Assessment of clinical outcomes in patients with inflammatory arthritis: analysis from the UK Medical Cannabis Registry.

The aim of this study was to assess changes in validated patient-reported outcome measures after initiation of cannabis-based medicinal products (CBMPs) and the safety of CBMPs in patients with inflammatory arthritis. A prospective case series from the UK Medical Cannabis Registry was analyzed. The primary outcomes changes were in Brief Pain Inventory, McGill Pain Questionnaire, EuroQol 5-dimension 5-level (EQ-5D-5L), Generalised Anxiety Disorder-7 questionnaire, and Single-Item Sleep Quality Scale at 1, 3, 6, and 12 months of follow-up compared with baseline. Adverse events were analyzed in accordance with Common Terminology Criteria for Adverse Events, v.4.0. Statistical significance was defined as a P-value less than 0.050. Eighty-two patients met the inclusion criteria. Initiation of CBMP treatment was associated with improvements in Brief Pain Inventory, McGill Pain Questionnaire, EQ-5D-5L, Generalised Anxiety Disorder-7 questionnaire, and Single-Item Sleep Quality Scale at 1, 3, 6, and 12 months compared with baseline (P < 0.050). There were 102 (44.35%) mild adverse events, 97 (42.17%) moderate adverse events, and 31 (13.48%) severe adverse events recorded by 21 (25.61%) participants. This study suggests that CBMP treatment is associated with pain improvement and increased health-related quality of life for inflammatory arthritis patients. While causality cannot be inferred in this observational study, the results support the development of randomized control trials for inflammatory arthritis pain management with CBMPs.

Always read the label: a case report of a penile burn.

A 32-year-old man presented with chemical burns to his penis following accidental application of depilatory cream to the area. The gentleman consequently sustained deep dermal burns to his penis, experiencing genital swelling and dysuria. This injury was managed conservatively in our burns unit and the patient was discharged shortly after. We present this unusual case of penile burns which has not previously been described in the literature despite depilatory creams being inexpensive and relatively easy to use, and subsequently popular choice amongst available hair removal options.

Severe scalds sustained during steam inhalation therapy in an adult population: Analysis of patient outcomes and the financial burden to healthcare services.

BACKGROUND: Steam inhalation therapy (SIT) is a common home remedy for the treatment of upper respiratory tract infections. Literature reports are increasingly discouraging this practice in the paediatric population due to the risk of scalds, however, this is yet to be echoed for adults. METHODS: A retrospective review of patients admitted to a tertiary burns centre from 2015 to 2020 was undertaken identifying all adult patients requiring in-patient specialist treatment for scald injuries sustained during steam inhalation. Cost analysis and long-term patient outcomes were reviewed. RESULTS: Twelve adult patients required inpatient management with a mean length of admission of 8 nights. One patient required operative intervention, long-term sequelae included scarring, skin sensitivity, pain, or psychological morbidity. The estimated mean cost per patient was £5402 giving a mean cost per year of £12 964. CONCLUSION: SIT can be associated with severe scald injuries in adults and incur considerable costs for healthcare providers.

Cu(I)-azidopyrrolo[3,2-d]pyrimidine Catalyzed Glaser-Hay Reaction under Mild Conditions.

The limitation of the CuAAC "click" reaction with a 2-azidopyridine substrate, owing to its equilibrium with a tetrazole isomer, is exploited herein for its utility in the Glaser-Hay reaction. A catalytic combination of a 2-azidopyridine analogue, 4-azido-5H-pyrrolo[3,2-d]pyrimidine, and CuI afforded homocoupled products of terminal alkynes, without any trace of triazole product, under mild conditions with a broad substrate scope. Emphasis on carbohydrate-based substrates appended to a propargylic group led to 1,3-diynes in good to excellent yields.

Endoscopic carpal tunnel release: practice in evolution.

This study reports on 565 consecutive endoscopic carpal tunnel releases using the Agee one-portal technique of which 25 (4.4%) were converted to the open technique. The follow-up period was from 4 to 52 months. Immediate symptomatic relief was reported in 562 wrists (99.5%). There were 25 complications (4.4%) including pillar pain (8 wrists), digital neuropraxia (n = 6), median nerve contusion (n = 3), incomplete division of the flexor retinaculum (n = 3), superficial infection (n = 3), reflex sympathetic dystrophy (n = 1), and tenderness of the scar (n = 1). We describe the evolution of our selection of patients and surgical technique. We recommend caution in performing ECTR in short patients who are liable to have small wrists because of the risk of contusion of the median nerve. We present some technical modifications that may make the technique safer.

Trends in hospital admissions for burns in England, 1991-2010: a descriptive population-based study.

OBJECTIVES: To describe trends in admissions to English hospitals and 30-day in-hospital mortality associated with a primary diagnosis of burns. DESIGN: Descriptive population-based study. SETTING: England. PARTICIPANTS: Patients admitted to hospital with a primary diagnosis of burns between 1991 and 2010. MAIN OUTCOME MEASURES: Age-specific and age-standardised admission rates, and 30-day in-hospital mortality percentages. RESULTS: During 1991-2010, there were 188,597 admissions to hospitals in England with a primary diagnosis of burns. Annual numbers of admissions decreased between 1991 and 2002, followed by a steeper increase up to 2010. Rates were higher in males, in the age groups 0-4 and ≥85 years, and in persons from deprived areas of residence, most ethnic minorities, and urban areas. There were 3196 in-hospital deaths within 30 days of admission for burns between 1991 and 2010. Between 2000 and 2010, this mortality decreased from 1.99% to 0.91%. The highest rates of 30-day in-hospital deaths occurred in the elderly and the lowest in children. CONCLUSION: Although in-hospital mortality from burns has decreased in recent years, if the recent upward trend in hospital admissions is genuine, it will have resource implications for regional burns units, and also suggests the need for a renewed emphasis on primary prevention. Observed inequalities with respect to age, gender, deprivation, ethnicity, and urban-rural status provide a rational basis for targeting primary prevention initiatives.

Patient-reported outcomes post axillary block dissections for skin cancer.

BACKGROUND AND AIM: There are limited studies that look at morbidities in patients who have undergone axillary lymph node dissection (ALND) for skin cancer. To date, there has been no study examining the functional status of the upper limb postoperatively. This study studies the disability in upper limb function of patients postoperatively and looks for factors that influence this. METHODS: Twenty-five patients who have undergone level I-III ALND were interviewed using the Disability of Arm, Shoulder and Hand (DASH) and European Quality of Life (EuroQol) questionnaires to determine their upper limb functional status and overall quality of life. These data were then compared with epidemiological and surgical factors collected from the patients' notes retrospectively to look for influencing factors. RESULTS: The majority of patients had low disability scores, with only 12% of patients having a score of 40 and above (out of 100). Age of patient, seniority of operator, surgery on the same side of hand dominance, seroma formation and physiotherapy had no significant effect on DASH scores. A higher DASH score was associated with the patients viewing themselves as 'less healthy'. CONCLUSION: ALND for cutaneous skin cancers does not result in a significant increase in upper limb disability in the majority of patients.

Tessier no. 7 cleft: a new subclassification and management protocol.

BACKGROUND: Tessier described rare craniofacial clefts anatomically. The no. 7 cleft is a lateral facial cleft consisting of macrostomia, lateral facial muscular diastasis, and bony abnormalities of the maxilla and zygoma. Early computed tomographic imaging provided preliminary insight into the bony abnormality. This article reviews this patient group, defining the clinical and radiological features, to advise optimal protocol management. METHODS: A retrospective case-note review of 15 patients with Tessier no. 7 clefts managed by the Australian Craniofacial Unit over the past 25 years was performed. Cases of hemifacial microsomia and Treacher-Collins syndrome were excluded. Clinical features of the patient group were analyzed with photography (all clefts) and imaging (seven clefts). Surgical management and outcome are reviewed. RESULTS: Fifteen patients and 18 clefts (three bilateral) were treated during the time period of the study. All patients had macrostomia (mean length, 2 cm) and 94 percent had soft-tissue ridging from muscular diastasis directed toward the tragus (44 percent), temporal area (28 percent), or lateral canthus (22 percent). Bony abnormalities included simple clefting of the maxillary molar region in 55 percent, maxillary duplication in 39 percent, and intermaxillary fusion in 6 percent. Surgical intervention included macrostomia repair at the first available opportunity, resection of maxillary duplication (median age, 4 years), and alveolar bone grafting to the cleft (median age, 10 years). Optimal follow-up of these patients is impaired because of long distances required for review. Patients treated with this management protocol have had good functional and aesthetic results to date. CONCLUSIONS: This article describes the Tessier no. 7 cleft in great detail and suggests a new subclassification of the bony abnormality. An adjusted management protocol is proposed to address the bony abnormalities of cleft and duplication, with favorable outcomes for treated patients with this condition.

Free flap neovascularization: myth or reality?

The blood supply of 17 free flaps was studied several months after surgery. The aim was to see whether or not the free flaps acquired blood flow through vessels across the flap inset independently of the main vascular anastomoses. A color Doppler flowmeter was used to identify the original arterial and venous anastomoses, the vessels in the margin of the flap, and also across the flap inset. The main vascular pedicle was then manually compressed for 2 min and blood flow was again examined in the vessels at the margin of the flap. The flap vessels (post-anastomotic), the anastomoses, and the recipient vessels (pre-anastomotic) could be identified in every case. There was no evidence of anastomotic stenosis. No vessels (neo-vascularization) greater than 0.5 mm could be identified across the flap inset. Small arteries could be identified in the flap near the inset. These vessels emptied completely on manual compression of the vascular pedicle for 2 min and did not refill until the compression was released. This evidence suggests that the free flaps do not receive significant blood flow through vessels across the flap inset, and are therefore significantly dependent for vascularity on the original anastomoses even 1 year after surgery.