scholarly journals A Rare Case of Burkholderia cepacia Complex Septic Arthritis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
John Koo ◽  
Gregory D. Deans
Keyword(s):  
Synovial Fluid ◽  
Septic Arthritis ◽  
Burkholderia Cepacia ◽  
Penetrating Trauma ◽  
Calcium Pyrophosphate ◽  
Opioid Use Disorder ◽  
Burkholderia Cepacia Complex ◽  
Opioid Use ◽  
Irrigation And Debridement ◽  
History Of

Bacteria of the Burkholderia cepacia complex have rarely been reported to cause septic arthritis. Cases have been reported in patients who were immunocompromised, at extremes of age or who had history of steroid injection or penetrating trauma. A 67-year-old man with a history of opioid use disorder, osteoarthritis, and gout but no known immunocompromise was admitted to hospital with pain and swelling of his right knee. Cultures of synovial fluid and urine grew Burkholderia cepacia complex. Microscopy of synovial fluid also identified intracellular calcium pyrophosphate crystals. The patient’s symptoms improved with joint irrigation and debridement and prolonged antimicrobial therapy. This case highlights the importance of diagnostic aspiration of an acutely inflamed joint to obtain a specific etiological diagnosis.

Demographic characteristics, medical and psychiatric history of patients with prescription opioid use disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S300-S301
Author(s):  
S. Herrera ◽  
A. Riquelme ◽  
T. León ◽  
M. Babul
Keyword(s):  
Opioid Analgesics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Demographic Characteristics ◽  
Prescription Opioid ◽  
Psychiatric History ◽  
Opioid Use ◽  
History Of ◽  
Competing Interest ◽  
Prescription Opioid Misuse

IntroductionOver the past two decades the prescription of opioid analgesics has increased with a subsequent escalating in prescription opioid misuse. It is estimated that 4.5 million (2.5%) of the United States of America population abuse of pain relievers; opioids are among the most commonly.In Chile there are few reports about the prevalence of opioid use disorder.ObjectivesThe aim of this study is to describe the demographic characteristics, medical and psychiatric comorbidity of patients that suffer from opioid addiction.Patients and methodsThis transversal study examined data of 7 patients with opioid use disorder (OUD; DSM-5) that consulted at the addiction unit of “Red de Salud, Pontificia Universidad Católica de Chile”, between November 2013 and October 2015. Data included: demographics, medical and psychiatric history, laboratory and imaging tests.ResultsOf all the patients, 57% were men, 25 to 67 years of age, 43% between 35-40 years; 57% were married; 57% had completed studies at university. 43% had also alcohol use disorder, 28% marijuana, 28% cocaine and 28% benzodiazepines than in most cases began before OUD. In addition; 57% had medical comorbidity among which stand out obesity (17%), osteoarthritis (17%) and chronic low back pain (17%). Eighty-three percent require hospitalization. Twenty-eight percent had abnormal liver tests and one patient had positive hepatitis B core antibody. Opioids used were: morphine(14%), codeine (43%), tramadol (42%).ConclusionThese results emphasize on the misuse of prescription opioids analgesics, the complexity of patients with OUD and the prevalence of other substance use disorder that precedes and accompany OUD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Kratom Use Within the Context of the Evolving Opioid Crisis and the COVID-19 Pandemic in the United States

2021 ◽  
Vol 12 ◽  
Author(s):  
Walter C. Prozialeck ◽  
Peter C. Lamar ◽  
Michael Krupp ◽  
Matthew Moon ◽  
Laura E. Phelps ◽  
...  
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Southeast Asia ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Potential Harm ◽  
History Of ◽  
Chronic Pain Conditions

Kratom (Mitragyna speciosa, Korth.) is an evergreen tree that is indigenous to Southeast Asia. When ingested, kratom leaves or decoctions from the leaves have been reported to produce complex stimulant and opioid-like effects. For generations, native populations in Southeast Asia have used kratom products to stave off fatigue, improve mood, alleviate pain and manage symptoms of opioid withdrawal. Despite the long history of kratom use in Asia, it is only within the past 10–20 years that kratom has emerged as an important herbal agent in the United States, where it is being used for the self-treatment of pain, opioid withdrawal symptoms, and mood disorders. The increase in the use of kratom in the United States has coincided with the serious epidemic of opioid abuse and dependence. Since 2015, efforts to restrict access to prescription opioids have resulted in a marked increase in the use of “street” opioids such as heroin and illicit fentanyl. At the same time, many patients with chronic pain conditions or opioid use disorder have been denied access to appropriate medical help. The lack of access to care for patients with chronic pain and opioid use disorder has been magnified by the emergence of the COVID-19 pandemic. In this report, we highlight how these converging factors have led to a surge in interest in kratom as a potential harm reduction agent in the treatment of pain and opioid use disorder.

scholarly journals Chronic Corynebacterium striatum Septic Arthritis in a Patient Referred for Total Knee Arthroplasty

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Katharine Hollnagel ◽  
Jacob Willen ◽  
Michael Ellis ◽  
Yalda Soleimanifard ◽  
Robert Booth ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Septic Arthritis ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Irrigation And Debridement ◽  
Plain Films ◽  
Corynebacterium Striatum ◽  
Multiple Cultures ◽  
History Of ◽  
Total Knee

Background. While Corynebacterium striatum and other Corynebacterium species were historically considered contaminants, they are recently being identified as pathogens with increasing frequency. Case Summary. We report the case of a 78-year-old gentleman with a three-year history of knee pain and established diagnosis of osteoarthritis referred for consideration for total knee arthroplasty. He had no knee pain with passive range-of-motion. Plain films demonstrated bony erosions atypical for osteoarthritis. Joint aspiration white blood cell count was 30,548/mm3, but multiple cultures were positive for C. striatum. The infection was successfully treated with open irrigation and debridement, complete synovectomy, and six weeks of intravenous daptomycin. Conclusion. To our knowledge, this is the first report of chronic C. striatum septic arthritis of a native joint and only the third case of C. striatum septic arthritis of the knee.

Patients With Opioid Use Disorder Have Increased Readmission Rates, Emergency Room Visits, and Costs Following a Hallux Valgus Procedure

2020 ◽  
pp. 193864002095010
Author(s):  
James M. Parrish ◽  
Rushabh M. Vakharia ◽  
Dillon C. Benson ◽  
Aaron K. Hoyt ◽  
Nathaniel W. Jenkins ◽  
...  
Keyword(s):  
Emergency Room ◽  
Hallux Valgus ◽  
Opioid Use Disorder ◽  
P Value ◽  
Administrative Claims ◽  
Opioid Use ◽  
Readmission Rates ◽  
Episode Of Care ◽  
History Of ◽  
Care Costs

Background Patients with a history of opioid use disorder (OUD) tend to have more complications, higher readmission rates, and increased costs following orthopaedic procedures. This study evaluated patients undergoing hallux valgus correction for their odds of increased (1) readmission rates, (2) emergency room (ER) visits, and (3) costs. Methods Patients undergoing hallux valgus corrections with OUD history were identified using a national Medicare administrative claims database of approximately 24 million orthopaedic surgery patients. OUD patients were matched to non–opioid use disorder (NUD) patients in a 1:4 ratio by age, sex, Elixhauser-Comorbidity Index (ECI), diabetes mellitus, hyperlipidemia, hypertension, and tobacco use. The query yielded 6318 patients (OUD = 1276; NUD = 5042) who underwent a hallux valgus correction. Primary outcomes analyzed included odds of 90-day readmission rates, 30-day ER visits, and 90-day episode-of-care costs. Demographics, odds ratios (ORs), ECI, and cost were assessed as appropriate using a Pearson χ2 test, logistic regression, and a t test. A P value <.05 was considered statistically significant. Results There were no significant differences in demographics between OUD and NUD patients. OUD patients had higher incidence and odds of 90-day readmission (9.56% vs 6.04%; OR = 1.55; P < .001) and 30-day ER visits (0.86% vs 0.35%; OR = 2.42; P = .021) and incurred greater 90-day episode-of-care costs ($7208.28 vs $6134.75; P < .001) compared with NUD patient controls. Conclusion The study demonstrates the possible influence of OUD on higher odds of readmission, ER visits, and costs following a hallux valgus correction. Levels of Evidence Level III: Retrospective cohort study

scholarly journals Alternatives to Arrest for Illicit Opioid Use: A Joint Criminal Justice and Healthcare Treatment Collaboration

2020 ◽  
Vol 14 ◽  
pp. 117822182095339
Author(s):  
Andrea J Yatsco ◽  
Rachel D Garza ◽  
Tiffany Champagne-Langabeer ◽  
James R Langabeer
Keyword(s):  
Public Health ◽  
Criminal Justice ◽  
Law Enforcement ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Health Crisis ◽  
Public Health Crisis ◽  
The Us ◽  
History Of ◽  
Illicit Opioid Use

Opioid overdoses continue to be a leading cause of death in the US. This public health crisis warrants innovative responses to help prevent fatal overdose. There is continued advocacy for collaborations between public health partners to create joint responses. The high correlation between persons with opioid use disorder who have a history of involvement in the criminal justice system is widely recognized, and allows for treatment intervention opportunities. Law enforcement-led treatment initiatives are still relatively new, with a few sparse early programs emerging almost a decade ago and only gaining popularity in the past few years. A lack of published methodologies creates a gap in the knowledge of applied programs that are effective and can be duplicated. This article seeks to outline an interagency relationship between police and healthcare that illustrates arrest is not the only option that law enforcement may utilize when encountering persons who use illicit substances. Program methods of a joint initiative between law enforcement and healthcare in a large, metropolitan area will be reviewed, supplemented with law enforcement overdose data and statistics on law enforcement treatment referrals.

Rating Opioid Use Disorder for Permanent Impairment

2020 ◽  
Vol 25 (1) ◽  
pp. 3-11
Author(s):  
James B. Talmage
Keyword(s):  
Treatment Compliance ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Extensive Literature ◽  
Opioid Use ◽  
Work Injury ◽  
Sixth Edition ◽  
Diagnostic And Statistical Manual ◽  
History Of

Abstract The duration of opioid therapy after surgery is the strongest known predictor of ultimate misuse, and researchers have reported that the number of days for which medication was prescribed and the total number of postoperative prescriptions each predicts long-term use. This article addresses the question of rating the impairment for an individual with no history of substance use disorder before a work injury, who is prescribed opioids for this injury, and who subsequently develops opioid use disorder (OUD). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, should be used in conjunction with the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Sixth Edition. A person who is prescribed opioids is not yet at maximum medical improvement (MMI) and cannot be rated. Referral for substantiation of the diagnosis and for initiation of treatment are necessary before OUD is confirmed and the patient is at MMI. The AMA Guides is based on impairments of activities of daily living (ADL), so a patient's MMI should result in a happy outcome and no impairment, although the burden of treatment compliance may be a relevant consideration. The article concludes with an extensive literature review, including abstracts of published articles regarding OUD in various settings.

A history of opioid abuse: Why buprenorphine is superior for the management of opioid use disorder and pain

2021 ◽  
Vol 17 (7) ◽  
pp. 43-50
Author(s):  
Michael D. Komrowski, MS ◽  
Nitin K. Sekhri, MD
Keyword(s):  
Public Health ◽  
Opioid Use Disorder ◽  
Opioid Abuse ◽  
Common Side Effect ◽  
Opioid Use ◽  
Health Crisis ◽  
Public Health Crisis ◽  
History Of ◽  
Opioid Medications ◽  
Regulatory Economic

Opioid abuse represents a public health crisis that has significant associated morbidity and mortality. Since beginning in the early 1990’s, the opioid abuse epidemic has been difficult to control due to regulatory, economic, and psychosocial factors that have perpetuated its existence. This era of opioid abuse has been punctuated by three distinct rises in mortality, precipitated by unique public health problems that needed to be addressed. Patients affected by opioid abuse have been historically treated with either methadone or naltrexone. While these agents have clinical utility supported by robust literature, we the authors posit that buprenorphine is a superior therapy for both opioid use disorder (OUD) as well as pain. This primacy is due to the pharmacological properties of buprenorphine which render it unique among other opioid medications. One such property is buprenorphine’s ceiling effect of respiratory depression, a common side effect and complicating factor in the administration of many classical opioid medications. This profile renders buprenorphine safer, while simultaneously retaining therapeutic utility in the medical practitioner’s pharmacopeia for the treatment of opioid use disorder and pain.

Current practices in naloxone prescribing upon hospital discharge

2019 ◽  
Vol 15 (5) ◽  
pp. 357-361
Author(s):  
Michelle Punzal, MD ◽  
Patricia Santos, MD, MBA ◽  
Xiaoshu Li, PhD ◽  
Douglas R. Oyler, PharmD ◽  
Alan M. Hall, MD
Keyword(s):  
Patient Education ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Academic Medical ◽  
Control And Prevention ◽  
Risk Patients ◽  
History Of ◽  
Current Practices

Objective: To evaluate current practices in naloxone prescribing upon hospital discharge.Design: Electronic cross-sectional survey.Setting: Academic medical center.Participants: Inpatient physicians and advanced practice providers.Main outcome measures: Respondents completed survey items including current naloxone prescribing practices, barriers to naloxone prescribing, and methods to improve naloxone prescribing.Results: The survey response rate was 51.6 percent. Greater than 90 percent of respondents agreed that naloxone should be prescribed for patients with an active opioid use disorder, history of overdose, and use of greater than 50 morphine milligram equivalents per day. Lack of patient education on proper use of naloxone was the most identified barrier to prescribing.Conclusions: Providers agree with the Centers for Disease Control and Prevention recommendations to prescribe naloxone to high-risk patients. Certain barriers affect the rate of naloxone prescribing at discharge, including lack of time, patient education, provider training, and concern for increasing riskier behaviors.

scholarly journals Use of methamphetamine and alcohol among people with opioid use disorder and HIV in Vietnam: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrew Edsall ◽  
Kim A. Hoffman ◽  
Dinh Thanh Thuy ◽  
Pham Phuong Mai ◽  
Nguyen Thu Hang ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Social Life ◽  
Hiv Transmission ◽  
Qualitative Interviews ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Heroin Use ◽  
Methamphetamine Use ◽  
Polysubstance Use ◽  
History Of

Abstract Background Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam. Methods We conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants’ experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach. Results Of 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV. Conclusions Participant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally. Trial registration BRAVO - NCT01936857, September 2013.

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