Patients on Buprenorphine Formulations Undergoing Surgery.

PURPOSE OF REVIEW: To review the pharmacology of buprenorphine, the evolution of buprenorphine dosing recommendations, and the current literature regarding its recommendations for the perioperative period. RECENT FINDINGS: There is a consensus that for all surgeries, buprenorphine should be continued throughout the perioperative period. If the surgery is a minimal to mild pain surgery, no dose adjustment is needed. There is no clear consensus regarding moderate to severe pain. With all surgeries, multimodal analgesia should be utilized, with regional anesthesia when possible. Patients taking buprenorphine should continue their buprenorphine perioperatively; whether to decrease or maintain dosing is up for debate. Multimodal analgesia should also be used throughout the perioperative period, and communication between the patient and all provider teams is of the utmost importance to provide adequate analgesia during the perioperative period, as well as to arrange safe analgesia upon discharge.

A prospective observational study evaluating the use of remote patient monitoring in ED discharged COVID-19 patients in NYC.

OBJECTIVES: We investigated whether continuous remote patient monitoring (RPM) could significantly reduce return Emergency Department (ED) revisits among coronavirus disease 2019 (COVID-19) patients discharged from the emergency Department. MATERIALS AND METHODS: A prospective observational study was conducted from a total of 2833 COVID-19 diagnosed patients who presented to the Montefiore Medical Center ED between September 2020-March 2021. Study patients were remotely monitored through a digital platform that was supervised 24/7 by licensed healthcare professionals. Age and time-period matched controls were randomly sampled through retrospective review. The primary outcome was ED revisit rates among the two groups. RESULTS: In our study, 150 patients enrolled in the RPM program and 150 controls were sampled for a total of 300 patients. Overall, 59.1% of the patients identified as Hispanic/Latino. The RPM group had higher body mass index (BMI) (29 (25-35) vs. 27 (25-31) p-value 0.020) and rates of hypertension (50.7% (76) vs. 35.8% (54) p-value 0.009). There were no statistically significant differences in rates of ED revisit between the RPM group (8% (12)) and control group (9.3% (14)) (OR: 0.863; 95% CI:0.413-1. 803; p- 0.695). DISCUSSION AND CONCLUSION: Our study explored the impact of continuous monitoring versus intermittent monitoring for reducing ED revisits in a largely underrepresented population of the Bronx. Our study demonstrated that continuous remote patient monitoring showed no significant difference in preventing ED revisits compared to non-standardized intermittent monitoring. However, potential other acute care settings where RPM may be useful for identifying high-risk patients for early interventions warrant further study.

Bipolar Disorder and Cardiovascular Risk in Rural versus Urban Populations in Colombia: A Comparative Clinical and Epidemiological Evaluation.

Background: Various multifactorial elements may contribute toward the urban and rural disparities in cardiovascular disease (CVD) risk, particularly among patients with psychiatric diseases. Objective: To investigate whether rural patients diagnosed and treated for Bipolar Disorder (BD) have different risk profiles and outcomes of CVD compared to urban (BD) patients. Methods: We conducted a case-control study that included 125 BD patients (cases) from rural Filadelfia, Colombia and 250 BD patients (controls) treated in Bogotá, Colombia. Cases and controls were 2:1, matched by age and sex. We applied the Framingham Heart Study (FHS) risk calculator to assess risk. Differences by rural/urban status (i.e., case-control status) were assessed by chi-square, paired t-tests, and logistic regression. Findings: Rural BD patients were found to have lower education (p = 1.0 × 10-4), alcohol consumption (p = 3.0 × 10-4), smoking (p = 0.015), psychiatric (p = 1.0 × 10-4) and CV family history (p = 0.0042) compared to urban BD patients. Rural BD patients were 81% more likely to have a more favorable CVD risk profile (OR: 0.19, 95% CI [0.06-0.62]) than urban BD patients, despite rural BD patients having increased CVD morbidity (p = 1.0 × 10-2). Conclusion: Based on increase in morbidity but lower predictive risk in the rural population, our study suggests that the FHS-CVD calculator may not be optimal to assess CVD risk in this population.

Características clínicas, epidemiológicas y manejo terapéutico de la meningitis pediátrica en dos instituciones de Medellín, Colombia / Clinical, epidemiological characteristics and therapeutic management of pediatric meningitis in two institutions of Medellin, Colombia

Resumen Introducción: La meningitis es una emergencia médica que requiere diagnóstico y tratamiento oportuno para evitar complicaciones. Objetivo: Determinar las características clínicas, epidemiológicas y el manejo terapéutico de meningitis en la primera infancia. Materiales y métodos: Estudio transversal que evaluó menores hasta los seis años de edad con meningitis bacteriana o aséptica en dos centros de Medellín, 2010 - 2013. Se recolectaron características clínicas, paraclínicas y terapéuticas. Las variables cualitativas se describieron mediante frecuencias absolutas y relativas y las cuantitativas con mediana y rango intercuartílico. Se exploró diferencias en las características de los pacientes según grupo de edad, mediante la prueba Chi-cuadrado o Fisher. Resultados: De 56 pacientes, 33 (58,9%) eran del sexo masculino; 26 (46,4%) presentaron meningitis bacteriana, 20 (35,7%) aséptica y 10 (17,9%) indeterminada; 36 (64,3%) fueron mayores de dos meses, con manifestaciones clínicas inespecíficas (fiebre e irritabilidad). Se aislaron principalmente microorganismos Gram negativos en hemocultivos y Gram positivos en líquido cefalorraquídeo. El tratamiento antibiótico más frecuente fue cefalosporinas de tercera-generación en 13 (65%) menores de 2 meses y 28 (77,8%) mayores. Fallecieron dos pacientes y seis presentaron complicaciones. Conclusiones: la meningitis bacteriana fue la más frecuente en menores de un año. El tratamiento combinado es ideal para garantizar un adecuado cubrimiento y evitar complicaciones.

Abstract Introduction: Meningitis is a medical emergency that requires early diagnosis and treatment to avoid complications. Objective: To determine the clinical, epidemiological characteristics and therapeutic management of meningitis in early childhood. Materials and methods: A cross-sectional study, which evaluated children up to six years old with bacterial or aseptic meningitis from 2010 to 2013, was conducted in two centers in Medellin. Clinical, paraclinical and therapeutic characteristics were collected. The qualitative variables were described by absolute and relative frequencies, and the quantitative ones with median and interquartile range. Differences in patient characteristics according to age group were explored, using the Chi-square or Fisher test. Results: From the 56 patients studied, 33 (58.9%) were male; 26 (46.4%) showed bacterial meningitis, 20 (35.7%) aseptic one and 10 (17.9%) indeterminate one; 36 (64.3%) were older than two months, with non-specific clinical manifestations (fever and irritability). Gram-negative microorganisms were mainly isolated in blood cultures and Gram positive in cerebrospinal fluid. The most common antibiotic treatment was third-generation cephalosporins in 13 (65%) children who were less than 2 months and 28 (77.8%) in older ones. Two patients died and six children presented complications. Conclusions: Bacterial meningitis was the most frequent in children under one year old. Combined treatment is ideal to ensure adequate coverage and avoid complications.

Use of strong opioids for chronic pain in osteoarthritis: an insight into the Latin American reality.

INTRODUCTION: Osteoarthritis is the most common cause of arthritis and one of the main causes of chronic pain. Although opioids are frequently employed for chronic pain treatment, their usage for osteoarthritis pain remains controversial due to the associated adverse effects. Most guidelines reserve their use for refractory pain in patients with hip and knee osteoarthritis. The situation is even more complex in Latin America, where the prevalence of insufficient pain treatment is high because of the limited availability and use of strong opioids. Areas covered: In this article we review the epidemiology of osteoarthritis, its socioeconomic burden, its impact as a chronic pain cause and the pharmacological treatment options, giving emphasis to the role of strong opioids, their safety and efficacy, especially in Latin American countries, where restrictions regulate their usage. Expert commentary: Usage of strong opioids is safe and effective in the short-term management of osteoarthritis with moderate to severe pain, when other pharmacological treatments are inadequate and surgery is contraindicated, provided their use adheres to existing guidelines. Educational programs for patients and physicians and further research on treating chronic pain with opioids should be implemented to reduce adverse effects and improve care quality.

Perfil clínico y microbiológico de niños con neutropenia febril posterior a tratamientos antineoplásicos tratados en una institución hospitalaria de Medellín (Colombia), 2009-2010: Estudio de serie de casos / Clinical and microbiological profile of children with febrile neutropenia following antineoplastic treatments in a hospital in Medellin (Colombia), 2009-2010: case series

Objetivo: describir el perfil clínico y microbiológico de los niños con neutropeniafebril sometidos a tratamientos antineoplásicos, en una institución hospitalaria de Medellín. Materiales y métodos: estudio descriptivo retrospectivo en el que se incluyen las historias clínicas de 34 pacientes pediátricos con tratamiento antineoplásico, neutropenia febril y episodios infecciosos. La información serecolecta en un formulario donde se registraron variables sociodemográficas,clínicas y paraclínicas. Se usó el programa SPSS® versión 19.0 para procesar la información obtenida y realizar el análisis. Resultados: la edad promedio del primer episodio fue de 5,2±2 años. El 50% de los casos fueron sexo femenino. Los hallazgos clínicos más frecuentes en los tres primeros episodios evaluados fueron taquicardia, vómito y diarrea. Se observaron diferencias significativas en el recuento de leucocitos totales y neutrófilos: los primeros con tendencia a la reducción entre episodios, mientras que los neutrófilos presentaron aumento del primer al segundo episodio y reducción durante el tercero. Los principales focos de infección fueron mucosa oral (15,9%), tracto gastrointestinal (15,9%)y pulmonar (11,1%). Staphylococcus fueron los agentes etiológicos más frecuentemente reportados con un 12,8% del total de episodios. Conclusión:la neutropenia febril secundaria a tratamientos antineoplásicos, predispone a distintos procesos infecciosos de etiología variable, desarrollando una sintomatología amplia e impactando en la salud de los pacientes.

Uso de rituximab en pacientes pediátricos con síndrome nefrótico córtico-resistente. Experiencia de un centro / Use of rituximab in pediatric patients with steroidresistant nephrotic syndrome. A single center study / Uso de rituximab em pacientes pediátricos com síndrome nefrótica córtico-resistente. Experiência de um centro

Introducción: los esteroides son el tratamiento de elección del síndrome nefrótico con tasas de éxito hasta del 90%. En pacientes que no responden adecuadamente a ellos, se han usado diferentes esquemas de inmunosupresión. Objetivo y métodos: describir la respuesta terapéutica en un grupo de siete niños con síndrome nefrótico córtico-dependiente (SNCD) o córtico-resistente (SNCR) que recibieron tratamiento con rituximab y micofenolato mofetil en un hospital universitario de la ciudad de Medellín durante los años 2010-2012. Resultados: dos pacientes tenían SNCD y cinco, SNCR; la mediana de edad en el momento del diagnóstico fue de 2 años (p25-75: 1-5); seis meses después de la aplicación del rituximab se encontró disminución de la proteinuria en el 93% de los pacientes; los esteroides se lograron suspender en el 100%; además, disminuyó el número de recaídas; sin embargo, la proteinuria reapareció un año después de dicho tratamiento. Conclusión: con el rituximab disminuyen la proteinuria y la dosis de esteroides, pero la enfermedad recurre 12 meses después de usarlo. Se sugiere hacer otro estudio evaluando el efecto de una segunda dosis de rituximab al año de la primera.

Introduction: Steroids are the cornerstone of therapy for nephrotic syndrome (NS) with a remission rate as high as 90%. In patients who do not respond to them or are steroid dependent, other immunosuppressive drugs have been used. Although rituximab use in NS is off-label, many authors have published their experience with it. Objective and methods: To describe retrospectively a group of seven children with nephrotic syndrome, either steroid-dependent (SDNS) or steroid- resistant (SRNS), treated with rituximab and mycophenolate, at Pablo Tobón Uribe Hospital, in Medellín, Colombia. Results: Two patients with SDNS and five with SRNS were evaluated; median age at diagnosis was 2 years (p25-75: 1-5); six months after treatment with rituximab there was reduction in proteinuria (93%), in the steroid dose (100%) and in the relapse episodes. However, proteinuria reappeared 12 months after treatment. Conclusion: During the first year after rituximab treatment of NS there is reduction in proteinuria and in the steroid dose, but thereafter there is relapse. It is suggested to carry out another study using a second dose of rituximab one year after the first one.

Introdução: os esteroides são o tratamento de eleição da síndrome nefrótica com taxas de sucesso até da 90%. Em pacientes que não respondem adequadamente a eles, usaram-se diferentes esquemas de imunossupressão. Não está aprovado o uso do rituximab em pacientes com síndrome nefrótica, mas alguns grupos publicaram sua experiência com ele nesta doença. Objetivo e métodos: descrever a resposta terapêutica num grupo de sete meninos com síndrome nefrótica córtico-dependente (SNCD) ou córtico -resistente (SNCR) que receberam tratamento com rituximab e micofenolato mofetil num hospital universitário da cidade de Medellín durante os anos 2010-2012. Resultados: dois pacientes tinham SNCD e cinco, SNCR; a idade no momento do diagnóstico foi de 2 anos (p25-75: 1-5); seis meses depois da aplicação do rituximab se encontrou diminuição de 93% da proteinúria e de 100% na dose de prednisolona; ademais, diminuiu o número de recaídas; no entanto, a proteinúria reapareceu um ano depois de dito tratamento. Conclusão: com o rituximab diminuem a proteinúria e a dose de esteroides, mas a doença recorre 12 meses depois de usá-lo. Sugere-se fazer outro estudo avaliando o efeito de uma segunda dose de rituximab no ano seguinte da primeira dose.