INTRODUCTIONInjecting drug abusers are vulnerable to many infectious complications. We describe a case of tetanus in a Singaporean who regularly abused buprenorphine.

CLINICAL PICTUREA 49-year-old male was hospitalised for progressive generalised spasms associated with dysarthria and opisthotonus. Tetanus was diagnosed clinically.

TREATMENTSupportive management was instituted in the intensive care unit (ICU). Toxicology samples tested positive for buprenorphine.

OUTCOMEHe recovered rapidly and was transferred out of the ICU after 8 days. Retrospective questioning confirmed parenteral abuse of buprenorphine.

CONCLUSIONThis case highlights an uncommon and potentially lethal complication of parenteral drug abuse.

Buprenorphine ; Disease Progression ; Dysarthria ; Humans ; Male ; Middle Aged ; Singapore ; Substance Abuse, Intravenous ; Substance-Related Disorders ; complications ; Tetanus ; diagnosis ; etiology ; therapy

Blood surveys on narcotic addicts in the asylums in Korea were carried out from 1959 to 1962, of 3,991 smears collected from addicts, 13 were found to be positive for P. vivax, 23 positive for P. falciparum and 1 positive for P. malarace. All positive cases for malaria parasites were found in the Seoul Narcotic Asylum. The possibility of transmission of malaria parasites through either mosquitos or artificial ways is discussed. The transmission of P. falciparum and P. malariae malaria among addicts would occur probably by the indiscriminate use of congealed syringes and needles and not by the infected anopheline mosquitos. The decreasing in number of positive cases infected with malaria parasites among addicts appeared to be due to the effectiveness of drug administration. In addition, the blood survey on the applicants for the blood donor service in Seoul was carried out monthly from August 1961 to December 1962 and one positive smear in P. vivax out of 7.091 was found.
Adult ; Human ; Korea ; Malaria/*etiology ; Middle Aged ; Substance-Related Disorders/*complications ; *Syringes

The link between toxic hepatitis and exposure to organic solvents is relatively well-documented, but there are no specific laboratory or histologic findings diagnostic of chemical-induced hepatitis. Clinical history, therefore, is very important in making a diagnosis. A history of glue sniffing is sometimes overlooked and glue sniffing has not received much attention as a cause of hepatitis. Toluene, a main organic solvent in glue, is known to cause disturbances in various organs such as the heart, nervous system, liver and kidneys. We present a case of hepatitis in an individual who has sniffed glue for euphoria for 3 years. There is an increasing tendency towards glue sniffing among young adolescents today, so toxicity caused by exposure to organic solvents should be considered as one possible cause of hepatitis in young adolescents.
Adhesives ; Adult ; English Abstract ; Hepatitis, Toxic/*etiology ; Humans ; Male ; Substance-Related Disorders/*complications ; Toluene

Child, Preschool ; Constipation ; therapy ; Female ; Humans ; Infant ; Male ; Musculoskeletal Manipulations ; Substance-Related Disorders ; complications

OBJECTIVEThis study examined the gender differences in drug-related problems and predictors of recidivism among a sample of 1444 offenders with co-morbid drug abuse and mental disorders participating in California's Proposition 36 Program.

METHODSBackground characteristics and problem severity in multiple key life areas were assessed at intake by using Addiction Severity Index, and drug treatment participation, mental health diagnoses and arrests were based on official records.

RESULTSWomen demonstrated greater problem severity than men in family relationships, health, psychological health, and sexual and physical abuse history. Men on the other hand had greater criminal history, high rates of attention disorder, and psychotic disorder. More men than women were rearrested during the year after treatment admission. Logistic regression analyses showed that for the combined sample, male, young age, cocaine use (relative to methamphetamine), drug abuse severity, methadone treatment, arrest history and fewer prior treatment history were associated with higher recidivism at 12-month follow-up; lower education, cocaine use, and arrest history were related to women's recidivism, while young age, outpatient treatment, and arrest history were predictors of men's recidivism.

CONCLUSIONAlthough the specific type of mental disorder did not seem to be predictive of recidivism, the high rates of mental health disorder and arrest of this population is problematic. Intervention strategies taking into consideration gender-specific problems and needs can improve outcomes for both.

Adolescent ; Adult ; Crime ; Female ; Humans ; Male ; Mental Disorders ; complications ; Middle Aged ; Recurrence ; Sex Factors ; Substance Abuse Treatment Centers ; Substance-Related Disorders ; complications ; Treatment Outcome ; Young Adult

Adult ; Female ; Humans ; Ketamine ; adverse effects ; Kidney ; drug effects ; physiopathology ; Kidney Diseases ; chemically induced ; complications ; Substance-Related Disorders ; complications

BACKGROUNDFollowing the increased human immunodeficiency virus (HIV) notification (infection) rates via sexual transmission and increased abuse of new synthetic drugs instead of heroin in China, a study on HIV infections and risk factors among synthetic drugs and heroin users in Beijing was conducted to provide a cue for further development of targets and strategies of HIV/AIDS control and prevention for different drug populations.

METHODSA total of 428 subjects including 224 heroin users and 204 new synthetic drug users was recruited from communities in Beijing by convenience sampling. A χ(2) test was used to compare HIV and syphilis infections between the two subpopulations. Logistic regression models were used to evaluate factors related to HIV, syphilis infections and abuse of synthetic drugs.

RESULTSUnbalanced distributions of demographics were detected between the two subpopulations. Compared with heroin users, most users of synthetic drugs were migrants, single and of younger age (age ≤ 30 years). Ten HIV infections and twenty-four syphilis infections were confirmed among 428 subjects. No significant difference in HIV infection was found between the two subpopulations (crude odds ratio (OR) = 0.46, 95% confidence interval (CI): 0.07 - 15.80 and adjusted odds ratio (AOR) = 1.26, 95%CI: 0.09 - 18.28) while four times as many syphilis infections were identified among users of synthetics drugs (AOR = 3.92, 95%CI: 1.06 - 14.56). HIV and syphilis infections appeared to work synergistically. The migrants who were of Han ethnicity, single and who had stayed in Beijing for more than six months were more likely to abuse synthetics drugs.

CONCLUSIONSThe new synthetic drug users and heroin users are different subpopulations. We optimistically speculate that HIV has not yet been introduced into the former in Beijing, but considering higher syphilis infections in synthetic drug users and the role of syphilis in HIV infection, synthetic drug users, as a possible and important driver of the HIV/AIDS epidemic in Beijing, should be paid more attention in HIV prevention and control strategies.

Adult ; China ; epidemiology ; Drug Users ; Female ; HIV Infections ; epidemiology ; prevention & control ; Heroin Dependence ; complications ; Humans ; Logistic Models ; Male ; Middle Aged ; Pilot Projects ; Substance-Related Disorders ; complications ; Syphilis ; epidemiology

Adult ; Buprenorphine ; adverse effects ; Disease Progression ; Humans ; Male ; Narcotics ; adverse effects ; Soft Tissue Infections ; chemically induced ; diagnosis ; etiology ; Substance Abuse, Intravenous ; complications ; Substance-Related Disorders ; complications ; diagnosis ; Vascular Diseases ; chemically induced ; diagnosis ; etiology

Geriatric patients are vulnerable to stress associated with surgery. The preoperative assessment of elderly patients plays an important role in their perioperative care, in terms of risk identification, preoperative optimization, and the avoidance of postoperative complications. The preoperative assessment of geriatric patients may require multidisciplinary consultation and include a consideration of neurocognitive function, functional status, frailty, nutrition, substance abuse, polypharmacy, and decision-making capacity, as well as a meticulous evaluation of comorbidities. Preoperative laboratory tests should be ordered after a review of the medical charts, history, and physical examination. Any abnormal findings should be well documented. Cardiac and pulmonary complications are common in elderly patients. Risk identification according to surgical invasiveness, the continuation or cessation of medication, and preoperative risk-reduction strategies should be considered. Renal function should be evaluated and the dosage of medications should be adjusted based on the glomerular filtration rate, not serum levels of creatinine alone. Postoperative cognitive dysfunction, delirium, frailty, functional dependence, malnutrition, and polypharmacy are associated with poor postoperative outcomes; risk factors should be screened for and corrected preoperatively, if possible. Delays in the operation and prolonged operative times increase morbidity. Despite its importance, there are still no standardized preoperative assessment guidelines for Korean geriatric patients. Further studies should evaluate the clinical impact and cost-effectiveness of a preoperative geriatric assessment targeting the actual medical environment of Korea. Medical conditions should be optimized and proactive risk-reduction strategies should be used as part of a comprehensive preoperative assessment to improve surgical outcomes while avoiding a functional decline after surgery.
Aged ; Comorbidity ; Creatinine ; Delirium ; Geriatric Assessment ; Glomerular Filtration Rate ; Humans ; Korea ; Malnutrition ; Operative Time ; Perioperative Care ; Physical Examination ; Polypharmacy ; Postoperative Complications ; Risk Factors ; Substance-Related Disorders

Adult ; Anti-Bacterial Agents ; adverse effects ; Female ; Humans ; Laryngeal Diseases ; etiology ; microbiology ; Mycosis Fungoides ; etiology ; Prescription Drug Misuse ; Substance-Related Disorders ; complications ; Young Adult