Calcific myofibrosis due to pentazocine abuse: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pentazocine, a synthetic narcotic analgesic, is commonly used for the relief of moderate to severe pain secondary to various conditions. It is usually well tolerated; however, adverse effects are not uncommon, especially when higher doses are used and when it is used in a dependent fashion. There have been reports of various complications associated with its use, including skin fibrosis, skin ulceration, abnormal skin pigmentation and symmetrical myopathy with fibrous myopathy. Fibrosis has usually been reported in the muscles at the site of injection of the drug. Being opioid in nature, it has a high abuse potential.</p> <p>Case presentation</p> <p>Here we report a case of pentazocine-induced calcific myofibrosis in a 42-year-old man involving muscles which were not injected with pentazocine.</p> <p>Conclusion</p> <p>This case highlights the care that needs to be taken when prescribing opioid analgesics, such as pentazocine, as routine painkillers. Patients who have history of substance abuse are more likely to abuse other agents, including prescription drugs. Rare consequences such as calcific myofibrosis are devastating and can cause significant lifelong disability.</p

2019 WSES guidelines for the management of severe acute pancreatitis

Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen. © 2019 The Author(s).Peer reviewe

An open-label pilot study of the effectiveness of adalimumab in patients with rheumatoid arthritis and previous infliximab treatment: relationship to reasons for failure and anti-infliximab antibody status

This prospective open-label pilot study evaluated the effectiveness and safety of adalimumab and the relationship to antibodies against infliximab (IFX) in adult patients with active rheumatoid arthritis (RA) who had been treated previously with IFX and experienced treatment failure owing to lack or loss of response or intolerance. Patients self-administered adalimumab 40 mg subcutaneously every other week for 16 weeks, followed by maintenance therapy for up to Week 56. Measures of effectiveness included American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) response criteria, 28-joint Disease Activity Score, and the Health Assessment Questionnaire Disability Index. Serum IFX concentrations, human antichimeric antibody against IFX (HACA), adalimumab serum concentrations, antiadalimumab antibody, and safety also were assessed. Of the 41 enrolled patients, 37 completed 16 weeks and 30 completed 56 weeks of treatment. Patients experienced clinically meaningful improvements in all measures of RA activity, with greater response rates observed for patients who had experienced loss of initial response to or intolerance of IFX. At Week 16, 46% of patients achieved an ACR20 and 28% achieved an ACR50; 61% achieved an at least moderate and 17% achieved a good EULAR response. Clinical benefit was maintained through Week 56 in all effectiveness parameters. Baseline HACA status did not significantly impact effectiveness. No new safety signals were observed; neither former IFX intolerance status nor baseline HACA status had a clinically relevant impact on adverse event frequency or severity. Adalimumab was effective and well-tolerated in patients with RA who previously failed IFX therapy, irrespective of reason for discontinuation and of HACA status

The role of aquaria in beluga research and conservation

Aquaria that care for and maintain belugas (Delphinapterus leucas) under professional care have the opportunity to contribute to the conservation of wild belugas through research, expertise in animal care and husbandry, and engaging and educating the public about threats to the species’ health and population sustainability. In an aquarium setting, belugas can be studied under controlled conditions, with known variables that are often difficult to discern when studying wild belugas. Information on nutrition, health status and environmental parameters can be easily obtained in a controlled setting. Biological samples are collected from professionally trained whales that voluntarily participate in informative experimental paradigms. Research studies in aquaria seek to contribute to the recovery and management of endangered beluga populations, such as those in Cook Inlet. Mystic Aquarium’s efforts are presented as a case study. Key research priorities address action items in the Cook Inlet Beluga Recovery Plan and include: (1) understanding the beluga immune system, microbial communities, pathogens and disease; (2) development of non-invasive methods for assessing reproductive status, body condition and health in wild whales; (3) investigation of diving physiology and the impact of altered dive patterns on health; (4) understanding reproduction, a key to recovery and sustainability of wild populations; (5) development and testing of new technologies for tracking and monitoring whales and habitat use; and (6) understanding how noise affects beluga hearing, behaviour and physiology. Expertise in animal handling, behaviour and nutrition contribute to rescue, rehabilitation and capture release efforts. Moreover, ‘students’ of all ages have the opportunity to be engaged, educated and contribute to beluga conservation