Características de la adicción como factores pronósticos en el tratamiento con naltrexona de la dependencia de opiáceos / Addiction characteristics as prognosis factors in opiate dependence treated with naltrexone

Introducción. Se estudia el valor pronóstico de las características de la adicción en el tratamiento de opiáceos. Para ello se consideran diversas variables relacionadas con la historia previa de consumo de opiáceos (vía de administración, cantidad de sustancia consumida, edad de inicio en la adicción, tiempo de consumo, abuso de otras sustancias). Objetivo. Establecer el valor pronóstico de las características de la adicción en el tratamiento con naltrexona de la dependencia de opiáceos. Métodos. Estudio observacional retrospectivo con diseño de un grupo de tratamiento sin grupo control. Se estudian 945 pacientes dependientes de opiáceos que durante 1991-1995 inician de forma consecutiva tratamiento con naltrexona en el Hospital Ramón y Cajal descriptivas e inferenciales (técnicas de supervivencia). Resultados. Se establecen como variables predictivas de mala evolución el consumo habitual de heroína previo por vía intravenosa, historia prolongada de consumo, edad de inicio en la adicción anterior a los 17 años o posterior a los 25 años y consumo concomitante de otras sustancias, en particular benzodiacepinas y cocaína. Cantidades elevadas de consumo de heroína tienden asimismo asociarse con peor evolución. Conclusiones. Determinadas características de la adicción (duración de la dependencia, vía previa de consumo, edad de inicio, cantidad consumida, consumo de otras sustancias) tienen valor pronóstico en la evolución del tratamiento. Son necesarios estudios posteriores que puedan facilitar la comprensión de la importancia pronostica de la historia adictiva en la evolución del tratamiento (AU)

Introduction. Addiction characteristics as prognostic factors in opiate dependence treatment were studied. Thus, several factors related to previous opiate consumption record were considered (current heroin route, amount of heroin, onset age of heroin consumption, time of heroin consumption, other drug consumption record). Objective. To establish the prognostic value of addiction characteristic in a naltrexone program of opiate dependence. Methods. To achieve this objective, an observational, retrospective study was designed with a design of a treatment group with no control group. 945 subjects diagnosed of opiate dependence who were consecutively hospitalized voluntarily in the naltrexone program of the Hospital Ramon y Cajal of Madrid during 1991-1995 form a part of the study population. Descriptive and survival techniques were used to analyze the data. Results. Previous intravenous heroin route, chronic heroin consumption record, onset age of heroin use younger than 17 or older than 25, and other drug consumption especially benzodiazepine and also cocaine provide a prognostic value for a worse outcome. High quantities of heroin consumption also tend to be associated with a poorer evolution. Conclusions. Several addiction characteristics (current previous route, onset age of heroin consumption, quantity of heroin consumption, time of heroin consumption, other drug consumption) have a prognostic value for treatment evolution. Further studies are necessary to provide a more complete knowledge of addiction characteristics as prognosis factors in opiate dependence treatment (AU)

[Addiction characteristics as prognostic factors in opiate dependence treated with naltrexone]. / Características de la adicción como factores pronósticos en el tratamiento con naltrexona de la dependencia de opiáceos.

INTRODUCTION: Addiction characteristics as prognostic factors in opiate dependence treatment were studied. Thus, several factors related to previous opiate consumption record were considered (current heroin route, amount of heroin, onset age of heroin consumption, time of heroin consumption, other drug consumption record). OBJECTIVE: To establish the prognostic value of addiction characteristics in a naltrexone program for opiate dependence. METHODS: To achieve this objective, an observational, retrospective study was designed with a design of a treatment group with no control group. 945 subjects diagnosed of opiate dependence who were consecutively hospitalized voluntarily in the naltrexone program of the Hospital Ramon y Cajal of Madrid during 1991-1995 form a part of the study population. Descriptive and survival techniques were used to analyze the data. RESULTS: Previous intravenous heroin route, chronic heroin consumption record, onset age of heroin use younger than 17 or older than 25, and other drug consumption especially benzodiazepine and also cocaine provide a prognostic value for a worse outcome. High quantities of heroin consumption also tend to be associated with a poorer evolution. CONCLUSIONS: Several addiction characteristics (current previous route, onset age of heroin consumption, quantity of heroin consumption, time of heroin consumption, other drug consumption) have a prognostic value for treatment evolution. Further studies are necessary to provide a more complete knowledge of addiction characteristics as prognosis factors in opiate dependence treatment.

[Abuse, tolerance and dependence of zolpidem: three case reports]. / Abuso, tolerancia y dependencia de zolpidem: a propósito de tres casos.

Zolpidem is an imidazopyridine, which acts at the benzodiacepine omega1 receptor subtype. Zolpidem was marketed as a short-acting hypnotic and it was assumed that had a lower potential for abuse than benzodiacepines. Since 1993, several cases of zolpidem dependence have been reported. We have observed three patients with abuse, dependence and withdrawal syndrome to zolpidem. Two of them had history of drugs abuse and all of them developed withdrawal symptoms when discontinuing it. In Spain, zolpidem may be sold without medical prescription like other non benzodiacepines hypnotics and it may be playing an important role in the increase of abuse cases. We think zolpidem should be considered as a benzodiacepine with the same control and regulation.

Abuso, tolerancia y dependencia de zolpidem: a propósito de tres casos / Abuse, tolerance and dependence of zolpidem: three case reports

Zolpidem es una imidazopiridina que actúa a través del subtipo 1 del receptor de benzodiacepinas. Zolpidem fue comercializado como un hipnótico de acción corta y se asumía que tenía menor potencial de abuso que las benzodiacepinas. Desde 1993 se han publicado varios casos de dependencia de zolpidem. Nosotros hemos visto tres pacientes con abuso, dependencia y síndrome de retirada de zolpidem. Dos de ellos tenían historia de abuso de otras sustancias y todos ellos experimentaron síntomas de abstinencia cuando suspendieron la administración. En España, zolpidem puede adquirirse sin prescripción médica como otros hipnóticos no benzodiacepínicos, lo cual puede desempeñar un papel muy importante en el incremento de los casos de abuso. Creemos que zolpidem debe ser considerado como una benzodiacepina con el mismo control y regulación (AU)

Long-term effects of a nationwide control program on the seropositivity for Trypanosoma cruzi infection in young men from Argentina.

Unselected nationwide cohorts of Argentine men 18 years of age summoned for military service were tested for antibodies to Trypanosoma cruzi each year from 1981 to 1993. After an initial screening using indirect hemagglutination test, the positive sera were retested by titrated indirect hemagglutination and immunofluorescence antibody tests at 39 laboratories or at the national reference center in Buenos Aires. Nearly 1.8 million men were examined for T. cruzi antibodies using the same standardized procedures under a quality assurance program. The prevalence of seropositivity for T. cruzi decreased significantly from 5.8% in 1981 to 1.9% in 1993, but the decrease was not homogeneous among provinces within each region or constant over time. Prior to the nationwide control campaign initiated in 1961-1962, 15 provinces had high (> 20%) percentages of houses with domiciliary infestation by Triatoma infestans bugs, which decreased to nine provinces in 1982, and four provinces in 1992. The observed decrease in the prevalence of seropositivity for T. cruzi may be mostly attributed to the spraying with insecticides to eliminate the domiciliary populations of Triatoma infestans. The lack of a sustainable triatomine surveillance program set a limit to the decrease of seropositivity rates and prompted a revised strategy based on community participation.

Congenital transmission of Trypanosoma cruzi: an operational outline for detecting and treating infected infants in north-western Argentina.

We designed a set of procedures for first-line local health services to detect and treat the congenital transmission of Trypanosoma cruzi at a province-wide scale, and field-tested the programme in the province of Tucumán, northwestern Argentina, from 1992 to 1994. The programme consists of routine screening of pregnant women for seroreactivity to T. cruzi, serological and parasitological follow-up of the newborn at least twice during the first year of age, treatment of the infected infants, and evaluation of the outcome. 927 (5.5%) of 16 842 pregnant women were seroreactive to T. cruzi by indirect haemagglutination assay and ELISA. Twenty-one (6.7%) of 315 newborns to seroreactive mothers were diagnosed as infected with T. cruzi parasites microhaematocrit concentration before 30 days of age. Five newborns who initially tested negative had a T. cruzi infection detected by microhaematocrit and/or serological techniques at 3 or 6 months of age. Thus, congenital infection was diagnosed in 26 (7.1%) infants born to seroreactive women and residing in houses free of triatomine bugs. Four of 6 infants born to seroreactive mothers died during the first year of age and had some evidence of T. cruzi infection; one of the deaths was attributed to T. cruzi based on clinical evidence. After specific treatment with nifurtimox or benznidazole, 30 of 32 infants remained parasitologically and serologically negative. This study shows the feasibility of controlling the incidence of congenitally acquired T. cruzi infections at a province-wide scale by means of a specific screening programme at first-line health services level.

Quality assurance of the serologic diagnosis of Chagas' disease.

A quality assurance program of the Chagas' disease laboratory network of Argentina has been conducted by the National Reference Center since 1988, with the aim of assessing the reliability of serologic test results. Chagas' disease is endemic in Argentina, but the prevalence of seropositivity for Trypanosoma cruzi among 18- to 20-year-old men decreased from 5.8% in 1981 to 1.8% in 1994. About 600 laboratories form the Chagas' disease laboratory network, with main central laboratories in each of the 24 provinces in Argentina. The quality assurance program promotes regular use of good laboratory practice and internal and external quality control to improve performance of the participants; it also provides technical assistance and guidelines. Eventual corrective measures are discussed in workshops. Results of the first external evaluation by proficiency testing of serum panels and confirmation of results for 58 of the main laboratories reveal that from 1988 to 1994 the rate of agreement has increased.

Serological evidence of human Hantavirus infection in Argentina, Bolivia and Uruguay.

A serological survey was conducted in 1985-1987 to determine the presence of infection for Hantavirus in the general population in Argentina, Uruguay, Paraguay and Bolivia, as well as among rodent-exposed laboratory workers in Argentina. Out of 748 individuals tested by immunofluorescence 20 proved positive for Hantaan virus 76/118 strain of whom 16 also reacted against Seoul virus 80/39 strain and 2 against Puumala virus Sotkamo strain. Ten out of 72 Argentine laboratory workers were positive for the first 2 viruses by ELISA, immunofluorescence and/or plaque reduction neutralization test, in 4 of whom recent infection was demonstrated by IgM antibody presence. Inapparent Hantavirus infection was thus demonstrated for the first time in 2.7% of regional inhabitants, together with 13.9% among rodent-exposed laboratory workers. Our data established the existence of human Hantavirus infection nearly 10 years before the recognition of clinical cases of hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome in Argentina.

[Local migration in Spain, from the sixteenth to the nineteenth century]. / Las migraciones locales en Espana, siglos XVI-XIX.

PIP: Internal migration trends in Spain from the sixteenth to the nineteenth century are discussed, with a focus on urbanization and the emergence of the modern city. Data are from official and other published sources.^ieng

Long-term preservation of blood samples for diagnosis of Trypanosoma cruzi infection.

Feasability and suitability for field research of a whole-blood preservation method was evaluated through the screening of anti-Trypanosoma cruzi antibodies in 1209 samples under different conditions. Antibody reactivity of paired samples from preserved capillary blood (CBP) and sera from venous blood (VBS) were studied by specific techniques. Over 96% concordance was found on indoor studies carried out with samples without storage or after 15 or 30 days preservation of CBP at 37 degrees C and VBS at -20 degrees C. Outdoor studies performed at field conditions, achieved a 92.1% concordance.

[Urbanization and internal migration during the transition to a manufacturing system: the Catalan case]. / Urbanizacion y migraciones internas durante la transicion al sistema fabril: el caso catalan.

PIP: The author analyzes urbanization processes in Catalonia, Spain, during the eighteenth and nineteenth centuries, with a focus on the transformation of the Catalan economy and subsequent migration from rural areas to the cities. Problems of defining urban areas and determining data reliability are first considered. Phases in urban growth during the period are then described, and rural-urban migration is estimated. Data are from the censuses of 1857, 1877, and 1900 and cover 150 cities.^ieng

Brain cell karyotypes of six new world sand flies (Diptera: Psychodidae).

The brain cell karyotypes of six New World sand flies are described and compared. Lutzomyia trapidoi has three pairs of chromosomes, 2N = 6. The other species, L. gomezi, L. erwindonaldoi, L. carmelinoi, L. walkeri and L. columbiana, have four pairs of chromosomes, 2N = 8. No heteromorphic chromosomes were observed. Cytogenetic similarities among sand fly species are discussed.

Silica and glomerulonephritis: case report and review of the literature.

A 54-year-old foundry worker with extensive silica exposure, but no pulmonary disease, developed the nephrotic syndrome and renal failure over a 3-month period. Renal biopsy demonstrated a proliferative glomerulonephritis; energy dispersive x-ray analysis detected silicon within the renal tubules. Measurements of respirable silica at the foundry revealed levels up to 2.5 times the current occupational standard. Similar glomerular disease has been reported in silica-exposed animals and workers with silicosis. This case suggests that clinicians should include silica exposure in the differential diagnosis of unexplained diffuse proliferative glomerulonephritis, renal disease may occur without clinically evident pulmonary disease in silica exposure, and silica-induced glomerulonephritis warrants further clinical and epidemiologic research.