Addiction Rehab: Very Long-Term Outcome of Peripheral Arterial Disease in Patients Undergoing Percutaneous Coronary Revascularization: A Retrospective Analysis.

Very long-term outcome of peripheral arterial disease in patients undergoing percutaneous coronary revascularization: a retrospective analysis.

Filed under: Addiction Rehab

Minerva Cardioangiol. 2012 Dec; 60(6): 553-60
Pullara A, D’Ascenzo F, Gonella A, Moretti C, Sciuto F, Omedè PL, Bollati M, Biondi Zoccai G, Gaita F, Sheiban I

Peripheral arterial disease (PAD) in patients undergoing percutaneous coronary intervention (PCI) with stent implantation is a well known risk factor leading to an increased rates of stroke, cardiovascular death and myocardial infarction. Anyway there are few data on very-long term outcome (more than 1 year follow up) of PAD after stent implantation. We thus aimed to evaluate the influence of PAD on very long-term outcome of our PCI-population.We retrospectively identified all patients undergoing PCI with stent implantation at our center between July 2002 and June 2004, and thus eligible for at least 4 years of follow-up. For the purpose of this study, we considered a diagnosis of PAD based on clinical evaluation and/or angiographic documentation. We adjudicated the following clinical events: death, myocardial infarction, repeat revascularization, and their composite (i.e. major adverse cardiac events, MACE). RESULTS; A total of 1008 patients were included, 109 with PAD and 899 Without PAD. Those with had more often diabetes (35% vs. 25%, P=0.002), hypertension (83% vs. 68%, P=0.001) and unfavorable basal clinical condition at the start of this study: past-Percutaneous Coronary Intervention (PCI) (30% vs. 22%, P=0.005), past-Coronary Artery Bypass Graft (CABG) (24% vs. 14%, P=0.001), ejection fraction (EF) <35% (14% vs. 7%, P=0.02) and chronic renal failure (CRF) (15% vs. 6%, P=0.002). In addiction patient with PAD were more likely to have chronic total occlusion (CTO) (36% vs. 25%, p=0.02) and unprotected left main (16% vs. 8%,P=0.01). Clinical outcome at the time of follow-up (4,42 ± 1,66 years) was as follow: Revascularization (53% vs. 37%, P=0.002), Cardiac death (21% vs. 13%, P=0.04), MACE (69% vs. 49%, p<.001). Indipendent predictors of MACE according to our survival analysis were: PAD (HR 1.31; 95% CI 1.01-1.69), Age >75 (HR 1.23; 95% CI 1-1.51), Chronic heart failure (HR1.72; 95% CI 1.19-2.5), Unprotected left main (HR 1.48; 95% CI 1.12-1.96).This long-term registry shows that PAD remains an important clinical condition that negatively influences the outcome of patients undergoing PCI with stent implantation in a very long-term follow-up period.
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Linking GABA(A) receptor subunits to Alcohol-induced conditioned taste aversion and recovery from acute Alcohol intoxication.

Filed under: Addiction Rehab

Neuropharmacology. 2012 Nov 9;
Blednov YA, Benavidez JM, Black M, Chandra D, Homanics GE, Rudolph U, Harris RA

GABA type A receptors (GABA(A)-R) are important for ethanol actions and it is of interest to link individual subunits with specific ethanol behaviors. We studied null mutant mice for six different GABA(A)-R subunits (?1, ?2, ?3, ?4, ?5 and ?). Only mice lacking the ?2 subunit showed reduction of conditioned taste aversion (CTA) to ethanol. These results are in agreement with data from knock-in mice with mutation of the ethanol-sensitive site in the ?2-subunit (Blednov et al., 2011) and indicate this aversive property of ethanol is dependent on ethanol action on ?2-containing GABA(A)-R. Deletion of the ?2-subunit led to faster recovery whereas absence of the ?3-subunit slowed recovery from ethanol-induced incoordination (rotarod). Deletion of the other four subunits did not affect this behavior. Similar changes in this behavior for the ?2 and ?3 null mutants were found for flurazepam motor-incoordination. However, no differences in recovery were found in motor-incoordinating effects of an ?1-selective modulator (zolpidem) or an ?4-selective agonist (gaboxadol). Therefore, recovery of rotarod incoordination is under control of two GABA(A)-R subunits: ?2 and ?3. For motor activity, ?3 null mice demonstrated higher activation by ethanol (1 g/kg) whereas both ?2 and ?3 (-/-) knockout mice were less sensitive to ethanol-induced reduction of motor activity (1.5 g/kg). These studies demonstrate that the effects of ethanol at GABAergic synapses containing ?2 subunit are important for specific behavioral effects of ethanol which may be relevant to the genetic linkage of the ?2 subunit with human alcoholism.
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Accidental overdose of proprietary branded, combination analgesics available over the counter.

Filed under: Addiction Rehab

Br J Hosp Med (Lond). 2012 Nov; 73(11): 650-1
McWhirter K, Jones R

This article presents two cases of accidental overdose involving proprietary branded over the counter combination analgesic medication, where both patients were unaware of potential side effects of the compounds. In the first case the patient presented with an acute confusional state associated with profound metabolic acidosis related to excessive intake of a combination analgesic for poorly controlled back pain. In the second, the patient presented with profound gastrointestinal upset related to use of the same drug, in this case after excessive ingestion related to opiate addiction. These cases demonstrate the potential hidden dangers of combination analgesic abuse and are a reminder that medical staff should always be mindful of unintentional overdose in patients presenting acutely with unexplained symptoms.
HubMed – addiction


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