Levorphanol as a Second Line Opioid in Cancer Patients Presenting to an Outpatient Supportive Care Center: An Open-label Study.

CONTEXT: Levorphanol is a potent opioid agonist and NMDA receptor blocker with minimal drug interactions, and there are few reports of its use in cancer patients. OBJECTIVES: We aimed to determine the frequency of successful opioid rotation (OR) to levorphanol and the median opioid rotation ratio (ORR) from Morphine Equivalent Daily Dose (MEDD). METHODS: This is a prospective, single-group, interventional study. Cancer outpatients requiring an OR and receiving a MEDD of 60-300 mg were rotated to levorphanol using a ratio of 10:1 and assessed daily for 10-day. Successful OR was defined as a 2-point improvement in the Edmonton Symptom Assessment System (ESAS) pain score on day 10 or achieving the personalized pain goal between days 3-10 in patients with uncontrolled pain or resolution of opioid side effects (OSE) in those undergoing OR for OSE alone. The ORR to levorphanol was calculated using net-MEDD (MEDD before OR minus the MEDD of the breakthrough opioid used along with levorphanol after OR). RESULTS: Forty patients underwent OR to levorphanol, and uncontrolled pain 35/40 (87.5%) was the most common indication. The median net-MEDD and levorphanol doses were 95 and 10 mg, respectively, and 33/40 (82.5%) had a successful OR with a median (IQR) ORR of 8.56 (7.5-10). Successful OR was associated with significant improvement in ESAS and OSE scale scores. There was a strong association between MEDD and levorphanol dose. CONCLUSION: This study provided preliminary data that cancer patients could be successfully rotated to levorphanol using an ORR of 8.5. Levorphanol was associated with improved pain and symptom control and was well- tolerated.

In-home cannabis smoking more prevalent than in-home tobacco smoking among 2019 Global Drug Survey respondents.

PURPOSE OF THE RESEARCH: Early evidence from studies of home smoking policies suggests that in-home cannabis smoking is more often allowed than in-home tobacco smoking, but there are not yet data on whether cannabis is more often smoked in the home compared to tobacco, or whether in-home cannabis and tobacco smoking differs by usage status. Using cross-sectional data from over 100,000 sentinel drug users from 17 countries, we compared cannabis and tobacco smoking in the homes of Global Drug Survey 2019 respondents who currently used cannabis only, tobacco only, both tobacco and cannabis, or neither. PRINCIPAL RESULTS: Complete data on cannabis and tobacco use and in-home smoking were available for 107,272 adults (average age = 30 ± 12, 34% women, countries with the three highest response rates; Germany = 32%, USA = 10%, New Zealand = 9%). In total, 53.6% and 50.6% of respondents reported past-year cannabis and tobacco smoking in their home respectively. Stratifying respondents into current cannabis-only users, tobacco-only users, dual users, and non-users, past-year in-home cannabis smoking was more prevalent (78.8%) among cannabis-only users than was in-home tobacco smoking (67.9%) among tobacco-only users. Among dual users, past-year in-home cannabis smoking (82.8%; 95%CI = 80%-86%) was higher than in-home tobacco smoking (75.9%; 95%CI = 69%-81%; p < 0.001). In-home cannabis and tobacco smoking was similar among non-users (20.2% and 20.5%, respectively). MAJOR CONCLUSIONS: Past-year in-home cannabis smoking was more prevalent than tobacco smoking in the homes of participants who used cannabis and/or tobacco, supporting our speculation that in-home cannabis smoking might be more socially acceptable than in-home tobacco smoking.

Cannabis use, sedentary behavior, and physical activity in a nationally representative sample of US adults.

BACKGROUND: Prior research examining the relationship between cannabis use, sedentary behavior, and physical activity has generated conflicting findings, potentially due to biases in the self-reported measures used to assess physical activity. This study aimed to more precisely explore the relationship between cannabis use and sedentary behavior/physical activity using objective measures. METHODS: Data were obtained from the 2005-2006 National Health and Nutrition Examination Survey. A total of 2,092 participants (ages 20-59; 48.8% female) had accelerometer-measured sedentary behavior, light physical activity, and moderate-to-vigorous physical activity. Participants were classified as light, moderate, frequent, or non-current cannabis users depending on how often they used cannabis in the previous 30 days. Multivariable linear regression estimated minutes in sedentary behavior/physical activity by cannabis use status. Logistic regression modeled self-reported moderate-to-vigorous physical activity in relation to current cannabis use. RESULTS: Fully adjusted regression models indicated that current cannabis users' accelerometer-measured sedentary behavior did not significantly differ from non-current users. Frequent cannabis users engaged in more physical activity than non-current users. Light cannabis users had greater odds of self-reporting physical activity compared to non-current users. CONCLUSIONS: This study is the first to evaluate the relationship between cannabis use and accelerometer-measured sedentary behavior and physical activity. Such objective measures should be used in other cohorts to replicate our findings that cannabis use is associated with greater physical activity and not associated with sedentary behavior in order to fully assess the potential public health impact of increases in cannabis use.

Short Physical Performance Battery and Incident Cardiovascular Events Among Older Women.

Background The Short Physical Performance Battery (SPPB) is an inexpensive, reliable, and easy-to-implement measure of lower-extremity physical function. Strong evidence links SPPB scores with all-cause mortality, but little is known about its relationship with incident cardiovascular disease (CVD). Methods and Results Women (n=5043, mean age=79±7) with no history of myocardial infarction or stroke completed 3 timed assessments-standing balance, strength (5 chair stands), and usual gait speed (4 m walk)-yielding an SPPB score from 0 (worst) to 12 (best). Women were followed for CVD events (myocardial infarction, stroke, or CVD death) up to 6 years. Hazard ratios were estimated for women with Very Low (0-3), Low (4-6), Moderate (7-9), and High (10-12) SPPB scores using Cox proportional hazard models adjusted for demographic, behavioral, and health-related variables including objective measurements of physical activity, blood pressure, lipids, and glucose levels. Restricted cubic splines tested linearity of associations. With 361 CVD cases, crude incidence rates/1000 person-years were 41.0, 24.3, 16.1, and 8.6 for Very Low, Low, Moderate, and High SPPB categories, respectively. Corresponding fully adjusted hazard ratios (95% CIs) were 2.28 (1.50-3.48), 1.70 (1.23-2.36) 1.49 (1.12-1.98), and 1.00 (referent); P-trend <0.001. The dose-response relationship was linear (linear P<0.001; nonlinear P>0.38). Conclusions Results suggest SPPB may provide a measure of cardiovascular health in older adults beyond that captured by traditional risk factors. Because of its high test-retest reliability and low administrative burden, the SPPB should be a routine part of office-based CVD risk assessment.

Tratamiento quirúrgico con clavo intramedular elástico estable en fracturas diafisiarias del antebrazo en niños / Treatment of forearm shaft fractures in children by elastic stable intramedullary nail

Objetivo: Evaluar los resultados del tratamiento quirúrgico de las fracturas diafisiarias del radio y/o cubito mediante la colocación intramedular de clavos Kirschner moldeados en pacientes pediátricos. Material y métodos: Estudio descriptivo observacional de pacientes tratados con clavo intramedular en fracturas diafisiarias de antebrazo en elHospital Nacional Cayetano Heredia û Lima. Se usaron clavos Kirschner moldeado de acuerdo a especificaciones del clavo ESIN y se evaluaron la técnica operatoria, tiempo de consolidación, complicaciones y funcionalidad. Resultados: Se incluyeron 12 pacientes, 10 de sexo masculino, con edad promedio de 13.7 años (11 a 15 años), se encontró evidencia de consolidación a las seis semanas y el tiempo operatorio promedio fue de 75 minutos. Un paciente presentó parestesias del nervio cubital que remitió a los 4 meses, la perdida sanguínea fue mínima con un abordaje minimamente invasivo. Todas las fracturas consolidaron. Conclusión: El uso de clavo Kirschner moldeado es una alternativa de tratamiento en este tipo de fracturas debido a su bajo costo, y resultados comparables con el ESIN que es el tratamiento de elección.

Objective: To evaluate the surgical treatment of radius or ulna shaft fractures by molded intramedullary Kirschner wire in paediatric patients. Material and methods: Descriptive observational study of patients treated with intramedullary nailing of forearm diaphyeal fractures al the Hospital Nacional Cayetano Heredia. We used Kirschner wires molded acording to ESIN specifications, evaluating the surgical technique, time of consolidation, complications, and functional results. Results: We evaluated 12 patients, 10 male and 2 females, with average age of 13.7 years and evidence of consolidation in six weeks. Operative time averaged 75 minutes. One patient presented ulnar nerve paresthesias that improved in four months, little blood less with a minimally invasive approach, 78 per cent of all fractures healed with good functional outcome. Conclusion: The use of Kirshner molding wires is an alternative treatment in this type of fractures due its low cost and results comparables with the ESIN that is the treatment of choice.

Influencia del fenómeno de El Niño en la epidemiología de la bartonelosis humana en los departamentos de Ancash y Cusco entre 1996 y 1999 / Influence of El Niño phenomenon in the epidemiology of human bartonellosis in the Departments of Ancash and Cusco between 1996 and 1999

Objetivo: Determinar la influencia de factores climáticos y del fenómeno El Niño 1997 - 1998 en la epidemiología de la bartonelosis en Ancash y Cusco, Perú. Materiales y métodos: Se Desarrolló un estudio ecológico. Se obtuvo información mensual climática de Urubamba y Carhuaz del SENAMHI, así como reporte de casos mensuales confirmados de la OGE, entre 1996 y 1999. Resultados: en los departamentos de Ancash y Cusco los coeficientes de correlación para los parámetros ambientales locales (temperatura máxima, media y mínima mensual, y precipitación total) no fueron estadísticamente singificativos, mientras que la Temperatura Superficial de Mar fue el mejor parámetro que correlacionó con la tasa de incidencia de la bartonelosis, tanto a nivel local como regional. La tasa de incidencia de bartonelosis fue estadísticamente superior durante El Niño 1997 - 1998 en Ancash y Cusco, de manera simultanea. Conclusiones: Los incrementos significativos en la tasa de incidencia de bartonelosis durante El Niño en departamentos tan distantes como Ancash y Cusco de manera simultanea, evidencian que los factores climatológicos y el fenómeno El Niño modifican la epidemiología de la Bartonelosis humana.

SARS: Síndrome Respiratorio Agudo Grave. Información básica para la vigilancia epidemiológica / SARS: Severe Acute Respiratory Syndrome. Basic information for the epidemiological surveillance

La presente publicación describe los principales aspectos históricos, epidemiológicos, clínicos, terapéuticosy medidas de control y prevención de esta nueva enfermedad conocida como SRAS (Síndrome Respiratorio AgudoSevero), que se ha considerado como la primera enfermedad infecciosa de origen viral epidémica del siglo XXI afectando principalmente áreas de China, incluyendo Taiwán y Hong Kong, así como Vietnam, Singapur y Canadá(Toronto). El agente viral causante de esta enfermedad es un nuevo coronavirus. El tratamiento más efectivo aun no ha sido definido(AU)

SARS: Síndrome Respiratorio Agudo Grave. Información básica para la vigilancia epidemiológica / SARS: Severe Acute Respiratory Syndrome. Basic information for the epidemiological surveillance

La presente publicación describe los principales aspectos históricos, epidemiológicos, clínicos, terapéuticosy medidas de control y prevención de esta nueva enfermedad conocida como SRAS (Síndrome Respiratorio AgudoSevero), que se ha considerado como la primera enfermedad infecciosa de origen viral epidémica del siglo XXI afectando principalmente áreas de China, incluyendo Taiwán y Hong Kong, así como Vietnam, Singapur y Canadá(Toronto). El agente viral causante de esta enfermedad es un nuevo coronavirus. El tratamiento más efectivo aun no ha sido definido

Sindrome Respiratorio Agudo Grave - SARS / Serious acute respiratory syndrome - SARS

El presente documento contiene: Introducción, información general sobre SARS, recomendaciones sobre los casos sospechosos identificados en vuelo, medidas de control de infecciones, recomendaciones en el transporte de pacientes SARS, consideraciones para el alta de los pacientes SARS, estabilidad y resistencia del coronavirus SARS.

Sindrome Respiratorio Agudo Grave - SARS / Serious acute respiratory syndrome - SARS

El presente documento contiene: Introducción, información general sobre SARS, recomendaciones sobre los casos sospechosos identificados en vuelo, medidas de control de infecciones, recomendaciones en el transporte de pacientes SARS, consideraciones para el alta de los pacientes SARS, estabilidad y resistencia del coronavirus SARS. (AU)

Seroprevalencia de leptospirosis en humanos y reservorios en la localidad de Koribeni. La Convención, Cusco / Seroprevalence of leptospirosis in humans and reservoirs in the locality of Koribeni. The convention, Cusco

Del 5 al 16 de julio de 1998 personal del Ministerio de Salud (MINSA) viajó a la comunidad de Koribeni (Echerate - Cusco) a fin de determinar la seroprevalencia de infección por leptospira en humanos y animales (domésticos y silvestres). Conocer la magnitud del problema, los posibles reservorios y los serovares predominantes. Se tomaron muestras de animales domésticos, peridomésticos y se capturaron ratas y marsupiales. Las muestras se procesaron en el INS mediante aglutinación macroscópica (tamizaje) y aglutinación microscópica (MAT). Para los cultivos se usó el medio Fletcher. De 164 muestras humanas, 41 (25 por ciento) presentaron anticuerpos contra Leptospira interrogans. El serovar prevalente fue Autumnalis (31 por ciento) seguido de Djasiman (11 por ciento), Botaviae (9.25 por ciento) y otros (48.75 por ciento). En 33 muestras de sangre canina, 12 (36.4 por ciento) fueron positivas, el serovar prevalente fue Autumnalis (27.8 por ciento) seguido de Australis (16.6 por ciento) Poma (16.2 por ciento) y otros (39.4 por ciento). Los cultivos (33) fueron negativos (suero y órganos correspondientes a 18 animales entre ratas, cuyes y marsupiales). El género Autumnalis fue prevalente en humanos y canes lo que presupone que puedan ser éstos los reservorios que brinden la infección a los humanos. Llamó la atención la ausencia del serovar canícola en los sueros estudiados. La leptospirosis ha sido considerada dentro de la vigilancia del síndrome icterohemorrágico que el MINSA ha iniciado en Cusco, Huánuco y Ayacucho.