Latest Updates

Patient with a History of Active Substance Abuse Requesting Opioids for Chronic Pain

Burton R. Beakley, M.D, Harold J. Campbell, B.S, Martin J Carney, B.S, Mark R. Jones, M.D, Alan D. Kaye, MD, PhD
    • Recent data demonstrate the clinical, economic, and social burden of chronic pain and opioid abuse.
    • Drug tests now have the ability to distinguish heroin from alternate opioid intoxication by recognizing the metabolite 6-monoacetylmorphine (6-MAM).
    • Using the basis of medical ethical conduct to treat patients with chronic pain and prescribe opioid medications. These tenets include nonmaleficence, beneficence, justice, and autonomy.

Viral Hepatitis C: Epidemiology, ­Pathogenesis, Transmission, And ­Natural History

Raymond T. Chung, MD, Jacinta A Holmes, MBBS, PhD, Anna Lidofsky, BS
    • Changing incidence and prevalence of HCV
    • Increasing burden of HCV-related liver disease

Evidence-Based Surgery

Karl Y. Bilimoria, MD, MS, Benjamin S Brooke, MD, PhD
    • Methods to appraise the strength of scientific evidence in surgery
    • Overview of methods to evaluate the quality of research studies
    • Methods to interpret and apply scientific evidence to clinical practice
    • Different approaches in clinical and health services research
    • Approaches to measuring the quality of care in surgery

Evidence-Based Surgery

Karl Y. Bilimoria, MD, MS, Benjamin S Brooke, MD, PhD
    • Methods to appraise the strength of scientific evidence in surgery
    • Overview of methods to evaluate the quality of research studies
    • Methods to interpret and apply scientific evidence to clinical practice
    • Different approaches in clinical and health services research
    • Approaches to measuring the quality of care in surgery

Evidence-Based Surgery

Karl Y. Bilimoria, MD, MS, Benjamin S Brooke, MD, PhD
    • Methods to appraise the strength of scientific evidence in surgery
    • Overview of methods to evaluate the quality of research studies
    • Methods to interpret and apply scientific evidence to clinical practice
    • Different approaches in clinical and health services research
    • Approaches to measuring the quality of care in surgery

Hepatitis B Virus

Ming V. Lin, MD, April Wall, MD
    • Tenofovir alafenamide (AF) was FDA approved in November 2016 for the treatment of chronic hepatitis B. It has enhanced plasma stability and more efficient delivery to the hepatocytes with a lower dose compared with tenofovir disoproxil fumarate (DF). Tenofovir AF has similar efficacy to tenofovir DF but less nephrotoxicity (smaller increase in serum Cr and median changes in estimated GFR) and bone toxicity (smaller mean percentage decrease from baseline hip and spine bone mineral density).
    • Major advances in basic research in hepatitis B are paving the way for the identification of new therapeutic targets with the goal of complete cure with physical elimination of cccDNA.
    • Postmarketing studies have demonstrated a risk of HBV reactivation during treatment with hepatitis C direct antiviral agents, and it is recommended to monitor patients with HBV-HCV coinfection with serial lab tests and consider concomitant HBV treatment analogue for patients who meet the standard criteria for HBV treatment.

Cannabis for Seizure Disorders

    • THC exerts anticonvulsive effects at low doses but may worsen seizure activity at higher doses
    • CBD is the preferred agent of study for drug-resistant epilepsy, particularly in childhood epilepsy syndromes that do not respond to AEDs; CBD has shown great promise as an alternative modality in such cases, with a significant reduction in seizure frequency and severity in various models and studies
    • Other phytocannabinoids sharing similarities with CBD, such as CBDV, are emerging as candidates to study epileptogenesis intervention
    • Pathways implicated in cannabinoid treatment of seizure disorders do not involve CB1 or CB2 receptors; other endocannabinoid receptors predominate in the anticonvulsive mechanisms mediated by intracellular Ca2+ modulation and glutamatergic neurotransmission reduction

Preterm Premature Rupture of Membranes

Daniel Castro, MD, Errol R. Norwitz, MD, PhD, MBA
    • In the setting of preterm premature rupture of membranes, pregnancy outcome is contingent upon the underlying cause, gestational age at diagnosis and delivery, and presence of complications (placental abruption, infection).
    • Latency (time from rupture of membranes to delivery) depends on gestational age, severity of oligohydramnios, number of fetuses (shorter in twins), presence or absence of complications, fetal wellbeing, and use of broad-spectrum antibiotics.
    • Efforts to reseal ruptured membranes using a variety of tissue sealants has been attempted, but neither the safety nor efficacy of these sealants has yet been established.
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