Predictors and Clinical Outcomes of Postoperative Delirium After Administration of Dexamethasone in Patients Undergoing Coronary Artery Bypass Surgery.

Predictors and clinical outcomes of postoperative delirium after administration of dexamethasone in patients undergoing coronary artery bypass surgery.

Filed under: Addiction Rehab

Int J Prev Med. 2012 Jun; 3(6): 420-7
Mardani D, Bigdelian H

Postoperative delirium (POD) is one of the important complications of cardiac surgery and it is assumed to provoke inflammatory responses. Theoretically, anti-inflammatory effects of dexamethasone can have an influence on the incidence and outcomes of POD. The aim of our study was to assess POD predictors and outcomes of dexamethasone administration after cardiac surgery.Patients’ mental status was examined by mini-mental status examination and psychiatric interviewing to diagnose delirium. Subsequently, authors analyzed the patient variables for identification of predictors and outcomes of POD.Between 196 patients who met the inclusion criteria, 34 (17.34%) patients were delirious. History of chronic renal failure, obstructive pulmonary disease, smoking, and addiction strongly predicted development of POD. Other predictors were intra-aortic balloon pump insertion, transfusion of packed cells, and atrial fibrillation rhythm. In our study, the administration of dexamethasone significantly reduced the risk for POD. Furthermore, delirium was associated with longer intensive care unit (ICU) stay.Our study reports the predictors of POD, which patients commonly facing them in cardiac surgery ICU. Appropriate management and prevention of these predictors, especially modifiable ones, can decrease the incident of POD and improves cognitive outcomes of cardiac surgeries.
HubMed – addiction


What are Differences between Non-injecting and Injecting Drug Addicts?

Filed under: Addiction Rehab

Int J Prev Med. 2012 Jun; 3(6): 414-9
Noroozi M, Nedjat S, Golestan B, Majdzadeh R

This study aims to identify the differences between Injecting Drug Users (IDUs) and non-IDUs, with regard to some potential factors. This could be useful to design effective interventions for harm reduction, which is one of the priority areas in reducing the burden of addiction.Sixty cases and 60 controls participated in this pair-matched case-control study, which was conducted in Tehran. The cases were IDUs who were asked to introduce two friends; one IDU and the other non-IDU as the paired control. In addition to demographic variables, onset age of cigarette smoking, dropping out of school, imprisonment, history of being sexually abused for money, and family history of using illegal drugs were obtained from the cases and controls via an interview. Pair Odds Ratio (OR) was estimated through McNemar and conditional multivariable logistic regression analysis.Eighty-three % of the IDUs and 92% the controls were male. The mean for onset age of cigarette smoking was 16 in the cases and 20 in the controls, which was significantly different between cases and controls (P<0.001). In the multivariate analysis, dropping out from school was significantly different between cases and controls (OR=4.22 95% CI: 2.23 - 14.0). Imprisonment was more frequent in IDUs compared to non-IDUs (OR=3.70 95% CI: 1.09 - 11.08). The cases had more sexual relationship for earning money compared to the controls (OR=3.14 95% CI: 1.24 - 13.70). Onset age of cigarette smoking was significantly (P<0.001) sooner in the IDUs compared to the non-IDUs (15.9 and 20.1 years, respectively). IDUs reported 5.5 times more that non-IDUs of having an addict in their family (P value=0.04).The finding of this study can be useful in identifying the persons who are at risk of IDU. Therefore, people who involve with risk factors recognized in this study should be triggered for harm reduction prevention strategies. HubMed – addiction


Monitoring extracellular pH, oxygen, and dopamine during reward delivery in the striatum of primates.

Filed under: Addiction Rehab

Front Behav Neurosci. 2012; 6: 36
Ariansen JL, Heien ML, Hermans A, Phillips PE, Hernadi I, Bermudez MA, Schultz W, Wightman RM

Dopamine projections that extend from the ventral tegmental area to the striatum have been implicated in the biological basis for behaviors associated with reward and addiction. Until recently, it has been difficult to evaluate the complex balance of energy utilization and neural activity in the striatum. Many techniques such as electrophysiology, functional magnetic resonance imaging (fMRI), and fast-scan cyclic voltammetry have been employed to monitor these neurochemical and neurophysiological changes. In this brain region, physiological responses to cues and rewards cause local, transient pH changes. Oxygen and pH are coupled in the brain through a complex system of blood flow and metabolism as a result of transient neural activity. Indeed, this balance is at the heart of imaging studies such as fMRI. To this end, we measured pH and O(2) changes with fast-scan cyclic voltammetry in the striatum as indices of changes in metabolism and blood flow in vivo in three Macaca mulatta monkeys during reward-based behaviors. Specifically, the animals were presented with Pavlovian conditioned cues that predicted different probabilities of liquid reward. They also received free reward without predictive cues. The primary detected change consisted of pH shifts in the striatal extracellular environment following the reward predicting cues or the free reward. We observed three types of cue responses that consisted of purely basic pH shifts, basic pH shifts followed by acidic pH shifts, and purely acidic pH shifts. These responses increased with reward probability, but were not significantly different from each other. The pH changes were accompanied by increases in extracellular O(2). The changes in pH and extracellular O(2) are consistent with current theories of metabolism and blood flow. However, they were of sufficient magnitude that they masked dopamine changes in the majority of cases. The findings suggest a role of these chemical responses in neuronal reward processing.
HubMed – addiction



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Rumor mill: Jesse Jackson Jr. in rehab?

Filed under: Addiction Rehab

Jesse Jackson Jr.'s month-long absence from Congress is due an alcohol addiction. Jackson's office, however, is denying the rehab rumors and claims the Illinois congressman is suffering from a “mood disorder.” All parties seem to agree that Jackson is …
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Andy Dick Enters Rehab After Staged Intervention

Filed under: Addiction Rehab

This isn't Dick's first time in rehab. His battle with addiction has been playing out in the tabloids for years, and he appeared on VH1's "Celebrity Rehab with Dr. Drew" and a 2009 spinoff show called "Sober House," where Dick publicly swore he would …
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