Cessation Of Use Research Articles

Community managed alcohol programs in Canada: Overview of key dimensions and implementation.

People with severe alcohol dependence and unstable housing are vulnerable to multiple harms related to drinking and homelessness. Managed Alcohol Programs (MAP) aim to reduce harms of severe alcohol use without expecting cessation of use. There is promising evidence that MAPs reduce acute and social harms associated with alcohol dependence. The aim of this paper is to describe MAPs in Canada including key dimensions and implementation issues. Thirteen Canadian MAPs were identified through the Canadian Managed Alcohol Program Study. Nine key informant interviews were conducted and analysed alongside program documents and reports to create individual case reports. Inductive content analysis and cross case comparisons were employed to identify six key dimensions of MAPs. Community based MAPs have a common goal of preserving dignity and reducing harms of drinking while increasing access to housing, health and social services. MAPs are offered as both residential and day programs with differences in six key dimensions including program goals and eligibility, food and accomodation, alcohol dispensing and administration, funding and money management, primary care services and clinical monitoring, and social and cultural connections. MAPs consist of four pillars with the alcohol intervention provided alongside housing interventions, primary care services, social and cultural interventions. Availability of permanent housing and re-establishing social and cultural connections are central to recovery and healing goals of MAPs. Additional research regarding Indigenous and gendered approaches to program development as well as outcomes related to chronic harms and differences in alcohol management are needed.

How do we determine the impact of e-cigarettes on cigarette smoking cessation or reduction? Review and recommendations for answering the research question with scientific rigor.

To propose a hierarchy of methodological criteria to consider when determining whether a study provides sufficient information to answer the question of whether e-cigarettes can facilitate cigarette smoking cessation or reduction. A PubMed search to 1 February 2017 was conducted of all studies related to e-cigarettes and smoking cessation or reduction. Australia, Europe, Iran, Korea, New Zealand and the United States. 91 articles. Coders organized studies according to six proposed methodological criteria: (1) examines outcome of interest (cigarette abstinence or reduction), (2) assesses e-cigarette use for cessation as exposure of interest, (3) employs appropriate control/comparison groups, (4) ensures that measurement of exposure precedes the outcome, (5) evaluates dose and duration of the exposure and (6) evaluates the type and quality of the e-cigarette used. Twenty-four papers did not examine the outcomes of interest. Forty did not assess the specific reason for e-cigarette use as an exposure of interest. Twenty papers did not employ prospective study designs with appropriate comparison groups. The few observational studies meeting some of the criteria (duration, type, use for cessation) triangulated with findings from three randomized trials to suggest that e-cigarettes can help adult smokers quit or reduce cigarette smoking. Only a small proportion of studies seeking to address the effect of e-cigarettes on smoking cessation or reduction meet a set of proposed quality standards. Those that do are consistent with randomized controlled trial evidence in suggesting that e-cigarettes can help with smoking cessation or reduction.

A Rare Case of Mango Tea-associated Hepatotoxicity

Mango (Mangifera genus) fruit, pulp and seed kernel extract have been purported to be hepatoprotective.1 The tea is thought to help control pain. We report a rare case of mango tea induced acute liver injury which rapidly improved after cessation of use. A 53 year old Hispanic woman with history of dyspepsia presented with 1 day of epigastric pain not relieved by PPI and 1 month of anorexia and fatigue in the setting of abnormal liver tests. She reported drinking a glass of homemade mango tea, prepared by boiling the whole fruit, 3-5 times weekly for the past month. She also took Excedrin 1-2 times/week for occasional back pain. Her physical exam was significant for normal vital signs, mild epigastric and RUQ tenderness, no organomegaly, and no jaundice. Labs showed a hepatocellular pattern of injury: AST 2461, ALT 1626, ALK Phos 168 U/L, TB 1.7, DB 0.9 mg/dL, TP 7.8, ALB 3.5 g/dL, GGT 339, PT 10.6, and INR 1.01. Acetaminophen level was 20, EtOH level < 3, amylase 42, lipase 185, and LDH 1453. With cessation of mango tea and IVF hydration, hepatic panel trended down within 12 hours to: AST 776, ALT 1042, ALK P 163 U/L, TB 1.5, DB 1.0 mg/dL, TP 6.2, and ALB 3.0 g/dL. The patient became febrile on the day of admission with temperature of 101.7F. Evaluation for infections revealed negative viral serology for EBV, CMV, herpes, varicella, HBV and HCV with remote immunity to HAV. Anti-smooth muscle Ab and ANA titers were within normal limits. Abdominal ultrasound revealed normal liver size, homogeneous parenchyma, small mobile calculi in the gallbladder, and normal common bile duct. Abdominal CT showed unremarkable liver, spleen, gallbladder, and pancreas. MRCP showed unremarkable liver, mild cholelithiasis, and no biliary ductal dilatation or choledocholithiasis. Liver enzymes continued to trend down and the patient was discharged. On follow up, 16 days after presentation, hepatic panel had returned to within normal limits: AST 26, ALT 41, ALK P 109 U/L, TB 0.5, DB 0.1 mg/dL, TP 7.2, and ALB 4.2 g/dL (Figure 1). We posit ingestion of large amounts of mango tea induced acute hepatocellular injury in our patient. RUCAM/CIOMS score for herb induced liver injury causality was 7 (probable). This is contrary to current literature.1 (1. Antioxidant and hepatoprotective activities of thai mango seed kernel extract. Nithitanakool S et al. Planta Med. 2009; 75(10):1118-23) Patients must be careful in their use of natural teas.FigureTable: Table. RUCAM/CIOMS Score

Effectiveness of behaviour change communication for preventing tobacco use among high school children in rural area, Bengaluru

Background: Adolescents in high school are vulnerable to various health risk behaviors. One of it is tobacco use which is the leading cause of death and disease worldwide today. Educational programs applied in schools can have immense potential in promoting healthy behaviours and help them to refrain from risky behaviours among school going adolescents. The objectives of the study were to assess the prevalence of tobacco use among high school students in the rural field practice area of Vydehi Institute of Medical Sciences and Research Centre, Bengaluru and to evaluate the effectiveness of behavior change communication using life skills education on tobacco use initiation and cessation of use among high school childrenMethods: An interventional study was conducted in a randomly selected rural high school. A total of 454 students studying in 8th 9th and 10th standard participated in the study. Pretested semi structured questionnaire was used to collect data. Intervention was given in the form of life skills education with interactive sessions involving debates, group discussions, role plays, situational analysis on prevention of tobacco use. Follow up was done at intervals of 1 month, 3months, and 6 months to assess the change in tobacco use prevalence using a questionnaire.Results: Over all, prevalence of tobacco use was 69 (15.2%) with 50 (11%) being male and 19(4.2%) female students. Prevalence of tobacco use reduced from 69 (15.2%) during pre-intervention to 58 (12.9%), 39 (8.7%), and 33 (7.3%) by the end of one month, three months and six months respectively after the intervention.Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.

Birds of a feather?

The complications of using vaginal mesh for pelvic organ prolapse are well known. SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks), NHS England Mesh working Group and the Scottish Independent Review of the Use, Safety and Efficacy of Transvaginal Mesh Implants in the Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse in Women all published reports in 2016. Their conclusions have overlapping themes, with an emphasis on the need for robust clinical governance, multi-disciplinary team working, thorough audit, and recording and reporting of adverse events. Adequate patient information and informed consent is a fundamental principle underlying all healthcare management. The midurethral synthetic sling is made of the same type 1 macroporous material as vaginal prolapse mesh and so slings have been included with mesh in adverse publicity with a consequent decline in their use, with resurgence of fascial slings and more complex surgery such as colposuspension. The impact of this has been particularly evident in Scotland, where patients have been refusing to have a synthetic sling. As recently as 2011, it was common practice to inform patients that a synthetic sling was the procedure of choice and it was acceptable to give this as the sole option. This is now in violation of the Montgomery ruling of the UK Supreme Court (Montgomery v Lanarkshire Health Board [2015] UKSC 11), which requires a thorough discussion of pros and cons and alternatives. However, complete cessation of use, as has been the case with vaginal mesh, would equate to throwing the baby out with the bathwater. The price would be paid by the patient, who would end up with more complex surgery, with greater overall risks (apart from the risks of any synthetic material, i.e. extrusion and erosion, which are low in the case of sub-urethral slings). Some patients would likely be denied treatment altogether on the grounds of obesity or other comorbidities which make them unsuitable for an abdominal procedure. The midurethral sling is no longer a ‘new’ device and has reassuring 17-year follow-up data with a 90% objective continence rate and no serious long-term tape-induced adverse effects (Nilsson et al. Int Urogynecol J 2013;24:1265-9). So at what point is a prosthesis considered well established in clinical practice? In the history of implantable devices, defective/faulty ones will usually be identified within 10 years of market launch. Examples include trocar-guided meshes for prolapse, PIP breast implants, and Pinnacle Hip implants. On the other hand, the full extent of complications with synthetic slings such as extrusion and erosion may not yet be apparent. In the UK, we need to centralise the management of mesh-related complications in specialist units to allow the development of the expertise needed for successful remediation. With patient groups such as TVT MUM clamouring for a total ban on the product, there is an urgent need for the development of agreed clinical decision-making tools to enable patients to make fully informed choices in the management of their urinary incontinence. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Long Term Effects of Menopausal Hormone Therapy on Cerebral Pulsatility Index

Menopausal hormone therapy (MHT) is used for management of menopausal symptoms; however, the long-term effects of MHT on the cardiovascular and cerebrovascular system are controversial. Previous studies have shown that pulsatility index (a measure of the variability of blood velocity in a vessel) of the middle cerebral artery (MCA) decreases during the use of MHT, but increases again within months after suspension of MHT; however, these effects have not been studied long term. PURPOSE: The purpose of this study was to evaluate the long term effects of prior use of MHT on MCA pulsatility index (PI). METHODS: Fifty-four postmenopausal women were evaluated 3 years after cessation of use of MHT or placebo (as part of a 4 year randomized, placebo-controlled clinical trial). Women had received either a placebo (PLA: n=19; age=59±3 y; BMI=28±3 kg/m2) or MHT (MHT: n=35; age=60±3 y; BMI=27±5 kg/m2). MCA velocity (MCAv), mean arterial pressure (MAP), and end-tidal CO2 were continuously measured throughout the study. Baseline measurements were recorded then women underwent a stepped hypercapnic protocol inhaling 2%, 4%, then 6% CO2 at each stage for three minutes. PI was calculated as (systolic MCAv-diastolic MCAv)/mean MCAv. RESULTS: Baseline MAP and MCAv were similar between groups (PLA: MAP=90±2 mmHg; MCAv=60±3 cm/s; MHT: MAP=91±1 mmHg; MCAv=69±3 cm/s; p>0.05 for both). PI was greater in the MHT group compared to the placebo group at baseline (MHT: PI=0.86±0.02 vs. PLA: PI=0.77±0.02; p<0.05), during 2% CO2 (MHT: PI=0.85±0.02 vs. PLA: PI=0.76±0.02; p<0.05), and during 4% CO2 (MHT: PI=0.82±0.02 vs. PLA: PI=0.73±0.02; p<0.05). PI was not different between groups during 6% CO2 (MHT: PI=0.75±0.02; PLA: PI=0.71±0.02; p=0.28). CONCLUSIONS: Cerebral PI was higher in women who had taken MHT compared to women who had not taken MHT. The differences between groups persisted until the CO2 vasodilatory stimulus increased to 6%. Taken together, these results suggest that previous use of MHT alters regulation of the cerebral circulation that has effects at least up to three years after cessation. Supported by NIH grant AG44170, HL118154

A sensitive assay for urinary cocaine metabolite benzoylecgonine shows more positive results and longer half-lives than those using traditional cut-offs.

Cocaine is a common drug of abuse. To detect its use, a screening detection concentration for the cocaine metabolite benzoylecgonine is commonly set at 150 ng/mL and its confirmatory cut‐off is set at 100 ng/mL. Studies have suggested that these cut‐offs may be set too high, allowing some patients with this substance abuse problem to be missed or improperly monitored. With the advent of liquid chromatography–tandem mass spectrometry (LC–MS/MS) technology it is possible to reliably detect and quantify lower concentrations of its metabolite benzoylecgonine as part of a larger drug panel. One purpose of the study was to establish if there was a significant increase in detection of cocaine use with a ten‐fold more sensitive cut‐off. A very sensitive dilute and shoot assay for benzoylecgonine was developed with a lower limit of quantitation of 5 ng/mL. Validation of the 5 ng/mL cut‐off was achieved by plotting all the positive cocaine observations as a frequency distribution on a logarithmic scale. The number of positive results with measurable concentrations below the typical industry 100 ng/mL cut‐off level but above the high sensitivity 5 ng/mL cut‐off level was observed to be 51.9% of the observed positives. The lower cut‐off also allowed a re‐evaluation of the window of detection after cessation of use. It was observed to be between 17 and 22 days. © 2016 Precision Diagnostics, LLC. Drug Testing and Analysis published by John Wiley & Sons, Ltd.

Modeling Exposure of Mammalian Predators to Anticoagulant Rodenticides

Anticoagulant rodenticides (AR) are a widespread and effective method of rodent control but there is concern about the impact these may have on non-target organisms, in particular secondary poisoning of rodent predators. Incidence and concentration of AR in free-living predators in Denmark is very high. We postulate that this is caused by widespread exposure due to widespread use of AR in Denmark in and around buildings. To investigate this theory a spatio-temporal model of AR use and mammalian predator distribution was created. This model was supported by data from an experimental study of mice as vectors of AR, and was used to evaluate likely impacts of restrictions imposed on AR use in Denmark banning the use of rodenticides for plant protection in woodlands and tree-crops. The model uses input based on frequencies and timings of baiting for rodent control for urban, rural and woodland locations and creates an exposure map based on spatio-temporal modelling of movement of mice-vectored AR (based on Apodemus flavicollis). Simulated predator territories are super-imposed over this exposure map to create an exposure index. Predictions from the model concur with field studies of AR prevalence both before and after the change in AR use. In most cases incidence of exposure to AR is predicted to be greater than 90%, although cessation of use in woodlots and Christmas tree plantations should reduce mean exposure concentrations. Model results suggest that the driver of high AR incidence in non-target small mammal predators is likely to be the pattern of use and not the distance AR is vectored. Reducing baiting frequency by 75% had different effects depending on the landscape simulated, but having a maximum of 12% reduction in exposure incidence, and in one landscape a maximum reduction of <2%. We discuss sources of uncertainty in the model and directions for future development of predictive models for environmental impact assessment of rodenticides. The majority of model assumptions and uncertainties err on the side of reducing the exposure index, hence we believe the predictions to be robust and to indicate that the scale of the problem may be large.

Loperamide, the “Poor Man’s Methadone”: Brief Review

ABSTRACTLoperamide is widely available as an inexpensive, over-the-counter remedy commonly used for management of diarrhea. Although an opioid, at therapeutic doses it acts primarily on the gastrointestinal tissues; however, larger than recommended amounts facilitate central nervous system (CNS) penetration. Such high doses of loperamide have recently gained popularity among users of opioids to manage withdrawal symptomatology and, less frequently, to achieve psychoactive effects. Chronic loperamide use can result in development of tolerance and, upon abrupt cessation of use, withdrawal. With increasing prevalence of use, side-effects are noted, one particularly being life-threatening cardiac arrhythmias. Users are often not forthcoming and routine drug screens do not detect loperamide, so providers need to be alert to such practices in order to recognize intoxication, be able to screen for use, and facilitate entry into treatment.

Opportunities for coppice management at the landscape level: the Italian experience

Abstract: Coppice silviculture has a long tradition in Italy. Societal demands have led to the development of forest management techniques for integrating wood production with other kinds of forest uses and regulations have been issued to limit forest degradation. In Italy, 35% of the national forest cover is currently managed under coppice silvicultural systems that provide 66% of the annual wood production. Fuel-wood demand is increasing and a large amount of fuel-wood is currently imported in Italy. Modern coppice practices differ from those adopted in the past and may have a reduced impact on ecosystem characteristics and processes. Nevertheless, coppice silviculture has a bad reputation mostly on grounds that are beyond economic, technical and ecological rationales. Neither cessation of use nor a generalized conversion from coppice to high forest are likely to respond simultaneously to the many demands deriving from complex and articulated political and economic perspectives operating at global, European, national, regional and forest stand-level scales. Different approaches of modern silviculture to coppice successfully tested in Italy for more than a decade are illustrated. We propose to combine different options at the stand and sub-stand level, including either development without human interference or conversion to high forest, and to apply these approaches within the framework of novel forest management plans and regionally consistent administrative procedures. This bottom-up approach represents a potential solution to the socio-economic and environmental challenges affecting coppicing as a silvicultural system.

Hearing devices for children with unilateral hearing loss: Patient- and parent-reported perspectives

ObjectiveManagement of children with unilateral hearing loss is not standardized. The primary goal of this study was to elicit patient- and parent-reported perspectives regarding usage of hearing devices in pediatric UHL and to suggest a basic algorithmic approach to management. MethodsOur tertiary care center recruited families of youth ages 5–19 years with unilateral hearing loss from January 2014 through October 2015. Parents of all youths completed a 36-item survey, and some youth ages 11–19 years participated in hour-long interviews. We assessed patterns of hearing device usage among participants, and performed qualitative data analysis to understand factors considered by youths when deciding whether or not to use a hearing device. ResultsSurvey information was collected for 50 patients. Distribution of hearing loss severity in affected ear was mild 14%, moderate 26%, severe 22%, and profound 38%. The majority of children had sensorineural hearing loss (57%), followed by mixed (32%), and then conductive (11%). 34 children (68%) had tried a hearing device; 20 continued to use the device. Retention rates were similar among children with different degrees of hearing loss: mild 66%, moderate 50%, severe 60%, profound 64%. Sixteen children tried a wireless contralateral routing of signal (CROS) device, and 15 tried a behind-the-ear (BTE) hearing aid. Retention rates for CROS and BTE devices were 69% and 47%, respectively. The most common reason for cessation of use was discomfort, followed by lack of benefit. ConclusionA majority of children with unilateral hearing loss who tried a hearing device continued to use it, and retention rates were similar across all degrees of hearing loss. These findings suggest that personal hearing devices should be included in management protocols.

Fractional-Dose Inactivated Poliovirus Vaccine Immunization Campaign - Telangana State, India, June 2016.

Wild poliovirus type 2 was declared eradicated in September 2015 (1). In April 2016, India, switched from use of trivalent oral poliovirus vaccine (tOPV; containing types 1, 2, and 3 polio vaccine viruses), to bivalent OPV (bOPV; containing types 1 and 3), as part of a globally synchronized initiative to withdraw Sabin poliovirus type 2 vaccine. Concurrently, inactivated poliovirus vaccine (IPV) was introduced into India's routine immunization program to maintain an immunity base that would mitigate the number of paralytic cases in the event of epidemic transmission of poliovirus type 2 (2,3). After cessation of use of type 2 Sabin vaccine, any reported isolation of vaccine-derived poliovirus type 2 (VDPV2) would be treated as a public health emergency and might need outbreak response with monovalent type 2 oral vaccine, IPV, or both (4). In response to identification of a VDPV2 isolate from a sewage sample collected in the southern state of Telangana in May 2016, India conducted a mass vaccination campaign in June 2016 using an intradermal fractional dose (0.1 ml) of IPV (fIPV). Because of a global IPV supply shortage, fIPV, which uses one fifth of regular intramuscular (IM) dose administered intradermally, has been recommended as a response strategy for VDPV2 (5). Clinical trials have demonstrated that fIPV is highly immunogenic (6,7). During the 6-day campaign, 311,064 children aged 6 weeks-3 years were vaccinated, achieving an estimated coverage of 94%. With appropriate preparation, an emergency fIPV response can be promptly and successfully implemented. Lessons learned from this campaign can be applied to successful implementation of future outbreak responses using fIPV.

Health professional advice, use of medications and smoking cessation: A population-based prospective cohort study

IntroductionThe mediating role of cessation medications in the association between health professional advice and quitting behaviors is unclear. MethodsData were from the Ontario Tobacco Survey longitudinal study, collected between July 2005 and June 2011 in Ontario, Canada. The analytic sample included 3437 baseline smokers who were seen by health professionals during follow-up. Logistic regression with generalized estimating equations and mediation analysis techniques were used to examine the impact of advice and medications on quitting outcomes (making a quit attempt, short-term quitting 1–6months and long-term quitting>6months). ResultsThose who received advice to quit smoking were more likely to use cessation medications than those who did not receive advice (21% vs. 13%, P<0.001). Receiving advice was associated with making a quit attempt (adjusted odds ratio (OR) 1.25, 95% confidence interval (CI) 1.10–1.41) and long-term quitting (adjusted OR 1.49, 95% CI 1.10–2.02), but not with short-term quitting. Use of cessation medications was associated with making a quit attempt (adjusted OR 11.83, 95% CI 9.93–14.08), short-term quitting (adjusted OR 3.69, 95% CI 2.90–4.68), and long-term quitting (adjusted OR 2.73, 95% CI 1.95–3.82). Using prescription medications was associated with a higher likelihood of quitting short-term (adjusted OR 2.43, 95% CI 2.59–3.74) and long-term (adjusted OR 2.27, 95% CI 1.23–4.17) than using NRT. Use of cessation medications was a significant mediator in the pathway from receiving advice to quitting. ConclusionHealth professionals should advise smokers to quit and encourage them to use cessation medications, especially prescription medications when trying to quit.

Adénose vaginale : à propos d’une observation et revue de la littérature

We report a case of vaginal adenosis in a woman of 42years. This is a rare congenital disorder since cessation of use of diethylstilbestrol (DES), usually of benign course, not to ignore in its tubo-endometrial histological form which may progress to atypical adenosis precursor of vaginal clear cell adenocarcinoma in patients exposed in utero to DES.

Adverse Effects of Synthetic Cannabinoids: Management of Acute Toxicity and Withdrawal.

Although several chemical structural classes of synthetic cannabinoids (SCs) were recently classified as Schedule I substances, rates of use and cases of serious toxic effects remain high. While case reports and media bring attention to severe SC toxicity, daily SC use resulting in dependence and withdrawal is a significant concern that is often overlooked when discussing the risks of these drugs. There is a rich literature on evidence-based approaches to treating substance use disorders associated with most abused drugs, yet little has been published regarding how to best treat symptoms related to SC dependence given its recency as an emerging clinically significant issue. This review provides a background of the pharmacology of SCs, recent findings of adverse effects associated with both acute intoxication and withdrawal as a consequence of daily use, and treatment approaches that have been implemented to address these issues, with an emphasis on pharmacotherapies for managing detoxification. In order to determine prevalence of use in cannabis smokers, a population at high risk for SC use, we obtained data on demographics of SC users, frequency of use, and adverse effects over a 3.5-year period (2012-2015) in the New York City metropolitan area, a region with a recent history of high SC use. While controlled studies on the physiological and behavioral effects of SCs are lacking, it is clear that risks associated with using these drugs pertain not only to the unpredictable and severe nature of acute intoxication but also to the effects of long-term, chronic use. Recent reports in the literature parallel findings from our survey, indicating that there is a subset of people who use SCs daily. Although withdrawal has not been systematically characterized and effective treatments have yet to be elucidated, some symptom relief has been reported with benzodiazepines and the atypical antipsychotic, quetiapine. Given the continued use and abuse of SCs, empirical studies characterizing (1) SCs acute effects, (2) withdrawal upon cessation of use, and (3) effective treatment strategies for SC use disorder are urgently needed.

Mismatch Negativity and P50 Sensory Gating in Abstinent Former Cannabis Users.

Prolonged heavy exposure to cannabis is associated with impaired cognition and brain functional and structural alterations. We recently reported attenuated mismatch negativity (MMN) and altered P50 sensory gating in chronic cannabis users. This study investigated the extent of brain functional recovery (indexed by MMN and P50) in chronic users after cessation of use. Eighteen ex-users (median 13.5 years prior regular use; median 3.5 years abstinence) and 18 nonusers completed (1) a multifeature oddball task with duration, frequency, and intensity deviants and (2) a P50 paired-click paradigm. Trend level smaller duration MMN amplitude and larger P50 ratios (indicative of poorer sensory gating) were observed in ex-users compared to controls. Poorer P50 gating correlated with prior duration of cannabis use. Duration of abstinence was positively correlated with duration MMN amplitude, even after controlling for age and duration of cannabis use. Impaired sensory gating and attenuated MMN amplitude tended to persist in ex-users after prolonged cessation of use, suggesting a lack of full recovery. An association with prolonged duration of prior cannabis use may indicate persistent cannabis-related alterations to P50 sensory gating. Greater reductions in MMN amplitude with increasing abstinence (positive correlation) may be related to either self-medication or an accelerated aging process.

KB220Z™ a Pro-Dopamine Regulator Associated with the Protracted, Alleviation of Terrifying Lucid Dreams. Can We Infer Neuroplasticity-induced Changes in the Reward Circuit?

BackgroundRecent reports by our laboratory have indicated that lucid dreams may be linked to psychiatric conditions, including Attention Deficit Hyperactivity Disorder (ADHD) and other Reward Deficiency Syndrome-related diagnoses. In the latter case, it has been our observation that such lucid dreams can be unpleasant and frequently terrifying.Case presentationsWe present four cases of a dramatic and persistent alleviation of terrifying, lucid dreams in patients diagnosed with ADHD/PTSD and/or opiate/opioid addiction. The amelioration of such dreams could well be permanent, since the patients had stopped taking the nutraceutical for between 10 to 12 months, without their recollection or recurrence. In the first case, the patient is a 47-year-old, married male who required continued Buprenorphine/ Naloxone (Suboxone) treatment. The second case involved a 32-year-old female with the sole diagnosis of ADHD. The third case involves a 38-year-old male who carried the diagnoses of Substance Use Dependence and ADHD. The fourth case involved a 50-year-old female with the diagnoses of Alcohol Abuse, ADHD and Posttraumatic Stress Disorder.ResultsIn order to attempt to understand the possibility of neuroplasticity, we evaluated the effect of KB220Z in non-opioid-addicted rats utilizing functional Magnetic Resonance Imaging methodology. While we cannot make a definitive claim because rat brain functional connectivity may not be exactly the same as humans, it does provide some interesting clues. We did find following seeding of the dorsal hippocampus, enhanced connectivity volume across several Regions of Interest (ROI), with the exception of the pre- frontal cortex. Interestingly, the latter region is only infrequently activated in lucid human dreaming, when the dreamer reports that he/she had the thought that they were dreaming during the lucid dream.ConclusionsThe four patients initially reported a gradual but, then, complete amelioration of their long-term, terrifying, lucid dreams, while taking KB220Z. The persistent amelioration of these dreams continued for up to 12 months, after a self-initiated, cessation of use of KB220Z. These particular cases raise the scientific possibility that KB200Z increases both dopamine stability as well as functional connectivity between networks of brain reward circuitry in both rodents and humans. The increase in connectivity volume in rodents suggest the induction of neuroplasticity changes, which may be analogous to those involved in human lucid dreaming as well as Rapid Eye Movement sleep. The possibility that the complex induces long-term, neuroplasticity changes must await more intensive investigations, involving large-population, double-blinded studies.

Iatrogenic Cushing’s Syndrome Caused by Topical Corticosteroid Application and Its Life Threatening Complications

Introduction: The use of topical corticosteroids in children and adults, especially in covered areas and for a prolonged duration, may result in Cushing's syndrome and suppression of the hypothalamic-pituitary-adrenal axis. Case Presentation: The present report describes the cases of three children and a 25-year-old man who presented with clinical features of Cushing's syndrome and adrenal insufficiency following prolonged use of clobetasol cream. Two of the children continued with hypertension even after discontinuation of clobetasol, and were treated with angiotensin-converting enzyme inhibitors. One of these two children had developed acute renal failure, hypertensive encephalopathy, and permanent visual loss prior to admission. Conclusions: Whenever a cushingoid appearance is accompanied by adrenal insufficiency, the exogenous use of steroids, especially topical creams, should be explored. Hypertension may persist even after cessation of use and may result in life threatening complications. © 2015, Iranian Society of Pediatrics.

Good news for billions of children who will receive IPV

In The Lancet Infectious Diseases, Shahed Iqbal and colleagues 1 Iqbal S Shi J Seib K et al. Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000–12. Lancet Infect Dis. 2015; (published online Aug 17.)http://dx.doi.org/10.1016/S1473-3099(15)00059-6 Google Scholar present their analysis of data from the US Vaccine Adverse Event Reporting System (VAERS), the largest database of reported events temporally associated with, but not necessarily causally related to, the delivery of inactivated poliovirus vaccine (IPV). Their results show low numbers of temporally associated events reported with the delivery of more than 250 million IPV doses in the USA and no substantial adverse events, which confirms the safety of IPV. 1 Iqbal S Shi J Seib K et al. Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000–12. Lancet Infect Dis. 2015; (published online Aug 17.)http://dx.doi.org/10.1016/S1473-3099(15)00059-6 Google Scholar In view of the unprecedented global adoption of IPV as all countries prepare for the eradication of wild polioviruses and globally coordinated cessation of oral poliovirus vaccine (OPV), this news is positive. 1 Iqbal S Shi J Seib K et al. Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000–12. Lancet Infect Dis. 2015; (published online Aug 17.)http://dx.doi.org/10.1016/S1473-3099(15)00059-6 Google Scholar Although only 65 countries had included IPV in their routine immunisation schedules by December, 2012, 2 Thompson KM Pallansch MA Duintjer Tebbens RJ Wassilak SG Kim J-H Cochi SL Pre-eradication vaccine policy options for poliovirus infection and disease control. Risk Anal. 2013; 33: 516-543 Crossref PubMed Scopus (44) Google Scholar this number has now increased to nearly 90 countries, and during the remainder of 2015, more than 70 countries plan to introduce at least one IPV dose into their immunisation schedules. 3 WHOImmunization Vaccines and Biologicals (IVB), data as of May 1, 2015. http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/en/ Google Scholar Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000–12Fairly few adverse events were reported for the more than 250 million IPV doses distributed between 2000 and 2012. Sudden infant death syndrome reports after IPV were consistent with reporting patterns for other vaccines. No new or unexpected vaccine safety problems were identified for fatal, non-fatal serious, and non-serious reports in this assessment of adverse events after IPV. Full-Text PDF Is introduction of IPV “Good news for billions of children”? – Author's replyThe decision to globally coordinate cessation of use of the oral poliovirus vaccine (OPV), starting with serotype 2 between April 15 and April 30, 2016 (with expected cessation of serotypes 1 and 3 after certification of the world as free of wild polioviruses of those serotypes), represents a crucial step in the effort to end all cases of poliomyelitis.1 After all use of OPV ends, inactivated poliovirus vaccine (IPV) will represent the only option available to protect people from any potential risks of re-introduction of polioviruses. Full-Text PDF Is introduction of IPV “Good news for billions of children”?Mass worldwide vaccination with oral polio vaccine (OPV) has resulted in a steep decrease in polio infections and associated paralysis. Since the world is now close to eradicating polio, vaccine-derived polio constitutes an increasing proportion of overall polio infections. From this perspective, introduction of the more expensive inactivated polio vaccine (IPV) solves a problem as emphasised in the Comment by Kimberley Thompson.1 Full-Text PDF

Duration of detection of methamphetamine in hair after abstinence

Researchers in the field of hair analysis have known for at least two decades that test results for many chemical compounds remain positive for a considerable period of time after subjects have reported cessation of use. These findings were generally based on small sample populations or individual case studies. Within the last decade, hair analyses of larger populations have investigated the phenomenon of residual positives in abstinent individuals in order to determine the period of time required for various compounds to present negative hair test results at internationally accepted cutoff levels. Such data has primarily been used to establish guidelines for retesting former abusers of illicit drugs in order to evaluate claims of abstinence. To date, research has focused on cocaine and opiates. The present study is the first to examine the duration of detection of methamphetamine (MA) and its metabolite amphetamine (AP) in the hair of chronic MA users who recently ceased their consumption of the drug. The study population (n=63) consisted of inpatients at a hospital drug rehabilitation program in Chiang Mai, Thailand. Drug taking behavior was collected by personal interview at the time of enrollment. Subjects provided hair samples at approximately monthly intervals for MA and AP analysis by gas chromatography–mass spectrometry at 0.2ng/mg cutoff levels. The correlation of baseline MA and AP concentrations in hair at the beginning of abstinence with corresponding duration of detection indicated great individual variability for the rate of clearance of MA and AP from hair. In regard to duration of detection, the majority of chronic MA users remained MA positive for up to about 90 days of reported abstinence, but by 120 days, the detection rate had fallen to about 16%. All subjects tested negative for MA after 153 days of abstinence. For AP, the limit of the duration of detection was reached at 106 days. With the adoption of a margin of safety to compensate for outlier individual variability, the present study affirmed that hair analysis of chronic MA abusers should test negative for MA after 6 months of claimed abstinence.