Can beta agonists cause dilated cardiomyopathy?

We report a case of dilated cardiomyopathy that we believe is secondary to excessive use of inhaled beta agonists. Clinicians should be mindful of this possibility when using beta agonists to treat patients with obstructive airways disease; particularly if there is already recognised left ventricular dysfunction.

Streptococcus gallinaceus bacteraemia in an abattoir worker presenting with a febrile illness.

Streptococcus gallinaceus is a newly described species of viridans streptococci, previously only identified as causing disease in broiler chickens. This organism was recovered in pure culture from blood taken from a New Zealand abattoir worker presenting with a febrile illness. This first report of bacteraemia caused by S. gallinaceus in a human may help the understanding of the ecology of this recently described organism.

Misuse of over-the-counter codeine-containing analgesics: dependence and other adverse effects.

AIM: To review cases of codeine dependency from over-the-counter (OTC) combination analgesics admitted to a hospital detoxification unit. METHOD: Case records of all admissions following an index case were reviewed over a 2-year period. RESULTS: There were 7 cases reporting chronic excess of Nurofen Plus, of which 6 had prior or current histories of alcohol dependency. Complications which were likely contributed by excessive ibuprofen consumption included: gastric ulcer (4 patients), gastrointestinal bleeding (3), hepatotoxicity (1), and inflammatory bowel conditions (2). CONCLUSIONS: This pattern of admissions is new to the detoxification unit, and may relate to higher codeine content in the combination product, and marketing strategies. These cases likely represent the severer end of the spectrum of codeine dependency acquired from OTC pharmacy sources. The paucity of evidence to support additional benefit from the inclusion of codeine in analgesic combination products is concerning. There is a need for increased pharmacovigilance around these and other OTC medications.

Patients in methadone maintenance treatment who inject methadone syrup: a preliminary study.

An increased awareness of the injection of methadone syrup has been appreciated by methadone treatment clinicians and Needle Exchange outlets which distribute large-volume syringes. This study aimed to identify patterns of use by methadone injectors, and the reasons and perceived risks of this behaviour. Nineteen of 36 attendees at a needle exchange who stated they had injected methadone over the previous 3 months completed a structured interview. Results found a majority were methadone clinic patients. Forty-two percent injected three times a week or more. This practice continued in 58%, despite reported difficult venous access. Subjects' concerns included accelerating vein damage and possible toxicity of syrup additives. Reasons for injecting included immediate drug effect (80%) and 'needle-fixation' (47%). It is concluded that methadone clinic staff need to be aware of such patients who may require additional treatment approaches, and that methadone formulations should minimize harmful consequences if injected.

The genetics of alcoholism in Polynesians: alcohol and aldehyde dehydrogenase genotypes in young men.

BACKGROUND: The last 10 years have seen growing recognition of the significance of the genes encoding enzymes responsible for hepatic alcohol metabolism as protective factors in the development of alcoholism. METHODS: We have developed DNA sequencing assays for measuring genetic variation at the alcohol dehydrogenase 2 (ADH2), ADH3, and aldehyde dehydrogenase 2 (ALDH2) loci. These have been used to survey volunteer control subjects from three New Zealand ethnic groups (white, Asian, and Polynesian) and young male alcoholics recruited from white and New Zealand Maori patients in a local treatment program. RESULTS: The allele frequency values for whites and Asians obtained in our study closely match those obtained previously in other laboratories. Our data (the first for Polynesians) are 0.42 for ADH2*2, 0.78 for ADH3*1, and 0.00 for ALDH2*2. In the New Zealand Maori alcoholic patients, the ADH2*2 frequency is significantly lower (0.15; p < 0.01). The frequency of ADH3*1 is also lower in this group (0.60), but this value is not significant (0.05 < p < 0.06). CONCLUSIONS: In young male New Zealand Maori, the ADH2*2 allele is a protective factor against alcoholism even in the absence of ALDH2*2.