Pain physician
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The interventional pain management community saw the COVID-19 pandemic decimate elective interventional procedures and new patient visits across the United States until the reopening of America and the restarting of interventional procedures and elective surgical procedures began again. Health care providers, along with essential workers and patients, continue to be concerned about functioning in a safe and responsible manner. Consequently, a level of comfort is created by the testing health care workers with long exposure to new patients and patients undergoing interventions in high risk environments. As the United States and the world suffers from an ongoing infodemic, there are substantial amounts of misinformation, and some appropriate information being produced on molecular, antigen and antibody testing. Consequently, this manuscript is undertaken to describe the value and validity of coronavirus antibody testing. ⋯ Antibody tests have been developed to detect IgG only, both IgG and IgM, or total antibodies. At present, multiple antibody tests are available for use in the United States. In a review of 54 available studies through the end of April, mostly from China, the accuracy of pooled results for combination IgG/IgM tests was 91.4% (95% CI, 87.0 - 96.6) for 15 to 21 days post-symptom onset. Thus, antibody tests provide a promise and a peril in the ongoing Covid-19 pandemic.
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Randomized Controlled Trial
Relationship Between Epidural Steroid Dose and Suppression of Hypothalamus-Pituitary-Adrenal Axis.
The suppression of hypothalamic-pituitary-adrenal (HPA) axis is a common complication associated with epidural steroid injections (ESIs). However, the effect of different doses is unknown. ⋯ Although the difference in pain relief according to the ESI dose is not significant, the HPA suppression is prolonged with a higher dose than a lower dose, and the recovery is slower. Therefore, the time interval between consecutive ESIs should be adjusted depending on the steroid dose to ameliorate the adverse effects of steroids.
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Review
COVID-19 Pandemic - A Narrative Review of the Potential Roles of Chloroquine and Hydroxychloroquine.
Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used against malaria, rheumatism, inflammation in the joints, lupus, among others. These drugs showed positive results in preliminary scientific research for treatment of the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Since the studies with CQ and HCQ are initial with small patient populations, it is not yet known whether there are adverse effects from the use of CQ and HCQ for patients infected with the coronavirus. ⋯ From the studies reviewed, it is not possible to state the precise efficacy and safety of CQ and HCQ use in the treatment of COVID-19 at any time in the course of the disease. Future studies are warranted.
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Review
Overview of Stem Cell Therapy for Acute Respiratory Distress Syndrome with Focus on COVID 19.
There are as yet no effective strategies to treat the novel COVID-19 and to stem its symptoms, including ARDS. This review examines recent research studies in humans to determine whether mesenchymal stem cells (MSCs) may be used effectively and safely to target potentially deadly lung damage that may follow infection. ⋯ There is little published research on disease and survival outcomes among patients suffering severe lung disease associated with ARDS and COVID-19, and studies available are limited by lack of consistency in design and numerous flaws and limitations. Comparisons across studies are difficult. Nevertheless, it is documented that 8 ARDS patients with COVID-19 experienced symptom recovery and survival subsequent to MSC administration. MSCs are potentially life-saving treatment approaches for some patients who exhibit severe lung distress and have not responded to standard treatments. This is an obviously exciting research and treatment option for COVID-19 and other life-threatening diseases.
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Since the late 1940s, corticosteroids have been a mainstay class of agents in multiple interventional techniques and intra-articular injections. Exogenous glucocorticoids are structurally and pharmacologically similar to the endogenous hormones. As such, multiple actions of corticosteroids are exhibited, including those of anti-inflammatory and immunosuppressive effects. Epidural injections, with or without steroids, have been extensively used throughout the world. There are reports of epidural injections starting in 1901, with steroids being added to the local anesthetic since 1952, when steroids were administered into the sacral foramen. ⋯ This review shows an overall lack of significant difference between lidocaine alone and lidocaine with steroids in epidural injections. However, available evidence is limited for bupivacaine alone or with steroids. Evidence is also not available comparing local anesthetic alone with steroids for facet joint or peripheral joint intraarticular injections. Thus, it is concluded that local anesthetic with lidocaine may be utilized for epidural injections, with appropriate patient selection and steroids reserved for non-responsive patients with local anesthetic and with significant radiculitis.