An Interaction Effect Analysis of Thermodilution-Guided Hemodynamic Optimization, Patient Condition, and Mortality after Successful Cardiopulmonary Resuscitation.

Proper hemodynamic management is necessary among post-cardiac arrest patients to improve survival. We aimed to investigate the effects of PiCCO™-guided (pulse index contour cardiac output) hemodynamic management on mortality in post-resuscitation therapy. In this longitudinal analysis of 63 comatose patients after successful cardiopulmonary resuscitation cooled to 32-34 °C, 33 patients received PiCCO™, and 30 were not monitored with PiCCO™. Primary and secondary outcomes were 30 day and 1 year mortality. Kaplan-Meier curves and log-rank tests were used to assess differences in mortality among the groups. Interaction effects to disentangle the relationship between patient's condition, PiCCO™ application, and mortality were assessed by means of Chi-square tests and logistic regression models. A 30 day mortality was significantly higher among PiCCO™ patients, while 1 year mortality was marginally higher. More severe patient condition per se was not the cause of higher mortality rate in the PiCCO™ group. Patients in better health conditions (without ST-elevation myocardial infarction, without cardiogenic shock, without intra-aortic balloon pump device, or without stroke in prior history) had worse outcomes with PiCCO™-guided therapy. Catecholamine administration worsened both 30 day and 1 year mortality among all patients. Our analysis showed that there was a complex interaction relationship between PiCCO™-guided therapy, patients' condition, and 30 day mortality for most conditions.

Diverted medications and new psychoactive substances-A chemical network analysis of discarded injecting paraphernalia in Hungary.

BACKGROUND: Until about 2010, people who inject drugs (PWIDs) injected almost exclusively heroin and amphetamines in Hungary. After 2010, self-reported studies have indicated a dominance of new psychoactive substances on the drug market for injectable drugs. METHODS: Between March 2015 and February 2016, we collected used and discarded injecting paraphernalia. We utilized chemical analysis to assess and UCINet to visualize the connections between the most prevalent main substances and their respective co-occurring additional components at 7 locations in Hungary. RESULTS: The samples (n=2977) contained a mean of 4.5 components (SD=3.1, range: 1-18); 422 contained only one component. We found that the most common main components were the diverted substitution medication methadone (32%) and cathinones: pentedrone (18%), mephedrone (13%), alpha-PHP (8%), and alpha-PEP (5%). While these main substances also occurred among the top co-occurring additional components, caffeine and benzoic acid (a preservative) also frequently co-occurred. CONCLUSION: A large number of co-occurring additional components indicate either common reuse of injecting paraphernalia or the common addition of additives or both. While caffeine may indeed be an adulterant, the high prevalence of benzoic acid may be difficult to explain. The preference of methadone despite the availability of a wide array of drugs may indicate a preference for opioids during the current heroin drought and/or a true demand for opioid substitution therapy.