[Shifting from heroin to alcohol addiction: descriptive survey]. / Viraggio dalla dipendenza da eroina alla dipendenza da alcool: studio descrittivo pilota.

INTRODUCTION: Addiction is a disease which affects the relation between the person and the object of his addiction. One of the major risks for people addicted to heroin treated with Methadone Maintenance Treatment (MMT) is to develop addiction from another substance, particularly alcohol, while treating heroin addiction, "shifting" this way from heroin addic- tion to alcoholism. OBJECTIVE: describing such "shifting" process within the population taken into considera- tion for this study. METHODS: dA questionnaire made up of 38 items with multiple choice answer was devised. This was administered to a sample of clients within the ambulatory Pronta Assistenza (Pr.Assi) of the Department for Addiction of a Turin hospital (ASL TO2).Written informed consensus before filling in the questionnaire was acquired and anonymity was assured. RESULTS: The sample is made up by 51 individuals who filled in the questionnaire. Among the sample 46% seem to be at risk of development of alcohol related disease such as, but not only, alcoholism. 28% of them seem to be unaware of using alcohol. CONCLUSIONS: Considering all factors which affect the possibility to develop alcoholism while treating heroin addiction with MMT, the fact that alcohol is socially more tolerated than heroin seem to be crucial for the genesis of such a "shifting process": use of huge quantity of alcohol (more than 2UA) is far more tolerated in our socio-cultural environ- ment than use of even lowest quantity of heroin apart from behavioural alteration substance-related.

METODO, a prospective observational study to assess the efficacy and tolerability of methadone in heroin-addicted patients undergoing a methadone maintenance treatment: preliminary results at baseline evaluation.

METODO (methadone efficacy therapy optimization dosage on-going) is a prospective observational study to assess the efficacy and tolerability of methadone in 500 heroin-addicted patients taking a methadone maintenance treatment, enrolled through 2010 to 2011 in five Italian sites, observed over 2 years. The Opiate Dosage Adequacy Scale has been used for the evaluation of the "adequacy" of the methadone dosage and to stratify patients in adequate and not adequate groups. The treatment efficacy has been evaluated in correlation to the dosage adequacy during the visits. Moreover, patients have been evaluated according to the retention rate and duration of retention in treatment and a series of questionnaires.

Acute endocarditis of the patch caused by Staphylococcus capitis in treated tetralogy of Fallot. An unusual location by an unusual bacterium.

We present the case of a 46 year-old male, HCV infected, treated with corrective surgery for tetralogy of Fallot (TOF) immediately after percutaneous closure of the Blalock Taussig shunt. Four months later, the patient had infective endocarditis by Staphylococcus capitis localised on the right side of the patch, treated by oxacillin and gentamycin. The particularity of our report is the unusual location of the acute endocarditis and the bacterium involved: the pulmonary valve is much more likely to be involved in endocarditis in TOF patients and the patch endocarditis has rarely been reported. Moreover, Staphylococcus capitis has never been reported as a cause of acute endocarditis in corrected TOF patients. We believe that antibiotic therapy should be instituted as soon as possible even though an aggressive surgical treatment is mandatory to achieve complete recovery, mainly when clinical condition and inflammation markers do not improve.

Cardiovascular-associated disease in an addicted population: an observation study.

BACKGROUND: Illicit drugs such as cocaine, and methadone can induce acquired long QT syndrome. OBJECTIVE: The aim of this study was to evaluate the prevalence of cardiovascular disease and to assess the risk of torsades de pointes in substance abuse patients either with methadone or buprenorphine maintenance therapy, or without any specific therapy for opiate addiction. METHODS: From November 2008 to December 2009, 190 patients (153 men, mean age 38.2 years, 22-56 years) with a substance use disorder according to DSM IV TR criteria were included in the study. All patients underwent blood tests, serial electrocardiogram (ECG) and, when necessary, additional testing, including echocardiogram, exercise test and Holter monitoring. Age and sex-matched healthy controls were also evaluated and compared with the cases. RESULTS: One hundred and twenty-five patients (65.7%) had associated diseases. The prevalence of coronary artery disease and hypertension was, respectively, 2.1 and 5.2% in the addicted population. The percentage of abnormal ECGs was 34.2% in the addicted population and 4.7% in the nonaddicted population (P < 0.001). Twenty-five addicted patients had a QT interval prolongation (10 patients ≥ 480 ms). There were no sudden deaths or major cardiac events during the observation period. CONCLUSIONS: Our results indicate that the QT interval prolongation is not a negative prognostic marker in the addicted population, even with associated diseases. ECG should be performed when other drugs potentially prolonging QT interval are associated. Substance abuse patients should be followed by multidisciplinary teams, and blood tests and ECGs should be performed regularly.