IFDAT-International forum for drug and alcohol testing, 12-14 April 2010, Barcelona, Spain.

The second programme of its kind globally, the highly successful, collaborative, productive and energizing IFDAT-International Forum for Drug and Alcohol Testing, was held in Barcelona, Spain, from 12-14 April. IFDAT was attended by over 100 delegates, conference sponsors and exhibitors from the international workplace drug and alcohol testing industry. Representing over 20 countries, the delegate professionals, speakers, and presenters included employers, service agents, an international publisher, and workplace testing suppliers. The purpose of the forum was to exchange knowledge, learn about new technology, and support the evolution and growth of the emerging international workplace drug and alcohol testing industry. This purpose was accomplished. Delegates from around the globe exchanged their experiences and thoughts about effective workplace drug testing programmes over two days of intensive presentations and panel discussions. The presenters and panelists included drug and alcohol testing professionals, authorities, and intellectuals from around the world. IFDAT conferences are planned for every 18 months, and the next Forum, to be held in Houston, Texas, USA is in the planning process for 2011.

Effect of sucralfate on total carbon dioxide concentration in horses subjected to a simulated race test.

The purpose of this study was to test the hypothesis that sucralfate, a gastric ulcer medication, would alter plasma concentrations of total carbon dioxide (tCO2), lactate (LA), sodium (Na+), potassium (K+), chloride (Cl-) and total protein (TP), as well as calculated plasma strong ion difference (SID) and packed cell volume (PCV) in horses subjected to a simulated race test (SRT). Six unfit Standardbred mares (approximately 520 kg, 9-18 years) were used in a randomized crossover design with the investigators blinded to the treatment given. The horses were assigned to either a control (40-50 mL apple sauce administered orally (PO)) or a sucralfate (20 mg/kg bodyweight dissolved in 40-50 mL apple sauce administered PO) group. Each horse completed a series of SRTs during which blood samples were taken via jugular venipuncture at five sampling intervals (prior to receiving treatment, prior to SRT, immediately following exercise, and at 60 and 90 min post-SRT). During the SRTs, each horse ran on a treadmill fixed on a 6% grade for 2 min at a warm-up speed (4 m/s) and then for 2 min at a velocity predetermined to produce VO2max. Each horse then walked at 4 m/s for 2 min to complete the SRT. Plasma tCO2, electrolytes, LA, and blood PCV and TP were analysed at all intervals. No differences (P>0.05) were detected between control and sucralfate for any of the measured variables. There were differences (P<0.05) in tCO2, SID, PCV, TP, LA and electrolyte concentrations relative to sampling time. However, these differences were attributable to the physiological pressures associated with acute exercise and were not an effect of the medication. It was concluded that sucralfate did not alter plasma tCO2 concentration in this study.

Frontier medicine: the future and integrative medicine.

Vigorous and prolonged effort is required to gain true mastery of the healing arts. Conventional and complementary medicine have complementary strengths and weaknesses. Like the yin and yang of traditional Chinese medicine, they naturally flow into one another by a process of induction, creating balance. Integrative medicine is the frontier; it is the future. If we are to progress beyond our current understanding and ability to heal, we must work with theoretic models that allow us and our perception to operate "outside the box." For some, this understanding is intuitive. It is through cooperative and collaborative efforts of intuitively adept and technologically adept minds that we can integrate and advance our understanding; increase our ability to predict, prevent, and diagnose disease; and expand our therapeutic options.

Necrotizing enterocolitis: a chronic colonic disease.

While acute necrotizing enterocolitis is a common neonatal condition, the chronicity of the pathologic process is often overlooked. Between 1979 and 1983 at the Foothills Hospital in Calgary, a diagnosis of acute necrotizing enterocolitis was made in 211 infants. Seventeen infants (8%) required urgent surgical treatment in addition to standard medical management. Overall, 206 (98%) infants survived the acute episode. Long-term survival was 92% (194 children). The 12 late deaths were ascribed to chronic cardiovascular, pulmonary and cerebral diseases and "short gut syndrome". Colonic strictures developed in 9% of those treated medically; strictures distal to the mucous fistula developed in 50% of those requiring urgent resection and exteriorization. None of the strictures, which formed between 14 days and 18 months after the diagnosis was made, resolved spontaneously. They tended to be multiple and to involve longer segments in infants who required surgery. Diarrhea prolonged the morbidity in these children. The time course and varied presentation of strictures in this series suggests a rationale for management of infants who survive acute necrotizing enterocolitis.

The treatment of disseminated vasculitis with methotrexate.

With the great interest in recent years in the use of immunosuppressive/antiinflammatory drugs for the treatment of severe systemic inflammatory disorders, it is surprising that, except in Wegener's granulomatosis, the use of methotrexate (MTX) in disseminated vasculitides has been neglected. We have treated three patients with MTX, each with a different form of severe, corticosteroid-resistant, life-threatening, disseminated vasculitis. One had a nonspecific vasculitis characterized by excruciating muscle pain, weakness, and atrophy; the second had rheumatoid vasculitis with extensive skin ulceration and four-limb mononeuritis multiplex; the third had polyarteritis nodosa with hypertension, eventually fatal renal disease, and severe peripheral neuropathy. Treatment in each case was associated with a dramatic, favorable change in a course previously marked by relentless deterioration; two patients are alive 4 and 5 years later, without MTX. The purpose of this preliminary report is to indicate the possible efficacy of MTX in a wider group of disorders than those to which it is generally limited at present, and to stimulate its further evaluation.