Forecasting the future burden of opioids for osteoarthritis.

OBJECTIVE: To quantify the current national burden of opioids for osteoarthritis (OA) pain in Australia in terms of number of dispensed opioid prescriptions and associated costs, and to forecast the likely burden to the year 2030/31. DESIGN: Epidemiological modelling. METHODS: Published data were obtained on rates of opioid prescribing for people with OA and national OA prevalence projections. Trends in opioid dispensing from 2006 to 2016, and average costs for common opioid subtypes were obtained from the Pharmaceutical Benefits Scheme and Medicare Australia Statistics. Using these inputs, a model was developed to estimate the likely number of dispensed opioid prescriptions and costs to the public healthcare system by 2030/31. RESULTS: In 2015/16, an estimated 1.1 million opioid prescriptions were dispensed in Australia for 403,954 people with OA (of a total 2.2 million Australians with OA). Based on recent dispensing trends and OA prevalence projections, the number of dispensed opioid prescriptions is expected to nearly triple to 3,032,332 by 2030/31, for an estimated 562,610 people with OA. The estimated cost to the Australian healthcare system was $AUD25.2 million in 2015/16, rising to $AUD72.4 million by 2030/31. CONCLUSION: OA-related opioid dispensing and associated costs are set to increase substantially in Australia from 2015/16 to 2030/31. Use of opioids for OA pain is concerning given joint disease chronicity and the risk of adverse events, particularly among older people. These projections represent a conservative estimate of the full financial burden given additional costs associated with opioid-related harms and out-of-pocket costs borne by patients.

Interventions that cause weight loss and the impact on cardiovascular risk factors: a systematic review and meta-analysis.

Overweight and obesity increase the risks of diabetes and cardiovascular disease (CVD). This has been shown to be reversed with weight loss. A systematic review and meta-analysis were performed to determine the effect of weight loss in the primary prevention of CVD. PubMed, Embase and the Cochrane Library databases were searched electronically through to May 2013. Randomized controlled trials assessing weight loss and cardiovascular risk factors and outcomes were included. A random effects meta-analysis, with sub-group analyses for degree of weight loss, and age were performed. Because few studies reported clinical outcomes of CVD, analyses were limited to cardiovascular risk factors (83 studies). Interventions that caused any weight loss significantly reduced systolic blood pressure (-2.68 mmHg, 95% CI -3.37, -2.11), diastolic blood pressure (-1.34 mmHg, 95% CI -1.71, -0.97), low-density lipoprotein cholesterol (-0.20 mmol L(-1) , 95% CI -0.29, -0.10), triglycerides (-0.13 mmol L(-1) , 95% CI -0.22, -0.03), fasting plasma glucose (-0.32 mmol L(-1) , 95% CI -0.43, -0.22) and haemoglobin A1c(-0.40%, 95% CI -0.52, -0.28) over 6-12 months. Significant changes remained after 2 years for several risk factors. Similar results were seen in sub-group analyses. Interventions that cause weight loss are effective at improving cardiovascular risk factors at least for 2 years. © 2016 World Obesity.

Effect of urotensin II on skin microvessel tone in diabetic patients without heart failure or essential hypertension.

Urotensin II (UII) is a potent vasoconstrictor peptide. Increased plasma levels and kidney expression of UII and its receptor have been observed in diabetes mellitus (DM). The aim of the present study was to evaluate the direct effect of exogenous UII on microvascular tone in DM patients compared with healthy controls. Vasoactive effect of UII (10(-12), 10(-9) and 10(-7) mol/L) on skin microvascular tone was evaluated in 12 controls and 12 DM patients (Type 1 or Type 2) without concomitant heart failure or essential hypertension using the non-invasive technique of iontophoresis and laser Doppler velocimetry. In addition, responses to acetylcholine (ACh) and sodium nitroprusside (SNP) were evaluated. Urotensin II dose-dependently dilated skin microvasculature in control subjects (-51.8 +/- 59.4, 138.6 +/- 101.5, 204.2 +/- 115.7 and 207.5 +/- 81.6 arbitrary flux units (AFUs) for MilliQ and 10(-12), 10(-9) and 10(-7) mol/L UII, respectively) and dose-dependently vasoconstricted the microvasculature in DM patients (100.8 +/- 81.2, 46.2 +/- 85.1, 35.4 +/- 81.4 and 26.6 +/- 79.6 AFUs for MilliQ and 10(-12), 10(-9) and 10(-7) mol/L UII, respectively). Blood flow in control subjects and DM patients was differed significantly, with pair-wise comparisons indicating differences for 10(-9) and 10(-7) mol/L UII (P = 0.04 and P = 0.003). Results of blood flow in diet-controlled DM patients (204.7 +/- 193.6, 261.2 +/- 212.8, 256.1 +/- 202.9 and 233.7 +/- 115.9 AFUs for MilliQ and 10(-12), 10(-9) and 10(-7) mol/L UII, respectively) were similar to those in control subjects compared with results for DM patients receiving antidiabetic medication (48.8 + 80.0, -61.4 +/- 49.1, -75.0 +/- 40.0, -91.7 +/- 80.0 AFUs for MilliQ and 10(-12), 10(-9) and 10(-7) mol/L UII, respectively). Between-group significance remained after adjustment for baseline blood pressure values. Acetylcholine vasodilator responses were attenuated in DM patients compared with those in control subjects (1309.5 +/- 488.6 vs 3498.0 +/- 912.5 AFUs, respectively), whereas SNP responses were similar in the two groups (1467.9 +/- 411.3 vs 1984.4 +/- 410.7 AFUs, respectively). In conclusion, UII causes net vasoconstriction in DM. The UII-induced increases in peripheral vascular tone may contribute to DM-related cardiovascular complications.

[New conjugates of antitumor antibiotic doxorubicin with water-soluble galactomannan: synthesis and biological activity].

New water-soluble conjugates in the form of Schiff bases (DGM-1 and DGM-2) were prepared by the interaction of water-soluble periodate-oxidized galactomannan with doxorubicin or N-(L-lysyl)doxorubicin, respectively. The water-soluble galactomannan (DAVANAT a commercial product of Pro-Pharmaceuticals company) was obtained by partial acidic hydrolysis of high-molecular-mass galactomannan from Cyamopsis tetragonoloba (guar gum) seeds. The conjugate stability was studied in aqueous solutions. The DGM-1 antiproliferative activity was comparable with that of doxorubicin on three models: cell lines of murine melanoma B 16-F1, human breast cancer MCF-7 (HTB-22), and human colon cancer HT-29 (HTB-38). DGM-2 was poorly active in all the three tests. DGM- 1 can thus be regarded as a high-molecular-mass depot form of doxorubicin.

Use of a new rapid bioluminescence method for screening organophosphate and N-Methylcarbamate insecticides in processed baby foods.

An enzyme with high specific affinity for organophosphate and N-methylcarbamate insecticides has been incorporated into a new test for detection of these insecticides at the level of parts per billion (ppb) (commercially available as the Charm Pesticide Test). To measure the extent of insecticide inhibition of the enzyme, a specific bioluminescent substrate is used. The signal is counterproportional to the amount of insecticides. Random sampling of four baby food brands and testing for the cumulative levels of organophosphate and N-methylcarbamate insecticides found carbaryl to be the most common residue. Out of the 155 samples tested there were 132 negative samples (85.2%) and 23 suspected positive samples (14.2%). The suspected positive samples were further analyzed by high-performance liquid chromatography (HPLC) and gas chromatography/mass spectrometry (GC/MS). Carbaryl was confirmed in 18 of the samples. One of the samples contained an active metabolite of tetrachlorvinphos and in 3 of the positive samples an insecticide could not be identified by GC/MS. One positive sample was not processed for confirmation due to high fat content.

[Comparison of mosquito larvicidal efficacy between microbial encapsulated BTI (EBTI) and standard BTI (SBTI)].

A comparative study was conducted on the efficacy of mosquito larvicides EBTI and SBTI. The results showed that: 1. The residual efficacy of EBTI was remarkably higher than that of SBTI at 0.007-0.002ppm BTI concentration (P < 0.01), the mosquito larvae mortality of EBTI remained 100% until the 4th week; in contrast, the mosquito larva mortality of SBTI gradually and obviously declined from the 2nd to 4th week after treatment (x2 = 8.17-24.08), and reached 0 at the 4th week. 2. The lowest BTI concentration of EBTI at which a high efficacy persisted for 4 weeks was 0.007ppm BTI, the mosquito larva mortality remaining 100%.

[Critical illness polyneuropathy]. / 'Critical illness' polyneuropathie.

Critical illness polyneuropathy is a syndrome of neuromuscular complications after artificial respiration. The authors present the data of their own 22 patients all suffering from severe flaccid tetraparesis, areflexia and muscle atrophy, after an average of two weeks on artificial respiration. The prognosis is relatively favourable. The multi-conditional causes are discussed with emphasis on the combination of polyneuropathy and myopathy. The role of plasma factors such as cachectin, which is identical to tumour necrosis factor (TNF), is described. Attention is drawn to this important illness which occurs especially in patients in the intensive care unit with problems in the weaning from artificial respiration.