Topical Anesthetics for Analgesia in Acute Corneal Abrasion: Eye Care Providers Survey.

STUDY OBJECTIVES: To evaluate the current attitudes of ophthalmologists and optometrists regarding topical anesthetic (TA) use in the emergency department (ED) for analgesia in corneal abrasions. METHODS: A survey was distributed through email to ophthalmologists and optometrists, and their responses were deidentified. Three scenarios were presented involving the addition of tetracaine in addition to usual care in the setting of uncomplicated corneal abrasion. A 250-character space for comments and demographic questionnaire followed. A chi-square test, Fisher exact test, or sign test, at a significance level of 0.05, was used. RESULTS: Of the 978 individuals surveyed, 486 responded (MD/DOs: 47.1% and ODs: 52.9%). Topical anesthetic favorability significantly decreased with shorter practice length when the patient was only examined by an ED provider. Topical anesthetic favorability was significantly impacted by respondents' degree type. When respondents were posed with using TAs if the respondents were the patient, the respondents were 22.6% more likely to use TA when compared with their answers in the scenario where the ED provider examined the patient and 20.0% more likely when compared with the scenario where a MD/OD examined the patient. Most did not support tetracaine use. CONCLUSIONS: Although treating pain is associated with improved quality of life, most respondents did not support TA use in the ED. Practice length and degree type significantly impacted responses. Respondents were more inclined to use TAs when the respondents were the patient. Results suggest that eye care providers need additional research data supporting safety before routine use in the ED, given the potential for adverse events with TAs.

Gabapentinoid dosing and adverse events in patients with chronic kidney disease.

BACKGROUND: Gabapentinoids (GPs) are frequently prescribed in individuals with chronic kidney disease (CKD); however, their exclusive renal elimination warrants dose adjustments to decrease risk of toxicity. This study evaluated GP prescribing patterns and whether excessive dosing was associated with increased incidence of gabapentinoid-related adverse events (GRAEs). MATERIALS AND METHODS: A retrospective analysis of adult CKD and end-stage kidney disease (ESKD) patients hospitalized from 2014 to 2020 and receiving GPs was conducted. Patients were grouped based on whether the average daily dose prescribed was higher than recommended (inappropriately dosed, (ID)) or as recommended (appropriately dosed (AD)) for CKD stage. The occurrence of GRAEs was compared between groups. Patient characteristics, CKD stage, and hospital length of stay (LOS) were evaluated to determine association with GRAEs. RESULTS: The 200 patients included were predominantly female (51%), black (72%), CKD 5/ESKD (84%), and prescribed gabapentin (90%) with a mean age 61 ± 14 years. For the 111 (55%) patients in the AD group and 89 (45%) in the ID group there was no statistically significant difference in GRAEs (18 vs. 19%, p = 0.84). GRAEs were associated with older age (66 vs. 61 years; p < 0.001), seizure history (14% for GRAE vs. 3% for no GRAE, p = 0.02), and concomitant antipsychotic use (24% for GRAE vs. 5% for no GRAE; p < 0.001) but not with CKD severity. LOS was significantly longer for patients experiencing a GRAE (8.5 vs. 5.3 days; p < 0.001). CONCLUSION: Appropriate dosing of GPs is particularly important to minimize the risk of adverse events in patients of older age, with a history of seizures, or concomitant antipsychotic use. There is a need for prescriber education given the high frequency of inappropriate GP dosing observed in patients with advanced kidney disease.

Preoperative opioid usage predicts markedly inferior outcomes 2 years after reverse total shoulder arthroplasty.

BACKGROUND: Reverse total shoulder arthroplasty (RTSA) has proved to be a highly effective treatment for rotator cuff-deficient conditions and other end-stage shoulder pathologies. With value-based care emerging, identifying predictive factors of outcomes is of great interest. Although preoperative opioid use has been shown to predict inferior outcomes after anatomic total shoulder arthroplasty and rotator cuff repair, there is a paucity of data regarding its effect on outcomes after RTSA. We analyzed a series of RTSAs to determine the influence of preoperative opioid use on clinical and radiographic outcomes at a minimum of 2 years' follow-up. METHODS: A retrospective review of primary RTSA patient data revealed 264 patients with ≥2 years of clinical and radiographic follow-up. Patients were classified as preoperative opioid users (71 patients) if they had taken narcotic pain medication for a minimum of 3 months prior to surgery or as opioid naive (193 patients) at the time of surgery. Assessments included preoperative and postoperative visual analog scale pain scores, American Shoulder and Elbow Surgeons scores, strength, and range of motion, as well as complications and revisions. Radiographs were analyzed for signs of loosening or mechanical failure. The Mann-Whitney U and Fisher exact tests were used for comparisons between groups. Statistical significance was set at P < .05. RESULTS: The mean patient age was 69.9 years, and the mean follow-up time was 2.8 years. Opioid users were significantly younger (66.1 years vs. 70.7 years, P < .001) at the time of surgery and had significantly higher preoperative rates of mood disorders, chronic pain disorders, and disability status (all P < .05). Postoperatively, opioid users had inferior visual analog scale pain scores (2.59 vs. 1.25, P < .001), American Shoulder and Elbow Surgeons scores (63.2 vs. 75.2, P < .001), active forward elevation (P < .001), and internal and external rotational shoulder strength (all P < .05) compared with opioid-naive patients. Periprosthetic radiolucency (8.45% vs. 2.07%, P = .026) and subsequent revision arthroplasty (14.1% vs. 4.66%, P = .014) occurred more frequently in opioid users than in opioid-naive patients. Both groups improved from baseline preoperatively to most recent follow-up in terms of functional outcomes and pain. CONCLUSION: Preoperative opioid use portended markedly inferior clinical outcomes in patients undergoing RTSA. Additionally, opioid users had significantly increased rates of periprosthetic radiolucency and revision. Preoperative opioid use appears to be a significant marker for adverse outcomes after RTSA.

Sialendoscopy and Sjogren's Disease: A Systematic Review.

OBJECTIVES/HYPOTHESIS: This study is a systematic review of the literature which seeks to estimate the expected treatment outcomes of a patient with Sjogren's syndrome (SS) undergoing therapeutic sialendoscopy. STUDY DESIGN: Systematic Review. METHODS: PubMed, Scopus, and Cochrane library databases were used to search for studies published as of August 2020 regarding the treatment outcomes of SS with sialendoscopy. The key search terms included "Sjogren's syndrome" and "sialendoscopy." Only studies in the English language involving more than one human patient were included. PRISMA guidelines were followed in study inclusion and data extraction. The primary outcome assessed was improvement in patient symptoms. RESULTS: Six studies met criteria and were analyzed in this review, including 125 patients undergoing sialendoscopy of parotid and/or submandibular glands as well as 25 controls. Of these patients, 90% were female with an age range of 18 to 79 years. There was significant diversity in outcome reporting tools. The outcomes of symptom improvement were pooled qualitatively based on improvement noted in each study. Outcomes were defined as partial improvement if the measured outcomes improved and complete improvement if measured outcomes resolved entirely. Despite the limited number of studies on this topic, this meta-analysis suggests that a similar study of therapeutic sialendoscopy could expect to provide at least temporary improvement of symptoms 90% to 99% of the time. CONCLUSIONS: This review provides support for the application of sialendoscopy in the treatment of SS salivary disease. Larger studies with consistent outcome reporting tools and control groups are needed to validate these results and provide a consistent therapy protocol. Laryngoscope, 131:1474-1481, 2021.

Roaming-mediated isomerization in the photodissociation of nitrobenzene.

Roaming reactions comprise a new class of reaction in which a molecule undergoes frustrated dissociation to radicals, followed by an intramolecular abstraction reaction. Nitro compounds have long been known to dissociate to give NO as a major product. However, rates based upon isomerization via calculated tight transition states are implausibly slow, so the key dissociation pathway for this important class of molecules remains obscure. Here, we present an imaging study of the photodissociation of nitrobenzene with state-specific detection of the resulting NO products. We observe a bimodal translational energy distribution in which the slow products are formed with low NO rotational excitation, and the fast component is associated with high rotational excitation. High-level ab initio calculations identified a 'roaming-type' saddle point on the ground state. Branching ratio calculations then show that thermal dissociation of nitrobenzene is dominated by 'roaming-mediated isomerization' to phenyl nitrite, which subsequently decomposes to give C(6)H(5)O + NO.

Ab initio study on mechanisms and kinetics for reaction of NCS with NO.

The mechanisms and kinetics of the reaction of a thiocyanato radical (NCS) with NO were investigated by a high-level ab initio molecular orbital method in conjunction with variational RRKM calculations. The species involved were optimized at the B3LYP/6-311++G(3df,2p) level, and their single-point energies were refined by the CCSD(T)/aug-cc-PVQZ//B3LYP/6-311+G(3df,2p) method. Our calculated results indicate favorable pathways for the formation of several isomers of an NCSNO complex. Formation of OCS + N 2 also is possible, although this pathway involves a substantial energy barrier. The predicted total rate constants, k total, at a 2 torr He pressure can be represented by the following equations: k total = 9.74 x 10 (26) T (-13.88) exp(-6.53 (kcal mol (-1))/ RT) at T = 298-950 K and 1.17 x 10 (-22) T (2.52) exp(-6.86 (kcal mol (-1))/ RT) at T = 960-3000 K, in units of cm (3) molecule (-1) s (-1), and the predicted values are in good agreement with the experimental results in the temperature range of 298-468 K. The calculated results clearly indicate that the branching ratio for R M1 in the temperature range of 298-950 K has the largest value ( R M1 accounts for 0.53-0.39). However, in the higher temperature range (960-3000 K), the formation of OCS + N 2 ( P5) with branching ratio R P5 (0.40-0.79) becomes dominant. The rate constants for key individual product channels are provided for different temperature and pressure conditions.