Single high-dose buprenorphine for opioid craving during withdrawal.

BackgroundOpioid use disorder is one of the most prevalent addiction problems worldwide. Buprenorphine is used as a medication to treat this disorder, but in countries where buprenorphine is unavailable in combination with naloxone, diversion can be a problem if the medication is given outside a hospital setting.ObjectiveThe objective of this research is to evaluate the effect of a single, high dose of buprenorphine on craving in opioid-dependent patients over 5 days of abstinence from use of other opioids. The primary goal was to determine the safety and efficacy of buprenorphine during withdrawal in a hospital setting.MethodsNinety men who used opium, heroin, or prescribed opioids and met DSM-5 criteria for opioid use disorder (severe form) were randomized to three groups (n = 30 per group) to receive a single, sublingual dose of buprenorphine (32, 64, or 96 mg). The study was conducted in an inpatient psychiatric ward, with appropriate precautions and monitoring of respiratory and cardiovascular measures. Buprenorphine was administered when the patients were in moderate opiate withdrawal, as indicated by the presence of four to five symptoms. A structured clinical interview was conducted, and urine toxicology testing was performed at baseline. Self-reports of craving were obtained at baseline and on each of the 5 days after buprenorphine administration.FindingsCraving decreased from baseline in each of the three groups (p < 0.0001), with a significant interaction between group and time (p < 0.038), indicating that groups with higher doses of buprenorphine had greater reduction.ConclusionsA single, high dose of buprenorphine can reduce craving during opioid withdrawal; additional studies with follow-up are warranted to evaluate safety

Surgical implications of magnetic resonance-enhanced dura

Journal ArticleTHE PURPOSE OF this study was to assess tissue changes responsible for dural enhancement on magnetic resonance imaging (MRI) and its clinical implications. A prospective surgical, histopathological, and MRI study was performed in 7 3 patients with various types of disease, including meningiomas (n = 29), craniofacial tumors with possible direct intracranial extension (n = 2 1), gliomas and brain metastasis in close proximity to the dura mater (n = 9), and a variety of nonneoplastic processes (n = 1 4). Contrast-enhanced MRI was obtained within 5 days before surgery and in some cases within 3 days after surgery as well. Histopathological examination of the dural specimens was performed in all 59 patients with neoplasia and in selected patients with nonneoplastic processes. Dural invasion was noted in 1 8 of 29 meningiomas, 1 5 of 21 craniofacial neoplasms, 3 of 5 gliomas, and 3 of 4 brain metastases. In these patients invasion was focal and in direct continuity with the tumors. MRI disclosed that dura invaded by the tumor had a break in the continuity of enhancement, or that there was no discernible enhancement. Association between patterns of dural enhancement and tumor invasion of dura was statistically significant (P < 0.001) . The thickened-enhanced portion of the dura represented reactive changes. Postoperative enhancement was seen as early as 24 hours after surgery and as shown histologically to be associated with vasodilation and reactive changes. Conclusions from this study are: 1) dural enhancement is a nonspecific reaction and may be seen in association with many pathological conditions; 2) a fairly uniform "enhanced dura" adjacent to a tumor correlated with a dural inflammatory reaction, whereas discontinuous enhancing dura indicated dural invasion; 3) a few false-negative cases of dural invasion (one extracranial and four intracranial neoplasms) underscore that there are some limitations of contrast-enhanced MRI in predicting dural invasion by adjacent neoplasms

Two mistaken beliefs about suicide

Suicide has been known in all cultures, every region and ethnic group. Throughout history, the first recorded suicides were committed by Pyramus and Thisbe, who were lovers that died in Babylonia, Persia, around 2000 BC

Uncertainty management in multiobjective hydro-thermal self-scheduling under emission considerations

In this paper, a stochastic multiobjective framework is proposed for a day-ahead short-term Hydro Thermal Self-Scheduling (HTSS) problem for joint energy and reserve markets. An efficient linear formulations are introduced in this paper to deal with the nonlinearity of original problem due to the dynamic ramp rate limits, prohibited operating zones, operating services of thermal plants, multi-head power discharge characteristics of hydro generating units and spillage of reservoirs. Besides, system uncertainties including the generating units\u27 contingencies and price uncertainty are explicitly considered in the stochastic market clearing scheme. For the stochastic modeling of probable multiobjective optimization scenarios, a lattice Monte Carlo simulation has been adopted to have a better coverage of the system uncertainty spectrum. Consequently, the resulting multiobjective optimization scenarios should concurrently optimize competing objective functions including GENeration COmpany\u27s (GENCO\u27s) profit maximization and thermal units\u27 emission minimization. Accordingly, the ε-constraint method is used to solve the multiobjective optimization problem and generate the Pareto set. Then, a fuzzy satisfying method is employed to choose the most preferred solution among all Pareto optimal solutions. The performance of the presented method is verified in different case studies. The results obtained from ε-constraint method is compared with those reported by weighted sum method, evolutionary programming-based interactive Fuzzy satisfying method, differential evolution, quantum-behaved particle swarm optimization and hybrid multi-objective cultural algorithm, verifying the superiority of the proposed approach

Recurrent cannabis-induced catatonia: a case report and comprehensive systematic literature review

BackgroundCatatonia presents itself as a complex neuropsychiatric syndrome, giving rise to various motor, speech, and behavioral challenges. It is noteworthy that approximately 10% of psychiatric hospital admissions can be attributed to this condition. It is imperative to note that cannabis-induced catatonia, while infrequent, has been linked to the use of marijuana. This connection has the potential to disrupt neurotransmitter systems, necessitating further research for a comprehensive understanding and effective treatment, particularly given the evolving trends in cannabis use. In this context, we shall delve into a unique case of recurrent cannabis-induced catatonia.Case presentationA 23-year-old gentleman, who has previously struggled with substance use disorder, experienced the emergence of mutism, social isolation, and a fixed gaze subsequent to his use of cannabis. Remarkably, despite the absence of hallucinations, he exhibited recurrent episodes of catatonia. These episodes were effectively addressed through a combination of electroconvulsive therapy (ECT) and lorazepam administration. Notably, when the lorazepam dosage was gradually reduced to below 2 mg per day, the catatonic symptoms resurfaced; however, they promptly abated upon reinstating the medication. The diagnosis of cannabis-induced catatonia was established, and its management primarily involved a therapeutic approach encompassing ECT and lorazepam. It is pertinent to underscore that this catatonic condition can be directly linked to the individual’s cannabis usage.ConclusionThe connection between cannabis and catatonia is intricate and not entirely comprehended. Although cannabis possesses therapeutic advantages, it can paradoxically trigger catatonia in certain individuals. Multiple factors, such as genetics, cannabinoids, and neurotransmitter systems, contribute to this intricacy, underscoring the necessity for additional research

Early CT detection of intracranial seeding from medulloblastoma

Since 1975, intracranial subarachnoid metastases of medulloblastoma have been detected in seven of 23 initial contrast-enhanced computed tomographic (CT) scans in children with proven medulloblastoma. Furthermore, four of the seven cases with subarachnoid seeding were diagnosed after the introduction of high-resolution contrastenhanced CT. Only three cases of seeding had been detected in the previous 17 lowresolution cases studied with CT. Thus, it is quite likely that the incidence of subarachnoid metastases may be substantially more than the overall figure of 30% indicated by this series. This may have an impact on the treatment of these patients, since the frequent appearance of metastases may indicate the need for more vigorous chemotherapeutic regimens. One should be aware of the possibility of early intracranial subarachnoid seeding and that it can be demonstrated by contrast-enhanced CT. This is particularly true when using high-resolution scanners in conjunction with 5 mm sections through the posterior fossa . At the Childrens Hospital of Los Angeles , medulloblastoma is the most common posterior fossa brain tumor Materials and Methods We retrospecti vely reviewed surgically proven cases of medullobl astoma at Childrens Hospital of Los Angeles between 1975 and September 1983 . Since 1975 . when an EMI scanner was installed at this institution . 23 cases of medulloblastoma have been diagnosed with the aid of an initial CT scan . Several other cases either had no ini tial CT , or the initial record s could not be retrieved. The 23 cases that were available for review were scruti ni zed for evidence of subarachnoid seeding of tu mor . The primary criterion of metastases was subarachnoid enhancement on the postcontrast scan. An area of increased density on the precontrast scan and obliteration of the subarachnoid space were also considered manifestations of metastases. The scanning procedure recommended with high-resolution CT machines includes 5 mm slices through the posterior fossa before and after infusion of contrast material. Conray 60 was admini stered by drip infusion at the rate of 2 ml/ kg . It should be mentioned that this protocol was not in use during the earlier phases of this retrospective survey (before the introduction of high-resolution scanning)

Investigating the sequential patterns of methamphetamine use initiation in Iran

BACKGROUND: Methamphetamine (MA) remains one of the most commonly used amphetamine-type stimulants, accounting for the second most widely-used substance after marijuana. Due to increased use of MA, a wide variety of research has focused on the patterns of MA use initiation among adolescents. Nevertheless, there are few data available for people who use MA. The present study set out to assess the sequential patterns of substance use initiation in patients with MA use disorders in Iran. MATERIALS AND METHODS: This cross-sectional study described substance initiation patterns for 302 patients who used MA admitted to hospitals and psychiatric centers of Shiraz University of Medical Sciences. The study was conducted between April 2015 and June 2016. After obtaining informed consents, participants were interviewed by trained interviewers using face-to-face, semi-structured interviews. The collecting data were analyzed using the chi square tests and one-way analysis of variance (ANOVA) tests to compare the relationship between qualitative and quantitative variables, respectively. RESULTS: Out of 302 participants enrolled in the study, 16 (5.3%) and 286 (94.7%) were female and male, respectively. The mean age of participants in the study was 37.29 years. The mean age of onset of MA use was found to be 15.9 years. 46.1% of the patients started MA use before 15 years. 77.2% of the patients who used MA had family members with a history of substance use. 93.71% of the patients who used MA started substance use with tobacco, alcohol, or opium, as the most frequent substances. Tobacco, as the first substance or starting substance, exhibited the most widely-used substance (69.53% of the cases). Tobacco-alcohol-cannabis-opium-heroin-MA sequencing was significantly related to the early onset of the substance use. Early-onset substance use was significantly higher in those with lower income, primary education, and family history of substance use. No significant relationship was found between employment status with the age of onset of substance use, and different substance use with marital status. CONCLUSION: Tobacco, alcohol and opium can be considered as the main sequencing substances for initiation to MA use. Standardized measures to decrease and control access to main starting and sequencing substances, including tobacco, alcohol, and opium, can greatly help decrease the early onset of the MA use, develop suitable prevention, and establish early intervention strategies

Sleep patterns and habits in high school students in Iran

<p>Abstract</p> <p>Background</p> <p>Sleep patterns and habits in high school students in Iran have not been well studied to date. This paper aims to re-address this balance and analyse sleep patterns and habits in Iranian children of high school age.</p> <p>Methods</p> <p>The subjects were 1,420 high school students randomly selected by stratified cluster sampling. This was a self-report study using a questionnaire which included items about usual sleep/wake behaviours over the previous month, such as sleep schedule, falling asleep in class, difficulty falling asleep, tiredness or sleepiness during the day, difficulty getting up in the morning, nightmares, and taking sleeping pills.</p> <p>Results</p> <p>The mean duration of night sleep was 7.7 h, with no difference between girls, boys, and school year (grade). The mean time of waking in the morning was not different between genders. About 9.9% of the girls and 4.6% of the boys perceived their quality of sleep as being bad, and 58% of them reported sleepiness during the day. About 4.2% of the subjects had used medication to enhance sleep. The time of going to bed was associated with grade level and gender. Sleep latency was not associated with gender and grade leve, l and 1.4% experienced bruxism more than four times a week.</p> <p>Conclusion</p> <p>Our results are in contrast with that of previous studies that concluded sleep duration is shorter in Asia than in Europe, that boys woke-up significantly later than girls, and that the frequency of sleep latency category was associated with gender and grade level. The magnitude of the daytime sleepiness, daytime sleepiness during classes, sleep latency, and incidences of waking up at night represent major public health concerns for Iran.</p

Clinical Breast Cancer Registry of IR. Iran (CBCR-IR):Study Protocol and First Results

BACKGROUND: Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country.METHODS: We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards.RESULTS: We registered 13086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients.CONCLUSION: The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.</p