Long-Term Outcomes of Persistent Post-Operative Opioid Use: A Retrospective Cohort Study.

OBJECTIVE: To determine the association between persistent post-operative opioid use and the long-term risk of opioid use disorder and opioid overdose. SUMMARY BACKGROUND DATA: Persistent post-operative opioid use is a commonly used outcome in the surgical literature; its incidence and risk factors have been well described. However, its association to long term outcomes, including opioid use disorder and opioid overdose, is unknown. METHODS: A retrospective cohort study utilizing the Veterans Health Administration corporate data warehouse. Patients undergoing any surgery between January 1st 2008 and December 31st 2018 were included and followed until December 31st 2020. Univariate and multivariate survival analysis were used to determine the association between persistent post-operative opioid use and opioid use disorder and overdose. Sensitivity analyses were conducted to determine the impact of different definitions of persistent opioid use and the effect of pre-operative opioid use. RESULTS: 304,780 patients undergoing surgery were included and followed for a median of 5.56 years (IQR 3.08-8.65). Persistent post-operative opioid use was associated with an increased hazard of developing both opioid use disorder (HR = 1.88, CI: 1.80-1.96, p < 0.001) and overdose (HR = 1.78, CI: 1.67-1.90, p < 0.001). This association remained consistent after adjustment for comorbidities and across all sensitivity analyses. CONCLUSIONS: Surgical patients who develop persistent post-operative opioid use are at increased risk of both opioid use disorder and overdose as compared to surgical patients who do not develop persistent use.

Everything old is new again: a case series of pediatric cutaneous leishmaniasis in Portland, Maine.

Leishmaniasis has varying clinical manifestations and treatment regimens, dependent on species and host. Old world leishmaniasis, found primarily in Africa and Asia, may be associated with visceral disease, while new world disease, primarily in Latin America, may be associated with mucocutaneous disease. We present a case series of pediatric African patients with New World cutaneous leishmaniasis. Data extraction was performed via chart review, of children with cutaneous leishmaniasis presenting to the pediatric infectious diseases clinic in Portland, ME. Biopsy specimens were sent to the federal center for disease control (CDC) for identification via polymerase chain reaction (PCR) and culture. Five cases of cutaneous leishmaniasis were diagnosed in pediatric patients (ages 1-17 years) in Maine during the study period. Leishmaniasis was not initially suspected; thus, time to diagnosis was 1-4 months, Two patients were diagnosed with Leishmania panamensis, one with Leishmania brasiliensis, one with Leishmania sp. and one with mixed infection (L. panamensis and Leishmania mexicana). One patient was managed with surgical excision only, one was observed off therapy, and three were treated with ketoconazole. This case series highlights the importance of a high index of suspicion in migrant patients. Detailed travel history and epidemiologic knowledge is essential to diagnosis, as patients may present with forms of illness not congruent with their country of origin.

Experimental discovery of sRNAs in Vibrio cholerae by direct cloning, 5S/tRNA depletion and parallel sequencing.

Direct cloning and parallel sequencing, an extremely powerful method for microRNA (miRNA) discovery, has not yet been applied to bacterial transcriptomes. Here we present sRNA-Seq, an unbiased method that allows for interrogation of the entire small, non-coding RNA (sRNA) repertoire in any prokaryotic or eukaryotic organism. This method includes a novel treatment that depletes total RNA fractions of highly abundant tRNAs and small subunit rRNA, thereby enriching the starting pool for sRNA transcripts with novel functionality. As a proof-of-principle, we applied sRNA-Seq to the human pathogen Vibrio cholerae. Our results provide information, at unprecedented depth, on the complexity of the sRNA component of a bacterial transcriptome. From 407 039 sequence reads, all 20 known V. cholerae sRNAs, 500 new, putative intergenic sRNAs and 127 putative antisense sRNAs were identified in a limited number of growth conditions examined. In addition, characterization of a subset of the newly identified transcripts led to the identification of a novel sRNA regulator of carbon metabolism. Collectively, these results strongly suggest that the number of sRNAs in bacteria has been greatly underestimated and that future efforts to analyze bacterial transcriptomes will benefit from direct cloning and parallel sequencing experiments aided by 5S/tRNA depletion.