Electronic gaming machines: are they the ‘crack‐cocaine’ of gambling?

BACKGROUND: There is a general view that electronic gaming is the most 'addictive' form of gambling, in that it contributes more to causing problem gambling than any other gambling activity. As such, electronic gaming machines have been referred to as the 'crack-cocaine' of gambling. While this analogy has popular appeal, it is only recently that the scientific community has begun to investigate its validity. In line with the belief that electronic gambling has a higher 'addictive' potential than other forms of gambling, research has also begun to focus on identifying the characteristics of gaming machines that may be associated with problem gambling behaviour. AIMS AND METHODS: This paper will review the different types of modern electronic gaming machines, and will use the introduction of gaming machines to Australia to examine the association between electronic gaming and problem gambling, with particular reference to the characteristics of modern electronic gaming machines. FINDINGS AND CONCLUSIONS: Despite overwhelming acceptance that gaming machines are associated with the highest level of problem gambling, the empirical literature provides inconclusive evidence to support the analogy linking electronic gaming to 'crack-cocaine'. Rigorous and systematic evaluation is required to establish definitively the absolute 'addictive' potential of gaming machines and the degree to which machine characteristics influence the development and maintenance of problem gambling behaviour.     

Coexistence of Wolff–Parkinson–White and Brugada Syndrome: Mere Curiosity?

The association between Brugada syndrome (BS) and ventricular preexcitation is a rare condition, with sporadic cases already reported. We report the case of a 29‐year‐old man, with palpitation unrelated to physical or emotional stress. The electrocardiogram of the first visit revealed a ventricular preexcitation pattern and an end‐conduction delay, with negative T wave in V₁ and intraventricular conduction disturbance in V₂ (atypical for BS). The typical aspect of BS occurred after introduction of propafenone for the prevention of atrioventricular tachycardia. We discuss the recognition of this rare association, the proarrhythmic effects of some drugs, treatment options, and prognosis.     

The “Short‐Coupled” Variant of Right Ventricular Outflow Ventricular Tachycardia: A Not‐So‐Benign Form of Benign Ventricular Tachycardia?

Idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT-VT) and idiopathic RVOT-extrasystoles are generally considered benign arrhythmias. We described three cases who originally presented with typical "benign looking" RVOT-extrasystoles or RVOT-VT but developed malignant polymorphic VT during follow-up. The unusual aspect of their RVOT-extrasystoles was their coupling interval, which appears to be intermediate between the ultra-short coupling interval of idiopathic VF and the long coupling interval seen in the truly benign RVOT-VT.     

Plasticity of Addiction: A Mesolimbic Dopamine Short‐Circuit?

The development of drug addiction progresses along a continuum from acute drug use to compulsive use and drug seeking behavior. Many researchers have focused on identifying the physiological mechanisms involved in drug addiction in order to develop effective pharmacotherapies. Neuroplasticity, the putative mechanism underlying learning and memory, is modified by drugs of abuse and may contribute to the development of the eventual addicted state. Innovative treatments directly targeting these drug‐induced changes in brain reward components and circuits may be efficacious in reducing drug use and relapse.     

<Emphasis Type="Italic">Clostridium Difficile</Emphasis> Infection—An Unusual Cause of Refractory Pouchitis: Report of a Case

PURPOSE: Ileal pouch-anal anastomosis is the surgical procedure of choice for selected patients with severe ulcerative colitis. Pouchitis is a common complication of this procedure, with most cases responding to treatment with metronidazole, possibly with the addition of 5-aminosalicylic acid drugs and steroids. can frequently colonize the colon after treatment with broad-spectrum antibiotics, giving rise to diarrhea or colitis. The aim of this report was to describe the first case of -associated diarrhea manifest as pouchitis. METHODS: The management of refractory pouchitis in a 35-year-old female with toxin in the stool is described followed by a literature review of small-intestinal infection. RESULTS: Assays for toxin on stool sent during an episode considered to be caused by idiopathic chronic pouchitis were positive, and treatment with oral vancomycin was initiated. The patient responded with a reduction in bowel frequency to twice daily, a successful discontinuation of her antidiarrheal medication, and a rapid increase in weight. A subsequent stool assay was negative for the toxin. CONCLUSIONS: infection can complicate pouchitis in patients with an ileal pouch-anal anastomosis and should be considered in patients who fail to respond to standard treatment, including metronidazole. In cases of refractory pouchitis, superadded infection with should be excluded before initiation of potent anti-inflammatory drugs.     

Tamponnade cardiaque : première manifestation du Myélome Multiple : à propos d'un cas et revue de la littérature: Cardiac tamponade as first manifestation of multiple myeloma : A case report with literature review

Multiple myeloma is a hematologic malignancy characterized by clonal proliferation of plasma cells, mainly in bone marrow. Extramedullary disease is reported in many cases and may occur at diagnosis, at progression, or during relapse phase. Pericardial involvement is a rare condition that usually occurs with advanced-stage disease.We report a rare case of 76-year-old women with plasma cell-based pericardial effusion with cardiac tamponade as a form of presentation of multiple myeloma and discuss it in the light of literature.Diagnosis was established by pericardial fluid cytology. The patient received systemic chemotherapy, according to MPT protocol.     

Molecular Analysis of β-Thalassemia Patients: First Identification of Mutations HBB:c.93-2A>G and HBB:c.114G>A in Brazil

The various clinical phenotypes in β-thalassemias have stimulated the study of genetic factors that could modify the manifestations of these diseases. We examined 21 patients with β-thalassemia (β-thal) in order to identify some genetic modifying factors: β-thalassemia mutations, HBG2:g.–158C>T polymorphism, α-globin gene deletions and (AT)xNz(AT)y motif within the hypersensitive site 2-locus control region (HS2-LCR). In the 42 alleles analyzed, the most frequent mutations observed were HBB:c.92+6T>C (30.9%), HBB:c.118C>T (16.7%), HBB:c.93-21G>A (11.9%) and HBB:c.92+1G>A (4.8%); this finding is in accordance with previous data of the Brazilian population. The other genetic factors analyzed showed no relation with the severity of the disease. For the first time in Brazil, we report HBB:c.93-2A>G and HBB:c.114G>A mutations on the β-globin gene, both in a heterozygous state. This is also the first study to analyze the HS2-LCR in β-thalassemic individuals in the Brazilian population.