Sufentanil versus Fentanyl: Efficacy and Patient Satisfaction with Intrathecal Pain Management

Objectives: This study compared fentanyl vs. sufentanil in intrathecal pain pumps. H1: both reduce patient subjective pain ratings. H2: sufentanil is more effective than fentanyl. H3: overall satisfaction with pain control is greater with sufentanil. Materials/Method: This is an archival study of patients in tertiary pain management (N= 97, mean age = 58.77, standard deviation = 14.88). Pain was measured using the subjective units of discomfort scale. Satisfaction with pain control/relief was measured by asking patients each visit if they are satisfied with pain management and is recorded in a “yes”/ “no” manner. Pain ratings were analyzed with repeated measures analysis of variance and satisfaction was analyzed with chi square. Results/Discussion: Sufentanil was found to be marginally more effective, but both medications controlled a significant degree of variance in pain reduction over time. A significantly greater number of patients maintained on sufentanil were satisfied with care than patients on fentanyl.     

Effects of some common additives on the antimicrobial activities of alcohol-based hand sanitizers

Objective: To study the effects of some common additives on the antimicrobial activities of alcohol-based hand sanitizers. Methods: The antibacterial activities of varying aqueous concentrations of ethanol and isopropyl alcohol were tested by the agar well diffusion method. The influences of different concentrations of glycerin was similarly tested. Finally, isopropyl alcohol and benzalkonium chloride were combined in different ratios within the sate use concentrations of each, and the effects of these combinations were compared with values obtained for the two agents used alone. Statistical methods, such as student t test and one-way ANOVA were used when appropriate to evaluate the differences in activity. Results: The activities of the alcohols showed marked concentration dependence, and both showed peak activity at 85%-95% concentration range. Over the concentration range of 60%-100%, isopropyl alcohol inhibited more bacterial and fungal organisms than ethanol, though the inhibition zone diameters it produced were not statistically different from those of ethanol for organisms which were sensitive to both of them.Addition of glycerin reduced the antimicrobial activities of the isopropyl alcohol, as shown by reduction in the inhibition zone diameters produced in vitro, which may be due to reduced drug diffusion with increase in viscosity. Addition of benzalkonium to isopropyl alcohol systems improved the activity of the alcohol, but the overall activity of the combination was not superior to that seen in the use of benzalkonium alone. Conclusion: Alcohol-based hand sanitizers should not be used outside the concentration range of 85%-95% and isopropyl alcohol inhibits more bacterial and fungal organisms than ethanol for most concentrations. Inclusion of benzalkonium improves the antimicrobial spectrum and activity of isopropyl alcohol, and the combination may justifiably be used to achieve both immediate and long lasting effect. Glycerin may adversely affect the antimicrobial activities of isopropyl alcohol-based hand sanitizers and should be used with caution.     

Influenza in patients with hematological malignancies: Experience at two comprehensive cancer centers

The burden of influenza infections in patients with hematological malignancies (HMs) is not well defined. We describe the clinical presentation and associated outcomes of influenza at two comprehensive cancer centers (center 1 in the United States and center 2 in Mexico). Clinical and laboratory data on patients with HMs and influenza infection diagnosed from April 2009 to May 2014 at the two centers were reviewed retrospectively. A total of 190 patients were included, the majority were male (63%) with a median age of 49 years (range, 1‐88 years), and had active or refractory HMs (76%). Compared to center 1, patients in center 2 were significantly sicker (active cancer, decreased albumin levels, elevated creatinine levels, or hypoxia at influenza diagnosis) and experienced higher lower respiratory tract infection (LRI) rate (42% vs 7%; P < 0.001). In multivariable logistic regression analysis (odds ratio, 95% confidence interval), leukemia, (3.09, 1.23‐7.70), decreased albumin level (3.78, 1.55‐9.20), hypoxia at diagnosis (14.98, 3.30‐67.90), respiratory co‐infection (5.87, 1.65‐20.86), and corticosteroid use (2.71, 1.03‐7.15) were significantly associated with LRI; and elevated creatinine level (3.33, 1.05‐10.56), hypoxia at diagnosis (5.87, 1.12‐30.77), and respiratory co‐infection (6.30, 1.55‐25.67) were significantly associated with 60 day mortality in both centers. HM patients with influenza are at high risk for serious complications such as LRI and death, especially if they are immunosuppressed. Patients with respiratory symptoms should seek prompt medical care during influenza season.