Homeopatia na oncologia pediátrica: é possível? Uma série de casos / Homeopathy in oncology pediatric: is it possible? case series

A Homeopatia é uma das ciências médicas complementares mais utilizadas para pacientes com Câncer, sendo também utilizada durante o tratamento de crianças com a referida moléstia, havendo relato e debate de seu uso na literatura médica. Visando construir o conhecimento e dividir experiências, relatamos seis casos de crianças e adolescentes com câncer, para os quais realizamos tratamento homeopático, em nossa experiência na cidade de São Paulo. Além da diversidade de sexos e idade, os casos apresentam diagnósticos oncológicos diferentes, bem como momentos diferentes no tratamento, sendo curativo ou paliativo, e os medicamentos homeopáticos, baseados tanto na totalidade sintomática característica quanto no modo reacional para cada indivíduo, puderam ser utilizados para todos com satisfação de famílias e pacientes, mesmo quando o desfecho letal foi a via final no estado paliativo. Assim, a Homeopatia pode também ser prescrita para os casos oncológicos infantis como terapia complementar ao tratamento convencional, sendo a pesquisa neste campo vasta e possível.

Homeopathy is one of the most used complementary medical sciences for cancer patients, and is also used duringtreatment of children with the aforementioned disease, with reports and debate of its use in medical literature. Aiming to build knowledge and sharing experiences, we report six cases of children and adolescents with cancer, for which we carry out homeopathic treatment, in our experience in the city of São Paulo. In addition to the diversity of sexes and age, the cases present different oncological diagnoses, as well as as different moments in the treatment, being curative or palliative, and homeopathic medicines, based both on symptomatic totality characteristic and in the reactional mode for each individual, could be used for everyone with the satisfaction of families and patients, even when the lethal outcome was the final route in the palliative state. Therefore, Homeopathy can also be prescribed for oncological cases children as complementary therapy to conventional treatment, research in this field is vast and possible.

Iranian Registry of Crohn's and Colitis: study profile of first nation-wide inflammatory bowel disease registry in Middle East

BACKGROUND/AIMS: A recent study revealed increasing incidence and prevalence of inflammatory bowel disease (IBD) in Iran. The Iranian Registry of Crohn's and Colitis (IRCC) was designed recently to answer the needs. We reported the design, methods of data collection, and aims of IRCC in this paper. METHODS: IRCC is a multicenter prospective registry, which is established with collaboration of more than 100 gastroenterologists from different provinces of Iran. Minimum data set for IRCC was defined according to an international consensus on standard set of outcomes for IBD. A pilot feasibility study was performed on 553 IBD patients with a web-based questionnaire. The reliability of questionnaire evaluated by Cronbach's α. RESULTS: All sections of questionnaire had Cronbach's α of more than 0.6. In pilot study, 312 of participants (56.4%) were male and mean age was 38 years (standard deviation=12.8) and 378 patients (68.35%) had ulcerative colitis, 303 subjects (54,7%) had college education and 358 patients (64.74%) were of Fars ethnicity. We found that 68 (12.3%), 44 (7.9%), and 13 (2.3%) of participants were smokers, hookah and opium users, respectively. History of appendectomy was reported in 58 of patients (10.48%). The most common medication was 5-aminosalicylate (94.39%). CONCLUSIONS: To the best of our knowledge, IRCC is the first national IBD registry in the Middle East and could become a reliable infrastructure for national and international research on IBD. IRCC will improve the quality of care of IBD patients and provide national information for policy makers to better plan for controlling IBD in Iran.

Double-blind evaluation of homeopathy on cocaine craving: a randomized controlled pilot study / 中西医结合学报

<p><b>BACKGROUND</b>Brazil is among the nations with the greatest rates of annual cocaine usage. Pharmacological treatment of cocaine addiction is still limited, opening space for nonconventional interventions. Homeopathic Q-potencies of opium and Erythroxylum coca have been tested in the integrative treatment of cocaine craving among homeless addicts, but this setting had not proven feasible, due to insufficient recruitment.</p><p><b>OBJECTIVE</b>This study investigates the effectiveness and tolerability of homeopathic Q-potencies of opium and E. coca in the integrative treatment of cocaine craving in a community-based psychosocial rehabilitation setting.</p><p><b>DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS</b>A randomized, double-blind, placebo-controlled, parallel-group, eight-week pilot trial was performed at the Psychosocial Attention Center for Alcohol and Other Drugs (CAPS-AD), Sao Carlos/SP, Brazil. Eligible subjects included CAPS-AD patients between 18 and 65 years of age, with an International Classification of Diseases-10 diagnosis of cocaine dependence (F14.2). The patients were randomly assigned to two treatment groups: psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca (homeopathy group), and psychosocial rehabilitation plus indistinguishable placebo (placebo group).</p><p><b>MAIN OUTCOME MEASURES</b>The main outcome measure was the percentage of cocaine-using days. Secondary measures were the Minnesota Cocaine Craving Scale and 12-Item Short-Form Health Survey scores. Adverse events were reported in both groups.</p><p><b>RESULTS</b>The study population comprised 54 patients who attended at least one post-baseline assessment, out of the 104 subjects initially enrolled. The mean percentage of cocaine-using days in the homeopathy group was 18.1% (standard deviation (SD): 22.3%), compared to 29.8% (SD: 30.6%) in the placebo group (P < 0.01). Analysis of the Minnesota Cocaine Craving Scale scores showed no between-group differences in the intensity of cravings, but results significantly favored homeopathy over placebo in the proportion of weeks without craving episodes and the patients' appraisal of treatment efficacy for reduction of cravings. Analysis of 12-Item Short-Form Health Survey scores found no significant differences. Few adverse events were reported: 0.57 adverse events/patient in the homeopathy group compared to 0.69 adverse events/patient in the placebo group (P = 0.41).</p><p><b>CONCLUSIONS</b>A psychosocial rehabilitation setting improved recruitment but was not sufficient to decrease dropout frequency among Brazilian cocaine treatment seekers. Psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca were more effective than psychosocial rehabilitation alone in reducing cocaine cravings. Due to high dropout rate and risk of bias, further research is required to confirm our findings, with specific focus on strategies to increase patient retention.</p><p><b>TRIAL REGISTRATION</b>RBR-2xzcwz (http://www.ensaiosclinicos.gov.br).</p>

The Medicinal Usage and Restriction of Ginseng in Britain and America, 1660–1900 / 의사학

This article demonstrates the medicinal usage of ginseng in the West from 1660 to 1914. Asian[Korea] ginseng was first introduced into England in the early 17th century, and North American ginseng was found in the early 18th century. Starting from the late 17th century doctors prescribed ginseng to cure many different kinds of ailments and disease such as: fatigue general lethargy, fever, torpidity, trembling in the joints, nervous disorder, laughing and crying hysteria, scurvy, spermatic vessel infection, jaundice, leprosy, dry gripes and constipation, strangury, yellow fever, dysentery, infertility and addictions of alcohol, opium and tobacco, etc. In the mid-18th century Materia Medica began to specify medicinal properties of ginseng and the patent medicines containing ginseng were widely circulated. However, starting in the late 18th century the medicinal properties of ginseng began to be disparaged and major pharmacopoeias removed ginseng from their contents. The reform of the pharmacopoeia, influenced by Linnaeus in botany and Lavoisier in chemistry, introduced nomenclature that emphasized identifying ingredients and active constituents. Western medicine at this period, however, failed to identify and to extract the active constituents of ginseng. Apart from the technical underdevelopment of the period, the medical discourses reveal that the so-called chemical experiment of ginseng were conducted with unqualified materials and without proper differentiation of various species of ginseng.

Clinical and laboratory findings of rhabdomyolysis in opioid overdose patients in the intensive care unit of a poisoning center in 2014 in Iran / 한국역학회지

OBJECTIVES: The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis.METHODS: This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test.RESULTS: A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20–29 and 30–39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8±1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8±0.3 mg/dL and 140.4±4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%).CONCLUSIONS: Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment.

Clinical and laboratory findings of rhabdomyolysis in opioid overdose patients in the intensive care unit of a poisoning center in 2014 in Iran / 한국역학회지

OBJECTIVES: The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis. METHODS: This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test. RESULTS: A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20–29 and 30–39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8±1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8±0.3 mg/dL and 140.4±4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%). CONCLUSIONS: Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment.

Evaluation of spinal anesthesia blockade time with 0. 5% hyperbaric bupivacaine, with or without sufentanil, in chronic opioid users: a randomized clinical trial / Avaliação do tempo de bloqueio da raquianestesia com bupivacaína a hiperbárica 0, 5%, com ou sem sufentanil, em usuários crônicos de opioides: um estudo clínico randômico

Abstract Objective: The primary outcome of this study was to evaluate the effect of adding sufentanil to hyperbaric bupivacaine on duration of sensory blockade of spinal anesthesia in chronic opioid users in comparison with non-addicts. Methods: Sixty patients scheduled for orthopedic surgery under spinal anesthesia were allocated into four groups: group 1 (no history of opium use who received intrathecal hyperbaric bupivacaine along with 1 mL saline as placebo); group 2 (no history of opium use who received intrathecal bupivacaine along with 1 mL sufentanil [5 µg]); group 3 (positive history of opium use who received intrathecal bupivacaine along with 1 mL saline as placebo) and group 4 (positive history of opium use who received intrathecal bupivacaine along with 1 mL sufentanil [5 µg]). The onset time and duration of sensory and motor blockade were measured. Results: The duration of sensory blockade in group 3 was 120 ± 23.1 min which was significantly less than other groups (G1 = 148 ± 28.7, G2 = 144 ± 26.4, G4 = 139 ± 24.7, p = 0.007). The duration of motor blockade in group 3 was 145 ± 30.0 min which was significantly less than other groups (G1 = 164 ± 36.0, G2 = 174 ± 26.8, G4 = 174 ± 24.9, p = 0.03). Conclusions: Addition of 5 µg intrathecal sufentanil to hyperbaric bupivacaine in chronic opioid users lengthened the sensory and motor duration of blockade to be equivalent to blockade measured in non-addicts.

Resumo Objetivo: Avaliar o efeito da adição de sufentanil à bupivacaína hiperbárica na duração do bloqueio sensorial da raquianestesia em usuários crônicos de opioides em comparação com não adictos. Métodos: Foram distribuídos em quatro grupos 60 pacientes agendados para cirurgia ortopédica sob raquianestesia: Grupo 1 (sem história de uso de ópio, recebeu bupivacaína hiperbárica intratecal juntamente com 1 mL de solução salina como placebo); Grupo 2 (sem história de uso de ópio, recebeu bupivacaína intratecal juntamente com 1 mL de sufentanil [5 µg]); Grupo 3 (com história de uso de ópio, recebeu bupivacaína intratecal juntamente com 1 mL de solução salina como placebo) e Grupo 4 (com história de uso de ópio, recebeu bupivacaína intratecal juntamente com 1 mL de sufentanil [5 µg]). O tempo de início e a duração dos bloqueios sensitivo e motor foram registrados. Resultados: A duração do bloqueio sensorial no Grupo 3 foi de 120 ± 23,1 min, um tempo significativamente menor do que nos outros grupos (G1 = 148 ± 28,7, G2 = 144 ± 26,4, G4 = 139 ± 24,7, p = 0,007). A duração do bloqueio motor no Grupo 3 foi de 145 ± 30,0 min, um tempo significativamente menor do que nos outros grupos (G1 = 164 ± 36.0, G2 = 174 ± 26.8, G4 = 174 ± 24,9; p = 0,03). Conclusões: A adição de 5 µg de sufentanil intratecal à bupivacaína hiperbárica em usuários crônicos de opioides aumenta a duração dos bloqueios sensorial e motor de forma equivalente ao bloqueio avaliado em não adictos.

Cooperation and Conflict: Faction Problem of Western Medicine Group in Modern China / 의사학

After the defeat of the Opium War and the Sino-Japanese War, China's intellectuals realized necessity of modernization (Westernization) to survive in the imperial order of the survival of the fittest. In particular, it was urgent to accept Western medicine and train the doctors who learned Western medicine to change the sick and weary Chinese to be robust. Thus, new occupations of the Western Medicine Group (xiyi, doctors who learned Western medicine) emerged in China. As with the first profession, the new Western Medicine Group tried to define standards of Western medicine and medical profession; however, it was difficult in the absence of the strong central government. In addition, they formed a faction by the country where they studied or the language they learned. The factions included the Britain - America faction(yingmeipai) consisting of the Britain - America studied doctors or graduates from Protestant missions based medical schools, and the Germany - Japan faction(deripai), graduates from medical schools by Japanese or German government and the Chinese government. In 1915, they founded the National Medical Association of China mainly consisting of the Britain - America faction and the National Medical and Pharmaceutical Association of China led by the Germany – Japan faction. Initially, exchanges were active so most of eminent doctors belonged the two associations at the same time. They had a consciousness of a common occupation group as a doctor who had learned Western medicine. Thus, they actively cooperated to keep their profits against Chinese medicine and enjoy their reputation. Their cooperation emitted light particularly in translation of medical terms and unified works. Thanks to cooperation, the two associations selected medical terminologies by properly using the cases of the West and Japan. Additionally, medical schools of the Britain - America faction and the Germany – Japan faction produced various levels of the Western Medicine Group doctors for China to timely respond to the rapidly increased demand. However, a conflict over the promotion of hygiene administration and the unification, organization of medical education did not end. This conflict was deepening as the Nanjing nationalist government promoted sanitary administration. It was the Britain - America faction who seized a chance of victory. It was because figures from the Britain - America faction held important positions in the hygiene department. Of course, some related to the National Medical and Pharmaceutical Association of China were also involved in the hygiene department; however, most took charge of simple technical tasks, not having a significant impact on hygiene administration. To solve the problem of factions of the Western Medicine Group, the Britain - America faction or the Germany - Japan faction had to arrange the education system with a strong power, or to organize a new association of two factions mixed, as in Chinese faction(zhonghuapai). But an effort of the Britain - America faction to unify the systems of medical schools did not reach the Germany - Japan faction's medical schools. Additionally, from 1928, executives of the two Chinese medical associations discussed their merger; however they could not agree because of practitioners'interests involved. Substantially, a conflict between factions of the Western Medicine Group continued even until the mid-1930s. This implies that the then Chinese government had a lack of capacity of uniting and organizing the medical community.

[Comparison of the effects of methadone and morphine on postoperative pain scale following thoracic surgery in opium addict patients]

Post operative pain is cause of suffering in most patients and can cause a lot of problems. Analgesic effects of many narcotics have been widely studied. In this study, the effects of methadone and morphine on postoperative pain scale following thoracic surgery in opium addict patients were assessed. In this clinical trial and double blind study, sixty opium addict patients [ASA I, II], aged 20-65 yr, were randomly allocated into two groups. Thirty minutes before induction of general anesthesia the first group received 0.1 mg/kg methadone and the second group received 0.1 mg/kg morphine. The two groups were assessed and compared in regard to the intensity of pain and meperidine requirement in the first post operative 24 hr. Intensity of post operative pain and meperidine requirement in the methadone group were significantly lower than those in the morphine group [P<0.01]. Administration of 0.1mg/kg methadone as premedication for opium addict patients reduces the post operative pain more than morphine. Therefore, premedication with methadone for opium addict patients undergoing thoracic surgery is recommended

Comparison of efficacy of thioridazine with clonidine acting through different mechanisms in acute opioid abstinence syndrome

To compare the efficacy, safety and tolerability of thioridazine with clonidine in patients with Acute opioid Abstinence Syndrome. This single blind comparative clinical trial was carried out at Department of Pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Center [JPMC], Karachi. Fifty two addicts were selected randomly and were grouped into, group-A to received thioridazine 100 mg/day and group -B to received clonidine 150mcg/day. All participants completed the treatment program and stayed in hospital for ten days. The efficacy safety and tolerability of thioridazine was scant, while clonidine showed statistically significant turn down in the objective signs of acute opioid abstinence syndrome. Clonidine had more powerful effects than thioridazine. While treating the withdrawal signs of opioid abstinence syndrome may possibly pointed out that over activation of norepinephrine is a major factor contributes to the commencement of opioid abstinence syndrome

[Analytical review on Persian poppy [Papaver bracteatum lindl.] as a native and economical medicinal plant]

Persian poppy or great scarlet poppy [Papaver bracteatuin LindI.] is proposed as a new source of raw material for codeine production and addiction treatment. This species as a native plant is growing in North and West of Iran. As for possible of illegal cultivation of opium poppy, cultivation of Persian poppy in Iran was associated with restrictions and despite the being abundant biodiversity of this plant in Iran, this plant was not considered yet. However, Persian poppy is lacking in morphine and rich in the baine. It has appropriate potential for domestication, mass production, and industrial processing as a valuable medicinal plant. For this reason, in this study was investigated kind of traits in this plant

Receptores opioides até o contexto atual / Opioid receptors to date

JUSTIFICATIVA E OBJETIVOS: Devido à finalidade do ambulatório e os fármacos utilizados rotineiramente, o objetivo deste estudo foi rever e atualizar os conhecimentos sobre os receptores opioides e como complemento de estudo após palestra apresentada aos integrantes da equipe. CONTEÚDO: Foram revisados desde os aspectos históricos até os conhecimentos mais recentes sobre receptores opioides, descritos seus subtipos e mecanismos de ação. Para tal, foram consultadas referências indexadas pelo Pubmed. CONCLUSÃO: Com os dados presentes na literatura atual, concluiu-se que ainda existe muito a ser pesquisado sobre o tópico, visando medicações mais seguras e novas técnicas biomoleculares ainda são necessárias.

BACKGROUND AND OBJECTIVES: Due to the objective of the outpatient setting and to routinely used drugs, this study aimed at reviewing and updating the knowledge about opioid receptors and worked as a study complement after a lecture presented to team members. CONTENTS: We have reviewed from historical aspects to most recent developments about opioid receptors, in addition to describing subtypes and action mechanisms. For such, Pubmed-indexed references were queried. CONCLUSION: After reviewing current literature data, we have concluded that there is still a lot to be researched about the topic, aiming at safer drugs, and new biomolecular techniques are still needed.

Homeopathic potencies of Opium in alcohol dependence: exploratory open-label study / Potências homeopáticas de Opium na dependência do álcool: estudo exploratório e aberto / Potencias homeopáticas de Opium en alcoholismo: estudio exploratorio abierto

The conventional pharmacological options for the treatment of alcoholism are limited, which led to the search for solutions in alternative or complementary medicine (CAM). Homeopathy is a CAM modality recognized as medical specialty in Brazil. According to the clinical experience of the early homeopaths, Opium was used to treat patients with alcohol dependence. Aim: to perform a preliminary assessment of the effectiveness and tolerability of fifty-millesimal potencies of Opium in the treatment of alcohol-dependent patients. Methods: exploratory, prospective, open-label trial, with pre-treatment measures as control. Confidence intervals were used to estimate the magnitude of the clinical differences. Results: a total of 14 patients were included, from which 12 were evaluated (intention to treat analysis - ITT). There was a significant reduction in the average daily alcohol consumption (-29.37 units of alcohol/day; 95% CI=10.63; 48.11) and in the severity of alcohol dependence, measured by the mean score of the Short Alcohol Dependence Data questionnaire (-10.17; 95% CI= 4.12; 16.22). No serious adverse events were reported. Randomized controlled studies with larger samples are needed.

Contexto: as opções farmacológicas convencionais para o tratamento do alcoolismo ainda são limitadas, contribuindo para a busca de soluções na medicina alternativa ou complementar (CAM). A homeopatia é uma modalidade de CAM reconhecida como especialidade médica no Brasil. Na experiência clínica dos primeiros homeopatas, Opium era usado no tratamento de pacientes com dependência do álcool. Objetivo: avaliação preliminar da efetividade e da tolerabilidade de dinamizações homeopáticas de Opium no tratamento de pacientes dependentes do álcool. Métodos: estudo exploratório, prospectivo e aberto, com medidas pré-tratamento como controle. Intervalos de confiança foram utillizados para se estimar a magnitude das diferenças clínicas. Resultados: 14 pacientes foram incluídos e 12 avaliados (análise segundo a intenção de tratar- ITT). Houve uma redução clinicamente significativa no consumo médio diário de álcool (-29,37 unidades de álcool/dia, 95% CI=10,63; 48,11) e na severidade da dependência do álcool, medida pelo escore médio do questionário Short Alcohol Dependence Data (-10,17 pontos 95% CI= 4,12; 16,22). Não foram relatados ou observados eventos adversos graves. Os resultados justificam estudos maiores, randomizados e controlados.

Oral opium: an unusual cause of lead poisoning

<p><b>INTRODUCTION</b>The number of cases of lead poisoning (LP), a widely known disease with various aetiologies, being reported globally has decreased over the years due to both limited domestic applications of lead and enforcement of stringent safety measures. However, a new presentation of lead poisoning, lead-contaminated opium (LCO), is gradually emerging in our region. This study aimed to determine the prevalence and clinical effects of lead toxicity associated with opium use.</p><p><b>METHODS</b>Between November 2006 and December 2007, all patients diagnosed with LP at a central laboratory in Tehran, Iran, were assessed for potential causes of poisoning. Patients with a history of LCO abuse were evaluated and recruited for the study.</p><p><b>RESULTS</b>Overall, there were 240 patients with LP, and poisoning from LCO was diagnosed in 25 patients. The duration of addiction was between three months and 40 years, and the duration of symptoms was 28.1 ± 17.7 days. Mean blood lead levels of the patients were 145 ± 61 (range 61-323) μg/dL. The average creatinine and haemoglobin levels were 77.4 ± 8.1 μmol/L and 105 ± 25 g/L, respectively. The association between the duration of addiction and levels of lead in blood was not statistically significant (r = -0.142, p = 0.54). The most common symptoms were gastrointestinal complaints, followed by musculoskeletal complaints with muscle weakness (92%). Anorexia was also a leading complaint.</p><p><b>CONCLUSION</b>The results of our study suggest that the possibility of LP should be considered with high suspicion among opium users presenting with acute abdominal symptoms.</p>

The effect of adjuvant midazolam compared with fentanyl on the duration of spinal anesthesia with 0.5% bupivacaine in opium abusers / 대한마취과학회지

BACKGROUND: There are a number of adjuvants to be used for local anesthetics in spinal block. The aim of this study was to demonstrate the possible effect of intrathecal midazolam compared with bupivacaine as adjuvants in spinal anesthesia with bupivacaine in chronic opium abuses. METHODS: In a double blind, randomized clinical trial, 90 opium abuser patients undergoing lower limb orthopedic surgery were selected and randomly assigned into 3 groups (30 cases each). The patients received 15 mg plain bupivacaine, or 15 mg bupivacaine plus 25 mcg fentanyl or 15 mg bupivacaine plus 1 mg midazolam, intrathecally. RESULTS: The duration of anesthesia was much longer in the bupivacaine-midazolam group than the bupivacaine-fentanyl group; both were longer than the plain bupivacaine group (P < 0.05). CONCLUSIONS: Subarachnoid injection of adjuvant midazolam or fentanyl with plain 0.5% bupivacaine in opium abusers in lower limb orthopedic surgery increases the duration of sensory block. Therefore midazolam is more effective than fentanyl in such cases.

Relationship between Opium Abuse and Severity of Depression in Type 2 Diabetic Patients

BACKGROUND: Opium use in diabetic populations is associated with major depressive disorder (MDD). This study was designed to investigate the relationship between opium use and severity of depression in Iranian diabetic patients. METHODS: In this case-control study, 642 type 2 diabetic patients were recruited from those presenting at two outpatient clinics at the Akhavan Hospital in Kashan, Iran; of them, 600 diabetic patients were included in the study and divided into two groups: opium-abusers (150 patients) and non-opium-abusers (450 patients). Clinical and demographic information was obtained through a detailed questionnaire. Depression symptomalogy and severity were assessed with the Beck Depression Inventory (BDI), and a corresponding diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders-IV, Text Revision, 2000 (DSM-IV TR) criteria. RESULTS: The mean depression score was higher in the opium abuse group than in the non-abuser group (29.27+/-1.44 vs. 18.29+/-1.31, P<0.001). In general, a significant association was found between opium abuse and depression among patients (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.87 to 7.44; P=0.001). No significant relationship was found between dysthymia and opium abuse (OR, 0.68; 95% CI, 0.18 to 1.192; P=0.155), while MDD was significantly higher in the opium abuser group (OR, 7.32; 95% CI, 5.20 to 12.01; P<0.001). CONCLUSION: Depression is more frequent in opium-dependent diabetic patients, and its severity is also greater. Given these findings, opium-dependent diabetic patients should be advised about the increased risks of depression and related comorbidities.

Plausible impact of dietary habits on reduced blood sugar in diabetic opium addicts with coronary artery disease

The effect of opium on glycemic control in diabetics is a controversial issue, as some studies have shown glucose lowering effect of opium in diabetes while the results of other studies do not support this idea. The possible role of opioid peptides in the regulation of food intake has been previously investigated. However, there is no data available about relationship between opium using and dietary pattern. The aim of the present study was to determine the daily intake of different nutrients in opium addict with diabetes diagnosed with coronary artery disease [CAD]. This study comprised 232 consecutive diabetic patients with CAD, and candidates for isolated coronary artery bypass surgery in Tehran Heart Center. Of these, 26 patients were opium addicts. Nutritional assessment was obtained by a validated semi-quantitative food frequency questionnaire [FFQ]. In opium addicts compared to non-addicts, consumption of carbohydrates [360.0 +/- 120.9 versus 447.8 +/- 249.8 Gr/day, P=0.016] and vitamin A [1170.4 +/- 570.2 versus 1496.3 +/- 889.6 micro g/d as Retinol Activity Equivalent [RAE], P=0.040] was lower than non-addicts and intake of other nutrients were similar across two group of patients. Opium addiction in diabetic patients may lead to decrease of vitamin A and carbohydrate intake. This study showed that carbohydrate intake in addicted diabetic patients is lower than their non-addict counterpart. Thus, the so called lowering effect of opium on blood sugar may be due to nutritional habit of addicted patients