Effects of extended abstinence on cognitive functions in tramadol-dependent patients: A cohort study.

BACKGROUND: Some pieces of the literature report impaired cognitive functioning in tramadol dependence. Whether extended abstinence improves cognitive functioning or not is not well studied. AIM: We aimed to measure the change in cognitive functioning following complete abstinence among individuals with tramadol dependence. METHODS: Eighty-three male tramadol-dependent (TD) and 57 matched healthy controls participated in this study. Cognitive functions were assessed using: The Trail making test (TMT), Wechsler Memory Scale-Revised (WMS-R), and Wechsler Adult Intelligence Scale (WAIS). Patients were assessed in the first week immediately after the end of the in-patient treatment program (T1), and after six months of sustained abstinence (T2). RESULTS: At T1, the TD group showed deficits on all tested cognitive parameters (visual attention, task switching, working memory, visual memory, verbal memory, verbal knowledge, Verbal IQ, Performance IQ, and Full-Scale IQ) in comparison to the control group. At T2, significant improvements had occurred in all the tested parameters except performance IQ. The cognitive performance of the abstinent individuals at T2 was comparable to the control group for the verbal subsets of WMS-R, Verbal IQ, Performance IQ, and Full-Scale IQ. Nevertheless, it was still worse than the control group in TMT, and all other WMS subsets. CONCLUSION: tramadol dependence has negative effects on cognitive performance, which improves with extended abstinence.

Colonoscopic techniques in polyp detection: An Egyptian study. / Técnicas colonoscópicas para la detección de pólipos: un estudio egipcio.

INTRODUCTION AND AIMS: The polyp detection rate (PDR) is defined as the percentage of colonoscopies in which one or more polyps are detected, and has been shown to be highly correlated with the adenoma detection rate. The aim of the present study was to evaluate the PDR at the Endoscopy Unit of the Kasr Al-Ainy Hospital, Cairo University, Egypt, through the i-SCAN, Endocuff, and underwater colonoscopy techniques. MATERIALS AND METHODS: The study was conducted on 100 Egyptian subjects over 50 years of age. Their polyp detection rate was measured through 4 different colonoscopic techniques. An equal number of patients were divided into 4 groups: i-SCAN, Endocuff, underwater colonoscopy, and controls. The control group was examined using standard white light colonoscopy. The colonoscopy evaluation included the type of agent utilized for bowel preparation, preparation grade, and colonoscopy withdrawal time. RESULTS: The general PDR was 48%. The i-SCAN technique had the highest rate (56%), followed by the underwater (52%) and the Endocuff (48%) techniques. CONCLUSION: The i-SCAN and underwater colonoscopy techniques produced higher PDR than the Endocuff-assisted and standard techniques, but with no statistical significance.

Seroprevalence of Toxoplasma gondii among patients with schizophrenia and bipolar disorder in Upper Egypt: a comparative study with a control group.

Schizophrenia and bipolar disorder are serious neuropsychiatric disorders. Studies have found a high seroprevalence of Toxoplasma gondii in psychiatric patients. This study aimed to estimate the seroprevalence of T. gondii infection among schizophrenia and bipolar disorder patients. A case-control study was conducted in Assiut University Hospitals on 53 patients with schizophrenia, 57 patients with bipolar disorder, and 50 healthy volunteers. The psychiatric patients were recruited from the psychiatry department and the controls from their relatives. Both groups were subjected to socio-demographic assessment. Neither of them was immunodeficient nor with any other psychiatric disorders. Anti-Toxoplasma IgG antibodies were detected by indirect-ELISA to find the relationship between T. gondii infection and psychiatric disorders. Data were analysed using Chi-square test. The seropositivity rate, among patients with schizophrenia (50.9%) and patients with bipolar disorders (52.6%), was significantly higher than control group (30%) (P = 0.031 and 0.018 respectively). We found no statistically significant difference among all groups regarding environmental risk factors associated with T. gondii infection, except cat contact which was higher in schizophrenia and bipolar disorder patients (P = 0.011 and 0.007 respectively). The results of our study confirm that T. gondii infection is significantly correlated with schizophrenia and bipolar disorder and significantly associated with cat contact rather than beef consumption.

Feasibility of measuring arsenic and selenium in human skin using in vivo x-ray fluorescence (XRF)--a comparison of methods.

In recent years, in vivo measurement systems of arsenic in skin by K-shell x-ray fluorescence (XRF) have been developed, including one which was applied in a pilot study of human subjects. Improved tube-based approaches suggest the method can be further exploited for in vivo studies. Recently, it has been suggested that selenium deficiency is correlated with arsenic toxicity. A non-invasive measurement of both elements could therefore be of potential interest. The main aim of this current study was to evaluate and compare the performance of an upgraded portable XRF system and an advanced version of the benchtop XRF system for both selenium and arsenic. This evaluation was performed in terms of arsenic and selenium Kα detection limits for a 4W gold anode Olympus InnovX Delta portable analyzer (40 kVp) in polyester resin skin-mimicking phantoms. Unlike the polychromatic source earlier reported in the literature, the benchtop tube-based technique involves monochromatic excitation (25 W silver anode, manufactured by x-ray optics, XOS) and a higher throughput detector type. Use of a single exciting energy allows for a lower in vivo dose delivered and superior signal-noise ratio. For the portable XRF method, arsenic and selenium minimum detection limits (MDLs) of 0.59 ± 0.03 ppm and 0.75 ± 0.02 ppm respectively were found for 1 min measurement times. The MDLs for arsenic and selenium using the benchtop system were found to be 0.35 ± 0.01 ppm and 0.670 ± 0.004 ppm respectively for 30 min measurement times. In terms of a figure of merit (FOM), allowing for dose as well as MDL, the benchtop system was found to be superior for arsenic and the two systems were equivalent, within error, for selenium. We shall discuss the performance and possible improvements of each system, their ease of use and potential for field application.

CUFA algorithm: assessment of liver fibrosis using routine laboratory data.

Staging of liver fibrosis is an integral part of the management of HCV. Liver biopsy is hampered by its invasiveness and possibility of sampling error. Current noninvasive methods are disadvantaged by their cost and complexity. In this study, we aimed at developing a noninvasive method for the staging of liver fibrosis based only on routine laboratory tests and clinical data. Basic clinical and laboratory data and liver biopsies were collected from 994 patients presenting for the evaluation of HCV. Logistic regression was used to create a model predictive of fibrosis stages. A sequential test was then developed by combining our new model with APRI. In the training set (497) a model was created by logistic regression for the prediction of significant fibrosis (≥F2), it included platelets, AST and age (PLASA). The areas under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 0.753, 66.8, 71.4, 69.8, 68.4, respectively, while in the validation set (497), they were 0.777, 66.7, 72.8, 68.6 and 71, respectively. These were the best performance indicators when compared to APRI, FIB-4, King's score, platelets, fibrosis index, age-platelet index and Lok index in the same set of patients. A sequential test was then developed including APRI followed by PLASA [Cairo University Fibrosis Assessment (CUFA) algorithm], this allowed saving 20% and 34% of liver biopsies for patients being tested for significant fibrosis and cirrhosis, respectively. In conclusion, the CUFA algorithms at no cost allow saving a significant proportion of patients from performing a liver biopsy or a more complex costly test. These algorithms could be used as the first step in the assessment of liver fibrosis before embarking on the more costly advanced serum markers, Fibroscan or liver biopsy.