Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings

Aims This study aimed to determine the relative effectiveness of 12 months of interim methadone (IM; supervised methadone with emergency counseling only for the first 4 months of treatment), standard methadone treatment (SM; with routine counseling) and restored methadone treatment (RM: routine counseling with smaller case‐loads). Design A randomized controlled trial was conducted comparing IM, SM and RM treatment. IM lasted for 4 months, after which participants were transferred to SM. Setting The study was conducted in two methadone treatment programs in Baltimore, MD, USA. Participants The study included 230 adult methadone patients newly admitted through waiting‐lists. Measurements We administered the Addiction Severity Index and a supplemental questionnaire at baseline, 4 and 12 months post‐ baseline. Measurements included retention in treatment, self‐reported days of heroin and cocaine use, criminal behavior and arrests and urine tests for heroin and cocaine metabolites. Findings At 12 months, on an intent‐to‐treat basis, there were no significant differences in retention in treatment among the IM, SM and RM groups (60.6%, 54.8% and 37.0%, respectively). Positive urine tests for the three groups declined significantly from baseline (Ps < 0.001 and 0.003, for heroin and cocaine metabolites, respectively) but there were no significant group x time interactions for these measures. At least one arrest was reported by 30.6% of the sample during the year, but there were no significant between‐group effects. Conclusions Limited availability of drug counseling services should not be a barrier to providing supervised methadone to adults dependent on heroin—at least for the first 4 months of treatment.     

Effect of dexmedetomidine on intraocular pressure as an additive in peribulbar block during glaucoma surgery

Purpose:The purpose of this study is to assess the effect of dexmedetomidine on intraocular pressure (IOP) as an additive in peribulbar injections in glaucoma surgeries.Methods:A prospective, randomized, double-blind, parallel assignment interventional study was conducted for patients undergoing glaucoma surgeries at a tertiary eye care hospital in North India. Patients were randomized to two groups, Dexmed group and Placebo group. In the Dexmed group, dexmedetomidine (0.4 μg/kg body weight) was given as an additive along with peribulbar block. The primary outcome was change in IOP pre- and postperibulbar injections (IOP before the block, and after 5 and 15 min of the block). Secondary outcome measures were onset of block, adverse effects (bradycardia, hypotension, respiratory depression, and level 4 sedation), and surgeon satisfaction.Results:A total of 104 patients were randomized, 52 each in the Dexmed group and Placebo group. The percentage decrease in IOP was significantly more in the Dexmed group than in the Placebo group both at 5 and 15 min'' post block (P < 0.05). At 5 min, the mean percent decrease in IOP in Dexmed group was -10.48, whereas it was 2.85 in the Placebo group. At 15 min, the mean percent decrease in IOP was -22.59 and -9.42 in the Dexmed and Placebo group, respectively. There was no significant difference between the two groups in the onset of block and adverse effects. Surgeon satisfaction was significantly greater in the Dexmed group than the Placebo group (P < 0.05).Conclusion:Dexmedetomidine lowers IOP significantly in patients undergoing glaucoma surgeries with safe hemodynamic changes and sedative effect.     

HbA1c during pregnancy: its relationship to meal related glycaemia and neonatal birth weight in patients with diabetes

OBJECTIVE: Although home blood glucose (HBG) profiles correlate closely with HbA1c, the strength of the relationship during pregnancy is unclear due to physiological changes which can induce subnormal HbA1c levels. We therefore aimed to establish the strength of the association between mean HBG profiles and HbA1c in diabetic pregnancies and whether HbA1c levels and glycaemic variability affects neonatal birth weight (NBW). STUDY DESIGN: 7-point glycaemic profiles performed throughout pregnancy were obtained retrospectively in 94 consecutive patients attending the diabetes antenatal clinic and compared to the corresponding mean HbA1c levels. RESULTS: There was a significant linear correlation between mean HBG and HbA1c (HbA1c=0.5HBG+3.1, r=0.71, p<0.0001). Multiple regression analysis demonstrated that both pre- and post-prandial HBG levels correlated significantly and independently with HbA1c, correlation coefficients (r) were 0.63 and 0.65, respectively both p<0.0001. Significant correlations were also observed in patients with gestational diabetes (n=67, mean HbA1c=6.11, r=0.67; p<0.0001) and type 1 diabetes (n=18, mean HbA1c=6.75, r=0.64; p=0.004). All meal related HBG measurements showed similar significant correlations with HbA1c (r values pre- and post-breakfast, pre- and post-lunch, pre- and post-tea and pre-bed are 0.56, 0.55, 0.59, 0.55, 0.56, 0.59, 0.51, respectively p<0.0001 for all time points). Post hoc analysis showed that NBW increased with higher levels of HbA1c; NBW (centiles)+/-S.D. for HbA1c <6.5% versus >6.5% was 78.9%+/-29.2 versus 90.2%+/-18.6, p=0.02. CONCLUSION: Mean HbA1c levels are closely correlated to all meal related glucose measurements during pregnancy. It is therefore a reliable indicator of overall glycaemic control among patients with diabetes during pregnancy.     

Fetal megalourethra associated with hypoplastic left heart and imperforate anus: a previously unreported association

We report two cases of a fetus with a megalourethra associated with a hypoplastic left heart, dilated and echogenic bowels, vesico-colonic fistula and an imperforate anus. This combination of fetal abnormalities may represent an unclassified syndrome.     

Atypical optic neuritis: An overview

Optic neuritis (ON) refers to conditions that involve inflammation of the optic nerve. Various autoantibodies have been found, which are associated with central nervous system inflammatory disorders and have provided much information about the immune targets and mechanisms that impact the prognosis, treatment, and recurrence of atypical ON. Therefore, neurologists and ophthalmologists together should work to find out clinical, laboratory, and imaging findings that may provide important clues to the etiology of atypical ON and its management. Various biomarkers have been identified to confirm and distinguish atypical optic neuritis from others. The purpose of this review is to present the current scenario of atypical ON and its clinical management.