Equus asinus papillomavirus (EaPV1) provides new insights into equine papillomavirus diversity.

We detected a novel papillomavirus (EaPV1) from healthy skin and from sun associated cutaneous lesions of an Asinara (Sardinia, Italy) white donkey reared in captivity in a wildlife recovery centre. The entire genome of EaPV1 was cloned, sequenced, and characterised. Genome is 7467 bp long, and shows some characteristic elements of horse papillomaviruses, including a small untranslated region between the early and late regions and the lack of the retinoblastoma tumour suppressor binding domain LXCXE in E7. Additionally, a typical E6 ORF is missing. EaPV1 DNA was detected in low copies in normal skin of white and grey donkeys of the Asinara Island, and does not transform rodent fibroblasts in standard transformation assays. Pairwise nucleotide alignments and phylogenetic analyses based on concatenated E1-E2-L1 amino acid sequences revealed the highest similarity with the Equine papillomavirus type 1. The discovery of EaPV1, the prototype of a novel genus and the first papillomavirus isolated in donkeys, confirms a broad diversity in Equidae papillomaviruses. Taken together, data suggest that EaPV1 is a non-malignant papillomavirus adapted to healthy skin of donkeys.

Clinical experience with baclofen in the management of alcohol-dependent patients with psychiatric comorbidity: a selected case series.

AIMS: To illustrate the potential indications for, and adverse effects of, baclofen pharmacotherapy for alcohol dependence in patients with co-existing psychiatric illness. METHODS: Audit of the files of alcohol-dependent patients treated for comorbid non-psychotic psychiatric illness in a specialist detoxification unit with integrated outpatient treatment. Files were selected of patients who had been offered treatment with baclofen because other alcohol pharmacotherapies had previously been unsuccessful in preventing relapse or were contraindicated. RESULTS: Of the 21 selected patients, 13 attended for outpatient treatment, with follow-up periods ranging from 4 days to 27 months, and the outcomes could be rated. Prescribed baclofen doses ranged from 30 to 275 mg daily. Common side effects at lower doses included tiredness and sedation; one patient on 120 mg/day developed reversible severe back pain, and a patient taking up to 275 mg/day developed somnolence, dizziness and incontinence. Seven patients maintained significant periods of abstinence, and one patient reduced daily consumption to non-problematic levels. Two patients consumed an overdose of other central nervous system (CNS) depressants, while taking baclofen in the first week of treatment, were briefly unwell, were given emergency monitoring, but made a full recovery. CONCLUSION: While more than half the patients reported significant reduction in alcohol use, it is not possible to draw definite conclusions about the effectiveness of baclofen, given that it was combined with other psychiatric and alcohol treatments, and because there was no control or comparison group. We recommend caution when offering baclofen to patients with a history of recurrent overdosing or a history of other substance misuse. When prescribing in conjunction with other medications with CNS depressant action, close monitoring is recommended at initiation and during dose escalation.

A randomized controlled trial of motivational enhancement therapy (MET) for mild to moderate alcohol dependence.

OBJECTIVE: This study was designed to conduct a randomized controlled trial of motivational enhancement therapy (MET) with two control conditions: nondirective reflective listening (NDRL) and no further counseling (NFC); and to conduct this study in a sample of patients with a primary diagnosis of mild to moderate alcohol dependence, in a "real-life" clinical setting. METHOD: Patients with mild to moderate alcohol dependence were recruited, assessed and treated at the Community Alcohol and Drug Service of Christchurch, New Zealand. All patients received a feedback/education session before randomization to either four sessions of MET, four sessions of NDRL, or NFC. Outcome data on 122 subjects (57.4% men) were obtained 6 months following the end of treatment, by an interviewer who was blind to the treatment condition. The primary drinking outcome was unequivocal heavy drinking, defined as drinking 10 or more standard drinks six or more times in the follow-up period. Global assessment scale (GAS) measured general personal/social functioning. RESULTS: Of patients treated with MET, 42.9% showed unequivocal heavy drinking compared with 62.5% of the NDRL and 65.0% of the NFC groups (p = .04). No significant differences were found for GAS score according to treatment condition. CONCLUSIONS: In patients with mild to moderate alcohol dependence, MET is more effective for reducing unequivocal heavy drinking than either a feedback/education session alone or four sessions of NDRL. MET can be considered an effective "value added" counseling intervention in a real-life clinical setting. In patients with mild to moderate alcohol dependence, nondirective reflective listening provides no additional advantage over a feedback/education session alone.

Methadone maintenance treatment: outcomes from the Otago methadone programme.

AIM: To provide information on methadone treatment outcomes for opiate-dependent individuals. METHODS: Questionnaires and random urine tests were completed for 112 Otago clients comparing outcomes before and during methadone maintenance treatment. RESULTS: Treatment retention rates were high, with 86% of clients remaining on the programme six months or more. The number of clients on benefits reduced by almost 30% during treatment, with employment rates doubling from 19% to 40% (including attendance at educational programmes). For the 89 clients injecting opiates daily at initial presentation, 64% reported no opiate use in the three months prior to review. Of the remaining 36%, opiate use reduced significantly. Rates of sharing injecting equipment reduced by almost 90%. Almost 50% of cannabis users reduced their use from daily to less than daily use. Clients reporting no current use of illicit benzodiazepines increased by 85%. Heavy binge drinking weekly or more reduced by almost 75%. Use of other illicit drugs reduced by almost 90%. Drug-related convictions reduced by almost 60%, while accidental drug overdoses reduced by over 90%. CONCLUSION: The widespread benefits of methadone maintenance treatment demonstrated underline the importance of making quality methadone programmes readily accessible within the health system. Currently, there are long waiting lists and many individuals cannot gain access to active treatment. We believe the health system urgently needs to look at expanding existing services and/or establishing private methadone clinics similar to those in New South Wales.

Dependent opioid users assessed for methadone treatment in Otago: patterns of drug use.

AIMS: To provide detailed information about the types of drugs used and the patterns of drug use for injecting drug users presenting for methadone treatment. METHODS: A retrospective case note review was carried out for 126 consecutive clients who were assessed for methadone treatment in the Otago province over a 2 year period. Patterns of drug use in the three months prior to presentation were recorded. RESULTS: Over 60% of those presenting were using three or more opioid drugs, with the most common being homebake (63%), sustained release morphine sulphate tablets (62%), buprenorphine (52%), opium poppies (50%) and methadone (41%). Use of diacetylmorphine (heroin) was reported primarily by those returning from recent overseas travel. Most clients reported the regular use of multiple other of clients using benzodiazepines daily. Almost 80% of the group were regular tobacco smokers and 11% showed evidence of alcohol disorders (abuse or dependence). Low levels of use were reported for cocaine, amphetamines, and hallucinogens. CONCLUSION: These patterns of drug use have important implications for the planning of methadone treatment programmes.

The dangers of dextropropoxyphene.

OBJECTIVE: Dextropropoxyphene is a commonly used analgesic despite its high toxicity in overdose and potential for abuse and dependence. This case report highlights these dangers. CLINICAL PICTURE: The case of a female who was addicted to dextropropoxyphene as an alternative to other opioids is described. Its use in high doses with other psychotropic agents resulted in adverse health effects. TREATMENT: The patient was treated with methadone and psychosocial interventions. OUTCOME: The patient reduced her drug use and experienced improved physical health and psychosocial functioning. CONCLUSIONS: Caution is needed when prescribing dextropropoxyphene because of its adverse effects compared with equally efficacious analgesics.

Socioeconomic characteristics of a Dunedin sample of bipolar patients.

In order to determine the sociodemographic characteristics of people suffering from bipolar affective disorder, a cohort of hospitalised adult patients was compared with the general New Zealand population. A review of the casenotes of all those treated in Dunedin's psychiatric inpatient facilities between 1 January 1985 and 31 December 1987 identified 50 women and 41 men. Although their age structure did not differ from the general population, more bipolar patients were unmarried, either never married or divorced. These hospitalised bipolar patients held more secondary school qualifications than the average New Zealander but their subsequent employment record was statistically poorer. A majority were social welfare beneficiaries. Often thought to be a relatively benign condition, bipolar affective disorder has serious and destructive influences on marital and occupational function.