RESUMEN

OBJECTIVE: Low back pain is the leading cause of worldwide disability, with lumbosacral radiculopathy accounting for over one-third of these cases. There are limited data on the relationship between etiologies and lumbosacral radiculopathy, and it is unknown whether specific causes predict treatment outcomes. DESIGN, SETTING, AND SUBJECTS: This study explores patient-reported etiologies for lumbosacral radiculopathy in a chronic pain clinic between January 2007 and December 2015 and examines whether these causes affected epidural steroid injection outcomes. METHODS: We reviewed the medical records of 1,242 patients with lumbosacral radiculopathy who received epidural steroid injections. The recording of an inciting event was done contemporaneously based on note templates. A positive outcome following an epidural steroid injection was defined as ≥30% pain relief sustained for six or more weeks without additional intervention. Factors associated with epidural steroid injection outcome were analyzed by multivariable logistic regression. RESULTS: Fifty point seven percent reported an inciting event, and 59.9% of patients experienced a positive epidural steroid injection outcome. The most commonly reported causes were falls (13.1%), motor vehicle collisions (10.7%), and lifting (7.8%). Individuals with a herniated disc (56.3%) were more likely to report a precipitating cause than those with stenosis (44.7%) or degenerative discs (47.8%, P = 0.012). An inciting event did not predict treatment outcome. Factors associated with negative treatment outcome included opioid consumption (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.39-0.95, P = 0.027), secondary gain (OR = 0.69, 95% CI = 0.50-0.96, P = 0.030), and baseline pain score (OR = 0.90, 95% CI = 0.84-0.97, P = 0.006). The number of levels injected was associated with a positive outcome (OR = 2.72, 95% CI = 1.28-6.47, P = 0.008). CONCLUSIONS: Reported inciting events are common in patients with lumbosacral radiculopathy but are not associated with outcome following epidural steroid injection, and their occurrence is not always consistent with the purported mechanism of injury.

Asunto(s)

Analgésicos Opioides/uso terapéutico , Glucocorticoides/uso terapéutico , Dolor de la Región Lumbar/tratamiento farmacológico , Vértebras Lumbares , Radiculopatía/tratamiento farmacológico , Sacro , Accidentes por Caídas , Accidentes de Tránsito , Adulto , Anciano , Dexametasona/uso terapéutico , Femenino , Humanos , Inyecciones Epidurales , Degeneración del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/complicaciones , Elevación , Modelos Logísticos , Dolor de la Región Lumbar/etiología , Región Lumbosacra , Masculino , Acetato de Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Dimensión del Dolor , Pronóstico , Radiculopatía/etiología , Estenosis Espinal/complicaciones , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit. DESIGN: Prospective cohort quality improvement project. SETTING: Eighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution. PARTICIPANTS: Patients admitted to ACIR between December 2015-November 2016 (N=788). INTERVENTIONS: An interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project. MAIN OUTCOME MEASURES: (1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge. RESULTS: The adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P<.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P<.001). CONCLUSIONS: Implementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids.

Asunto(s)

Analgésicos Opioides/administración & dosificación , Sobredosis de Droga/prevención & control , Pacientes Internos , Trastornos Relacionados con Opioides/prevención & control , Centros de Rehabilitación , Conducta de Reducción del Riesgo , Femenino , Humanos , Capacitación en Servicio , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Naloxona/administración & dosificación , Antagonistas de Narcóticos/administración & dosificación , Educación del Paciente como Asunto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Prospectivos , Mejoramiento de la Calidad

RESUMEN

OBJECTIVE: The study aimed to determine the basic histomorphologic effects of Bacillus clausii (B. clausii) spores in enteropathogenic Escherichia coli (E. coli) O127:H21-infected mice by evaluating the spleen, mesenteric lymph nodes, and intestinal mucosa. METHODS: The study involved 46 apparently healthy Balb/c mice (Mus musculus) which were acclimatized for 19 days prior to any intervention. Sixteen mice were used to determine the sublethal dose of E. coli, which was performed by administering serially-diluted solutions and subsequent generation of a standard curve. From the remaining 30 mice, ten served as normal controls while the remaining 20 were randomized to receive either B. clausii or placebo of sterile water for a week. All mice were then challenged with E. coli for another week and euthanized, and the spleen, mesenteric lymph nodes, and small intestine harvested and examined microscopically. All study personnel were blinded of the treatment assignments. RESULTS: Histologic evaluation of the small intestine in E. coli only-fed mice exhibited prominent attachment effacement lesions, with severely denuded mucosa, lymphocytic infiltration, and debris in the intestinal lumen. However, mice given B. clausii prior to E. coli infection displayed only minimal mucosal damage with less sloughing of villus tips, plus increased mucus-secreting goblet cells. In the spleen, E. coli only-fed mice showed moderate to severe lymphoid hyperplasia with blurred boundaries between red and white pulp. In contrast, mice which received B. clausii prior to E. coli infection had only mild degrees of lymphoid hyperplasia. Similar findings were seen in the mesenteric lymph nodes where E. coli only-fed mice showed moderate to severe lymphoid hyperplasia while those given B. clausii prior to E. coli infection merely had mild lymphoid hyperplasia. CONCLUSION: B. clausii exerts a potential protective and immunomodulatory action in E. coli O127:H21-infected mice based on histomorphologic effects. However, additional studies are needed to fully characterize these mechanisms.mice based on histomorphologic effects. 

Asunto(s)

Animales , Escherichia coli Enteropatógena , Células Caliciformes , Ratones Endogámicos BALB C , Bazo , Bacillus clausii , Hiperplasia , Infecciones por Escherichia coli , Mucosa Intestinal , Ganglios Linfáticos

RESUMEN

OBJECTIVE: We present a case of osteomesopyknosis, a nonmalignant sclerosing bone dysplasia of the axial skeleton, with unknown etiology and unknown prevalence. METHODS: We studied a 49-year-old female who suffered from back and pelvic pain. Her history was obtained, a physical examination performed, and the laboratory results and imaging diagnostics were studied to describe her disease. RESULTS: A 49-year-old, perimenopausal female suffered excruciating, intermittent, dull back and pelvic pain for 1.5 years. Nonmalignant blastic bone lesions along her spine and pelvis were discovered on computed tomography (CT) and confirmed by magnetic resonance imaging (MRI) and bone scans. Other metabolic/endocrine conditions were ruled out. Her son also has similar symptoms, and corresponding changes were observed on his vertebrae MRI. Both were diagnosed with osteomesopyknosis. CONCLUSION: Osteomesopyknosis is a rare, autosomal dominant condition characterized by nonmalignant osteosclerosis restricted to the axial skeleton. The disease may produce chronic low-grade back pain in the thoracic and lumbar regions.