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Biomedical subjects

Mukta Panda

Publications and source records attributed to Mukta Panda.

11 recordsLinked to original sources
PubMed2006

The influence of discordance in pain assessment on the functional status of patients with chronic nonmalignant pain.

BACKGROUND: Chronic pain is a frequent cause of suffering and disability that seriously affects patients' quality of life and imposes a staggering socioeconomic toll on society. Little is known about the impact of patient-physician disagreement (discordance) regarding the assessment of chronic pain on patients' quality of life in primary care settings. This study evaluates the role of discordance and other potentially modifiable factors that affect the quality of life and functional status of chronic pain patients. METHODS: We evaluated 436 patient-physician encounters at 12 academic medical centers in the United States. We surveyed chronic nonmalignant pain patients to understand their pain perceptions. We concurrently surveyed their physicians about their perceptions of their patient's pain in primary care settings. RESULTS: More than 50% of physicians disagreed with their patient's pain. Thirty-nine percent of primary care physicians underestimated their patient's pain. In the multivariate analysis, this discordance was associated with poor physical functioning and worse bodily pain (P < 0.018 and P < 0.001 respectively). Patients with chronic, nonmalignant pain have reductions in physical function and bodily pain domains of the SF-36 compared to age-matched populations. Depression and obesity represented other associations. CONCLUSION: Patients with chronic nonmalignant pain have poor physical functioning and worse bodily pain. Discordance, obesity, and depression are other modifiable factors. Prospective studies are needed to design interventions. However, a multifaceted approach appears to represent the best opportunity to reduce the pain and suffering of this challenging population.

Chronic Disease↗
PubMed2006

Refractory hypoxemia in right ventricular infarction: a case report.

Right ventricular infarction has many clinical features. Although hypoxemia is a common presenting symptom with multiple causes in the setting of myocardial infarction, the authors present a case resulting from an acute right-to-left shunt secondary to a previously dormant patent foramen ovale. A 74-year-old male presented to the hospital after feeling unwell for the previous 2 days. Initial evaluation revealed marked hypoxemia without respiratory distress. Electrocardiographic findings and cardiac seromarkers revealed a completed inferior myocardial infarction. The patient's hypoxemia was refractory to 100% oxygen, indicating a right-to-left shunt. A transesophageal echocardiogram confirmed clinical suspicions for a right-to-left shunt through a patent foramen ovale. Despite sporadic reports in the literature, this still is a poorly recognized clinical condition. The authors review a case report that will enable the general intemist to consider a right-to-left shunt in the setting of hypoxemia in myocardial infarction.

Aged↗
PubMed2006

No poinsettia this Christmas.

Poinsettia is one of the most delightful decorations during the Christmas season. Natural rubber latex and poinsettia share some common allergen proteins. Hence, people with latex allergy may develop cross-reactivity with poinsettia. We report the case of a 50-year-old white female with a history of latex allergy, who developed a skin rash due to exposure to the poinsettia plant. The patient was admitted to the hospital for evaluation of near syncope. Her diagnostic workup was normal. She received a poinsettia plant from a friend during hospitalization. Because of her latex allergy, we carried out an extensive research of literature which revealed a cross-reactivity between latex allergy and poinsettia. The rash responded well to systemic antihistaminic treatment and removal of the plant from the room.

Allergens↗
PubMed2006

Cardiac perforation and tamponade: a potentially fatal complication during transjugular intrahepatic portosystemic shunt placement.

Transjugular intrahepatic portosystemic shunt (TIPS) is a low-resistance channel between the hepatic vein and the intrahepatic portion of the portal vein. This is an important addition to the therapeutic armamentarium against portal hypertension. Complications are either technical or due to the creation of a shunt. Procedure-related mortality is about 0 to 2%. Cardiac perforation, one of the rarest complications during TIPS, can occur while traversing the catheter from the jugular vein past the right atrium to enter the hepatic vein. We are reporting the case of a 50-year-old woman who became acutely hypotensive with cardiovascular compromise during the TIPS procedure. A stat echocardiogram confirmed cardiac tamponade and emergency pericardiocentesis resulted in improvement of hemodynamic status with complete recovery.

Cardiac Tamponade↗
PubMed2005

Public perceptions of alcohol use by physicians.

OBJECTIVES: The objective of this study was to assess public perceptions of alcohol use by physicians on duty. METHODS: A random telephone survey of 408 adults in one Tennessee county was used. RESULTS: Only 1% of the respondents reported that they suspected that a physician with whom they were in professional contact during the last year had used alcohol. Only 7% reported encountering physicians whom they suspected of having used alcohol while on duty. When queried about their beliefs, 98% disagreed that social drinking is acceptable while on duty, 92% believed that physicians should not have even a single drink while on duty, and 91% believed that doctors have an obligation to inform patients that they have consumed an alcoholic beverage before advising or treating them. CONCLUSIONS: Patients rarely suspect that physicians use alcohol while on duty and are highly intolerant of this practice. Physicians can only gain in prestige and public confidence by adding categoric proscriptions about alcohol use on duty to their ethical codes.

Adolescent↗
PubMed2005

Racial differences in opioid use for chronic nonmalignant pain.

BACKGROUND: Chronic pain is a frequent cause of suffering and disability that negatively affects patients' quality of life. There is growing evidence that disparities in the treatment of pain occur because of differences in race. OBJECTIVE: To determine whether race plays a role in treatment decisions involving patients with chronic nonmalignant pain in a primary care population. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey was administered to patients with chronic nonmalignant pain and their treating physicians at 12 academic medical centers. We enrolled 463 patients with nonmalignant pain persisting for more than 3 consecutive months and the primary care physicians participating in their care. RESULTS: Analysis of the 397 black and white patients showed that blacks had significantly higher pain scores (6.7 on a scale of 0 to 10, 95% confidence interval (CI) 6.4 to 7.0) compared with whites (5.6, 95% CI 5.3 to 5.9); however, white patients were more likely to be taking opioid analgesics compared with blacks (45.7% vs 32.2%, P<.006). Even after controlling for potentially confounding variables, white patients were significantly more likely (odds ratio (OR) 2.67, 95% CI 1.71 to 4.15) to be taking opioid analgesics than black patients. There were no differences by race in the use of other treatment modalities such as physical therapy and nonsteroidal anti-inflammatories or in the use of specialty referral. CONCLUSION: Equal treatment by race occurs in nonopioid-related therapies, but white patients are more likely than black patients to be treated with opioids. Further studies are needed to better explain this racial difference and define its effect on patient outcomes.

Black or African American↗
PubMed2004

Determinants of prescribing meperidine compared to morphine in hospitalized patients.

Morphine is a preferred narcotic since meperidine forms toxic metabolites. Determinants of meperidine use have been poorly described. The objective of this study is to explore factors associated with the ordering of meperidine versus morphine. Retrospective chart review of adult patients, randomly selected based on orders for morphine or meperidine. 1552 orders were written for 670 patients. Of these, 36% were for meperidine. In multivariable analysis, the ordering of meperidine was associated with the following variables in decreasing order of importance: physician specialty, total doses received, hospital location, patient race, age and insurance, and physician gender. More orders for meperidine were written for those receiving fewer doses. Though meperidine has little role in the routine management of hospital pain, we found it continues to be used frequently. Importantly, meperidine is ordered more frequently for patients who receive shorter courses of narcotics. Our study suggests that interventions targeted at more appropriate use of meperidine rather than complete elimination might be more acceptable to physicians while minimizing the risk of toxicity.

Adult↗