A Case Report of Challenging Diagnosis of Persistent Hypoglycemia Secondary to Methadone Dose-Dependence in a Patient With End-Stage Renal Disease (ESRD) and Liver Cirrhosis (LC).

Methadone is a widely used opioid used for the management of chronic pain, treatment for opioid use disorders (heroin addiction), as well as for acute opioid withdrawal syndrome. Even though methadone is considered a safe drug, it is not exempt from unwanted side effects, some of them can be rare and may be overlooked due to patients' comorbidities, delaying proper identification of the actual etiology. This article highlights one of those side effects, hypoglycemia, in a 64-year-old woman with a medical history of end-stage renal disease (ESRD) on hemodialysis, Acquired immune deficiency syndrome, liver cirrhosis, and a history of intravenous (IV) drug abuse disorder on a methadone maintenance program, and the importance of prompt identification and management, such as dose splitting or alternate medication to manage opioid withdrawal. The case underscores the importance of a proper approach and the high clinical suspicion that must be present when multiple variables are in place.

A barrier to care: Distance traveled affects adherence to treatment and follow-up plans for patients with infantile hemangioma.

A chart review was performed of all patients diagnosed with infantile hemangioma in the pediatric dermatology clinic to determine whether distance traveled by the patient affected adherence to follow-up and treatment plans. An increase in distance was associated with an increase in likelihood of nonadherence to treatment or follow-up plans. Compared to patients who lived within 10 miles of a pediatric dermatologist, families who lived farther away were less likely to adhere to treatment plans. Families who traveled over 20 miles to clinic were 7.38 times more likely to be nonadherent to the treatment plan than those who traveled 0-10 miles.

Medication discrepancies in late-stage chronic kidney disease.

BACKGROUND: Late-stage chronic kidney disease (LS-CKD) can be defined by glomerular filtration rate (GFR) 0-30 mL/min. It is a period of risk for medication discrepancies because of frequent hospitalizations, fragmented medical care, inadequate communication and polypharmacy. In this study, we sought to characterize medication discrepancies in LS-CKD. METHODS: We analyzed all patients enrolled in Northwell Health's Healthy Transitions in LS-CKD program. All patients had estimated GFR 0-30 mL/min, not on dialysis. Medications were reviewed by a nurse at a home visit. Patients' medication usage and practice were compared with nephrologists' medication lists, and discrepancies were characterized. Patients were categorized as having either no discrepancies or one or more. Associations between patient characteristics and number of medication discrepancies were evaluated by chi-square or Fisher's exact test for categorical variables, and two-sample t-test or Wilcoxon text for continuous variables. RESULTS: Seven hundred and thirteen patients with a median age of 70 (interquartile range 58-79) years were studied. There were 392 patients (55.0% of the study population) with at least one medication discrepancy. The therapeutic classes of medications with most frequently occurring medication discrepancies were cardiovascular, vitamins, bone and mineral disease agents, diuretics, analgesics and diabetes medications. In multivariable analysis, factors associated with higher risk of discrepancies were congestive heart failure [odds ratio (OR) 2.13; 95% confidence interval (CI) 1.44-3.16; P = 0.0002] and number of medications (OR 1.29; 95% CI 1.21-1.37; P < 0.0001). CONCLUSIONS: Medication discrepancies are common in LS-CKD, affect the majority of patients and include high-risk medication classes. Congestive heart failure and total number of medications are independently associated with greater risk for multiple drug discrepancies. The frequency of medication discrepancies indicates a need for great care in medication management of these patients.

Effects Of Polylactic Acid Coating and Compression Load on the Delivery of Protein and Steroid from HA Ceramic Devices.

Density variations, due to particle size and time and temperature of sintering, affect the delivery profile of substances from ceramic delivery devices. This investigation was conducted to study the effect of polylactic acid (PLA) impregnation on the porosity of hydroxyapatite (HA) capsules by studying the delivery rate of bovine serum albumin (BSA) and testosterone (TE). HA capsules were fabricated by cold compressing calcined particles at 1000, 3000, and 5000 lbs. Each group was subdivided into PLA-impregnated and non-PLA impregnated capsules. Each capsule was loaded with either 40 mg of TE (impregnated or nonimpregnated with PLA polymer) or BSA. Data obtained in this study suggest that: (1) PLA impregnation of HA ceramic capsules decreases the rate of release of drugs from the ceramic reservoir, (2) Physiochemical characteristics of the drugs to be delivered is an instrumental key in the sustained release profiles, (3) Compression load of HA reservoirs is a key factor in predicting the duration and level of sustained delivery, and (4) Polymer coating of HA ceramic capsules reduces the pore size, as well as, blocking some of the pores on the surface.

Defining the role of adenosine and glucocorticoids in down regulation of the inflammatory response associated with LPS activated macrophages - biomed 2011.

During infection and inflammation, macrophages play a pivotal role in the generation of inflammatory mediators and regulation of innate and adaptive immune responses. They also contribute to resolution of inflammation. It is generally accepted that monocytes are relatively short living cells which die spontaneously in the absence of appropriate stimuli. Proinflammatory factors like lipopolysaccharide (LPS) are known to enhance survival of proinflammatory monocytes, and the signals released from cells within the inflammatory site result in local accumulation of a population of activated macrophages. Glucocorticoids and adenosine are thought to play a role on the inflammatory macrophages. Macrophage-like cells were activated with LPS in the presence of glucocorticoids (GC) or adenosine. Glucocorticoid suppressed the nitric oxide and cytokine response associated with LPS activation of macrophages, while adenosine down regulated cytokine response. Signaling mechanism may be different depending upon receptor activation.

Integrated plan to augment surge capacity.

INTRODUCTION: Surge capacity is defined as a healthcare system's ability to rapidly expand beyond normal services to meet the increased demand for appropriate space, qualified personnel, medical care, and public health in the event ofbioterrorism, disaster, or other large-scale, public health emergencies. There are many individuals and agencies, including policy makers, planners, administrators, and staff at the federal, state, and local level, involved in the process of planning for and executing policy in respect to a surge in the medical requirements of a population. They are responsible to ensure there is sufficient surge capacity within their own jurisdiction. PROBLEM: The [US] federal government has required New York State to create a system of hospital bed surge capacity that provides for 500 adult and pediatric patients per 1 million population, which has been estimated to be an increase of 15-20% in bed availability. In response, the New York City Department of Health and Mental Hygiene (NYC DOH) has requested that area hospitals take an inventory of available beds and set a goal to provide for a 20% surge capacity to be available during a mass-casualty event or other conditions calling for increased inpatient bed availability. METHODS: In 2003, under the auspices of the NYC DOH, the New York Institute of All Hazard Preparedness (NYIHP) was formed from four unaffiliated, healthcare facilities in Central Brooklyn to address this and other goals. RESULTS: The NYIHP hospitals have developed a surge capacity plan to provide necessary space and utilities. As these plans have been applied, a bed surge capacity of approximately 25% was identified and created for Central Brooklyn to provide for the increased demand on the medical care system that may accompany a disaster. Through the process of developing an integrated plan that would engage a public health incident, the facilities of NYIHP demonstrate that a model of cooperation may be applied to an inherently fractioned medical system.