The illicitly manufactured fentanyl (IMF) market in the United States has grown increasingly adulterated, complicating public health and law enforcement responses. This study examines qualitative and quantitative fentanyl adulteration trends using data from the National Institute of Standards and Technology's (NIST) Rapid Drug Analysis and Research (RaDAR) program between January 2024 and June 2026. Analyzing 4563 qualitative and 1224 quantitative results from samples collected across 17 states, the research highlights significant geographic (East vs. West) and temporal shifts in the unregulated drug supply. Results indicate a sharp increase in sample complexity, with many samples containing over five compounds by late 2025. The data details the widespread emergence and subsequent regional shifts of α2-agonists (from xylazine to medetomidine), local anesthetics (lidocaine, tetracaine, and procaine), and the industrial chemical BTMPS. Quantitative findings reveal that IMF from the West consistently exhibited higher fentanyl purity (≈13% mass fraction) compared with the East (≈5% mass fraction). Furthermore, paired concentration analysis suggests that the presence of IMF in stimulants such as cocaine and methamphetamine likely stems from low-level unintentional contamination rather than intentional mixing. Ultimately, this research underscores the volatility of the IMF supply and demonstrates the critical need for continuous, comprehensive drug checking networks to rapidly detect and respond to evolving adulteration trends.

Acute abdominal pain is a common emergency department presentation and is often associated with diagnostic uncertainty. Historically, opioid analgesia was used cautiously because of concern that it could alter physical examination findings and interfere with diagnostic accuracy. Non-opioid and opioid-sparing strategies are increasingly used for pain management. This systematic review evaluates the efficacy and safety of analgesic strategies for acute, non-traumatic abdominal pain, with attention to pain relief, adverse effects, rescue analgesia, and diagnostic accuracy. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized comparative trials of opioid-containing treatment versus non-opioid, opioid-sparing, or placebo strategies. Eligible studies included adults aged 18 years or older with acute abdominal pain or an acute intra-abdominal cause of pain; studies limited to renal or ureteric colic were excluded. Of the 316 records identified, 45 duplicates were removed, 271 records were screened, 26 reports underwent full-text assessment, and 16 randomized trials were included. Across the included trials, opioids provided effective short-term analgesia but were not consistently superior to alternatives. Hydromorphone produced greater pain improvement than intravenous lidocaine at 90 minutes (between-group difference = 1.2 points, 95% confidence interval (CI) = 0.3-2.2) with less rescue analgesia. In acute pancreatitis, median Visual Analog Scale (VAS) reductions at 30 minutes were 45.5 (95% CI = 30-54) with tramadol, 41.5 (95% CI = 34-50) with paracetamol, and 40.5 (95% CI = 30-47) with dexketoprofen, with no statistically significant between-group difference. An erector spinae plane block produced lower pain scores and reduced rescue fentanyl compared with intravenous tramadol. In biliary colic, mean pain relief at 30 minutes was 3.8 (95% CI = 2.4-5.2) with ketorolac and 3.9 (95% CI = 2.4-5.3) with meperidine, with no statistically significant between-group difference. Butorphanol provided greater early pain relief than ketorolac at 15 minutes but not at 30 minutes. Low-dose morphine plus paracetamol did not significantly differ from standard-dose morphine, and intravenous lidocaine and morphine did not significantly differ at the primary 60-minute endpoint. Several placebo-controlled trials assessed diagnostic accuracy using different definitions and patient populations. In one trial, diagnostic accuracy was 86% with morphine and 85% with placebo (difference 1 percentage point, 95% CI = -11 to 12). This imprecise estimate does not rule out a clinically important difference, and the available trials do not establish whether opioids affect diagnostic accuracy across acute abdominal presentations. Some studies identified changes in tenderness, rigidity, or localization after analgesia, but these were not consistently associated with diagnostic error or adverse management outcomes. Adverse effects were generally short-term and included nausea, vomiting, dizziness, and sedation, although most trials were not large enough or followed long enough to reliably evaluate uncommon serious adverse events. Overall, the evidence supports an individualized approach to analgesia. Opioids remain effective when clinically indicated, but are not consistently superior to non-opioid or opioid-sparing alternatives, and analgesia should not be routinely delayed solely because of concern for diagnostic interference.

Although lidocaine is the internationally accepted International Nonproprietary Name (INN), the alternative term lignocaine continues to be used in English-language dental literature. However, patterns and consistency of terminology usage within individual publications have not been systematically investigated. This scoping review systematically mapped terminology usage in 526 English-language dental articles related to local anesthetics or local anesthesia techniques identified through searches of PubMed and Web of Science. Articles were classified into three groups according to terminology usage: Lidocaine (Lido), Lignocaine (Ligno), and Lidocaine+Lignocaine (Lido+Ligno). Terminology usage was compared between the Title/Abstract/Keywords (TAK) and Full Text (FT), and a proportion difference was calculated to evaluate differences across dental specialties and geographic regions. The Lido group predominated in both TAK and FT, whereas the proportion of the Lido+Ligno group increased in FT. The proportion difference was negative for the Lido and Ligno groups but positive for the Lido+Ligno group. Asia showed the largest differences between TAK and FT, with distinctive terminology patterns observed in India, whereas terminology usage remained relatively consistent in Japan, Korea, and Taiwan. Although lidocaine remains the predominant spelling in English-language dental literature, concurrent use of lidocaine and lignocaine within individual publications is common. These findings highlight the importance of consistent terminology in dental academic communication. The analytical framework presented in this study may also be applicable to investigations of other synonymous medical and dental terms.

BACKGROUND This study aimed to compare the safety and efficacy of phacoemulsification performed using topical cyclopentolate (Cykloftyal) vs standard intracameral mydriatic and anesthetic combination (Mydrane) in patients undergoing implantation of enhanced monofocal intraocular lenses. MATERIAL AND METHODS The medical records of 100 patients (100 eyes, 50 per group) were retrospectively analyzed. Patients received either intracameral Mydrane alone or topical cyclopentolate with intracameral lidocaine. Pupil diameter at the start and end of surgery, surgical duration, visual acuity, intraoperative complications, and postoperative adverse events were compared. RESULTS There was no statistically significant difference in surgical duration between the intracameral Mydrane group (8.80 min) and the topical cyclopentolate plus intracameral lidocaine group (9.24 min; P=0.54), nor in postoperative visual acuity at any distance. However, the initial pupil diameter was significantly larger in the topical cyclopentolate group (7.39±0.47 mm) than in the intracameral Mydrane group (6.08±1.05 mm; P<0.005), indicating a very large clinical effect size (Cohen's d=1.61). Pupil size at the end of the procedure showed no significant difference between the groups. No major intraoperative complications, such as posterior capsule rupture, were observed in either group. CONCLUSIONS In this cohort, topical cyclopentolate served as a safe and effective alternative to intracameral mydriasis, offering significantly wider initial pupil dilation while maintaining comparable surgical efficiency in uncomplicated cataract cases. Given its cost-effectiveness and wide accessibility, it remains a valuable strategy for resource-limited settings and complex cases requiring maximal visualization. Its potential utility in complex cases requiring maximal visualization remains a hypothesis to be evaluated in future prospective studies.

Chronic low back pain with radiating lower-extremity symptoms in the absence of clear radiculopathy or major central canal stenosis remains a common diagnostic and therapeutic challenge. In patients with radiating low back pain without a convincing compressive correlate, posterior myofascial structures may be considered among several potential contributors; however, the present report evaluates the anatomical feasibility of a distal thoracolumbar fascia (TLF) hydrodissection approach rather than a clinical pain generator. We developed an ultrasound-guided hydrodissection technique targeting the distal TLF deep to the gluteus maximus and inferior to the sacroiliac joint. This technical report describes the clinical rationale, procedural technique, and cadaveric dye-spread assessment of injectate distribution and gross neural sparing. The technique was developed for a selected clinical context characterized by chronic low back pain radiating to the posterior thigh or calf, intact motor function, and lumbar magnetic resonance imaging (MRI) findings that may include fatty infiltration of the lower lumbar multifidus, with or without involvement of the gluteal origin region, after limited or unsustained benefit from standard image-guided interventions. For the described clinical technique, the symptomatic side would receive 10 mL of injectate prepared to a final concentration of 15% dextrose with 0.1% lignocaine. For cadaveric assessment, three fresh-frozen cadavers (two male, one female; mean age 74.3 years) underwent bilateral ultrasound-guided injection of the same target plane, yielding six injected sides. Each side received 10 mL of undiluted 1% methylene blue. Layered dissection demonstrated cephalad spread to approximately the L3 level in six out of six sides (100%). Multifidus staining occurred in six out of six (100%) and longissimus thoracis staining in six out of six (100%), whereas iliocostalis lumborum staining occurred in 0 out of six (0%). Partial proximal sacrotuberous ligament staining was observed in six out of six (100%). No gross dye was observed in the sciatic nerve, sacral plexus, neural foramina, or epidural space in 0 out of six sides (0%). In this fresh-frozen cadaver model, ultrasound-guided injection at the distal TLF-gluteal junction was technically achievable and produced a consistent gross cephalad dye-spread pattern toward the posterior fascial-paraspinal region. Because both sides of each cadaver were injected, the present design was not intended to determine contralateral crossover. These cadaveric findings do not exclude microscopic spread and do not establish histologic or in vivo safety. They also do not establish safety or efficacy of the described injectate formulation at this target in living patients. This report should be interpreted as hypothesis-generating rather than evidence of clinical effectiveness or safety.

The rising incidence of antimicrobial resistance necessitates the development of sustainable and eco-friendly nanomaterials. In this study, silver-iron oxide nanoparticles (Ag-FeO NPs) were phyto-synthesized using Traganum nudatum seed extract as a natural reducing and stabilizing agent, and their physicochemical properties and antimicrobial activity were systematically evaluated. UV-Vis spectroscopy showed a characteristic absorption peak at 359 nm, providing supportive evidence of nanoparticle formation. Fourier-transform infrared spectroscopy revealed functional groups at 1,645 and 3,315 cm[-1], indicating the involvement of plant-derived phytochemicals in nanoparticle stabilization. Transmission electron microscopy analysis showed heterogeneous spherical and rod-like nanostructures with moderate aggregation, while scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy qualitatively indicated the presence of silver and iron, together with oxygen and carbon. Dynamic light scattering analysis showed an average hydrodynamic particle size of 7.3 nm and a broad particle size distribution (PDI = 0.60), with a zeta potential of -1.36 mV. GC-MS profiling identified bioactive metabolites, including 3-(octanoyloxy)propane-1,2-diyl bis(decanoate), n-hexadecanoic acid, hentriacontane, and lidocaine, potentially contributing to nanoparticle synthesis and bioactivity. Ag-FeO NPs exhibited significant antimicrobial activity against Escherichia coli, methicillin-resistant Staphylococcus aureus, and Candida albicans. SEM analysis of C. albicans revealed severe ultrastructural damage, including surface deformation and cell wall disruption. Ag-FeO NPs produced greater reductions in MCF-7 cell viability than in MCF-10A non-tumorigenic epithelial cells, although a clear concentration-dependent response was not observed within the tested range. Computational prediction analyses using PASS, SwissTargetPrediction, SwissADME, and ProTox-II indicated that several identified phytochemicals possess antimicrobial and antineoplastic potential together with favorable pharmacokinetic characteristics. Overall, the integration of green synthesis, experimental validation, and computational modeling highlights the potential of T. nudatum-mediated Ag-FeO NPs as effective and sustainable agents for biomedical applications.

Despite the recent therapeutic advances, approximately one-third of patients with chronic migraine fail to achieve clinically meaningful benefit, and existing oral preventive therapies remain limited by tolerability and off-target effects. There is, therefore, a pressing need for new, well-tolerated, mechanistically distinct preventive treatments for chronic migraine. This hypothesis article evaluates the pharmacological and biological rationale supporting guanfacine as a potential preventive therapy for chronic migraine.