Right Inguinal Varicose Vein in Connection with Femoral Vein Following Intravenous Drug Abuse: A Rare Radiologic Finding

Varicose veins are enlarged, protuberant superficial veins that are palpable beneath the skin. The causes of such a venous pathology may be primary, secondary, or congenital. The major agents leading to the development of varicose veins include: Hereditary, prolonged standing, Increasing age, Heavy lifting, Prior superficial or deep vein clots, Female gender and Multiple pregnancies. In this manuscript, we report a case of inguinal varicose vein in connection with femoral vein, resulted from direct intravenous injection of drug. The diagnosis was made based on Doppler sonography.

Delirium in Patients with Substance Abuse: A Case-Series

Severe agitation in patients with delirium may be difficult for clinicians’ management because of problems of differential diagnosis and treatment. Regrettably, theory and guidelines concerning this issue may fail to cover the incredible complexity of clinical practice. Our aim is to describe three cases of delirium from our real-life clinical experience, with a specific focus on their complexity as far as differential diagnosis and psychopharmacological treatment are concerned. In clinical practice, as shown by the three cases we describe, the etiology of delirium is various and mixed, lab analysis are not specific and it is not possible to exactly assess which kind of substances were used by patients. New drugs and smart drugs are not yet detectable by our urine analysis, and their effects, interaction with prescription drugs and pharmacokinetics are not well known. With the aim to obtain a successful sedation and to calm the patient, in our cases, we needed to use a pharmacological combined approach (benzodiazepines, first and second generation antipsychotics) with different routes of administration and, when inevitable, physical restraint.

Experience of Drug Abusers Participating in Community-Based Drug Rehabilitation Services Provided by the Counselling Centres for Psychotropic Substance Abusers (CCPSAs) in Hong Kong

Despite the official statistics showing that the number of drug users has been declining, the problem of drug abuse remains serious in Hong Kong. This problem is evidenced by the trend of hidden and prolonged drug abuse. The recovery of drug abusers is an important process, because the misuse of drugs can cause many bio-psycho-social complications. Therefore, 11 Counselling Centres for Psychotropic Substance Abusers (CCPSAs) in different districts in Hong Kong play an important role on those drug abusers [1]. As a core community-based drug rehabilitation service in Hong Kong, studies about CCPSAs are limited. This study uses a descriptive qualitative approach to explore the experience of drug abusers participating in community-based drug rehabilitation services provided by CCPSAs. Five CCPSA users, who utilized the services for more than two months, participated in the semi-structured face-to-face interviews. Data collected were then analysed by thematic analysis, and five themes were generated: 1) receiving supportive counselling service in CCPSAs, 2) revealing variance towards nonmandatory services in CCPSAs, 3) encountering intrapersonal conflicts when participating in CCPSAs, 4) expanding social network through integration in group activities and 5) wishing to be a companion to other drug abusers. Findings of this study provide valuable insights towards services modification and the enhancement of drug rehabilitation and drug abusers’ wellbeing over the collaboration of healthcare workers, services providers and the media. However, this study has some limitations, and it presents suggestions for future research.

Endogenous Klebsiellapneumoniae endophthalmitis associated with intravenous drug abuse

Enndogenous endophthalmitis （EE） accounts for 2%- 15% of endophthalmitis cases;j EE may occur when microorganisms from remote infection site enter into the eye by crossing the blood-ocular barrier and reproduce in the eye. It is well known that EE often occurs secondary to systemic underlying condition, such as diabetes mellitus,

Suicide Ideation and Its Associated Factors among Men in Selected Compounds of Lusaka, Zambia

Background: Globally, it is estimated that more than 800,000 individuals die by suicide each year, making suicide one of the biggest causes of death worldwide. Additionally, suicide kills far more males than women, more so in developing regions that are characterized by economic distress due to low income. Although the number of suicide cases has been seen to increase from 2013 to date, limited studies provide information on the factors influencing the trend. Therefore, this study aimed at investigating the prevalence of suicidal ideation and factors associated with suicide in males in selected compounds of Lusaka. Methods: The study used an analytical quantitative cross- sectional study design that involved 367 men in Mtendere and Kaunda Square townships in Lusaka district, Zambia. A structured questionnaire was used to collect data from participants, which was analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. The Chi-square, Fisher’s exact test and Wilcoxon rank sum tests were used to test relationships among variables at a five percent level of significance. Ethical approval and clearance was obtained from the National Health Research Authority. Results: Participants had a median age of 29 years (IQR, 27 - 32 years), 216 (58.9%) were single and 278 (75.8%) attained tertiary education. Under a quarter, 75 (20.4%) reported suicide ideations, and 97 (26.4%) reported low social support. For most participants, 347 (94.7%) experienced at least one stressful life event, and 359 (97.8%) experienced severe levels of stress. Under half, 170 (46.3%) were alcohol dependent, while 54 (14.7%) used alcohol harmfully. Suicide ideation was significantly associated with marital status (p Conclusion: Suicide ideation is relatively high among men in Mtendere and Kaunda Square townships, mainly influenced by marital status, education level, social support, stressful events alcohol abuse. Efforts must be channeled towards suicide awareness campaigns, and establishment of supportive environments in health facilities which can make it easy for men to open up about their struggles.

氯胺酮滥用对长期依赖者认知功能影响的Meta分析

为研究氯胺酮滥用对长期依赖者认知功能的影响,在线检索了PubMed、Cochrane Library、Web of Science英文数据库,中国知网和万方数据平台中文数据库,检索日期截至2022年1月。两名研究者各自独立提取文献信息,提取数据后应用Stata 14.0软件计算标准化均数差(standardized mean difference,SMD),95%可信区间(95%confi dence interval,95%CI)以及异质性。结果显示,最终符合标准的研究有8项,其中观察组285例,健康对照组345例。Meta分析结果表明,与健康对照组相比,氯胺酮滥用损害依赖者的认知处理速度(SMD=-1.16,95%CI:-1.48~-0.83,z=7.05,P<0.001)、言语记忆(SMD=-0.72,95%CI:-1.22~-0.22,z=-2.803,P=0.005)、视觉记忆(SMD=-0.70,95%CI:-1.18~-0.23,z=-2.890,P=0.004),且差异有统计学意义;而对于工作记忆(SMD=-0.05,95%CI:-0.66~0.55,z=0.18,P=0.859)和执行能力(SMD=0.19,95%CI:-0.27~0.66,z=0.81,P=0.418)的影响无统计学差异(P>0.05)。该结果说明,氯胺酮长期滥用可以显著损害依赖者的认知处理速度、言语记忆和视觉记忆,但未发现其对工作记忆与执行能力有显著作用。

Work as An Effective Intervention Strategy and Rehabilitation Treatment Program for People Who Abuse Drugs And Alcohol

Despite years of interventions in the United States, substance abuse continues to be a major national problem in our society. For individuals affected, it can constitute a major disability and a decrease in quality of life. Current American societal expectations are that individuals who identify!they are involved in substance abuse will go to treatment, eventually recover, get off public assistance straightaway, and return to work. Most rehabilitation professionals also maintain the same expectations. The reality is that efforts of prevention do not appear to diminish the number of people with substance abuse. Traditional treatment appears to have minimal, if any, influence upon the cessation of substance abuse, and traditional vocational rehabilitation practices appear unsuited for the unique problems and types of symptoms experienced by substance abusers. Creative, yet sound, alternatives that combine effective treatment strategies and non-traditional vocational rehabilitation methods need to be exqlored and tested for effectiveness, and applied.

HCV and HIV Infection among Heroin Abusers in a Methadone Maintenance Treatment Program

Over the years, it was getting attention to hepatitis C virus (HCV) and human immu-nodeficiency virus (HIV) infection among injected drug users (IDUs) in Taiwan. This study investigated the frequency of risky behaviors for HCV carriers and IDUs who were HIV carriers in methadone maintenance treatment program. The subjects, intravenously injected heroin abusers, were collected from a special methadone maintenance treatment clinic. The survey included characteristics of participants, sexual activity and attitude towards condom usage. The total number of subjects was 151. Data were analyzed using the statistical package SPSS 15.0. The analytical methods included descriptive analysis, Fisher’s exact test, and the logistic regression model. The study showed that 82% of intravenously injected heroin abusers were hepatitis C virus (HCV)-positive, and 44.4% were hepatitis B virus (HBV)-positive;89.5% of HIV-positive heroin abusers were type C hepatitis positive. Only 21.2% of these intra-venously injected heroin abusers always used a condom, and 39.7% never used a condom during sexual activity. Logistic regression analysis showed smoking, sharing syringes needles, HBV status and condom use status were four main risk factors on HIV infection. Sharing or using contaminated syringes needles was the main cause of HIV, HBV, and HCV infection in the drug addiction group. Since our government has the policy of providing a methadone maintenance treatment program, the spread of HIV is under control, but knowledge about HIV and safe sex education still needs improvement.

Acupuncture treatment of substanceinduced psychosis, addiction and pain: A review with case study

Substance-induced psychosis is an extreme mental disorder that is relevant to up to 25%of individuals presenting with first episode of psychosis.One out of three of those continuing the drug abuse will have a recurrent psychosis.In order to treat the psychosis and prevent recurrent drug abuse which might lead to another psychosis,the therapist should understand all parts of the process leading up to psychosis,including the root causes for the drug abuse and the addiction,the effect of the drugs on the body and the psychosis itself.This article reviews substance-induced psychosis and the process leading to the abuse,the addiction and the psychosis from both Western and traditional Chinese medicine and includes three case studies of patients with acute psychosis who were treated successfully.

基于年龄-时期-队列模型的中国物质使用障碍疾病负担及预测研究

目的分析1990—2019年中国物质使用障碍(SUD)的发病和疾病负担情况,评估不同年龄、时期和出生队列对SUD疾病负担的影响,并预测2020—2034年SUD的疾病负担情况,为SUD的预防提供参考。方法利用2019全球疾病负担研究数据库,通过发病率、过早死亡损失寿命年(YLLs)、伤残损失寿命年(YLDs)和伤残调整寿命年(DALYs)等指标描述疾病负担,采用Joinpoint回归模型分析SUD标化发病率、标化DALYs率的变化趋势,基于年龄-时期-队列模型探讨SUD发病率及疾病负担的年龄、时期和队列效应。采用灰色预测模型GM(1,1)对SUD的发病率及疾病负担趋势进行拟合,同时预测2020—2034年SUD的发病率及疾病负担。结果1990—2019年中国苯丙胺类药物[平均年度变化百分比(AAPC)=-0.9%]、可卡因(AAPC=-0.5%)SUD标化发病率呈下降的趋势(P<0.001),大麻(AAPC=0.9%)SUD标化发病率呈逐年上升的趋势(P<0.001),阿片类药物SUD标化发病率变化趋势不明显(P>0.05)。这4种SUD造成的DALYs率均呈现逐年降低的趋势(AAPC_(苯丙胺类药物)=-2.2%、AAPC_(可卡因)=-1.5%、AAPC_(大麻)=-1.0%、AAPC_(阿片类药物)=-1.0%,P<0.001)。年龄-时期-队列效应结果显示,苯丙胺类药物、可卡因、大麻、阿片类药物SUD的发病峰值均在25~30岁组。大麻SUD造成的DALYs率随着年龄的增长而逐渐增加,而苯丙胺类药物、可卡因类、阿片类药物SUD的DALYs率分别在25~29岁、30~34岁、35~39岁组达到峰值。时期结果显示,苯丙胺类药物、可卡因、大麻SUD的发病风险呈现先降低后上升的趋势,阿片类药物SUD发病风险呈先升高后降低然后又升高的趋势。出生队列效应结果显示,苯丙胺类药物、可卡因、阿片类药物SUD的发病风险除个别出生队列出现小幅度波动外,整体上呈现逐渐降低的趋势;苯丙胺类药物、可卡因、阿片类药物SUD造成的DALYs率风险整体上呈现逐渐降低的趋势,而大麻SUD造成的DALYs率风险呈现逐年升高的趋势。预测结果显示2020—2034年苯丙胺类药物、可卡因、阿片类药物SUD的发病率呈下降趋势,大麻SUD的发病率呈波动上升的趋势。归因于苯丙胺类药物、可卡因、大麻及阿片类药物SUD的DALYs呈逐年下降的趋势。结论中国SUD疾病负担未来呈逐年下降的趋势,其发病率和疾病负担均不同程度地受年龄效应、时期效应及队列效应的影响,早期预防和有效干预是控制SUD的关键措施。

Brain reward circuitry:The overlapping neurobiology of trauma and substance use disorders

Mental health symptoms secondary to trauma exposure and substance use disorders(SUDs)co-occur frequently in both clinical and community samples.The possibility of a shared aetiology remains an important question in translational neuroscience.Advancements in genetics,basic science,and neuroimaging have led to an improved understanding of the neural basis of these disorders,their frequent comorbidity and high rates of relapse remain a clinical challenge.This project aimed to conduct a review of the field’s current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD.A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders,and is summarized in detail,including evidence from both animal and clinical studies.Upon summarizing the relevant literature,this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues.It provides an overview of brain reward circuitry and its relation to the neurobiology,symptomology,and phenomenology of trauma and substance use.This review provides clinical insights and implications of the proposed theory,including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology.Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.

Early Life Stress as Factor for Use of Psychoactive Substances: Integrative Review

Purpose: To identify, analyze and synthetize the scientific evidences that support Early Life Stress (ELS) diagnosis using the Childhood Trauma Questionnaire (CTQ), since it assumes the use of psychoactive substances later in adolescence and adulthood. Individuals that experienced some form of childhood stress may present, in adulthood, consequences that manifest into mental disorders such as problematic use of psychoactive substances. Methods: An integrative review of the literature on the subject in the databases: PubMed, Web of Science, LILACS and Psycinfo, regards studies that have been indexed in the last ten years (2003-2014). Combination of controlled and uncontrolled factors in the use and abuse of psychoactive substances, CTQ and ELS adapted to each database. Findings: The alcohol was the most used drug by the participating subjects of these research;mostly, the use of psychoactive drugs, started when they were still in adolescence;ELS and the later use of psychoactive drugs can be found more frequently in female;the lack of internal resources for dealing with stress in adulthood after ELS occurrence may have as a consequence the use of psychoactive drugs as a coping mechanism. Conclusions: It was possible to identify scientific evidences that support the ELS diagnosis, measured by the CTQ, as a determining factor for the use and abuse of alcohol and/or other psychoactive drugs in adolescence and adulthood. Implications: Investigate the ELS as a strategy to improve the therapeutic project of patients in nursing care, which will be built based on scientific evidence, so it can be more effective.

Work and activity in rehabilitation of persons with co-occurring severe mental health difficulties and substance use problems

Background: Participating in working life is important for most peoples’ economy, self-confidence, independence, social life, and feeling of belonging. Persons with co-occurring severe mental health difficulties and substance use problems have challenges in entering working life. Objective: The aim of the study was to explore the importance of work and activity for the recovery of persons with co-occurring severe mental health difficulties and substance use problems and to determine the significant elements that aid them in getting into work and/or meaningful activities. Methods: A professional development program was conducted to explore how following-up on these persons could lead to participation in working life. The data were collected through qualitative interviews with 24 participants, and with 25 of those carrying out the follow-up. Results: The participants described the benefit from the follow-up as well. They expressed enthusiasm for work and vocational training, although they all did not obtain work. Many had a better life, with more daily structure and less substance abuse. The personal encounter between the helper and the participant was ascribed crucial importance— being respected and valued, being relied on, and being able to be honest were considered significant. Conclusions: The participants valued work and regular activities, a more structured life, decreased drug abuse, and altogether a better life. The helpers’ respect, recognition and their ability to see dignity through wretchedness?and broken agreements were important. The participants emphasized the importance of getting help for different problems from different helpers at the same time, and the providers’ interdisciplinary collaboration in teams was essential. It seems that the supported employment philosophy on speedy job seeking ought to be adapted to this target group and that prior social training may be necessary.

Perceptions of treatment among offenders with mental health problems and problematic substance use: The possible relevance of psychopathic personality traits

Substance abuse is related to re-offending, and substance abuse treatment may be effective in reducing criminal recidivism. Psychopathy, however, another factor that strongly correlates with re-offending, may be negatively associated with treatment utilization. This qualitative study explored perceptions of substance abuse treatment among offenders with mental health problems, problematic substance use, and various degrees of psychopathic personality traits. An Interpretative Phenomenological Analysis (IPA) revealed that some treatment perceptions may vary with degree of psychopathic traits. For instance, participants with low and high degrees of psychopathic personality traits had different views on treatment requirements imposed upon them. Many treatment perceptions were also similar between the two participant groups. Thus, treatment perceptions may not be explained by degree of psychopathic personality traits alone, but the presence of some particular psychopathic traits may be relevant in explaining certain treatment perceptions. The results highlight the complex relationship between the individual and the treatment system, and may give input to future studies on rehabilitation of offenders with multiple treatment needs.

Modifying current thin-film microextraction(TFME)solutions for analyzing prohibited substances:Evaluating new coatings using liquid chromatography

For identifying and quantifying prohibited substances,solid-phase microextraction(SPME)continues to arouse interest as a sample preparation method.However,the practical implementation of this method in routine laboratory testing is currently hindered by the limited number of coatings compatible with the ubiquitous high-performance liquid chromatography(HPLC)systems.Only octadecyl(C18)and polydimethylsiloxane/divinylbenzene ligands are currently marketed for this purpose.To address this situation,the present study evaluated 12 HPLC-compatible coatings,including several chemistries not currently used in this application.The stationary phases of SPME devices in the geometry of thin filmcoated blades were prepared by applying silica particles bonded with various functional ligands(C18,octyl,phenyl-hexyl,3-cyanopropyl,benzenesulfonic acid,and selected combinations of these),as well as unbonded silica,to a metal support.Most of these chemistries have not been previously used as microextraction coatings.The 48 most commonly misused substances were selected to assess the extraction efficacy of each coating,and eight desorption solvent compositions were used to optimize the desorption conditions.All samples were analyzed using an HPLC system coupled with triple quadrupole tandem mass spectrometry.This evaluation enables selection of the best-performing coatings for quantifying prohibited substances and investigates the relationship between extraction efficacy and the physicochemical characteristics of the analytes.Ultimately,using the most suitable coatings is essential for trace-level analysis of chemically diverse prohibited substances.

行政滥用职权司法审查标准的反思与完善

滥用职权作为行政行为撤销的重要根据之一,历来饱受争议。由于立法上对滥用职权的概念没有作出权威解释,学界对滥用职权标准的界分也尚无统一定论,导致审判领域对滥用职权的适用不尽如人意,泛化适用或规避使用的情形时有发生。在新行政诉讼法体系下,采用主观、客观、职权三要件相结合的标准对滥用职权进行认定,将在一定程度上提升滥用职权标准的可适用性,优化法院对行政裁量的司法控制,并为行政诉讼司法审查体系的理论完善发挥建设性作用。在涉及滥用职权和明显不当这一组概念的界分时,可以采用实质和形式分离的方法对行政行为进行审查认定,提升行政诉讼的裁判质量。

娱乐性笑气滥用致神经系统损伤的临床及预后分析

目的分析娱乐性笑气滥用致神经系统损伤的临床特点及预后,为临床诊治提供依据。方法回顾因笑气滥用而导致神经系统损伤的患者病历资料,整理患者一般资料、临床表现和体征、治疗和预后情况。结果收集到27例患者,平均年龄为(22.48±4.39)岁,接触笑气的时间为12(6,24)个月。就诊时常见的主诉为肢体麻木(70.37%)、步态不稳(40.74%)、肢体无力(37.03%),最常见的临床类型为亚急性联合变性(81.48%)和周围神经病变(18.52%)。脊髓MRI提示:脊髓病灶的出现率为59.26%,矢状位上病变多位于颈髓(93.75%),轴位上病灶多位于后索(81.25%),倒“V”征的出现率为56.25%;头颅MRI显示2例(14.29%)出现明显的皮层萎缩。主要的实验室检查异常指标为高同型半胱氨酸血症(92.59%)。停止吸食及补充维生素B12治疗后,大多数患者预后良好。结论笑气滥用导致的神经系统损伤多表现为亚急性联合变性及周围神经病,脊髓磁共振扫描病变多位于脊髓后索,如及时终止笑气吸食,大多数患者预后良好。