Annals of clinical and laboratory science
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Ann. Clin. Lab. Sci. · Jan 2007
ReviewRational use and interpretation of urine drug testing in chronic opioid therapy.
Urine drug testing (UDT) has become an essential feature of pain management, as physicians seek to verify adherence to prescribed opioid regimens and to detect the use of illicit or unauthorized licit drugs. Results of urine drug tests have important consequences in regard to therapeutic decisions and the trust between physician and patient. ⋯ These factors include metabolic conversion between drugs, genetic variations in drug metabolism, the sensitivity and specificity of the analytical method for a particular drug or metabolite, and the effects of intentional and unintentional interferants. In this review, we focus on the technical features and limitations of analytical methods used for detecting drugs or their metabolites in urine, the statistical constructs that are pertinent to ordering UDT and interpreting test results, and the application of these concepts to the clinical monitoring of patients maintained on chronic opioid therapy.
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Ann. Clin. Lab. Sci. · Jan 2007
Clostridium difficile infection in an urban medical center: five-year analysis of infection rates among adult admissions and association with the use of proton pump inhibitors.
C. difficile-associated diarrhea (CDAD) has become a major cause of morbidity in hospitalized patients. In this study of five-year (2001-2005, inclusive) trends of incidence of CDAD among adults in an inner-city medical center, the overall annual incidence increased from 5.08 to 8.42 cases/10(3) admissions (p = 0.0005). Age distribution remained fairly constant for 2001-2004 but decreased significantly in 2005 (p = 0.005); no significant change was observed for gender. ⋯ After controlling for the effect of antibiotic use, PPI either pre- or during admission was associated with CDAD (odds ratio, OR (adjusted) = 2.75, 95% CI = 1.68 to 4.52; p = 0.0001); the association with H2A was not significant (OR (adjusted) = 0.95, 95% CI = 0.39 to 2.34; p = 0.9153). If only first-time use during hospital stay is considered, PPI were also strongly associated with CDAD (OR (adjusted) = 1.88, 95% CI: 1.07 to 3.31; p = 0.0283) and H2A were not associated with CDAD (OR (adjusted) = 0.73, 95%CI: 0.26 to 2.06; p = 0.5520). These data suggest that the widespread prescription of PPI for stress ulcer prophylaxis in acute care facilities may contribute to the increased incidence of CDAD.
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Ann. Clin. Lab. Sci. · Jan 2007
Effects of intrathecal injection of prednisolone acetate on expression of NR2B subunit and nNOS in spinal cord of rats after chronic compression of dorsal root ganglia.
N-methyl-D-aspartate receptor subunit 2B (NR2B) and neuronal nitric oxide synthase (nNOS) play important roles in the mechanism of neuropathic pain. To elucidate how glucocorticoids affect this mechanism, we studied the effects of intrathecal (it) injection of prednisolone acetate (PA) on a nociceptive stimulus and the changes of nNOS and NR2B subunit expression in the spinal dorsal horn of Sprague Dawley rats following chronic compression of the dorsal root ganglia (CCD). Paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured for 15 days postoperatively. ⋯ Chronic compression of the dorsal root ganglia induced time-dependent upregulation of nNOS and NR2B subunits of N-methyl-D-aspartate receptor within the spinal cord dorsal horn ipsilateral to CCD. Both upregulations were significantly diminished by it administration of PA (2.0 mg/kg), but not by lower doses of PA (0.5 or 1.0 mg/kg). The results suggest that PA upregulation of neuronal nitric oxide synthase and NR2B subunit expression in the spinal dorsal horn contributes to PA inhibition of hyperalgesia induced by chronic compression of dorsal root ganglia.