Postgraduate medicine
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Postgraduate medicine · Jun 2022
ReviewThe expanding role of chronic pain interventions in multimodal perioperative pain management: a narrative review.
Surgery is a risk factor for chronic pain and long-term opioid use. As perioperative pain management continues to evolve, treatment modalities traditionally used for chronic pain therapy may provide additional benefit to patients undergoing surgery. ⋯ There may also be a role for acupuncture, music therapy, and other integrative medicine therapies. A transitional pain service can help coordinate outpatient care with inpatient perioperative pain management and promote a more personalized and comprehensive approach that can improve postoperative outcomes.
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Postgraduate medicine · Jun 2022
ReviewThe "reversibility" of chronic atrophic gastritis after the eradication of Helicobacter pylori.
Gram-negative bacterium Helicobacter pylori (H. pylori) infection is lifelong and usually acquired in childhood, which is etiologically linked to gastric cancer (GC). H. pylori gastritis is defined as an infectious disease with varying severity in virtually all infected subjects. Chronic atrophic gastritis (CAG) is the precancerous condition with the decrease or the loss of gastric glands, which can further be replaced by metaplasia or fibrosis. ⋯ H. pylori infection is the most common cause and its eradication is recommended, which may contribute to the regression of CAG. However, it is controversial whether CAG is reversible after eradication therapy. In the review, we discuss recent studies which provide important insights into whether CAG is 'reversibility' and when it may progress into GC after eradicating H. pylori.
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Postgraduate medicine · Jun 2022
ReviewThe application of magnetic resonance imaging (MRI) for the prediction of surgical outcomes in trigeminal neuralgia.
Trigeminal neuralgia (TN) is a severe facial pain disorder that often requires surgical treatment. Neurovascular compression (NVC) has been widely accepted as the primary cause of classical TN (cTN). Vascular compression involving the near half of the cisternal segment of trigeminal nerve was the most likely cause of patient's symptoms. ⋯ However, a significant proportion of cTN patients with significant NVC fail to achieve long-term pain relief after technically successful surgery. Neuroimaging using magnetic resonance imaging (MRI) provides a noninvasive method to generate objective biomarkers of eventual response to TN surgery. This paper reviewed the progress of research on the prediction of surgical outcomes in TN with MRI.
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Postgraduate medicine · Jun 2022
Randomized Controlled TrialAnalgesic efficacy of naproxen sodium versus hydrocodone/acetaminophen in acute postsurgical dental pain: a randomized, double-blind, placebo-controlled trial.
Opioid/acetaminophen combinations may be overly prescribed in many post-surgical situations where a non-steroidal anti-inflammatory drug with equal or greater efficacy, fewer central nervous system side effects, and no risk for opioid abuse could be substituted. We compared a single, non-prescription dose of naproxen sodium 440 mg (NapS) against hydrocodone plus acetaminophen 10/650 mg (HYD+APAP) in post-impaction surgery pain. ⋯ In moderate-to-severe postsurgical dental pain, a single dose of NapS was at least as effective as HYD+APAP in the early hours, significantly more effective at reducing pain intensity and providing greater pain relief over 12 hours, and was better tolerated. When not contraindicated, NapS should be considered a preferred alternative to opioid combinations for acute pain. (ClinicalTrials.gov, Identifier: NCT04307940; https://clinicaltrials.gov/ct2/show/NCT04307940).
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Postgraduate medicine · Jun 2022
The deadliest lung lobe in COVID-19: a retrospective cohort study of elderly patients hospitalized for COVID-19.
The relationship between which lung lobe is affected on the chest X-ray (CXR) performed at the Emergency Department (ED) and mortality from COVID-19 has not been studied. With this in mind, the present study aimed to discern which lung lobe was the one with the highest associated mortality rate in the elderly population. ⋯ Right middle lobe involvement was an independent predictor of in-hospital mortality.