Heroin addiction in Bahrain: 15 years experience

This study describes the development and outcome of a new treatment programme for the management of heroin addiction in Bahrain. The problem reached its peak in the early 1980s with several reported deaths and with the involvement of many disciplines in the overall response. In 1983, treatment of all addicts was restricted by law to the government psychiatric hospital. The newly established specialized drug unit was overwhelmed by the number of patients seeking treatment. The lack of sufficient resources and suitably trained staff forced the unit to adopt an outpatient maintenance therapy approach for most of its clients. In 1987, a new comprehensive treatment programme was introduced that relies on a clear philosophy, safe detoxification (using objective scales for withdrawal manifestations) rather than maintenance therapy, followed by psychological and social rehabilitation. A national committee for drug addiction leas formed and an intensive programme of education was started at ail levels. The results indicate an initial increase at inpatient level but a marked drop of outpatient attendance. The use of the Opioid Objective Withdrawal Manifestations Scale (OOWMS) revealed that only a small number of our patients developed moderate or severe signs of withdrawal that required detoxification, and the rate of dispensed controlled medication was reduced by 99%. The effect of this approach is discussed, with special reference to the need for a collaborative effort from all disciplines in planning, implementing, continuously evaluating and modifying the national programmes for handling the serious problem of addiction.     

X-ray structures of aza-proline-containing peptides

The aza-analogue of proline (AzPro) contains a nitrogen atom in place of the CH^α of the cognate residue. The resolution of the crystal structures of seven AzPro-containing peptides, presenting a set of ten AzPro motifs, reveals the structural properties of this particular aza-residue. Because of sterical hindrances, both nitrogen atoms are out of planarity, and the reduced electronic conjugation in the two AzPro-adjacent amide groups probably explains the longer amide bond distances and the weak proton-accepting character of the two pyrazolidine nitrogens. The absolute configuration of both AzPro nitrogens depends on the chemical nature of the sequence. In all cases, the AzPro residue assumes the same intrinsic three-dimensional structure and presents folding tendencies opposed to those induced by proline.     

Role of Helicobacter pylori virulence factor and genotypes in non‐ulcer dyspepsia¶

Background and Aim: The role of Helicobacter pylori (HP) in non‐ulcer dyspepsia is debatable. Eradicating HP will help a small group of non‐ulcer dyspeptic patients. However, it is unclear which subgroup of patients will benefit from eradication therapy. The aim of the present study was to compare the cagA and cagE status, as well as vacA genotypes, of HP in non‐ulcer dyspeptic patients who responded successfully to eradication therapy compared with those patients who did not. Methods: Consecutive patients with moderate to severe (Likert 2 or 3) non‐ulcer dyspepsia with HP were recruited prospectively. Gastric biopsies were taken, DNA extracted and polymerase chain reaction performed to determine the cagA and cagE status and vacA alleles. Eradication therapy was offered until HP was eradicated successfully. The HP status was checked 1 month after eradication therapy using the [¹³C]‐urea breath test. All patients were assessed by one interviewer using Gastrointestinal Symptom Rating Scale (GSRS), a four‐point Likert scale, and SF‐36 for quality of life over 12 months. Treatment success was defined as minimal or no symptoms (Likert 1 or 0). The cagA, cagE and vacA status was blinded to the investigators until completion of the study. Results: Seventy‐three patients (36 males, 37 females) were recruited to the study. The mean ± SD patient age was 53.38 ± 12.09 years. When the 36 patients who improved (group A) were compared with the 37 (group B) who did not, no significant difference was found in the cagE positive rate (55.6 vs 43.2%, respectively; P = 0.638), cagA positive rate (83.1 vs 73.0%, respectively; P = 0.247), vacA m1 versus m2 subtype (84.0 vs 55.6%, respectively; P = 0.472) or vacA s1a versus s1c (39.4 vs 57.1%, respectively; P = 0.166). There was also no significant difference noted in the SF‐36 scores between the two groups after the conclusion of eradication therapy. Conclusions: Stratification of HP genotypes and virulence factor has no significant impact on the treatment success of non‐ulcer dyspepsia.     

Third‐Generation Mobile Phones (UMTS) Do Not Interfere with Permanent Implanted Pacemakers

Aims: Third‐generation mobile phones, UMTS (Universal Mobile Telecommunication System), were recently introduced in Europe. The safety of these devices with regard to their interference with implanted pacemakers is as yet unknown and is the point of interest in this study. Methods and Results: The study comprised 100 patients with permanent pacemaker implantation between November 2004 and June 2005. Two UMTS cellular phones (T‐Mobile, Vodafone) were tested in the standby, dialing, and operating mode with 23 single‐chamber and 77 dual‐chamber pacemakers. Continuous surface electrocardiograms (ECGs), intracardiac electrograms, and marker channels were recorded when calls were made by a stationary phone to cellular phone. All pacemakers were tested under a “worst‐case scenario,” which includes a programming of the pacemaker to unipolar sensing and pacing modes and inducing of a maximum sensitivity setting during continuous pacing of the patient. Patients had pacemaker implantation between June 1990 and April 2005. The mean age was 68.4 ± 15.1 years. Regardless of atrial and ventricular sensitivity settings, both UMTS mobile phones (Nokia 6650 and Motorola A835) did not show any interference with all tested pacemakers. In addition, both cellular phones did not interfere with the marker channels and the intracardiac ECGs of the pacemakers. Conclusion: Third‐generation mobile phones are safe for patients with permanent pacemakers. This is due to the high‐frequency band for this system (1,800–2,200 MHz) and the low power output between 0.01 W and 0.25 W. (PACE 2010; 860–864)     

Plasma concentration following oral and intramuscular atropine in children and their clinical effects

In a paediatric population, we compared i.m. v oral atropine pre-medication to a control group without atropine and determined atropine plasma concentrations (APC). Forty-five children were randomly assigned to one of three groups. Group I received atropine, 20 μg·kg⁻¹ i.m., 15 min prior to induction. Group II received atropine, 30 μg·kg⁻¹ orally, group III received no atropine. APC (expressed as percent of muscarine-2 receptor subtype occupancy), heart rate, rectal temperature, and salivation were determined before atropine, and 15, 25, 45, 60, 90, 120 (no APC), and 150 min following atropine. Only 10–20% of the M2-cholinoceptors were occupied after oral atropine with a peak at 90 min compared to 60–70% occupancy with a peak 25 min after i.m. atropine. The peak in M2-cholinoceptor occupation in group I was paralleled by a peak percentage change in heart rate of 15% from baseline. The peak in receptor occupation in group II did not correspond to the peak increase in heart rate. The percentage change of heart rate over time was not significantly different from baseline values in any of the groups. Bradycardia or temperature changes did not occur in any of the groups. Antisialogogue effects were observed only in group I. We conclude that atropine, 30 μg·kg⁻¹ orally is not an equipotent dosage to atropine, 20 μg·kg⁻¹ i.m.