Education and Experience in Intrathecal Drug Delivery Systems (IDDS) During Pain Medicine Fellowships.

Objective: Targeted drug delivery (TDD) via intrathecal drug delivery systems (IDDS) exposure and clinical adoption remains low despite multiple well-designed trials that demonstrate safety, efficacy, reliability, and cost-saving benefits. This study aims to understand the possible contributing factors starting with Pain Medicine fellowship training. Materials and Methods: An internet-based, anonymous pilot survey was distributed to pain medicine fellows enrolled in an Accreditation Council for Graduate Medical Education (ACGME) accredited pain medicine training program during the 2021-2022 academic year. Fellowship programs were identified using published online ACGME accreditation data. The survey was distributed via email to fellowship program directors and coordinators and was made available through pain medicine societies. Results: Seventy-one of four hundred and twenty-three pain medicine fellows (17% response rate) completed the survey. Nine percent of respondents evidence-informed opinion coincided with the most recent Polyanalgesic Consensus Conference (PACC) guidelines recommendations for IDDS treatment indications. Fifty-one percent of respondents felt there was an unmet need for IDDS training. About one-third of respondents felt that lack of curriculum, faculty, and cases were barriers to IDDS use, respectively. Thirty-one percent of fellows reported sufficient training for IDDS in their fellowship programs. The majority (70%) of respondents somewhat or strongly support direct training by IDDS manufacturers. Conclusion: A wide variability exists surrounding IDDS training during ACGME accredited pain medicine fellowship. Insufficient case exposure and lack of a standardized curriculum may play a role in future therapy adoption. The results from this study call for a more standardized training approach with an emphasis on adequate clinical exposure, utilization of peer reviewed educational curriculum and supplemental material to aid pain medicine fellows' education.

Review of Opioid Sparing Interventional Pain Management Options and Techniques for Radiofrequency Ablations for Sacroiliac Joint Pain.

PURPOSE OF REVIEW: The goal of this clinical review was to provide an update about the existing treatment options and associated evidence for various radiofrequency ablation techniques for sacroiliac joint pain. An electronic literature search on radiofrequency for the treatment of sacroiliac joint pain was conducted using PubMed, NCBI and Google Scholar. The following search keywords were used: radiofrequency ablation (cooled, pulsed, conventional, bipolar, intra-articular), sacroiliac joint and sacroiliac pain. The search was limited to human subjects, English language and articles with available full text. The bibliographic sections of all manuscripts were further searched for additional relevant citations. The full text of the relevant articles was reviewed by all the authors. RECENT FINDINGS: Our study showed that radiofrequency ablation is a safe and effective treatment option that can be utilized to manage sacroiliac joint pain. It offers accessibility to the primary care physician, reduces office visits with "pain" as the primary complaint and provides the added benefit of acting as a non-opioid sparing means of analgesia.

Synthesis, characterization, thermal properties, antimicrobial evaluation, ADMET study, and molecular docking simulation of new mono Cu (II) and Zn (II) complexes with 2-oxoindole derivatives.

One of the interesting research fields is developing and assessing novel metal-containing medications. A new isatin-3-thiosemicarbazone derivative 4 was synthesized by two different methods based on hydrazone derivatives 2 and 3. Additionally, the chelation of thiosemicarbazone with copper (II) and zinc (II) forms a monobasic tridentate (ONS) complex with two five-member rings and a tetrahedral geometry structure. The structure of synthesized complexes was characterized using elemental analysis, FT-IR, mass spectra, and 1H/13C NMR. Thermogravimetric analysis revealed the upgrading of the thermal stability of metal complexes compared to their thiosemicarbazone ligand. The stoichiometric ratio of the coordination confirmed the formation of 1:1 (M: L) stoichiometry. In vitro antimicrobial activity was screened against two gram-positive, two gram-negative, and one fungal strain. Both ligand 4 and Zn complex 6 displayed high antimicrobial activity compared with copper complex 5 based on the zone of inhibition. Further, MIC and MBC were determined for both zinc and ligand. The zinc complex 6 displayed excellent antimicrobial activity with (MIC = 3.9-27.77 µg/mL) against bacterial strains and (MIC = 7.81 µg/mL) against C. albicans, as well as exhibited MBC values ranging between (MBC = 6.51-45.58 µg/mL) and (MFC = 13.58 µg/mL), respectively, and demonstrated bactericidal and fungicidal behavior. The in-silico ADMET study for ligand and two complexes were determined and showed non-AMES toxicity, non-carcinogenic, and obey the rule of five. A comparative docking study provided more insight into the binding mechanisms and suggested that antimicrobial activity may be due to inhibition of different targets.

Capability of acidic electrolyzed water in the elimination of Salmonella Typhimurium and Escherichia coli in the chicken breast

Aims@#This study aimed to investigate the effect of acidic electrolyzed water (AEW) as pre-refrigeration and pre-freezing processing steps for chicken meat in regard to the behavior of S. Typhimurium and E. coli during storage.@*Methodology and results@#AEW (free available chlorine 30 ppm and pH 2.7) was tested against S. Typhimurium and E. coli in growth media (brain heart infusion broth) and by exposing inoculated chicken fillets. The in vitro study appointed 10 minutes as the straightening exposure time of fresh prepared AEW for S. Typhimurium and E. coli. The reduction effect of AEW was significant (p<0.05) for both S. Typhimurium and E. coli along the 8 days of refrigerated storage with a maximum reduction after 24 h of post-treatment reaching 23.3% (1.4 log CFU/g) and 32.43% (2.15 log CFU/g) for S. Typhimurium and E. coli, respectively. AEW resulted in a significant reduction (p<0.05) as a pre-freezing application for both microorganisms, where the maximum reductions of 20% (1.2 log CFU/g) and 31.84% (2.14 log CFU/g) for S. Typhimurium and E. coli, respectively, were reported at zero time (just after dipping). In exposed samples to AEW, S. Typhimurium could not be detected by the 6th week of frozen storage while E. coli continued detectable until till 10th week but with a reduced population of 30% compared to control.@*Conclusion, significance and impact of study@#The findings of the present study suggest the application of AEW as a pre-refrigeration and pre-freezing treatment for chicken products. AEW application significantly improved the safety of chicken products.

Antibiofilm activity of carvacrol loaded chitosan nanoparticles against Listeria monocytogenes

Aims@#This study was designed to evaluate the effectiveness of the synthesised carvacrol loaded chitosan nanoparticles (CLCNPs) on the growing and pre-formed biofilms of Listeria monocytogenes isolated from slaughterhouses.@*Methodology and results@#The swab samples were collected from knives, hocks and cutting tables representing slaughterhouses meat contact surfaces (MCS), while those samples from walls and floors represent slaughterhouses meat non-contact surfaces (MNCS). The bacteriological analysis revealed the existence of L. monocytogenes with a prevalence rate of 3.3, 10 and 6.7% for knives, hocks and cutting tables, respectively and 2.2 and 6.6% for walls and floors, respectively. The isolates L. monocytogenes were assayed for biofilm production by the crystal violet binding assay method. Among the 10 L. monocytogenes isolates, 10%, 50% and 30% of the isolates were found to be strong, moderate and weak biofilm producers, respectively. The activities of carvacrol, chitosan nanoparticles (NPs) and CLCNPs against the only strong biofilm producer strain of L. monocytogenes were tested by microtiter plate assay. The minimum inhibitory concentrations (MIC) values were 3.75 mg/mL for CAR, 5 mg/mL for chitosan NPs and 0.62 mg/mL for CLCNPs. CLCNPs inhibit the produced biofilm by 35.79, 73.37 and 77.76%, when 0.5 MIC, 1 MIC and 2 MIC were used, respectively. Furthermore, the pre-formed L. monocytogenes biofilms were significantly reduced from 1.01 (control) OD570 to 0.40 and 0.29 OD570 by applying 2 MIC and 4 MIC doses, respectively.@*Conclusion, significance and impact of study@#The data generated is promising to develop bio-green disinfectants to inhibit biofilm formation by L. monocytogenes in the food processing environment and control its adverse effects for consumers.

The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain.

Moderate to severe pain occurs in many cancer patients during their clinical course and may stem from the primary pathology, metastasis, or as treatment side effects. Uncontrolled pain using conservative medical therapy can often lead to patient distress, loss of productivity, shorter life expectancy, longer hospital stays, and increase in healthcare utilization. Various publications shed light on strategies for conservative medical management for cancer pain and a few international publications have reviewed limited interventional data. Our multi-institutional working group was assembled to review and highlight the body of evidence that exists for opioid utilization for cancer pain, adjunct medication such as ketamine and methadone and interventional therapies. We discuss neurolysis via injections, neuromodulation including targeted drug delivery and spinal cord stimulation, vertebral tumor ablation and augmentation, radiotherapy and surgical techniques. In the United States, there is a significant variance in the interventional treatment of cancer pain based on fellowship training. As a first of its kind, this best practices and interventional guideline will offer evidenced-based recommendations for reducing pain and suffering associated with malignancy.