Treatment of high dose of intravenous midazolam abuse: a case report.

This study reports a rare case of high-dose midazolam abuse and Munchausen Syndrome. A 48-year-old female physician was referred by a psychiatrist to the Toxicology Department of Imam Reza Hospital for abstaining from 300 mg/day of parenteral midazolam. She had mimicked the symptoms of Crohn's disease; therefore, she had undergone 15 colonoscopies and 40 times MRI or CT scan, all of which were normal. Six months earlier, she had switched oral methadone to 30 mg/day of intravenous midazolam. She also had several skin lesions on injection sites that she considered pyoderma gangrenosum. When the total daily dose of intravenous midazolam was switched to oral bioequivalence of clonazepam, she could not tolerate withdrawal (Clinical Institute Withdrawal Assessment Scale-Benzodiazepines = 68). Therefore, she received midazolam again as a continuous intravenous infusion. Within 7 days, the whole dose was replaced by the bioequivalence oral dose of clonazepam. She was also treated with carbamazepine and cognitive behavior therapy. Afterward, she was transferred to the psychiatric ward for further psychiatric treatment. Dependency on a high dose of midazolam could be treated by tapering off the long-acting benzodiazepine.

Multimodality imaging of the effects of a novel dentifrice on oral biofilm.

OBJECTIVE: Oral biofilm formation and progression on the surface of the tooth can lead to advanced oral disease such as gingivitis. The purpose of this randomized, controlled, double-blinded study was to evaluate the effects of a novel dental gel on oral plaque biofilm using multimodal imaging techniques. MATERIALS AND METHODS: Twenty-five subjects with moderate gingival inflammation (Löe and Silness Gingival Index ≥2) and pocket depths <4 were randomly assigned to brush twice daily for 21 days with the test or the control dental gel. In vivo multimodality in situ imaging was performed over a 3-week period using in vivo Optical Coherence Tomography (OCT) and Non-Linear Optical microscopy (NLOM). Plaque levels, gingival inflammation and gingival bleeding were also charted on days 0, 7, 14, and 21 using standard clinical indices. RESULTS: After 3 weeks, OCT and NLOM images showed a macroscopic break-up of the plaque layer and smaller, fragmented residual deposits in the test group with no apparent changes in the pellicle. Biofilm was also reduced in the control group, but to a lesser degree with regard to thickness, continuity and surface area. Paralleling these imaging results, clinical indices were significantly improved in both groups (P < 0.05) and significantly lower in the test group (P < 0.05). CONCLUSION: Both dental gels reduced oral biofilm with the test gel showing greater efficacy (P < 0.05) as determined by clinical and imaging parameters.