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Pre-exposure Prophylaxis (PrEP) Eligibility and Awareness Among Older Adults with Opioid use Disorder.
No full textClinical factors linked to xylazine exposure in emergency department patients with illicit opioid overdose.
No full textBACKGROUND AND AIMS: Xylazine, an alpha-2 agonist used in veterinary anesthesia, is increasingly detected in the illicit opioid supply but little is known about the patient level factors associated with xylazine in non-fatal opioid overdose. This study aimed to determine the demographic and clinical factors associated with xylazine detection among emergency department (ED) patients with opioid overdose.
DESIGN: Observational study. The Toxicology Investigators Consortium (ToxIC) Fentalog Study is a multicenter, prospective cohort of adult patients with suspected opioid overdose. This analysis included patients enrolled from September 2020 to September 2023.
SETTING: In this multicenter study, participating sites included 10 institutions across 9 states in 4 regions of the United States (US): Northeast, Southeast, Midwest and West.
PARTICIPANTS: Patients were eligible for Fentalog Study inclusion if they were at least 18 years old, had a suspected opioid overdose and had waste blood available for toxicologic analysis. Only patients with qualitative serum detection of illicit opioids and/or xylazine were included in the final cohort. Of 5554 patients screened, 1289 were eligible for Fentalog Study inclusion.
MEASUREMENTS: Based on results of liquid chromatography with a quadrupole time-of-flight mass spectrometer (LCQTOF-MS) and/or liquid chromatography with a triple quadrupole mass spectrometer (LC-QQQ-MS), patients were categorized into those with xylazine detected (positive cases) and without xylazine detected (negative controls). To determine clinical variables associated with xylazine detection, the primary outcome of interest was qualitative detection of xylazine on serum sampling by LCQTOF-MS.
FINDINGS: Xylazine was detected in 238 patients. Patients with xylazine were primarily male (78%), white (48%), non-Hispanic (82%) and located in the Northeast US (75%). Bradycardia on initial ED vital signs was associated with higher likelihood of xylazine detection (adjusted odds ratio = 2.11, 95% confidence interval = 1.06-4.06).
CONCLUSIONS: Xylazine detection among emergency department opioid overdose patients appears to be more prevalent in the Northeast US and bradycardia appears to be a statistically significant clinical predictor
The Use of Acuity Based Tools for Nurse-Patient Assignments on Nursing Satisfaction in Medical-Surgical Units
No full textOcular Morbidity and Visual Outcomes in Rare Craniofacial Clefts: A Contemporary Cohort Study of 102 Cases.
No full textBACKGROUND: Craniofacial clefts are rare congenital anomalies with heterogeneous presentations and significant functional and reconstructive challenges. This study evaluates periorbital pathology, surgical burden, and visual outcomes to inform care strategies for affected patients.
METHODS: A retrospective cohort study was conducted of patients with rare craniofacial clefts. Clefts were categorized into superior periorbital (Tessier 9-11), inferior periorbital (3-6, 8), superior medial (12-14), inferior medial (0-2), and lateral (7).
RESULTS: Among 102 children, mean age at presentation was 2.0±3.8 years with follow-up 9.6±7.5 years. Thirteen (12.7%) had superior periorbital, 32 (31.4%) had inferior periorbital, 22 (21.6%) had superior medial, 35 (34.3%) had inferior medial, and 44 (43.1%) had lateral clefts. Eighty-two (80.4%) had periorbital abnormalities, including surface pathology (n=41, 40.2%), strabismus (n=26, 25.5%), and nasolacrimal duct obstruction (n=25, 23.5%). Sixty-four (63.3%) subjects underwent 484 periorbital procedures. Poor vision was observed in 39 patients (38.2%) and was associated with a higher number of clefts (2.3 vs 1.6, p=0.002). Inferior periorbital (p=0.004), inferior medial (p=0.023), and globe anomalies (p\u3c 0.020), were independent predictors of poor vision. Superior periorbital clefts were associated with ocular surface pathology (p=0.016) but not poor vision after adjusting for confounders.
CONCLUSIONS: Over one-third of patients with rare craniofacial clefts experience vision loss. Contrary to traditional assumptions that superior clefts pose the greatest threat to vision, inferior clefts carry a disproportionately high risk of visual impairment. These findings underscore the need for early, cleft-specific ophthalmologic evaluation, coordinated multidisciplinary care, and immediate protective measures to prevent irreversible vision loss and guide reconstructive planning
Do glucagon-like peptide 1 receptor agonists offer protective effect on colon cancer risk?
No full textPerinatal Outcomes in Individuals With Classic Versus Mosaic Turner Syndrome: A Retrospective Cohort Study
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Opioid Dispensing Trends Among Children and Adolescents Aged ≤ 19 Years in the United States: 2018-2022.
No full textPURPOSE: Since 2019, adolescent overdose deaths have more than doubled, primarily due to illegally-made fentanyl. Prescription opioid misuse during adolescence increases the risk of substance use disorders and overdose. This analysis examines opioid dispensing trends among individuals aged ≤19 years to support safer prescribing practices.
METHODS: We used IQVIA National Prescription Audit New to Brand data (2018-2022), which includes 92% of US retail pharmacy prescriptions dispensed. Annual rates and percentage changes were calculated by sex, age, prescriber specialty, and product type.
RESULTS: From 2018 to 2022, opioid dispensing rates decreased 36% from 46.9 to 30.2 prescriptions per 1,000 youth. Declines were observed across all age groups (0-2 years, 59.2%; 3-9 years, 50.8%; 10-19 years, 34.4%) and dispense rates were similar by sex (males 34.6; females 37.0). Short-acting opioids comprised 99.4% of prescriptions and declined by 42.8%, compared to 27.3% for long-acting formulations. Dentists and surgical subspecialists accounted for the highest proportions of prescribing (34.8% and 23.7%, respectively), while pediatricians accounted for 2%, with a 56% reduction over the study period.
DISCUSSION: Opioid prescribing to children and adolescents ≤19 years declined substantially from 2018 to 2022, reflecting evolving clinical practice. Targeted outreach to high-prescribing specialties may further improve the safety of opioid use in acute pain management
Trends in incidence rates of hepatocellular carcinoma and stage at diagnosis by demographics in the U.S. from 2004 to 2021: a joinpoint analysis of the SEER database.
No full textOBJECTIVES: Hepatocellular carcinoma (HCC) is the 13th most common cancer in the U.S., causing approximately 30,000 deaths annually. Incidence has risen substantially over recent decades. This study examines trends in age-adjusted HCC incidence from 2004 to 2021.
MATERIALS AND METHODS: Incidence data for HCC (ICD-10 C22.0) from 2004 to 2021 were obtained from the Surveillance, Epidemiology and End Results (SEER) registry, representing 48% of the U.S. population. Rates were age-adjusted to the 2000 U.S. standard population and stratified by sex, race/ethnicity, age, and stage at diagnosis. Annual percentage changes (APCs) were calculated using Joinpoint regression with statistical significance set at
RESULTS AND CONCLUSION: From 2004 to 2015, overall HCC incidence increased (APC 3.16