Does buprenorphine maintenance improve the quality of life of opioid users.

Background & objectives: The quality of life (QOL) of substance abusers is known to be severely impaired. Information on impact of opioid maintenance treatment on the QOL of opioid dependent subjects though available from the developed countries, is lacking from India. This study was carried out to assess the impact of buprenorphine maintenance treatment on the quality of life (QOL) of opioid dependent subjects at nine months follow up. Methods: Based on specified inclusion criteria a total of 231 subjects were recruited from five participating centres across India. They received sublingual buprenorphine as a directly observed therapy along with brief psychosocial intervention (provided in groups of 8-10 subjects) after intake in to the study. The WHOQOL-BREF scale domain scores obtained at baseline were compared to domain scores at nine months follow up. Results: At nine months follow up, among the 64.1 per cent retained in buprenorphine maintenance, there was a significant (P<0.001) decline in opioid use from 24.9 ± 10.1 days at baseline to 1.7 ± 4.7 days at nine months follow up and improvements in score of the four WHOQOL-BREF domains (Physical, Psychological, Social relationships and Environment). Interpretation & conclusions: The results showed the beneficial effects of buprenorphine maintenance treatment in improving the QOL of opioid-dependent subjects at nine month follow up. These results point towards the need for an expanded nation-wide provision of buprenorphine maintenance treatment as a harm reduction strategy for the opioid dependent population.

Amylase induction during seed germination in isoproturon susceptible and resistant biotypes of Phalaris minor Retz.

Isoproturon resistant biotype of P. minor germinates early, shows higher germination percentage and faster rate of growth as compared to the susceptible biotype. Higher amylase activity is observed in the initial hours of imbibition in the resistant biotype. In the susceptible biotype it is activated at a much later stage.

Social support in treatment-seeking heroin-dependent and alcohol dependent patients.

Social support is being recognized as a positive influence on health. It may influence motivation, treatment compliance and outcome in drug dependent patients. On the basis of clinical impression, it was hypothesized that social support in heroin (illicit drug) dependent patients is poorer than in alcohol dependent patients. The current study was undertaken to assess and compare the social support amongst treatment seeking alcohol dependent patients and heroin dependent patients. Despite lesser proportion of patients with any legal source of income in the heroin dependent subject group, the mean social support score across the two study groups was comparable. Overall, the mean social support scores were low in both the groups. The study provides some undestanding about the perceived social support amongst treatment seeking drug dependent individuals from India and also indicates the need to address the issue of social support in substance users.

An experimental study of tolerance among alcohol dependent individuals.

BACKGROUND & OBJECTIVES: Continued alcohol use leads to tolerance, however, some dependent individuals lose tolerance despite continued alcohol consumption. The exact mechanism for this is not known. This study evaluated tolerance in alcohol dependent patients in a treatment centre using multiple measures. METHODS: Male patients with alcohol dependence (DSM III R criteria) were chosen and detoxified in an inpatient setting. On day 14 of detoxification, each subject was given ethanol (0.75 g/kg body wt) mixed in an equal amount of placebo (cola) drink once and an equivalent amount of placebo (cola) during the other occasion in a single blind, randomised, cross over manner. Assessment of each subject was made using multiple measures (clinical, neuro-psychological tests, scales for subjective effect and blood alcohol levels), 30 min after intake of each drink. RESULTS: The subjects (n = 26) did not very under the two conditions (alcohol/placebo) as regards subjective effects, tests on logical memory and Bender Gestalt test (BGT). Cognitive screening scores though different under the two conditions, were within the normative range. Of these 26 subjects, 50 per cent showed clinical signs of intoxication after consumption of alcohol. These two groups (impaired vs unimpaired) were comparable on all base-line clinical parameters, assessment of euphoria and sedation, and various neuropsychological tests except BGT under the two conditions (placebo/alcohol). The non-tolerant (impaired) group scored significantly (P < 0.05) worse on BGT after alcohol consumption. INTERPRETATION & CONCLUSIONS: The study suggests that clinical tests were more sensitive in detecting intoxication. Further studies are needed to understand the mechanism of loss of tolerance.

Co-existence of oblique pinnae and congenital heart disease.

The paper reports a syndrome in which oblique placement of one or both the pinnae on face was found to co-exist with congenital anomalies of heart like VSD, PDA and Tetralogy of Fallot, etc. Although clinically discernible in 90% of the subjects, objective evidence of obliquity of pinna was documented by photogrammetry. The values for the ear inclination in subjects categorized clinically as normally placed pinna were 7.9 degrees +/- 3.39 degrees with range 2 degrees-17 degrees. In contrast, subject where the pinna was clinically categorized as oblique had mean AEI 16.5 degrees +/- 5.81 degrees with a range 5 degrees-33 degrees. Eighteen of the 20 subjects with oblique pinna were demonstrated to have some congenital anomaly of heart as indicated by clinical and echocardiographic examination. In contrast, in subjects with normally placed pinna only 3 out of 34 possessed clinical heart defects. Presence of oblique pinna indicates a thorough search for undetected heart defects.

Frequency and significance of electrolyte abnormalities in pneumonia.

To determine the frequency of electrolyte disturbance in pneumonia, we studied 264 hospitalized children with pneumonia for serum sodium and potassium concentration, and plasma osmolality (Posm) on the day of admission. Urine osmalality (Uosm) and urine spot sodium concentration were measured in those who had a serum sodium less than or equal to 130 mEq/L. Hyponatremia was found in 27%, hypernatremia in 3.7%. Hypokalemia (serum potassium less than or equal to 3.5 mEq/L) in 19 and 2% had hyperkalemia (serum potassium greater than or equal to 6.5 mEq/L). Of all the hyponatremia, 68% were secondary to syndrome of inappropriate ADH secretion (SIADH) as suggested by a concomitant lowering of Posm less than or equal to 280 mosm/kg and increased urinary osmolality and sodium excretion. Hyponatremia was associated with 60% longer hospital stay, two fold increase in complications and the 3.5 times higher mortality compared to that of normonatremia. The above variables were affected further, if hypokalemia coexisted with hyponatremia.

Serum lipids in healthy tribals living at high altitudes in the Himalayas.

Serum lipids of 70 healthy volunteer tribals (36 males, 34 females) living at high altitudes (3100-4500 metres) in the Himalayas were studied. The mean total cholesterol, triglycerides, HDLc, LDLc and VLDLc levels for the group were 178.6 +/- 19.5, 101.4 +/- 18.3, 44.1 +/- 12.4, 114.5 +/- 17.3 and 20.2 +/- 3.6 mg/dl respectively. There was no significant difference between the two sexes and the various age groups. The total cholesterol/HDL ratio for men and women was 4.2 and 3.9 respectively. The various interacting factors responsible for overall pattern of lipids in these individuals is discussed.