Association of vitamin D binding protein polymorphisms with bronchopulmonary dysplasia: a case-control study of gc globulin and bronchopulmonary dysplasia.

OBJECTIVE: The pathophysiologies of bronchopulmonary dysplasia (BPD) are inflammation, infection, tissue damage, angiogenesis defects and genetic susceptibility. Because of the role of the vitamin D binding protein (Gc globulin) on these factors, we investigated the relationship between Gc globulin polymorphisms and BPD. STUDY DESIGN: This case-control study was performed with 160 neonates (⩽32 gestational ages, ⩽1500 g). PCR DNA sequence analyses were used for GC gene rs4588 and rs7041 single-nucleotide polymorphisms. RESULT: In the univariate analyses, it was observed that Gc2 was the only variant that was protective against BPD (Odd ratio (OR)=0.47, 95% coinfidence interval (CI)=0.24 to 0.89, P=0.020). In the multivariate analyses, Gc2 decreased the risk of disease (OR=0.15, 95% CI=0.029 to 0.79, P=0.026) independent of gestational age, birth weight, 5-min Appearance, Pulse, Grimace, Activity, and Respiration scores, respiratory distress syndrome and sepsis. CONCLUSION: The Gc2 variant was, after adjusting for confounders, associated with a decrease in the frequency of BPD. Our study adds Gc globulin to the list of candidate genes that potentially contribute to the etiology of the disease.

Managing substance use disorders in resident physicians.

Alcohol and other drug abuse is the leading cause of physician impairment. Prompt identification and early intervention by colleagues are the most effective ways of dealing with this problem in hospital residents. The author offers guidelines for recognizing the progressive signs of trouble inadvertently sent out by abusers, as well as effective ways in which colleagues can intervene. Also offered are steps in evaluation and treatment that can effectively address these illnesses and prevent compromising patient care.

Quantification of the alcohol withdrawal syndrome in 487 alcoholic patients.

While the alcohol withdrawal syndrome (AWS) is frequently encountered in a number of medical settings, its clinical management is inconsistent. Appropriate management of the AWS can be enhanced by objectively quantifying principal symptoms. The modified or Milwaukee Selective Severity Assessment (MSSA) measures 10 symptoms of the AWS, providing clinicians with a quantitative indication of the syndrome's severity. The MSSA was administered to 487 successively admitted alcoholics entering an inpatient chemical dependency treatment center. The MSSA was used to evaluate the severity, monitor progression, and determine efficacy of treatment of the AWS. The MSSA aided clinicians in deciding which patients required pharmacologic intervention for their AWS. Two groups of patients are described: 435 whose AWS was not judged to be severe enough to require medication, and 52 whose AWS was sufficiently severe to warrant pharmacologic intervention. The MSSA allowed clinicians to accurately identify patients requiring pharmacologic intervention of the AWS: only 10.6% of 487 hospitalized alcoholics required pharmacotherapy. The MSSA is a convenient, effective, and efficient tool for monitoring the AWS.

Treating substance-use disorders among physicians.

Of 40 participants of a two-year program for rehabilitating alcohol- and other-drug-dependent physicians, 15 have completed 24 months of treatment and monitoring, eight have completed 12 to 23 months, ten have completed one to 11 months, and seven discontinued treatment before completion. Of the 33 treated physicians, 31 have returned to full practice and 22 have experienced no relapse. The prognosis is quite favorable for most impaired physicians in appropriate treatment, monitoring, and follow-up are provided.

Benzodiazepines and drug abuse: clinical observations in chemically dependent persons before and during abstinence.

Sixty-nine (9.2%) of 750 consecutive persons entering a chemical-dependence treatment hospital had urinary evidence of benzodiazepines, a somewhat higher proportion than in the general adult American population. The 54 subjects in whose urine benzodiazepines, but not the other commonly abused psychoactive drugs, were detected, had varied clinical findings. One had used benzodiazepines only, 38 others were alcoholic benzodiazepine users, and 15 were multiple-drug (including benzodiazepines) users. Of these 54 only 6 (11%) developed major withdrawal symptoms. All 6 had used high doses of benzodiazepines (larger than or equal to 30 mg of diazepam or equivalent) daily. The risk of major withdrawal symptoms was about 50% for the high benzodiazepines--heavy alcohol group and zero for all other benzodiazepine-consuming patients. While clinical vigilance regarding withdrawal is urged for all benzodiazepine consumers, it is especially important amongst alcoholics, consuming high doses of benzodiazepines.

Alcohol and benzodiazepines: withdrawal syndromes.

A mixed alcohol-benzodiazepine (BD) addiction was recognized in 25 alcoholics who were admitted for detoxification. They experienced a withdrawal syndrome, atypical for alcoholics, starting 2--10 days after abrupt discontinuation of drugs and characterized by more psychomotor and less autonomic nervous system signs than is usual in alcohol withdrawal. The timing and nature of the specific symptoms in the mixed sedative addiction resembled BD withdrawal. Treatment with tapering oral barbiturates after sedative tolerance tests was effective. Awareness of the mixed alcohol--BD addiction should result in improved recognition and treatment.