Drug injecting in patients in New Zealand Methadone Maintenance Treatment programs: An anonymous survey

Introduction and Aims. To investigate the prevalence and nature of injecting behaviour among patients on Methadone Maintenance Treatment (MMT) programs. Design and Methods. A self‐reported questionnaire was handed to 423 patients enrolled in MMT across six clinics in the lower North Island of New Zealand. Results. A total of 151 patients responded, giving a 35.6% response rate. One hundred and twenty (79.5%) respondents reported they had injected methadone while enrolled in MMT, 84 (55.6%) had injected methadone in the last year and of those 43 (35.8%) had injected methadone in the last week. Reasons given for injecting of methadone included: rapid onset of effect, needle fixation and euphoria. Time on the methadone programme was negatively associated with ever injecting methadone [odds ratio (95% CI) 0.92 (0.85–0.99), P = 0.029] and injecting other substances [odds ratio (95% CI) 0.93(0.87–1.0), P = 0.046]. More frequent pharmacy‐observed consumption was associated with increased injecting of other substances [odds ratio (95% CI) 1.32 (1.09–1.59), P = 0.005] but not methadone. The time a person had been enrolled on the methadone programme was associated with decreased use of other substances [odds ratio (95% CI) 0.93 (0.87–1.0), P = 0.046]. Discussion and Conclusions. Many individuals on MMT continue to inject their methadone. In this sample, the frequency of injection of methadone did not correlate with prescribed dose or takeaway arrangements. The beneficial impact of time on the programme emphasises the importance of retention in treatment. It is suggested that these results also indicate a need for routine education concerning safe injecting.[Judson G, Bird R, O'Connor P, Bevin T, Loan R, Schroder M, McGrath R, Weatherall M, Moriarty H, Robinson G. Drug injecting in patients in New Zealand Methadone Maintenance Treatment programs: An anonymous survey. Drug Alcohol Rev 2009]     

Inappropriate left ventricular hypertrophy in minor aortic valve disease: a source of error in clinical assessment

A group of patients with minor aortic valve disease and inappropriatelysevere left ventricular hypertrophy is described. Clinical,electrocardiographic and echocardiographic assessment of thedegree of left ventricular hypertrophy suggested that they hadhaemodynamically severe aortic stenosis but this was not borneout at cardiac catheterisation. Although a chance associationbetween non-obstructive hypertrophic cardiomyopathy and mildaortic stenosis may have been responsible, an abnormally severehypertrophic response to minor aortic outflow obstruction isproposed as another possible explanation. The association betweenminor aortic valve disease and severe left ventricular hypertrophyshould be considered when assessing aortic stenosis since theprognosis with medical management seems good and valve replacementis likely to be of no benefit in such cases.     

Interaction of troponin-H and glutathione S-transferase-2 in the indirect flight muscles of Drosophila melanogaster

Summary Drosophila indirect flight muscles (IFMs) contain a 35 kDa protein which cross-reacts with antibodies to the IFM specific protein troponin-H isoform 34 (TnH-34). Peptide fingerprinting and peptide sequencing showed that this 35 kDa protein is glutathione S-transferase-2 (GST-2). GST-2 is present in the asynchronous indirect flight muscles but not in the synchronous tergal depressor of the trochanter (jump muscle). Genetic dissection of the sarcomere showed that GST-2 is stably associated with the thin filaments but the presence of myosin is required to achieve the correct stoichiometry, suggesting that there is also an interaction with the thick filament. The two Drosophila TnHs (isoforms 33 and 34) are naturally occurring fusion proteins in which a proline-rich extension of ~250 amino acids replaces the 27 C-terminal residues of the muscle-specific tropomyosin II isoform. The proteolytic enzyme, Igase, cleaves the hydrophobic C-terminal sequence of TnH-34 at three sites and TnH-33 at one site. This results in the release of GST-2 from the myofibril. The amount of GST-2 stably bound to the myofibril is directly proportional to the total amount of undigested TnH. It is concluded that GST-2 in the thin filament is stabilized there by interaction with TnH. We speculate that the hydrophobic N-terminal region of GST-2 interacts with the hydrophobic C-terminal extension of TnH, and that both are close to a myosin cross-bridge. This revised version was published online in August 2006 with corrections to the Cover Date.     

Photochemotherapy for psoriasis remission times. Psoralens and UV-A and combined photochemotherapy with anthralin

Oral methoxsalen and long-wave ultraviolet light (PUVA) was evaluated in 187 psoriatics, with emphasis on remission and recurrence after therapy. The mean number of years psoriasis had been present was 18.3, the mean psoriatic involvement 34.8% the dose at the time of maximum clearance was 11.8 J/cm², and the mean number of treatments to achieve maximum clearance was 175. Complete clearance was achieved in sixty-one patients and in this group the average number of treatments to achieve maximum clearance was 16.8, the initial remission times ranged from 4 to 64 weeks, with an average of 21.6 weeks. In patients subsequently retreated, the remission time was only 12.4 weeks (57%), but the mean number of treatments to achieve maximum clearance was reduced (11.4) and patients responded more easily to treatment. Sixteen patients were treated in addition to PUVA, with anthralin in Lassars' paste with clearing achieved between six and fifteen treatments, a mean of 9.5. Combinations of PUVA with other forms of psoriatic treatment may also help to reduce the cumulative PUVA exposures.     

Spectrum of ultraviolet radiation on human B and T lymphocyte viability

Human lymphocytes were irradiated with ultraviolet radiation (UV) of various wavelengths. Selective T cell killing was achieved with a dose of 0·1-0·067 J/cm² with UVC (a germicidal lamp) or 254 nm monochromatic radiation while preserving B cell function. Irradiation of lymphocytes with UVA up to 9 J/cm² caused no apparent T and B cell killing. Irradiation with monochromatic 280 and 296 nm radiation (UVB) showed similar susceptibility of both T and B cells with killing occurring with less than 0·5 J/cm².     

Pitfalls in the Diagnosis of Gastrointestinal Tuberculosis

Gastrointestinal tuberculosis is difficult to diagnose since it mimics many other abdominal conditions and has protean manifestations. The disease can present as an abdominal mass, bowel perforation, Crohn's disease and dysentery. These presentations are discussed with representative cases to illustrate the diagnostic difficulties. It is emphasized that to obviate the diagnostic pitfalls, tuberculosis should always be considered in the differential diagnosis of unusual gastrointestinal presentations particularly because radiological and laboratory tests may be non-contributory.     

c-myc GENE ABNORMALITIES IN MUCOSA-ASSOCIATED LYMPHOID TISSUE (MALT) LYMPHOMAS

c-myc gene abnormalities associated with lymphomagenesis, including rearrangements and mutations in the regulatory region between exon I and intron I, have been studied in 54 MALT lymphomas (43 low and 11 high grade) and 36 nodal lymphomas (27 low and 9 high grade). By Southern blot analysis, none of the 54 MALT lymphomas but 2 of 36 nodal lymphomas had c-myc gene rearrangements. Defined tumour cell populations from all MALT lymphoma cases were isolated by microdissection from frozen tissue sections and analysed by polymerase chain reaction–single-strand conformational polymorphism (PCR–SSCP) and direct sequencing for somatic mutations in the exon I/intron I region of the gene. Point mutations in this region were identified in nine cases of MALT lymphoma (7/43=16·2 per cent of low grade; 2/11=18·1 per cent of high grade). These mutations were located at either the exon I/intron I border of myc intron factor (MIF) binding sites, which are critical in the negative regulation of c-myc expression. Of the nodal lymphomas, only the two cases (5·6 per cent) with c-myc gene rearrangement showed scattered or clustered mutations. These results suggest that c-myc mutations in MALT lymphomas are unlikely to be associated with chromosome translocation, which is the main cause of somatic mutations observed in other types of lymphoma. The mutations involving the c-myc regulatory regions may play a pathogenetic role in at least a proportion of MALT lymphomas. © 1997 by John Wiley & Sons, Ltd.