An evaluation of opioid use during acute hospital admissions.

Long-term opioid use can begin with the treatment of acute pain. However, there is little evidence concerning the impact that better opioid awareness in the acute phase may have on reducing the use of opioids in the long term. This project explored which opioids are routinely prescribed within an acute hospital setting and how these opioids were used over the course of the hospital stay. Codeine and morphine remain the most commonly prescribed opioids. Opioids were prescribed and given to people across the age range, from 16 to 98 years. The project found that 19% of patients were admitted with a pre-existing opioid. Up to 66% of patients were discharged with opioid medication, with almost 20% leaving with more than one opioid. Regular opioid use routinely exposes patients to long-term opioid use and those patients initiated onto opioid medication during admission should have the benefit of planned de-escalation before discharge.

Sugar intake and dental decay: results from a national survey of children in Scotland.

The aim of this analysis was to investigate the strength of the association between sugar intake and treatment for dental decay in children in Scotland, and the impact of tooth brushing frequency on this association. The Survey of Sugar Intake among Children in Scotland was carried out in 2006 in those aged 3-17 years. Diet was assessed using the Scottish Collaborative Group FFQ, and interviews were carried out by trained fieldworkers who asked about dental health. A total of 1700 interviews were carried out, and 1512 FFQ were returned. Of the children, 56% had received treatment for decay (fillings or teeth removed due to decay). Intake of non-milk extrinsic sugars (NMES), but not total sugar, increased the risk of having had treatment for decay: adjusted OR 1.84 (95% CI 1.28, 2.64) for the highest ( ≥ 20.0% food energy) v. lowest ( ≤ 14.8% food energy) tertile of NMES intake. This raised risk remained in children who reported brushing their teeth at least twice a day. Compared with children who reported brushing their teeth at least twice a day and were in the lowest tertile of NMES intake, children who reported brushing their teeth once a day or less and were in the highest tertile of NMES intake were over three times more likely to have received treatment for decay (adjusted OR 3.39, 95% CI 1.97, 5.82). In order to improve dental health in children in Scotland, dental health strategies must continue to stress the importance of both reduced NMES intake and good oral hygiene.

Temporal evaluation of methionine synthase and related metabolites in the MAC15A mouse adenocarcinoma animal model.

Methionine dependence is unique to cancer cells and defined as the inability to grow in a methionine-deprived environment even if supplemented with the metabolic precursor homocysteine. Cobalamin-dependent methionine synthase (MS) catalyses the formation of methionine and tetrahydrofolate from homocysteine and methyltetrahydrofolate, thus linking the methionine and folate pathways. The apparent altered methionine metabolism in methionine-dependent cancer cells suggests a role for MS, although results to date are conflicting. We have analysed key metabolites of the MS-associated transmethylation, transsulphuration and folate pathways of the methionine-dependent MAC15A tumour model as a function of tumour progression over a 10-day period. MS activity increased 2-fold from day 1 to day 10. Cysteine, homocysteine, S-adenosylmethionine and S-adenosylhomocysteine levels in tumour cytosolic fractions decreased as a function of tumour progression. Plasma cysteine levels also decreased, whilst the distribution of folates in erythrocytes was altered, with a maximum increase in methyltetrahydrofolate observed by day 5. The increasing MS activity and decreasing cysteine levels suggest an increasing methionine requirement by the tumour, whilst the induction of enzyme activity indicates that MS is not defective in the methionine-dependent MAC15A tumour. The decrease in tumour S-adenosylmethionine and S-adenosylhomocysteine levels suggests that methionine is required for some function other than cellular methylation, e.g., incorporation into protein. Overall, the results support a theory of methionine conservation in response to tumour growth, where the methionine-dependent MAC15A tumour has a higher than normal methionine requirement.

Aneurysmal subarachnoid hemorrhage in young adults.

OBJECT: The authors reviewed the management protocols for young adults who presented with subarachnoid hemorrhage (SAH) at the Regional Neurosurgery Unit in Newcastle during a study period of 9 years. Aneurysmal SAH is uncommon in the age group selected (18-39 years) and, therefore, the performance of these patients has not been extensively reported in the literature. The authors also evaluated the good-grade rebleed rate (an index of management efficiency) in this cohort of patients. METHODS: The Newcastle neurosurgical unit serves a population of close to 3 million people, and an average of 180 patients with SAH are seen each year. The majority of patients are transferred from other hospitals in the region. This study includes patients admitted between January 1990 and December 1998. A total of 1,609 patients were admitted during this period, of whom 295 (18.4%) between the ages of 18 and 39 years constituted the study population of young adults. Two hundred ninety-five young adults presented with SAH; 181 (61.4%) were women and 114 (38.6%) were men, a ratio of 3:2. Of 246 patients in whom this value was recorded, 15 (6.1%) presented with a history of hypertension, and there was an association between hypertension and the occurrence of multiple aneurysms (Fisher two-tailed exact test, p = 0.008). Thirty-five patients (11.9%) presented with a hematoma on computerized tomography scans; of these, 20 (57%) were women and 15 were men. In six patients the lesion had rebled before treatment. The good-grade rebleed rate was three (1.7%) of 178. The overall favorable outcome rate was 83.8% (Glasgow Outcome Scale [GOS] 4 and 5) and unfavorable outcome occurred in 16.2% (GOS 1-3), with a total of 40 deaths in this group (13%). Age had no influence on outcome in young adults. Comparing the outcome at discharge with the follow-up evaluation at 6 months revealed that patients in the moderate and severe disability groups continued to improve and many achieved good recovery. CONCLUSIONS: In this report the authors detail the outcome of a large number of young adults with SAH. The incidence of SAH was higher in the female population, although the ratio was not as high as previously reported. The authors have also demonstrated a progressive increase in the incidence of aneurysmal SAH with age, even in young adults. Hypertension but not age influenced the occurrence of multiple aneurysms. The good-grade rebleed rate is low, although it is not zero. Generally, a satisfactory outcome was obtained and significant continuing improvements were noted between discharge and follow-up evaluation. This reflects the power of recovery in young adults. These are people whose economic productivity and fertility are at peak levels and therefore the financial and social burden occasioned by less-than-perfect outcomes is large.