Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002895 (sickle cell disease)
 11,747 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The identification of two patients who were misusing meperidine prescribed in a hospital prompted the establishment of a surveillance system to examine the possible extent of the problem of prescription narcotic abuse. All outpatient prescriptions for meperidine in a six-month period were reviewed and 17 high users were identified who were considered to be at greatest risk of misuse; they received 55% of all meperidine dispensed from the OPD pharmacy. These persons obtained their prescriptions primarily through the emergency room, they rarely saw the same physician twice, and 12 of them carried a diagnosis of sickle cell disease. Among these patients, four cases of definite abuse were identified. Interventions aimed at promoting continuity of care to the high users led to a 66% reduction in meperidine prescribed to this group in the emergency room and to a shift in their care to the clinics. Establishment of a registry for narcotic surveillance is a first toward recognition of outpatient drug abuse. Limiting prescribing privileges to the physician responsible for a patient's long-term care can further decrease this risk.
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PMID:Meperidine surveillance in an outpatient department: the recognition of misuse and its control. 50 Aug 45

This document establishes Department of Veterans Affairs (VA) regulations to implement specific provisions of the Veterans Omnibus Health Care Act of 1976 and the Veterans' Benefits and Services Act of 1988 concerning the confidentiality of certain medical records. These regulations protect the confidentiality of VA records pertaining to drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus (HIV), and sickle cell anemia.
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PMID:Confidentiality of certain medical records--VA. Final rule. 1017 36

The entity of delayed splenic rupture represents an initially missed injury, a delayed presentation of the latter, or an actually delayed development of an initially latent, minor, splenic injury. Having encountered a number of patients presenting with splenic rupture days after what was considered a minor abdominal trauma we review our experience with this entity. This is a retrospective study. During the past 6 years 26 patients were treated at our level II trauma center for blunt splenic injuries. The 8 patients who presented 48 h or more after injury are the focus of this communication. All patients had an underlying medical condition: five were drug addicts (one was HIV positive) and the other three were affected by cirrhosis, sickle cell disease, and HIV. The mechanisms of injury were as follows: blunt assault in 5 patients, a fall in 2 patients, and unknown in 1 patient. The patients presented to our hospital after a mean lag time of 5 days after injury (range, 2-10 days). One patient presented in shock and underwent laparotomy after a positive diagnostic peritoneal lavage. Four presented with a clinical acute abdomen, and three presented with abdominal pain and anemia. Abdominal computed tomography (CT) was performed in the seven hemodynamically stable patients demonstrating hemoperitoneum in all: five had a grade III injury and two had a grade II injury. All patients survived after an emergency splenectomy. Delayed presentation of splenic injury after minor abdominal trauma is not uncommon in our indigenous population. It may be associated with drug abuse and HIV.
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PMID:Delayed presentation of splenic injury: still a common syndrome. 1222 14

Pain due to vaso-occlusive crisis is the major cause of hospital use in sickle cell disease. Although available guidelines provide recommendations for opioid administration in this setting, only 4 (21%) of 19 medical textbooks present treatment regimens that are consistent with them. Moreover, only 7 texts (37%) note that addiction is infrequent in this population, while 11 (92%) of 12 texts provide such reassurance for cancer-related pain (P < .005). Finally, hydroxyurea use to decrease the frequency of vaso-occlusive crises is completely defined only in 2 textbooks. Thus, most medical texts provide neither adequate information for the treatment or prevention of pain due to vaso-occlusive crisis in sickle cell disease nor reassurance of the unlikelihood of addiction in this population. In contrast, treatment recommendations for less common hematologic disorders are consistent with current standards in 53% to 84% of appropriate texts (P < .05). Limited knowledge regarding the principles and appropriateness of opioid therapy; a lack of evidence-based research on pain control; and misconceptions and prejudices about drug abuse and addiction contribute to this educational void. Thus, research and training on pain control in sickle cell disease are needed to parallel studies of environmental and genetic factors contributing to the known clinical heterogeneity of this disorder.
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PMID:Treatment and prevention of pain due to vaso-occlusive crises in adults with sickle cell disease: an educational void. 1794 Feb 7

A case of late first trimester/early second trimester recurrent pregnancy loss in a 30-year-old para 3+0 Nigerian woman is reported. She was referred to the Radiologist for Hysterosalpingography (HSG) work-up following repeated spontaneous abortions at early pregnancy stage. There was no history of trauma, surgery, alcohol/drug abuse or haematological disorder such as sickle cell anaemia or Thalassemia. Her body weight was 105 kg. Systemic examination was normal. The HSG however demonstrated widely separated horns of the single endometrial cavity with intercornual angle measuring 107 degrees indicating a congenital abnormality of bicornuate type.
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PMID:Mullerian duct anomaly in a Nigerian woman with recurrent pregnancy loss. 2149 5

The Opioid Risk Tool (ORT) is a screening tool used to assess risk of opioid misuse by stratifying aberrant drug-seeking behaviors and/or identifying known risk factors for drug abuse. The objectives of this study were to risk stratify opioid misuse in a cancer pain population and determine the most common patient risk factors associated with misuse utilizing the ORT. This was a retrospective analysis conducted at an academic comprehensive cancer center. Patients were referred by an oncologist or hematologist to an outpatient palliative care clinic. One-hundred and fourteen patients with cancer (n = 107) or sickle cell disease (n = 7) were evaluated from July 2012 to July 2013. During the clinical interview, patients responded to a clinician administered ORT. Based on the ORT score, patients were stratified into low, moderate, or high risk for opioid misuse. Sample size included 57 men and 57 women. Sixty-five, 21, and 28 patients were deemed low, moderate, and high risk based on the ORT, respectively. The most common risk factors for opioid misuse were a history of depression (women = 32; men = 22) and family history of alcohol abuse (women = 26; men = 22). There was no difference between men and women in the prevalence of depression (P = .17) or family history of alcohol abuse (P = .57). The least common risk factor was a personal history of prescription drug abuse (n = 1) in women and history of preadolescent sexual abuse in men (n = 0). Twenty-five percent (n = 28) of the sample population were deemed high risk based on the ORT. Screening of cancer patients in the palliative care setting suggests that risk factors for opioid misuse exist. Stratifying patients based on a routine screening tool may help identify cancer patients at risk for aberrant drug behaviors.
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PMID:A single-center, retrospective analysis evaluating the utilization of the opioid risk tool in opioid-treated cancer patients. 2441 17