Nicholas J. Mynarski’s research while affiliated with Geisinger Commonwealth School of Medicine and other places

IntroductionHorner syndrome is a rare complication following anterior cervical discectomy and fusion (ACDF) surgeries, with an incidence rate of Case DescriptionWe report a case of a 45-year-old female with a history of non-Hodgkin's lymphoma and chronic obstructive pulmonary disease who developed Horner syndrome post-ACDF. Initially admitted for suspected cholecystitis found on imaging following a fall, the patient's clinical course was complicated by worsening cervical and lumbar pain. This prompted MRI evaluation revealing cervical stenosis at C5-C6 and ACDF was performed without intraoperative complications. However, on postoperative day three, the patient developed left eye ptosis and miosis, consistent with Horner syndrome. Subsequent MRI revealed a new fluid collection suggestive of a seroma. Despite conservative management, Horner syndrome persisted. Discussion Horner syndrome post-ACDF is a rare but potentially lifelong complication. Possible etiologies include prolonged retraction of the longus colli muscle and postoperative inflammation leading to seroma formation, potentially compressing sympathetic nerve fibers. Current literature suggests under diagnosis of Horner syndrome post-ACDF, emphasizing the need for heightened clinical suspicion. Future research should focus on refining surgical techniques to minimize sympathetic trunk damage and facilitate early diagnosis and management of this rare complication.

Objectives Opioid use disorder (OUD) is a major public health concern in the USA, resulting in high rates of overdose and other negative outcomes. Methadone, an OUD treatment, has been shown to be effective in reducing the risk of overdose and improving overall health and quality of life. This study analysed the distribution of methadone for the treatment of OUD across the USA over the past decade and through the COVID-19 pandemic. Design Retrospective observational study using secondary data analysis of the Drug Enforcement Administration and Medicaid Databases. Setting USA. Participants Patients who were dispensed methadone at US opioid treatment programmes (OTPs). Primary and secondary outcome measures The primary outcomes were the overall pattern in methadone distribution and the number of OTPs in the USA per year. The secondary outcome was Medicaid prescriptions for methadone. Results Methadone distribution for OUD has expanded significantly over the past decade, with an average state increase of +96.96% from 2010 to 2020. There was a significant increase in overall distribution of methadone to OTP from 2010 to 2020 (+61.00%, p<0.001) and from 2015 to 2020 (+26.22%, p<0.001). However, the distribution to OTPs did not significantly change from 2019 to 2021 (−5.15%, p=0.491). There was considerable state-level variation in methadone prescribing to Medicaid patients with four states having no prescriptions. Conclusions There have been dynamic changes in methadone distribution for OUD. Furthermore, pronounced variation in methadone distribution among states was observed, with some states having no OTPs or Medicaid coverage. New policies are urgently needed to increase access to methadone treatment, address the opioid epidemic in the USA and reduce overdose deaths.

The bear paw sign is a radiologic sign seen on computed tomography (CT) that indicates the development of xanthogranulomatous pyelonephritis (XGP). It refers to the multiple, rim-enhancing, low attenuation renal collections seen in the diffuse form of XGP. The term “bear paw” sign first appeared in the literature in 1989 and has since been widely used to describe this serious, but treatable, pathology.

Objectives To identify US prescription trends in methadone distribution for OUD from 2010 to 2020. Methods The weight of methadone in grams distributed to OTPs per state was derived from the US Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System. Methadone was adjusted for state population and compared across all fifty states and Washington DC from 2010 to 2020. Results The overall distribution of methadone to OTPs significantly (P < 0.0001) increased from 2010 to 2019 (+61.0%) and from 2015 to 2020 (+26.22%). The states with the highest percent change from 2010 to 2020 were Montana (+897.02%), Alaska (+421.11%), and Vermont (+353.67%). In contrast with prior increase of distribution, from 2019 (pre-COVID-19 pandemic) to 2020 (during pandemic), there was no significant change in the distribution of methadone to OTPs (-0.09%). Ohio (+26.02%) significantly increased while Alabama (-21.96%), New Hampshire (-24.13%) and Florida (-28.97%) significantly decreased methadone relative to the national mean. Conclusions This investigation revealed two trends related to methadone distribution in the US: increased utilization over the past decade and a plateau in utilization from 2019 to 2020. Policies are needed to remove access barriers to methadone treatment during the COVID-19 pandemic in order to reduce the worsening crisis of opioid overdoses in the US.

Background Methadone is an evidence-based treatment for opioid use disorder (OUD) and pain management. Methadone for OUD may be difficult for some patients to access, particularly those in rural areas. Objective The purpose of this study was to characterize methadone distribution patterns between 2017 and 2019 across the United States. Methods The US Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System was used to acquire the number of opioid treatment programs (OTPs) per state and methadone distribution weight in grams. Methadone distributions by weight, corrected for state population and number of OTPs, were compared from 2017 to 2019 between states, within regions, and nationally. Results The national distribution of methadone increased +12.3% for OTPs but decreased −34.6% for pain. Whereas all states saw a decrease in pain distribution, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for OTPs, and most states demonstrated a relatively stable or increasing number of OTPs, with an +11.5% increase nationally. The number of OTPs per 100K state population ranged from 2.1 in Rhode Island to 0.0 in Wyoming. Conclusion and Relevance Although methadone distribution for OUD was increasing in the United States, the pronounced regional disparities identified warrant further consideration to improve patient access to this evidence-based pharmacotherapy, particularly in the Midwest and West regions. Greater implementation of telehealth and involvement of primary care into opioid treatment practice offer possible solutions to eliminating geographical treatment barriers.

Objective Methadone is an evidence based treatment for opioid use disorder and is also employed for acute pain. The primary objective of this study was to explore methadone distribution patterns between the years 2017 and 2019 across the United States (US). This study builds upon previous literature that has analyzed prior years of US distribution patterns, and further outlines regional and state specific methadone trends. Methods The Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS) was used to acquire the number of narcotic treatment programs (NTPs) per state and methadone distribution weight in grams. Methadone distribution by weight, corrected for state populations, and number of NTPs were compared from 2017 to 2019 between states, within regions, and nationally. Results Between 2017 and 2019, the national distribution of methadone increased 12.30% for NTPs but decreased 34.57% for pain, for a total increase of 2.66%. While all states saw a decrease in distribution for pain, when compared regionally, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for NTPs and most states demonstrated a relatively stable or increasing number of NTPs, with an 11.49% increase in NTPs nationally. The number of NTPs per 100K in 2019 ranged from 2.08 in Rhode Island to 0.00 in Wyoming. Conclusion Although methadone distribution for OUD was increasing in the US, there were pronounced regional disparities.