Ugeskrift for laeger
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Ugeskrift for laeger · Mar 2011
[The clinical relevance of opioid-induced hyperalgesia remains unresolved].
Opioids are widely used as analgesics in chronic pain of malignant as well as non-malignant origin. During opioid treatment, pain is occasionally worsened. This could be due to progression of the disease or tolerance or opioid-induced hyperalgesia (OIH). ⋯ We conclude that only a few clinical studies on OIH are available. However, a growing body of experimental data supports the presence of OIH in clinical settings. Diagnostic tools for assessment of OIH have yet to be developed.
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Ugeskrift for laeger · Mar 2011
[Infection control to prevent tuberculosis in relation to resistance to antibiotics].
Infection control differs among nations. Notably in USA strict measures are enforced to prevent air-borne tuberculosis (TB) transmission. ⋯ If multi-drug resistant (MDR) TB is documented or suspected, according to risk-factors, patients should remain under air-borne precautions. The vast majority of Danish TB-patients (non-MDR) require less demanding, hygienic precautions.
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Contact tracing is an integrated part on tuberculosis management and is conducted by the medical officer in collaboration with the local chest clinics. The principle of contact tracing is to begin with the household contacts and expanding to more peripheral contacts depending of the number of persons with latent of active tuberculosis identified. Persons identified with latent TB infection should be offered isoniazid preventive treatment for six months.
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Tumour necrosis factor antagonists (anti-TNFα) have become an invaluable treatment against chronic inflammatory diseases. Individuals treated with anti-TNFα have more than a fourfold increased risk of tuberculosis (TB) reactivation depending on the clinical setting and the TNF-antagonist used. All candidates for anti-TNFα treatment in Denmark should be evaluated for possible latent TB using history of exposure, chest X-ray and an interferon-γ release assay. Preventive chemotherapy is recommended for all individuals with latent TB infection before initiation of anti-TNFα as it is expected to reduce the risk of progression to active TB.
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Hip and knee surgery is associated with a relatively large bleeding and a need for perioperative transfusion. Postoperative anaemia may delay recovery, but transfusion carries inherent risks. ⋯ The majority of these studies suffer from methodological weaknesses and have not been performed in a fast-track setting. Thus, large randomised studies evaluating a restrictive versus a liberal transfusion strategy in a procedure-specific setup are needed.