A French prospective observational study of the treatment of chronic hepatitis C in drug abusers.

The objective of this prospective, multicenter, observational study was to evaluate healthcare for hepatitis C virus (HCV)-infected drug abusers in France and to determine predictors of successful therapeutic intervention. A total of 170 drug users were recruited from 40 French centers. Three centers recruited 66 participants (38.8%), and one to eight patients each were enrolled from 37 other centers (n=104). A sustained viral response (SVR) was seen in 65 (38.2%) patients. SVR rates were significantly higher in compliant than in non-compliant patients (43.5% versus 23.9%; P=0.019), in patients from high- rather than low-recruiting centers (54.5% versus 27.9%; P<0.001) and in patients receiving Buprenorphine rather than methadone (48.1% versus 21.8%; P=0.001). In patients, who completed both the treatment and follow-up (n=94), SVR rate was 57.4%. Buprenorphine substitution therapy and genotypes 2 or 3 HCV infection were associated with significantly higher rates of SVR (P<0.01, for both comparisons). In conclusion, successful care of hepatitis requires an active treatment policy of every center toward drug addicts. Additional studies are needed to explore the difference in SVR with methadone versus Buprenorphine therapy.

Successful removal of a penile constriction wedding ring in a rural area.

BACKGROUND: Penile strangulation is a rarely described medical emergency. Removal of the strangulating object is challenging, with a lack of proper guidelines. OBJECTIVE: To describe the challenges faced during an attempt to urgently remove a metal object (wedding ring) constricting an erect penis. METHODS: We report a case of penile strangulation with a wedding ring in an adult man who presented at Van Velden Hospital casualty department, Limpopo, South Africa, and review the related literature. RESULT: The ring was successfully removed using an aspiration technique (via a pink needle). CONCLUSION: No proper guidelines exist for the treatment of this condition, so the 'best method' is the one with a successful outcome.

[Feasibility of drug use detection among individuals 15-25 years of age in community medicine]. / Faisabilité de la détection de l'usage de drogues chez les 15-25 ans en médecine de ville.

The objective of this work is to study the feasibility of the detection of drug use or misused substances during a visit with a municipal doctor, and to describe the interrogatory strategies used spontaneously by doctors. One tenth of the clients aged 15-25 of the 26 participating doctors, (the majority of them men visiting the doctor for a psychological problem), showed a "warning" signal and were detected. The doctors often chose to approach the problem of drugs directly and detected usage in two-thirds of the cases. Cannabis was most often concerned, but the use of psychotropic drugs with alcohol was the case in one-third of the subjects interrogated. On the other hand, a certain frustration was felt by the doctors because of the difficulty of approaching the root problems and of acquiring psychotherapeutic monitoring.

[Two-year follow-up of an opioid-user cohort treated with high-dose buprenorphine (Subutex)]. / Suivi à 2 ans d'une cohorte de patients dépendants aux opiacés traités par buprénorphine haut dosage (Subutex).

AIM OF THE STUDY: Care for opioid users changed greatly in France in 1996 when general practitioners (GP) were allowed to prescribe high-dose sublingual buprenorphine (Subutex((R))) for maintenance treatment of major opioid dependence. In order to evaluate treatment benefits, a prospective epidemiological 2-year follow-up was initiated in May 1996 with the participation of 105 French GPs. METHODS: A cohort of outpatient opioid users who started high-dose sublingual buprenorphine maintenance therapy at study onset or who had recently started were included in a prospective epidemiological study by GPs involved in management of drug abusers. Patients were followed for 2 years with collection of standardized information at 1, 3, 6, 12, and 24 months. The main evaluation criteria were follow-up by the same GP throughout the study and retention in the care system 2 years later. For patients who fulfilled these criteria, secondary end points were analyzed: information about buprenophine prescription, social status, and hepatitis B and C and HIV seroconversions. RESULTS: The 101 GPs included 919 patients and 909 were analyzed 2 years later. At study onset, a majority of the patients (70.6%) were taking an ongoing maintenance treatment, 10.5% had previously received such a treatment and the treatment was initiated for 18.8%. At the end of the study, 508 patients (55.9%) were still being followed by the same GP and 101 (11.1%) were followed by another healthcare provider (another GP, hospital or specialized center). No information about the care giver was available for 82 patients (9%). Among the other patients, 123 (13.5%) were lost to follow-up, 24 (2.6%) had moved, 23 (2.6%) were incarcerated, 11 (1.2%) had successfully discontinued drug usage and 7 (0.8%) had died. Other reasons for unsuccessful follow-up by the same GP were mainly (for 6 patients each): relapse, switch to methadone, no medical information, non-compliance with scheduled controls. Among the patients followed by the same GP, declaration of heroin and drug intake significantly decreased (p<0.001), and social status (GAF scale) and TMSP evaluation significantly improved (p<0.001). The social situation (housing condition and work) also improved significantly (p<0.001). The rate of buprenorphine treatment was 84% with longer and less fractionated prescriptions. The HBV, HBC and HIV seroconversion rates were low in this high-risk population (2.7%, 4.1% and 0.8% respectively). CONCLUSION: This two-year follow-up of 909 opioid users showed that nearly 70% of the patient remained within the healthcare system, mainly with the same GP or more rarely with another practitioner. Among the 508 patients still followed by the same GP, maintenance treatment with high-dose buprenorphine was observed in more than 80% of the patients. These patients had a significantly improved social status, a significant decrease in drug intake and a significant improvement in their social adaptation and severity of drug abuse.