Typologies of drug dependence: comparative validity of a multivariate and four univariate models

Data from a longitudinal cohort study were used to directly compare the concurrent and predictive validity of four univariate typologic approaches with a multivariate approach in subtyping drug dependence. The four univariate typologies were based upon: (a) age-of-onset of drug abuse/dependence, (b) presence of drug abuse in first-degree relatives, (c) presence of antisocial personality disorder, and (d) sex. The multivariate typologic approach was based on indices of vulnerability, chronicity, consequences, and psychopathology, yielding the Type A/B dichotomy first demonstrated in alcohol dependence. Subtypes generated from the univariate typologies were then each compared with the multivariate typology on measures of concurrent and predictive validity, and the strength of association was compared statistically. There was evidence of significantly greater concurrent validity of the Type A/B typology compared with the univariate typologies across all the domains of validation (risk, substance use, psychopathology, personality, and overall functioning). The multivariate typology also fared better than the univariate ones in all three domains on which predictive validity was evaluated: substance use, psychopathology, and overall functioning, as well as the degree of change in several composite scores (drug, medical, legal, and psychiatric) and the global psychiatric symptom index. This direct method of comparison seemed to demonstrate the superior validity of the multivariate cluster-analytic approach over the univariate approaches to classifying subjects with drug dependence.     

Effects of a community-based healthy heart program on increasing healthy women's physical activity: a randomized controlled trial guided by Community-based Participatory Research (CBPR)

Background  

Cardiovascular disease remains the leading killer of women in most developed areas of the world. Rates of physical inactivity and poor nutrition, which are two of the most important modifiable risk factors for cardiovascular disease in women, are substantial. This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women's physical activity in a randomized trial guided by community-based participatory research (CBPR) methods.     

Morgagni hernia repair in children over two decades: Institutional experience,systematic review,and meta-analysis of 296 patients

Background/Purpose

Morgagni diaphragmatic hernia (MH) is rare. We report our experience based on routine patch use in MH repair to curb recurrence. A systematic review and meta-analysis were performed to study the recurrence and complications associated with minimally invasive surgery and the use of patch.

Identification of ataxia‐associated mtDNA mutations (m.4052T>C and m.9035T>C) and evaluation of their pathogenicity in transmitochondrial cybrids

The potential pathogenicity of two homoplasmic mtDNA point mutations, 9035T>C and 4452T>C, found in a family afflicted with maternally transmitted cognitive developmental delay, learning disability, and progressive ataxia was evaluated using transmitochondrial cybrids. We confirmed that the 4452T>C transition in tRNA^Met represented a polymorphism; however, 9035T>C conversion in the ATP6 gene was responsible for a defective F₀‐ATPase. Accordingly, mutant cybrids had a reduced oligomycin‐sensitive ATP hydrolyzing activity. They had less than half of the steady‐state content of ATP and nearly an 8‐fold higher basal level of reactive oxygen species (ROS). Mutant cybrids were unable to cope with additional insults, i.e., glucose deprivation or tertiary‐butyl hydroperoxide, and they succumbed to either apoptotic or necrotic cell death. Both of these outcomes were prevented by the antioxidants CoQ₁₀ and vitamin E, suggesting that the abnormally high levels of ROS were the triggers of cell death. In conclusion, the principal metabolic defects, i.e., energy deficiency and ROS burden, resulted from the 9035T>C mutation and could be responsible for the development of clinical symptoms in this family. Furthermore, antioxidant therapy might prove helpful in the management of this disease. Muscle Nerve, 2009     

High-Output Cardiac Failure Following Insertion of Right Femoral Artery to Left Femoral Vein PTFE Graft for Haemodialysis: A Case Report

Arteriovenous grafts used for hemodialysis can produce high-output cardiac failure as a result of shunting of blood through the dialysis access. The following case demonstrates that the problem can occur shortly after graft formation and improved with graft ligation. It caused haemodynamic compromise because of previously undiagnosed, underlying valvular heart disease. It also caused a diagnostic difficulty in the immediate postoperative period as it was mistaken for postsurgical hemorrhage.     

Psychometric properties of Bengali version of QOLIE-10 in epileptic patients

Assessment of Quality of Life in Epilepsy has currently been emphasized to provide comprehensive care to patients.

Aim:

To develop and standardize and assess the psychometric properties of Bengali version of QOLIE-10 and to assess the relationship of quality of life with seizure variables and presence of psychiatric morbidity.

Design:

English QOLIE-10 was translated into Bengali by a translation committee using translation-re-translation technique. Inter-rater reliability between the English and Bengali version was assessed during initial practice session held amongst 20 bilingual patients. It was found that item 3 (related to driving) was reported to have difficulty in answering by all the patients as none drove any vehicle. Thus, this item was dropped. The inter-rater reliability of the resultant 9 item scale was found to be high (kappa = 0.9). One hundred and seven epilepsy patients attending the Epilepsy clinic were selected for the study if they met the following criteria: age >15 years, duration of seizure >1 year, regular intake of antiepileptic drugs, presence of informant and ability to read Bengali. For each patient, demographic and clinical data (seizure frequency, last seizure date, seizure type as per record, medicine intake history and records of past investigations such as EEG) was collected. Each patient were administered QOLIE-9 (Bengali) and SRQ-24 Bengali version to screen for psychiatric morbidity.

Results:

The Cronbach''s Alpha coefficient for QOLIE-9 was 0.81, which did not improve if any item was dropped. All items showed strong correlation with the total score. The instrument showed stable factor structure with three factors (Limitation, Depression, Illness effects). However, the item with regard to memory problem did not fit into any of the factors. The QOLIE-9 total showed a significant correlation with the seizure frequency (r = 0.76**). SRQ positive (i.e., suspected psychiatric morbidity) cases had higher QOLIE-9 score (thus, poorer quality of life) in comparison to non-psychiatric cases.

Conclusion:

Bengali QOLIE-9 is a valid and reliable instrument to assess the quality of life in patients suffering from epilepsy.     

Evaluation of analgesic efficacy,gastrotoxicity and nephrotoxicity of fixed-dose combinations of nonselective,preferential and selective cyclooxgenase inhibitors with paracetamol in rats

Nonsteroidal anti-inflammatory drugs (NSAIDs) are combined with paracetamol (PCM) with a view to enhance analgesic efficacy and reduce gastric toxicity. However, there are reports of enhanced nephrotoxicity with nonselective NSAID with PCM combinations. The present study investigated the analgesic efficacy, gastrotoxicity and nephrotoxicity of nonselective, preferential and selective cyclooxgenase inhibitors and their combination with PCM in rats.Graded doses of ibuprofen, meloxicam and celecoxib alone and their combination with fixed dose of PCM were administered to the rats by gavage for 14 days. The results showed that PCM potentiated the analgesic effect of all three classes of NSAIDs significantly as evidenced by increase in tail-flick latency in radiant heat method. Dose-dependent gastromucosal damage was produced by all the drugs, which was augmented significantly with PCM in the form of decreased total carbohydrate/protein ratio of mucin and increased gastric ulcer index. It was further confirmed by histopathology of rat’s stomach. The renal histopathology was conducted to evaluate inflammation, tubular damage, papillary necrosis, and interstitial changes. Increased nephrotoxicity was observed with all NSAIDs in dose-dependent manner and in combination with PCM.Our study revealed the augmented analgesia as well as enhanced gastrotoxicity and nephrotoxicity with all three major NSAIDs classes when combined with PCM. These findings highlighted the need for large pharmacoepidemiological studies to evaluate the magnitude of gastrotoxicity and nephrotoxicity in population who are on long-term treatment with NSAID combinations.