NSAIDs) induce antinociception with distinct development of tolerance. The agranular insular cortex (AIC) is a small region of the cerebral cortex located on the lateral area of the rat's cerebral hemisphere that is involved in the perception and response to pain...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28739618/atypical-presentation-of-parsonage-turner-syndrome-confounded-by-surgical-rotator-cuff-injury
#20
Dustin Adam Greenhill, Hesham Abdelfattah, Joseph S Torg, Joseph Milo Sewards
Parsonage-Turner syndrome (PTS) is a rare neuropathy that commonly presents as unexpected severe shoulder and arm pain that eventually subsides while weakness or paralysis ensues. During exceptions to this classic presentation, confirming PTS can be challenging. Alternative causes of upper extremity pain may confound the diagnostic algorithm. Moreover, objective findings from necessary diagnostic tests depend on when those tests are performed. We present an atypical onset of PTS, whereby the initial presentation of severe neuropathic pain was preceded by mild shoulder pain that should decrease one's clinical suspicion for PTS...
July 24, 2017: BMJ Case Reports
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