Orexin in Patients with Alcohol Dependence Treated for Relapse Prevention: A Pilot Study.

AIM: The aim of the study was to assess the blood concentration of orexin and its association with other clinical factors in patients with alcohol dependence. METHODS: Thirty-two males hospitalized on an addiction treatment ward due to alcohol dependence and 23 healthy men as a control group were enrolled in the study. The measurement of orexin in the blood was made at the beginning of the treatment (after withdrawal symptoms had stopped) and again after 4 weeks of observation. RESULTS: At the beginning of the observation, the alcohol-dependent patients had significantly greater orexin blood concentration than the control group. After 4 weeks of treatment for relapse prevention, the blood orexin level decreased significantly to a value similar to that in the control group. At the beginning of the study, more severely alcohol-dependent patients (Short Alcohol Dependence Data [SADD] score range: 20-45) had significantly greater orexin blood concentration than individuals with moderate addiction severity (SADD score range: 10-19). However, after 4 weeks of abstinence, the peptide blood concentration was similar in both groups of alcoholic patients. CONCLUSIONS: Orexin or its receptor is a potential target for relapse prevention treatment, but further study with long-term observation is needed to verify the usefulness of blood orexin determination as a marker of alcohol relapse risk.

Factors associated with adherence to antiretroviral therapy in HIV-infected subjects and the use of indicators to characterize the treatment adhesion profile.

At present, there is no gold standard to assess patient adherence to combination antiretroviral therapy (cART). Therefore, this study aimed to characterize the epidemiological profile, delineate adherence indicators, and identify factors associated with adherence and delays in obtaining medication in patients registered at the Specialized Assistance Service in HIV/AIDS in Brazil. This is a descriptive study based on secondary data obtained from official databases of the Brazilian Ministry of Health. Adherence and delay were measured by the frequency of cART medication acquisition in 24 months, and a multivariate linear regression model was developed to identify the factors associated with non-adherence and delays. In 50.2% of the subjects, the viral load remained undetectable throughout the study period. Only 12.4% of patients were fully adherent to cART. Regarding indicators, a value of 0.83 was found for adherence, 0.09 for delay in days, and 0.21 for the number of times the patient was late to obtain the medication. The multivariate analysis showed that males, age between 20 and 59 years, having not changed the cART, and the presence of ≥1000 HIV RNA copies/mL were predictive factors for adherence and delays (P≤0.01). We demonstrated that monitoring cART medication distribution is possible using health indicators, and identifying the factors associated with poor adherence to cART helps characterize patients at higher risks of unsuccessful therapy.

Factors associated with adherence to antiretroviral therapy in HIV-infected subjects and the use of indicators to characterize the treatment adhesion profile

At present, there is no gold standard to assess patient adherence to combination antiretroviral therapy (cART). Therefore, this study aimed to characterize the epidemiological profile, delineate adherence indicators, and identify factors associated with adherence and delays in obtaining medication in patients registered at the Specialized Assistance Service in HIV/AIDS in Brazil. This is a descriptive study based on secondary data obtained from official databases of the Brazilian Ministry of Health. Adherence and delay were measured by the frequency of cART medication acquisition in 24 months, and a multivariate linear regression model was developed to identify the factors associated with non-adherence and delays. In 50.2% of the subjects, the viral load remained undetectable throughout the study period. Only 12.4% of patients were fully adherent to cART. Regarding indicators, a value of 0.83 was found for adherence, 0.09 for delay in days, and 0.21 for the number of times the patient was late to obtain the medication. The multivariate analysis showed that males, age between 20 and 59 years, having not changed the cART, and the presence of ≥1000 HIV RNA copies/mL were predictive factors for adherence and delays (P≤0.01). We demonstrated that monitoring cART medication distribution is possible using health indicators, and identifying the factors associated with poor adherence to cART helps characterize patients at higher risks of unsuccessful therapy.

Clinical and biochemical heterogeneity of alcoholism: the role of family history and alexithymia.

Of 100 male patients with alcohol dependence, clinical and biochemical data were analysed in relation to family history of alcoholism and alexithymic personality traits. Family history was found in 38 patients and alexithymic personality traits in 79. No relationship was established between these two factors. In patients with a family history alcoholism began at a younger age with more severe clinical symptoms than in the remaining subjects. Patients with alexithymia had lower intensity of psychopathology but higher frequency of concomitant hypertension. Patients with family history had higher leukocyte counts and lower alcohol-induced elevations of liver enzymes and plasma lipids. In patients with alexithymia, higher values of hemoglobin and hematocrit were found. The results suggest that two predisposing factors to alcohol dependence such as family history of alcoholism and alexithymic personality determine the different clinical and biochemical features of the disease.

High prevalence of alexithymia in male patients with alcohol dependence.

The personality trait of alexithymia was assessed in 100 male inpatients with alcohol dependence using the Schaling-Sifneos Personality Scale. The score indicative of alexithymia (below 50 points) was found in 78 patients, a prevalence which exceeds that found in psychosomatic subjects. Patients with alexithymia did not differ from non-alexithymics in regard to demographic factors and severity of alcohol dependence. They were younger and had a shorter duration of illness what may indicate that alexithymia is not a result of the dependence. Alcoholic patients with concomitant hypertension had greater alexithymic scores. It is hypothesized that psychological and biological features of alexithymic subjects may render them more vulnerable to alcohol and more prone to subsequent development of the dependence.

Decrease in alcohol tolerance: clinical significance in alcohol dependence.

In 237 male inpatients with alcohol dependence, clinical, demographic and biochemical data were analyzed in relation to alcohol tolerance. All subjects had a history of marked tolerance. At the time of assessment, 46% of subjects continued to meet the criteria for marked tolerance and 54% of the subjects reported a loss or decreased tolerance. Subjects with decreased tolerance were older than those with high tolerance and had a longer duration of illness. The age of onset was similar in both groups. Patients with decreased tolerance had more mental confusion and psychotic symptoms, and were less likely to be currently married.

Development of ascending colon in human fetal period.

On the material of 178 fetuses of both sexes, ascending colon development in fetal period was studied. Variability of its measurements, shapes as well as of peritoneal and topographic proportions were traced.

Variations in the number and in origin of the thyroid arteries.

The number of arteries providing blood supply for the thyroid gland as well as the origin of the superior thyroid and inferior thyroid arteries were examined in 132 fetuses from single pregnancies and in 144 fetuses from twin pregnancies, aging 4 to 9 months. Most frequently (81% cases) four thyroid arteries were observed. Five thyroid arteries were noted in 14.4% cases. Sources of additional thyroid arteries were described.

[Plasma proteins as biochemical markers of alcohol abuse]. / Bialka osocza jako biochemiczne markery naduzywania alkoholu.

Fractions of plasma proteins were marked in 135 alcohol dependent men. The increase in the level of beta globulins was found in 58%, a fall in the level of gamma globulins was found in 52% and in 26% of patients a fall in the level of albumin was recorded. Patients with a shorter period of dependence more frequently showed a lowering of the concentration of gamma globulin (59% of cases). Persons with a greater pathological pattern of dependence, however, showed an increase in the level of beta globulin (65% of cases). The joint use of beta globulin and gamma globulin as markers of alcohol abuse allowed for the detection of irregularities in the range of at least one of the above mentioned markers in 84% of the patients. The joint use of albumin, beta globulin and gamma globulin showed irregularities in at least one of these three tests in 90% of the patients. The authors conclude that marking the changes in the fraction of plasma proteins may be used as a biochemical marker of alcohol abuse.

[Biochemical markers in relation to the degree of alcohol dependence]. / Markery biochemiczne, a nasilenie uzaleznienia od alkoholu.

In 93 alcohol dependent patients following laboratory tests were done: gamma-glutamic transpeptidase (GGTP), aspartate aminotransferase (SGOT), mean erythrocyte volume (MCV), triglycerides (TGL), and HDL-cholesterol to whole-cholesterol ratio (HDLC%). The psychometric evaluation was made by MAST questionnaire and by authors clinical scale for the evaluation of alcohol dependence. Lover values of GGTP and SGOT were shown in patients during abstinence than in subjects continuing drinking. Patients more severely dependent showed higher HDLC%. The more frequent abnormalities reflected: GGTP (33.7%), MCV (33.7%), and HDLC (31.4%). The use of these 3 markers allowed to reveal abnormalities in 72.1% of subjects, while the use of all 5 markers - in 81.4%. The identification significance of markers was different in persons with more and less severe alcohol dependence. Three most sensible markers in the group of less dependent subjects were GGTP, MCV, TGL (60% of subjects showed abnormalities regarding these markers). Among more severe dependent subjects HDLC%, GGTP, and MCV were most sensible markers (78.4% of abnormalities). Using all 5 markers the abnormalities in the group of less severe dependent subjects were found in 71.4%, and in the group of more severe dependent patients--in 88.2%.

[Severity of alcohol dependence and social functioning of male patients with alcoholism. II. Functioning in parental, employee's and autonomous roles]. / Stopien uzaleznienia od alkoholu a funkcjonowanie spoleczne mezczyzn z zespolem zaleznosci alkoholowej. Czesc II. Funkcjonowanie w zespolach ról rodzicielskich, pracowniczych oraz ról samoistnych.

The relations between social functioning and severity of alcohol dependence of 40 male patients from Dependence Treatment Ward in Bydgoszcz were studied. Using the MAST, CAGE, and self clinical scale the cohort was divided into two groups: less and more severe dependent probands. The demographic and social data of patients from both groups did not differ significantly. Social functioning was evaluated by use the Scale of Social Roles taking into consideration the set of basic roles: role of guardian, family support, educator, superior, subordinate, member of social group, patient, and the role of child. The dispositions to perform the role, privileges, fulfilling the duties, activity, and harmonization of the role were estimated in each of the role mentioned above and in every patient. It was shown that subjects more dependent on alcohol are significantly less active in the role of family support, educator, subordinate, and they possess significantly less dispositions to the role of educator and superior. No differences were shown between the groups regarding other characteristics of each role. The comparison of joint structural elements of the whole set of roles among more dependent patients showed deficits of social functioning as follow: the impairment of dispositions and fulfilling of duties as well as lesser activity, in comparison with less dependent probands. The level of privileges obtained from the roles did not differ in both groups. The specific influence of alcohol dependence severity on the way of social functioning demonstrated in the study may show the directions of therapy.

[Severity of alcohol dependence and social functioning of male patients with alcoholism. I. Functioning in the sharing of marital roles]. / Stopien uzaleznienia od alkoholu a funkcjonowanie spoleczne mezczyzn z zespolem zaleznosci alkholowej. Czesc I. Funkcjonowanie w zespole ról malzenskich.

The relations between social functioning and severity of alcohol dependence of 40 male patients from Dependence Treatment Ward in Bydgoszcz were studied. Using the MAST, CAGE, and self clinical scale the cohort was divided into two groups: less and more severe dependent probands. The demographic and social data of patients from both groups did not differ significantly. Social functiong was evaluated by use the Scale of Social Roles taking into consideration the set of marital roles (with basic roles of sexual partner, friend, guardian, and family support). The disposition to perform the role, privileges, fulfilling the duties, activity, and harmonization of the role were estimated in each of the role mentioned above and in every patient. It was shown that subjects more dependent on alcohol are significantly less active in the role of sexual partner and in support of family, as well as are less effective in performing such roles and are more egoistic in the role of sexual partner than men less dependent on alcohol. No differences were found in other roles among studied groups. The revealed differences were discussed in the aspect of psychologica and interactive hanges in marital couple.

[Social functioning of patients with alcohol dependence treated with disulfiram at the substance abuse treatment center]. / Funkcjonowanie spoleczne osób z zespolem zaleznosci alkoholowej przyjmujacych disulfiram w poradni odwykowej.

The effect of disulfiram ("Anticol") treatment lasting from 7 to 12 months of 57 alcohol dependent out-patients was evaluated. The satisfactory results (i.e. patients remained abstinent and took the medication regularly) were observed in 30 patients. Those patients did not differ from others in regard to age, length of alcohol abuse, the severity of dependence, the genetic encumbrance , the features of alexithymia , and the membership of AA-clubs. The percentage of patients with positive treatment results was significantly higher among subjects with high self-motivation to treatment, among married subjects, and among those professionally active. The findings are similar to the recent American results where about a half of alcoholics showed positive effects of disulfiram treatment, especially those with high motivation to the treatment and with the stabile social position.

[Depression and alcoholism: a potential familial-genetic relationship]. / Depresja i uzalenienie alkoholowe--potencjalne korelacje rodzinno-genetyczne.

In the paper, a review of literature was done for a potential familialgenetic relationship between alcohol dependence and depression. The incidence of secondary alcoholism in patients with depression may have different pathogenesis depending on gender: men with primary depression and alcoholism may exhibit two distinct illnesses, while in women secondary alcoholism may be a form of affective disorder (depression spectrum disease). Studies on the prevalence of alcohol dependence in families of depressive patients are inconsistent: some authors observed an increased risk of alcohol dependence while others did not. Secondary depression in alcohol dependent patients usually results from the pharmacological effect of alcohol, is concommittant with withdrawal syndrome or may be connected with psychological problems related to alcohol abuse. Usually, such depressive symptoms improve within 2-4 weeks after cessation of drinking and do not require additional treatment. However, the risk of major depression in alcohol-dependent persons is twice as high as in general population. Among various contemporary hypotheses about the genetic link between alcohol dependence and depression, a conception of "depressive spectrum", formulated by Winokur, received the strongest support from clinical and familial studies.

[The case of central pontine myelinolysis in an alcohol dependent male]. / Przypadek mielinozy srodkowej mostu u mezczyzny uzaleznionego od alkoholu.

Long-term alcohol abuse can lead to numerous central nervous system lesions, among them central pontine myelinolysis. In this paper, the first in Polish literature case of central pontine myelinolysis in an alcohol dependent male, clinically diagnosed, and confirmed by nuclear magnetic resonance with one year follow-up has been presented. The patient, 49 years old, was admitted to Addiction Treatment Unit, Department of Psychiatry in Bydgoszcz. After admission he manifested clouded consciousness, dysphasia, hyponatremia and neuropsychological abnormalities which showed brain stem lesion. He had no significant abnormalities in CT. Nuclear magnetic resonance revealed triangular hypointensive lesion 10 x 5 mm in central pontine region. One year after admission to Addiction Treatment Unit he still has troubles with walking and swallowing. He has bilateral pyramidal symptoms and emotional lability. He was treated with vinpocetine (0.075 g per day), piracetam (4.8 g per day) and chlorprotixen (0.09 g per day). He was admitted to Psychiatric Ward because of a suicidal attempt as a manifestation of mood disorder due to general medical condition.

The impact of non-steroid anti-inflammatory drugs and antibiotics on articular cartilage.

One of the essential elements in the proper functioning of articular cartilage is the proper balance of glycosaminoglycans and collagen proteins in the extracellular matrix. Any disproportion of this balance can produce degenerative changes. Certain pharmaceutical agents can induce changes of this kind. The present article provides a review of current opinions on the impact of non-steroid anti-inflammatory drugs and antibiotics on articular cartilage.

A scalable, fast, and multichannel arbitrary waveform generator.

This article reports on the development of a multichannel arbitrary waveform generator that simultaneously generates arbitrary voltage waveforms on 24 independent channels with a dynamic update rate of up to 25 Msps. A real-time execution of a single waveform and/or sequence of multiple waveforms in succession, with a user programmable arbitrary sequence order is provided under the control of a stand-alone sequencer circuit implemented using a field programmable gate array. The device is operated using an internal clock and can be synced to other devices by means of transistor-transistor logic (TTL) pulses. The device can provide up to 24 independent voltages in the range of up to ± 9 V with a dynamic update-rate of up to 25 Msps and a power consumption of less than 35 W. Every channel can be programmed for 16 independent arbitrary waveforms that can be accessed during run time with a minimum switching delay of 160 ns. The device has a low-noise of 250 µV(rms) and provides a stable long-term operation with a drift rate below 10 µV/min and a maximum deviation less than ± 300 µV(pp) over a period of 2 h.