Rejected

Atopic dermatitis (AD), a long-lasting skin disease characterized by intense itching and dry, red, swollen and cracked skin, affects between 2% and 10% of Japanese adults. In Japan, patients with moderate-to-severe or very severe AD have limited treatment options, most with unwanted side effects. There is a need for therapies that provide safe and effective long-term control. The underlying mechanism of AD may differ between Asian and Western patients, and this study aimed to evaluate dupilumab, a drug that blocks key molecules that cause AD, in Japanese patients with moderate-to-severe AD. The authors studied Japanese patients from three international, placebo-controlled clinical trials of dupilumab. Of the 1,597 adults with moderate-to-severe AD in those trials ("all patients"), 250 were Japanese. The investigators measured the effects of dupilumab treatment for 16 weeks or one year on the signs (what a clinician observes) and symptoms (what a patient feels) of AD. At the start of each trial, Japanese patients generally had more severe AD than all patients. Nevertheless, dupilumab significantly improved signs and symptoms of AD (including itch) compared with placebo (dummy drug) in the Japanese patients and was as well tolerated in the Japanese patients as in all patients; dupilumab was more likely than placebo to be associated with injection-site reaction or conjunctivitis ("pinkeye"). Compared with placebo, dupilumab reduced the amount of substances in the blood that are generally increased in patients with AD. The investigators concluded that, similar to all patients, dupilumab is effective and well tolerated in Japanese patients with moderate-to-severe AD.

A close association has been reported between depression and migraine. However, information concerning the impacts of migraine on the clinical presentation and prevalence of depression in a population-based study is currently limited.

Chronic pelvic pain is an important but underrecognized cause of morbidity in men. While there is abundant literature discussing female pelvic pain and the diagnostic role of imaging, much less attention has been given to imaging of non-gynecologic causes of chronic pelvic pain. Chronic pelvic pain in men can be a challenge to diagnose as pain may arise from visceral, musculoskeletal, or neurovascular pathology. Imaging of the pelvic viscera has been covered in detail elsewhere in this edition and therefore will not be reviewed here. We will focus upon topics less familiar to the abdominal radiologist, including imaging of pelvic floor, musculoskeletal, and neurovascular pathology.

Fomepizole has been recommended as first-line antidote to treat ethylene glycol and methanol poisoning. Despite more than 30 years of utilization, the safety of fomepizole when used clinically has not been well documented. Based on the long-standing clinical experience with fomepizole in France, we investigated its safety profile in patients treated for suspected toxic alcohol poisoning. We designed a 16-year post-marketing study to evaluate the indications for fomepizole prescriptions and to investigate its safety. Data were retrospectively collected using a standardized questionnaire sent each month by post to each French hospital that ordered fomepizole during the month before. The response rate to our survey was 59%. Five hundred and thirty-six patients [188 females/348 males; age, 46 years [34-55] (median [25th-75th percentiles])] were treated with fomepizole [cumulative dose, 18.6 mg/kg [15.5-26.3] (1,268 mg [900-2,100])]. Ethylene glycol/methanol poisoning was confirmed in 275 patients (51%) while a nontoxic exposure was diagnosed in 147 patients (27%). Toxic alcohol poisoning was misdiagnosed in the remaining 114 patients (21%), before the assessment of an alternative poisoning or non-poisoning diagnosis. Fifty adverse reactions were attributed to fomepizole in 36 patients (7%) including general reactions ( = 22), local reactions ( = 22) and laboratory test impairments ( = 6). All were considered mild and transient. None required stopping fomepizole. The most frequent adverse effects were injection site pain/burning ( = 13), nausea/vomiting ( = 8), vessel puncture site inflammation ( = 7), drowsiness/confusion ( = 5) and serum aminotransferase elevation ( = 3). None of the fatalities ( = 37, 7%) or persistent symptoms on discharge ( = 9; 2%) was related to fomepizole. Our longitudinal cohort study supports the safety of fomepizole administered to treat presumed EG and methanol poisoning.

To review data regarding bremelanotide, a recently approved therapy for hypoactive sexual desire disorder (HSDD). Literature search of Medline, SCOPUS, and EMBASE was performed using the search terms , and between January 1, 1996, and December 15, 2019. Reference lists from included articles were also reviewed for pertinent citations. We included phase 2 and 3 trials of bremelanotide. There were 2 reports of phase 3 trials and 2 reports of phase 2 trials. Additional information from supplementary analyses was also referenced. Bremelanotide demonstrates significant improvement in desire and a significant decrease in distress related to lack of desire. The most common adverse effects include nausea (39.9%), facial flushing (20.4%), and headache (11%). Bremelanotide is the second Food and Drug Administration-approved medication for the treatment of HSDD. Bremelanotide's place in therapy is unknown, as the HSDD guidelines were last updated in 2017. Although the trials met statistical significance for change in sexual desire elements and distress related to sexual desire, the clinical benefit may only be modest. Bremelanotide is a subcutaneous injection that can be administered as needed approximately 45 minutes prior to sexual activity. Bremelanotide is safe and has limited drug-drug interactions, including no clinically significant interactions with ethanol. Prescribing guidelines recommend no more than 1 dose in 24 hours and no more than 8 doses per month. Individuals should discontinue use after 8 weeks without benefit.

Maternal heart disease is one of the major causes for mortality among parturients. In our study, we surveyed 220 patients with different valvular disorders who gave birth in our medical center in the years 2012-2018. The aim of this study was to characterize various valvular pathologies and compare the results of different anesthetic approaches.

We describe a patient with an intrathecal drug delivery system (IDDS) for management of chronic back pain who developed worsening pain symptoms associated with an infected catheter tip, identified years after initial implantation. A 72-year-old woman had an IDDS initially implanted for management of chronic back pain. Years later, after suffering a vertebral compression fracture, workup revealed magnetic resonance imaging (MRI) findings suggestive of infection despite unremarkable laboratory findings. Her pain worsened, and after explantation of the IDDS, methicillin-resistant Staphylococcus aureus colonized the catheter tip. Worsening pain symptoms in a patient with intrathecal morphine pump must be met with a broad differential diagnosis.

Approximately one in three women in the United States deliver via Cesarean section (CS), making it one of the most common surgical procedures in the country. Neuraxial (spinal or epidural) anesthesia is the most effective and common anesthetic approach for pain relief during a CS in the United States and often associated with adverse effects such as nausea, vomiting, and pruritus. While recommended dose ranges exist to protect patient safety, there are a lack of guidelines for opioid doses that both optimize postoperative pain management and minimize side effects. This integrative review synthesizes the evidence regarding best practice of opioid dosing in neuraxial anesthesia for planned CS. Evidence supports the use of lower doses of intrathecal (IT) opioids, specifically 0.1 morphine, to achieve optimal pain management with minimal nausea, vomiting, and pruritus. Lower IT doses have potential to achieve pain management and to alleviate preventable side effects in women delivering via CS.

Herpes zoster or shingles causes a severe painful rash that spreads along dermatomes in the face or chest wall, which leads to a condition known as postherpetic neuralgia (PHN). There is no cure for PHN, but there are many treatments to reduce pain duration and severity. In this case report, we describe a patient treated for PHN using pregabalin (Lyrica) after failure with gabapentin. Despite being listed as a controlled substance by the Food and Drug Administration, pregabalin may be an effective first-line therapy for PHN and other forms of neuropathic and chronic pain.

4-Anilidopiperidine class of synthetic opioid analgesics, with it's representative fentanyl, are by far the most potent and clinically significant for the treatment of the severe chronic and surgical pain. However, side effects of μ-opioids are often quite serious. In order to improve the pharmacological profile of this class of opioid analgesics, a novel fentanyl analogs were designed, synthesized and evaluated in vivo for their antinociceptive activity.