Waiting for the Opportune Moment: The Tobacco Industry and Marijuana Legalization

Context

In 2012, Washington State and Colorado legalized the recreational use of marijuana, and Uruguay, beginning in 2014, will become the first country to legalize the sale and distribution of marijuana. The challenge facing policymakers and public health advocates is reducing the harms of an ineffective, costly, and discriminatory “war on drugs” while preventing another public health catastrophe similar to tobacco use, which kills 6 million people worldwide each year.

Methods

Between May and December 2013, using the standard snowball research technique, we searched the Legacy Tobacco Documents Library of previously secret tobacco industry documents (http://legacy.library.ucsf.edu).

Findings

Since at least the 1970s, tobacco companies have been interested in marijuana and marijuana legalization as both a potential and a rival product. As public opinion shifted and governments began relaxing laws pertaining to marijuana criminalization, the tobacco companies modified their corporate planning strategies to prepare for future consumer demand.

Conclusions

Policymakers and public health advocates must be aware that the tobacco industry or comparable multinational organizations (eg, food and beverage industries) are prepared to enter the marijuana market with the intention of increasing its already widespread use. In order to prevent domination of the market by companies seeking to maximize market size and profits, policymakers should learn from their successes and failures in regulating tobacco.     

CUTANEOUS LUPUS ERYTHEMATOSUS IN INDIA: IMMUNOFLUORESCENCE PROFILE

The clinical profile and cutaneous lesions of 65 patients with lupus erythematosus (LE) are described. This included 28 discoid LE (13 disseminated, 15 localized), five subacute cutaneous LE, and 32 systemic LE. The need to recognize a pigmented macular form constituting 25% of discoid LE is emphasized. Increased incidence of involvement of the lower lip in discoid LE and pigmentation in systemic LE is noted. Lupus band test was found to be highly sensitive; it was positive for lesional skin of all untreated patients with subacute cutaneous LE and systemic LE, it was, however, not useful on nonlesional skin.     

Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia

Introduction and Aims. The purpose of this study was to document treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program (STP) in Australia. Design and Methods. Clients attending the STP for methamphetamine use (n = 105) were assessed on entry to the service and at 3 (n = 86) and 6 months (n = 83) after starting treatment. At each interview methamphetamine use (days of use, severity of dependence), other drug use and health and social functioning (HIV risk behaviour, crime, disability, psychotic symptoms and hostility) were assessed for the past month. Results. Participants received a median of six counselling sessions (interquartile range 1–11) over a period of 89 days (interquartile range 41–148 days). Past month methamphetamine use fell from 79% at treatment entry to 53% at the 3‐month follow‐up (P < 0.001) and 55% at the 6‐month follow‐up (P < 0.001). There were statistically significant reductions in psychotic symptoms, hostility and disability associated with poor mental health. There was no change in other drug use, crime or HIV risk behaviour. Reductions in methamphetamine were more common among younger participants, those who had no history of drug treatment and those without concurrent heroin use. Discussion and Conclusions. Methamphetamine users entering the STP showed reductions in methamphetamine use and improvements in their mental health after treatment. Improved treatment responses are needed to address polydrug use and other harms within in this population.[McKetin R, Dunlop AJ, Holland RM, Sutherland RA, Baker AL, Salmon AM, Hudson SL. Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia. Drug Alcohol Rev 2013;32:80–87]     

Clinical Observations and Outcome of Ventricular Tachycardia Ablation in Patients with Left Ventricular Assist Devices

Background: Ablation of ventricular tachycardia (VT) in patients with left ventricular assist devices (LVAD) is challenging and not well documented. This report describes our experience with endocardial VT ablation in six patients with an LVAD. Methods: We retrospectively reviewed the clinical records of LVAD patients who underwent an ablation procedure for refractory VT. Results: A total of eight ablation procedures were performed in six patients who, during the last 2 weeks before the ablation procedure, received a total of 101 appropriate shocks for VT. A closed aortic valve (n = 2) or aortic atheroma (n = 1) required a transseptal catheterization in three of six patients. The apical LVAD cannula served as a VT substrate in two of six patients. VT was eliminated in four patients and markedly reduced in two others. The latter two patients experienced a total of only four implantable cardioverter defibrillator (ICD) shocks during a follow‐up of 130 and 493 days. Intravenous antiarrhythmic medications used in five of six patients before ablation were discontinued in all. The ablation procedures permitted hospital discharge in four of six patients. Five patients died during follow‐up (228 ± 207 days after the procedure). The cause of death was unrelated to cardiac arrhythmias. One patient is still alive 1,205 days after the procedure. Conclusion: Ablation of VT in LVAD patients is feasible and can result in a markedly decreased VT burden with a reduction of ICD shocks. The subsequent discontinuation of intravenous antiarrhythmic medications may facilitate hospital discharge. (PACE 2012; 35:1377–1383)     

MALIGNANT SYPHILIS (LUES MALIGNA) AND CONCURRENT INFECTION WITH HIV

Background. During the past 2 1/2 years we observed six patients who had a reactive serology for syphilis, of which four developed widespread noduloulcerative and two vesiculonecrotic lesions. The purpose was to report the occurrence of lues maligna, a rare form of secondary syphilis, in five patients infected with the human immunodeficiency virus (HIV) and in one patient with risk factors for infection. Methods. Tzanck preparations, viral cultures, and skin biopsies were performed to evaluate the etiology of the lesions. Results. Syphilis serology titers ranged from 1:32 to 1:128 and in one instance was as low as 1:8. Such titers can also be found in patients with the latent form of syphilis. Therefore, confirmation of the clinical diagnosis of lues maligna was dependent on skin biopsies that were compatible with secondary syphilis and negative viral studies that excluded varicella, disseminated varicella-zoster or herpes simplex. Lues maligna takes an aggressive course in HIV-infected patients since four of the patients required hospitalization and the two patients who refused to complete treatment, subsequently developed more severe skin and constitutional symptoms. Conclusions. HIV-infected patients are at risk for developing lues maligna. Despite its malignant presentation, lues maligna lesions respond rapidly to treatment with penicillin. Secondary syphilis should be added to the list of diseases known to be more aggressive in HIV-infected patients.     

Assessment of trace metal intake and status in a Gujerati pregnant Asian population and their influence on the outcome of pregnancy

Summary. Dietary assessments and biochemical indices including plasma zinc and copper were determined in pregnant vegetarian and non-vegetarian Gujerati women in India at 28 weeks gestation, and the results were contrasted with those of a comparable group of Gujerati pregnant women living in Harrow. Even though the dietary intake of energy, protein and zinc was significantly lower in the Indian vegetarian Gujerati group when compared to the equivalent group in Harrow, the birthweights of the babies delivered at term were similar. The intake of zinc in the diet of the Gujerati Indian vegetarian and non-vegetarian groups was only one quarter of the US recommended intake during pregnancy and was approximately one half in the Harrow Indian groups. Even so, the plasma concentrations of zinc were similar in all dietary groups in either India or Harrow. The albumin content in the plasma of both the Gujerati Indian vegetarian and non-vegetarian was significantly reduced when compared to the equivalent Harrow dietary groups. The plasma concentrations of both calcium and sodium were significantly correlated with the albumin concentration but not with the plasma content of zinc. Copper levels were elevated to the normal range in both dietary groups of the Gujerati and were similar to the concentrations found in the Harrow groups.     

Correlation of Basal Menses CA-125 Levels and 6 Month Pregnancy Rates in Women Undergoing Treatments for Infertility Without Assisted Reproductive Methods

PROBLEM: The objective of this study was to evaluate the correlation of menstrual CA-125 levels with pregnancy rates (PRs) after 6 months of treatment for infertility. METHOD: The sample consisted of a heterogenous group of 160 women who sought treatment for infertility. Treatments include progesterone supplementation, donor insemination, intrauterine insemination, and ovulation induction therapy. No laparoscopies were done during the study period. A baseline CA-125 level was drawn during menses before the initiation of therapy. Patients were followed for 6 months of treatment or until a pregnancy was achieved. RESULTS: There was no difference in the 6 month PR or viable PR by CA-125 level. CONCLUSIONS: Elevated CA-125 levels are not predictive of poor fertility potential at least during the first 6 months of infertility therapy. Even though these higher levels sometimes suggest that endometriosis is present, the data suggest that correction of male factor, cervical factor or ovulation factor provides effective PRs without the need for laparoscopic intervention.     

Evidence-Based Esthetic Dentistry

Abstract: :Evidence-based clinical practice integrates the best available evidence with clinical expertise. This article presents a clinical case scenario and, using a four-step, evidence-based approach, demonstrates how to (1) ask an evidence-based question; (2) search MEDLINE for the best evidence; (3) critically appraise the evidence; and (4) apply the evidence to the patient. The procedure is demonstrated with the sample question, Does bleaching of bonded porcelain veneers increase marginal leakage? A MEDLINE search strategy was developed for synonyms of the key words that best identify the problem, the intervention, and the outcome. The synonyms were combined using the Boolean operator “or” to identify a “sensitive” (i.e., inclusive) universe of 140,000 journal articles. These categories were then combined using the Boolean operator “and” to identify the most “specific” (i.e., exclusive) four articles from among the 140,000. Finally, to find the best evidence, the articles were limited to “humans” and “randomized controlled trials.” This identified one article. Critical appraisal of the limited data in this one article indicates that the methods are valid and statistically significant, but because of the methods employed, may not be clinically important. Evidence-based methods take one to the edge of the available information universe in about 15 minutes. The results can be both exhilarating and sobering. They can indicate the depth or limits of available information and suggest gaps in the knowledge-base that require further study. Most importantly, however, the results allow practitioners to communicate incisively and truthfully with patients and to make more informed clinical choices.     

Synthesis of keto-methylene and dehydro-keto-methylene pseudo-dipeptides

A new synthetic pathway is proposed for the preparation of keto-methylene and dehydro-keto-methylene dipeptide isosteres bearing the general formulas (RS)XxxΨ(COCH₂)(RS)Yyy and (RS)XxxΨ(COCH₂)ΔYyy. The method involves the condensation of an oxazolone derived from an N-benzoyl amino acid ( 3a, b ) via a modified Dakin-West reaction with the appropriately α-substituted succinoyl chloride half ester ( 2a, b ). This last compound is obtained from a Stobbe condensation followed by reaction with oxalyl chloride. The fully protected pseudo-dehydro dipeptides ( 41, b ) thus obtained can then be catalytically hydrogenated to the desired pseudo-dipeptides ( 5a, b ). Acid hydrolysis of ( 4 ) and ( 5 ) gives the pure fully deblocked dipeptide surrogates which are then N-protected for coupling into the desired peptide analogs. For preparative applications, the prior isolation of intermediates is not required throughout the procedure up to the final products. In this manner, the following compounds were prepared: Boc-(RS)PheΨ(COCH₂)(E, Z)Δ Phe-OH ( 9 ), Boc-(RS)Pheψ(COCH₂)(RS)Phe-OH (7a), and Boc-Glyψ(COCH₂)(RS)Leu-OH ( 7b ). Characterization of isolated intermediates and final products was carried out.