A Claims Analysis of the Utilization of Tramadol for Acute Pain in Patients Prescribed Buprenorphine/Naloxone for Opioid Use Disorder

Objective: To determine the prevalence of tramadol prescribing among commercially insured adults receiving medication assisted therapy (MAT) with buprenorphine/naloxone. Design: We conducted a cross-sectional descriptive study to evaluate the use of tramadol among patients prescribed buprenorphine/suboxone for MAT. Setting: This study utilized data from 2010 to 2013 Optum Clinformatics Data Mart (OptumInsight, Eden Prairie, MN). This cohort is an administrative health claims database from a large national insurer. This data included pharmacy and medical care utilization and information describing patient enrollment. Patients, Participants: Patients were 12 to 64 years of age and had complete and available medical, pharmacy and administrative records in the Optum Clinformatics Data Mart during study period. Main Outcome Measures: Patients who received at least one paid claim for buprenorphine/naloxone from 2010 to 2013 and also received at least one overlapping pharmacy dispensing for tramadol were identified for analysis. We determined if the concurrent buprenorphine/naloxone and tramadol dispensings were from the same or a different prescriber. Results: In this analysis of 18,734 U.S. commercially insured patients receiving MAT with buprenorphine/naloxone, we identified 1,198 (6.4%) patients who received at least one overlapping dispensing for tramadol during a four-year period spanning 2010 through 2013. Among these patients, 266 (1.42%) were co-prescribed buprenorphine/naloxone and tramadol from the same provider. Conclusions: These results suggest that the use of tramadol among patients receiving buprenorphine/naloxone is not uncommon. Further study is warranted to further determine the benefits and risks associated with the use of tramadol for pain management among patients prescribed buprenorphine/naloxone

Fulminant meningococcal supraglottitis: An emerging infectious syndrome?

We report a case of fulminant supraglottitis with dramatic external cervical swelling due to associated cellulitis. Blood cultures were positive for Neisseria meningitidis. The patient recovered completely after emergency fiberoptic intubation and appropriate antibiotic therapy. We summarize five other cases of meningococcal supraglottitis, all reported since 1995, and discuss possible pathophysiologic mechanisms

A Case of Post-Streptococcal Glomerulonephritis with Diffuse Alveolar Hemorrhage

Acute post-streptococcal glomerulonephritis (PSGN) is characterized by an abrupt onset of edema, hypertension, and hematuria. Life-threatening diffuse alveolar hemorrhage (DAH) is rarely associated with acute PSGN. There have been only two reported cases worldwide, and no case has been reported previously in Korea. Here, we present a patient who clinically presented with pulmonary-renal syndrome; the renal histology revealed post-infectious glomerulonephritis of immune complex origin. A 59-yr-old woman was admitted with oliguria and hemoptysis two weeks after pharyngitis. Renal insufficiency rapidly progressed, and respiratory distress developed. Chest radiography showed acute progressive bilateral pulmonary infiltrates. The clinical presentation suggested DAH with PSGN. Three days after treatment with high-dose steroids, the respiratory distress and pulmonary infiltrates resolved. Electron microscopy of a renal biopsy specimen sample revealed diffuse proliferative glomerulonephritis with characteristic subendothelial deposits of immune complex ("hump"). The renal function of the patient was restored, and the serum creatinine level was normalized after treatment

Temporal perception of good and poor readers

Abstract not available