Prevalence, Characteristics and Clinical Course of Neuropathic Pain in Primary Care Patients Consulting with Low Back-related Leg Pain.

OBJECTIVES: Little is known about the epidemiology of neuropathic pain in primary care patients consulting with low back-related leg pain. We aimed to describe prevalence, characteristics and clinical course of low back-related leg pain patients with and without neuropathic pain, consulting with their family doctor in the UK. METHODS: This was a prospective cohort study. Data were collected using a standardised baseline clinical examination and self-report questionnaires at baseline, 4, 12 and 36-months. We identified cases of neuropathic pain using three definitions: two based on clinical diagnosis (sciatica, with and without evidence of nerve root compression on MRI), one on the self-report version of Leeds Assessment for Neurological Symptoms and Signs (S-LANSS). Differences between patients with and without neuropathic pain were analysed comparing each definition. Clinical course (mean pain intensity measured as the highest of leg or back pain intensity: mean of three Numerical Rating Scales, each 0-10) was investigated using linear mixed models over 36-months. RESULTS: Prevalence of neuropathic pain varied from 48% to 74% according to definition used. At baseline, patients with neuropathic pain had more severe leg pain intensity, lower pain self-efficacy, more patients had sensory loss than those without. Distinct profiles were apparent depending on neuropathic pain definition. Mean pain intensity reduced after 4-months (6.1 to 3.9 (sciatica)), most rapidly in cases defined by clinical diagnosis. DISCUSSION: This research provides new information on the clinical course of neuropathic pain and a better understanding of neuropathic pain in low back-related leg pain patients consulting in primary care

Trends in gabapentinoid prescribing in UK primary care using the Clinical Practice Research Datalink: an observational study

Background The UK government reclassified gabapentin and pregabalin as ‘controlled drugs’ from April 2019. This study aimed to describe the trends in gabapentinoid prescribing before and immediately after reclassification, in the UK Clinical Practice Research Datalink, an electronic primary care health record broadly representative of the UK. Methods Separately for gabapentin and pregabalin, we calculated annual incident and prevalent prescribing rates from year of UK approval (April 1997 and 2004 respectively) to September 2019, and monthly incident and prevalent prescribing rates (October 2017–September 2019). Significant changes in temporal trends were determined using joinpoint regression. We also described potential prescribing indications, prior pain-related prescribing, and co-prescribing with potentially interacting medicines. Findings Incident gabapentin prescribing increased annually, peaking in 2016–17, at 625/100,000 patient years before falling steadily to 2019. Incident pregabalin prescribing peaked at 329/100,000 patient years in 2017–18 and did not fall significantly until 2019. Prevalent gabapentin and pregabalin prescribing increased annually to 2017–18 and 2018–19 respectively, before plateauing. Gabapentinoids were commonly co-prescribed with opioids (60%), antidepressants (52%), benzodiazepines (19%), and Z-drugs (10%). Interpretation Following a dramatic rise, incident gabapentinoid prescribing has started to fall but the specific impact of reclassification on prescribing rates remains unclear. Limited change in prevalent gabapentinoid prescribing during the 6 months following their reclassification as controlled drugs suggests little immediate impact on continued gabapentinoid prescribing for existing users. Funding National Institute for Health and Care Research (NIHR) Research for Patient Benefit Programme. NIHR Applied Research Collaboration West Midlands. NIHR School for Primary Care Research

Drug-Initiated Synthesis of Cladribine-Based Polymer Prodrug Nanoparticles: Biological Evaluation and Structure Activity Relationships

International audienceBy using two reversible deactivation radical polymerization techniques, either nitroxide-mediated polymerization or reversible addition-fragmentation chain transfer polymerization, the "drug-initiated" approach was applied to cladribine (CdA) as an anticancer drug to synthesize small libraries of well-defined and self-stabilized CdA-based polymer prodrug nanoparticles, differing from the nature and the molar mass of the grown polymer, and the nature of the linker between CdA and the polymer, thus allowing structure-cytotoxicity relationships to be determined. Their biological evaluation was investigated in vitro on L1210 cancer cells. The preparation of fluorescent CdA-based nanoparticles with excellent imaging ability was also reported by applying the "drug-initiated" approach to an aggregation-induced emission-active dye

The Pub and the People. A Worktown Study by Mass Observation.

Mass Observation was an independent social research organization which, between 1937 and 1949, documented the attitudes, opinions and everyday lives of the British people, using a combination of anthropological fieldwork, opinion surveys and written testimony. The Pub and the People is a classic text for its distinctly sociological approach, seeing patterns of drinking and socializing in context, rather than focusing primarily on pathological consequences. The main conclusions were that the pub is a living social organism and that the traditional approach of British sociology which, Mass Observation argued, focused on 'the drink problem' and the links between alcohol, crime and delinquency, failed to take account of the full social context. Mass Observation's focus on the pub as a place anticipates themes taken up in work on alcohol in cultural geography. Later alcohol researchers and epidemiologists have continued this orientation, recognizing the importance of physical and social environments in relation to alcohol consumption. Other studies have built on the MO initiative by looking at how drug and alcohol consumption links to identity, friendship and sociality or at the connections between intoxication and pleasure. The value of this classic text is that it reminds us that paying attention to the social context is not just a useful supplement, but absolutely central to understanding the use of alcohol or drugs

Rhenium and yttrium ions as antimicrobial agents against multidrug resistant Klebsiella pneumoniae and Acinetobacter baumannii biofilms

© 2019 The Authors. Letters in Applied Microbiology published by John Wiley & Sons Ltd on behalf of Society for Applied Microbiology. Antimicrobial resistance presents major global concerns to patient health. In this study, metal ions of molybdenum, rhenium, yttrium and thallium were tested against bacteria in planktonic and biofilm form using one strain of Klebsiella pneumoniae and Acinetobacter baumannii. The antimicrobial efficacy of the metal ions was evaluated against the planktonic bacterial strains using minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations, whilst the efficacy of the metal ions against biofilms was tested using a crystal violet biofilm assay. Live Dead staining was used to visualize the antimicrobial activity elicited by the metal ions on the bacterial cell. The results showed that higher concentrations of the metals were required to inhibit the growth of biofilms (72·9 mg l −1 to 416·7 mg l −1 ), in comparison to their planktonic counterparts. MICs of the metal ions (<46·9 mg l −1 ) (planktonic cells) did not affect biofilm formation. Overall, rhenium and yttrium were effective antimicrobial agents. Molybdenum demonstrated the greatest level of biotoxicity. When taking into account these results and the known toxicity of thallium, it is possible that rhenium or yttrium ions could be developed as effective biocidal formulations in order to prevent transmission in healthcare environments. Significance and Impact of the Study: The metal ions, molybdenum, rhenium, thallium and yttrium were tested against both Klebsiella pneumoniae and Acinetobacter baumannii in planktonic and biofilm forms. This research demonstrated that all the metal ions may be effective antimicrobial agents. However, molybdenum induced high levels of cytotoxicity, whilst, there was no significant difference in the toxicity of the other metal ions tested. When considering the results for the antimicrobial efficacy and biotoxicity of the metal ions, in conjunction with the known toxicity of thallium in certain chemical compositions, it was concluded that overall rhenium or yttrium ions may be effective antimicrobial agents, one potential application may be utilizing these metal ions in hospital surface cleaning formulations

Of tennis courts and fireplaces: Neurath's internment on the Isle of Man and his politics of design

Otto Neurath’s version of functionalism is one that begins with people “as we find them,” a proposition first set out in his 1917 essay “The Converse Taylor System.” Any attempt to redesign the existing furnishings of everyday life must take into account “functions” that go beyond the obvious purpose of objects: functions that are to do with sociability, happiness, familiarity, the love of “coziness,” and that address the diversity and contradictoriness of people. This essay considers how Neurath applied and made use of these ideas about design in 1940s Britain, during and after his internment on the Isle of Man between 1940–1941 and in talks, papers and correspondence from this period. It does not focus on the Isotype Institute, which would usually be considered his principal intervention in design, but on his commentary on everyday objects and practices. In particular it centres on four items – tennis courts, fireplaces, chairs and shoes – and through these elaborates some of the connections between Neurath’s ideas about the design of everyday life, and the significance of everyday practices, and his logical empiricism