Abstract Aims Buprenorphine is an opioid partial-agonist used to treat Opioid Use Disorders (OUD). While several state and federal policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution. Measurements Buprenorphine weights distributed from 2007 to 2017 were obtained from the Drug Enforcement Administration. Data was expressed as the percent change and as the mg per person in each state. Separately, the formulations for prescriptions covered by Medicaid (2008 to 2018) were examined. Findings Buprenorphine distributed to pharmacies increased about seven-fold (476.8 to 3,179.9 kg) while the quantities distributed to hospitals grew five-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of waivered physicians per 100K population and distribution per state ( r (49) = +0.76, p < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but this accounted for less than three-fifths (57.3% of 6.56 million prescriptions) in 2018. Conclusions Although buprenorphine availability has substantially increased over the last decade, distribution was very non-homogenous across the US.
A 25-year-old man presented with a 2-month history of progressively worsening left eye pain and an atypical corneal ring infiltrate. His condition deteriorated despite topical antibiotic therapy. Cultures for bacteria, fungus and acanthamoeba, repeated twice, all demonstrated no growth. On third corneal scraping, culture on Middlebrook agar grew colonies after 3 weeks of incubation. Sixteen-second deep sequencing identified
To report a case of bilateral peripheral corneal thinning with an appearance of Fuchs superficial marginal keratitis in the right eye and Terrien marginal degeneration in the left eye.Interventional case report.A 28-year-old woman presented with bilateral corneal thinning and a pseudopterygium in the right eye and peripheral corneal thinning in the left eye. Laboratory examinations were negative. Over the next several years, the patient experienced periodic episodes of bilateral ocular redness and discomfort associated with gradual corneal thinning. However, other signs of progression were different in each eye. Pseudopterygium growth was observed in the right eye, consistent with Fuchs superficial marginal keratitis. Progressive lipid deposition at the leading edge of corneal thinning was observed in the left eye, consistent with Terrien marginal degeneration. Chronic topical corticosteroid therapy was initiated with little, if any, subsequent disease progression. A perinuclear antineutrophil cytoplasmic antibody (p-ANCA)-positive vasculitis was subsequently diagnosed.Fuchs superficial marginal keratitis and Terrien marginal degeneration may represent different clinical features of the same disease process. Laboratory investigation for underlying systemic disease may be warranted in patients with the appearance of either disorder. Chronic antiinflammatory therapy may be effective in limiting the progression of corneal thinning in these diseases.
We will describe a case of a rapidly growing osteoma of the orbit in a young boy presenting with orbital cellulitis. The subsequent discussion elucidates the clinical and radiographic features of osteoma and attempts to clarify the confusing terminology surrounding the histopathology of the three main types of osteoma. Patients with osteoma of the skull should be referred for appropriate gastrointestinal studies to rule out the occurrence of Gardner's syndrome.
