Effect of opium addiction on postoperative arrhythmia among patients undergoing cabg operation on cardiopulmonary bypass

Abstract Objectives: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. Methods: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. Results: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. Conclusion: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.

Efectos de las adicciones en la práctica odontológica: un problema de salud pública / Effects of addictions in dental practice: a public health concern

En la actualidad el consumo de sustancias psicoactivas se vincula al aumento delos accidentes de tránsito y a las situaciones de violencia (robos, asaltos, suicidios, homicidios) y está presente en las causas más frecuentemente de muerte en el grupo de 15-24 años de edad. Los trastornos biológicos, psicológicos y sociales involucrados en el consumo y sus efectos en la salud de la población, nos motivan como profesionales de la salud a comprender y profundizar en esta problemática y aportar las bases suficientes en los programas de prevención y promoción de la salud.

Prevalence & correlates of metabolic syndrome in alcohol & opioid dependent inpatients.

Background & objectives: The research on the association of metabolic syndrome (MS) and substance abuse is scanty. The present research aimed to study the prevalence and correlates of MS among the inpatients at a Drug De-addiction Centre in north India. Methods: Consecutive male subjects (N=110) admitted to a drug de-addiction centre during July to December 2009 with a primary diagnosis of alcohol or opioid dependence were evaluated for the presence of MS as per the International Diabetes Federation (IDF) criteria. Results: The prevalence of MS was 24.6 and 29.3 per cent in alcohol and opioid dependent groups, respectively. MS showed a significant association with the age and body mass index (BMI) in the opioid dependent group. Co-morbid tobacco use was not associated with MS in either group. Interpretation & conclusions: The prevalence of MS in our sample of alcohol and opioid dependent male inpatients was greater than the prevalence of MS in general population, however it was comparable to that reported in physical and other psychiatric disorder populations. Even though the absence of any comparative study limits the generalizability of our findings, results indicate towards a need for screening of the patients with substance dependence especially for those aged above 30 years and/or having a high BMI for MS.

Manifestações do uso de maconha e opiáceos durante a gravidez / Outcomes of marijuana and opioids use during pregnancy

Visando a analisar o uso de maconha e opiáceos durante a gestação e suas consequências, tanto na formação como no futuro desenvolvimento da criança, realizou-se uma revisão crítica da literatura, com foco nos efeitos deletérios dessas drogas no recém-nato. Muitas dúvidas ainda não foram sanadas referentes à ação das drogas e o reflexo no concepto. Foram observadas coincidências entre o uso de maconha e o mau desenvolvimento do tubo neural do recém-nato, além de possíveis anencefalias. Em relação à ação dos opiáceos durante a gestação, foi observado um maior número de partos prematuros, bebês nascidos com baixo peso, com menor circunferência craniana e menor estatura

Aiming at analyzing the marijuana and opioids use during pregnancy and their consequences both in formation and in the future development of the child, a critic review of the literature was carried out focusing on the deleterious effects of these drugs in the recent born. Many questions have not been answered referring to the action of the drug and its reflection on the concept. It had been observed a relationship between use of marijuana and the poor development of the neural tube of the newly born and possible anencephalies. In relation to the opioids outcomes during pregnancy, an increase of premature births, babies born with low-birth weight, small cephalic circumference, and lower height were observed

A Study of Psychiatric Comorbidity in Opioid Dependence.

Aim: To assess psychiatric comorbidity in patients of opioid dependence Method: All the patients of opioid dependence attending alcohol and drug deaddiction OPD and adult psychiatry OPD on specific days, were screened. Those fulfilling the selection criteria were included in the study. A detailed evaluation was done for socio-demographic variables and history of drug using semi-structured proforma especially prepared for the study. Diagnosis of opioid dependence was made according to DSM-IV-TR criteria. The patients were seen for co-morbid psychiatric illness by applying Structured Clinical Interview for DSM-IV-TR I & II (SCID I & II). Results: Out of 25 patients 19 (76.0) were found to have comorbid psychiatric illness. Axis I and Axis II comorbidity was found in 76% and 20% of the samples, respectively. Patients of cluster B personality were dominating in the sample. Patients with more than one comorbidity accounted for 60% of the sample. Conclusion: Psychiatric comorbidity in opioid dependence are very high, other substance in particular. Number of comorbid diagnoses in a person may as high as four.

[Paraclinical disorders and prevalence of viral infections in injection drug users]

It is reported that 24-40% of hospital admissions in the world are related to addiction and its complications. Considering hepatitis, AIDS, cirrhosis and various malignancies following these complications, addiction is one of the most important problems in treatment centers worldwide. To determine Para clinical disorders and prevalence of viral infections in injection drug users This was a cross-sectional study in which Para clinical derangements including lab results, chest radiography, and abdominal and pelvic sonography of all patients admitted to infectious diseases ward at Al-Zahra hospital in Isfahan were evaluated during 2005. Also, the presence of HIV, HCV, and HBV infections in these patients during two consecutive years of 2004 and 2005 was taken into consideration. The total number of patients during 2 years was 92 among those 53 hospitalized during 2005 and 39 in 2004. The mean age was 31.7 years with an age range between 20 and 53. The mean length of injection was 3.9 years with a minimum of 2 months and a maximum of 21 years. Among patients hospitalized in 2005, 47% were abnormal for chest radiographs and 17% found to have splenomegaly based on sonography. Among these patients, leucocytosis [85.5%], anemia 86%], higher levels of ESR [74%], derangement in liver tests [60%] and coagulation disorders [55%] were also observed. Viral infections in patients admitted during 2004 were HCV [71%], HBV [12.8%], and HIV [7.6%] while 25.6% were negative for viral infection. In patients hospitalized through 2005, the viral infections were due to HCV [74.3%], HBV [14.3%], and HIV [17%] whereas 17% of patients found to be without viral infection. Based on data found in our study, the high prevalence of viral infection and Para clinical disorders in these patients highlights the importance and the urgency of such laboratory measurements at the very beginning following hospitalization

Family burden in opioid dependence syndrome in tertiary care centre.

This is a cross-sectional, hospital based study conducted in De-Addiction centre under department of psychiatry, AIIMS, New Delhi, India. Patients and their spouses fulfilling inclusion criteria were enrolled in the study after taking informed consent. A diagnosis of Opioid Dependence Syndrome (ODS) was made based on ICD-10 criteria and the assessment of severity of ODS was determined by Addiction Severity Index (Hindi version). Subsequently the family burden, perceived by spouses was assessed using Family Burden Interview Schedule (FBIS). Most of the subjects were from urban or semi-urban areas, mostly from around the service facility. The maximum number of subjects was of age group 31-40 years with majority of having below high school level education. Both subjective and objective family burden was perceived as "severe" by subjects' spouses. The relationship between spouses' perceived burden and socio-demographic variables including duration of substance abuse were not correlated. Hence it was found that opioid dependent subjects cause considerable amount of distress to their care providers.

Drug use among the urban poor in Kolkata: behaviour and environment correlates of low HIV infection.

BACKGROUND: HIV infection in injecting drug users (IDUs) has worked as a driving force for further spread of the virus in other population groups. Major metropolitan cities such as Mumbai, Kolkota, Chennai and Delhi have seen a diffusion of injecting drug use within the last decade. The prevalence of HIV infection among injectors ranges from 2% to 30%. Identifying effective interventional elements that have kept the prevalence of HIV low for the past 7 years among IDUs of Kolkata is thus of public health importance. METHODS: A purposive sample of opioid/opiate users was studied. Primary and secondary data on drug users, law-enforcement environment, records at drug treatment centres, jail admission data related to the 'Narcotic Drug and Psychotropic Substance Act' and interventions in other risk groups were collected. Laboratory tests for HIV, hepatitis B surface antigen and syphilis were done on consenting IDUs (n=129) and non-IDUs (n=120). For univariate and multivariate analysis, IDUs were taken as cases and non-IDUs as controls. RESULT: Of the IDUs, 2% were positive for HIV. No non-IDU was HIV-positive. Significantly more non-IDUs (10% v. 4%, p=0.05) were positive for syphilis. Sharing injection equipment within the past 6 months was reported by 71% of IDUs; sharing partners were stable and ranged from 1 to 3. More IDUs compared to non-IDUs reported being in touch with intervention programmes. The police has been tolerant to needle-syringe exchange and oral sublingual buprenorphine substitution conducted in Kolkata. Unlike in the early 1990s, non-IDUs did not switch to injecting during non-availability of brown sugar in the latter half of the 1990s and instead sought tratment. The availability of high quality heroin (>20%-50%) was low and the proportion of moderate quality heroin (>10%-20%) went up during these times due to increased police seizures. No intervention exists in jails despite the fact that a large number of drug users spend time in jail. CONCLUSION: Stable and few injection equipment-sharing partners of IDUs, launching of early targeted interventions among IDUs and sex workers in the city, police tolerance to harm reduction activities and preference of non-IDUs for detoxification during heroin draught periods have kept HIV prevalence at a low level among drug users of Kolkata for the past 7 years. immediate launching of interventions for drug users in jails seems necessary. Similar multi-pronged strategies with targeted and environmental intervention could work in other settings as well.

Mycobacterium tuberculosis infection among crack and injection drug users in San Juan, Puerto Rico

This study aims to determine the prevalence of Mycobacterium tuberculosis infection and its association with HIV and other health risk factors among drug users. A sample of 716 IDUs and crack users were enrolled from community sites. Consenting subjects were tested for HIV serum antibody status. Drug users with an unknown PPD status were administered a PPD skin test and an anergy panel of three antigens (Candida, mumps and tetanus). Overall, 68 (10.3 percent) were reactive to the PPD skin test, 240 (34.7 percent) were HIV positive and 195 (29.5 percent) showed cutaneous anergy. Participants infected with tuberculosis (TB) were more likely to be HIV seropositive, and to have a history of incarceration and residential drug treatment than those not infected. In addition, TB infection was more prevalent among intravenous drug users (IDUs) and shooting gallery managers. These findings suggest that drug users should be considered at high risk for TB and HIV infection. Innovative programs to monitor both infections among drug users are needed to arrest what can become a dual epidemic of HIV and TB in the near future

A descriptive-exploratory study of outcome and some biopsychosocial characteristics of drug dependent veterans in Puerto Rico

I. OBJECTIVE: The authors attempted to correlate outcomes with various significant biopsychosocial variables in drug dependent veterans receiving outpatient treatment at San Juan V.A.M.C. II. METHODS: The clinical charts of 120 inactive patients were examined using a 50 item questionnaire. The data was processed and analyzed using the EpiInfo v.5 computer program. The outcome of the patients was measured using a Goal Attainment Scale Technique with demonstrated validity and reliability. III. RESULTS: The patients retention in treatment for 12 or more visits and its relationship to good outcomes was the most significant finding of this study (P < 0.00000000, 80.5 of patients improved). Only 5 of patients with 3 or less visits showed positive outcomes. Another variable associated with good outcomes was a supportive wife (P < 0.02). HIV reactivity was strongly correlated with IV drug use (P < 0.037). IV. CONCLUSIONS: The strong correlation of the retention of patients in treatment for 12 or more visits and good outcomes should alert clinicians and policy makers as to the importance of available and effective treatments in the fight against substance abuse and mental health problems. This study also showed that a supportive family member is usually the best social asset that patients and therapists have in their fight for sobriety