A Scoping Review of Home Produced Heroin and Amphetamine Type Stimulant Substitutes: Implications for Prevention, Treatment and Policy

Several home-produced substances such as krokodil and boltushka are prevalent in many Eastern European countries. Anecdotal reports of its use have been circulating in Germany and Norway; however, this has not been confirmed. Its use has also been reported by the media in the USA, although only one confirmed report of its use exists. Home-produced drugs are associated with high levels of morbidity and a number of complex health issues such as the spread of blood borne viruses, gangrene, and internal organ damage. The high incidence of HIV rates amongst people who inject home-produced substances is a public health concern. The resulting physical health consequences of injecting these crude substances are very severe in comparison to heroin or amphetamine acquired in black markets. Due to this fact and the increased mortality associated with these substances, professionals in the area of prevention, treatment, and policy development need to be cognisant of the presentation, harms, and the dangers associated with home-produced substances globally. This scoping review aimed to examine existing literature on the subject of home-produced heroin and amphetamine-type stimulant substitutes. The review discussed the many implications such research may have in the areas of policy and practice. Data were gathered through the use of qualitative secondary resources such as journal articles, reports, reviews, case studies, and media reports. The home production of these substances relies on the utilisation of precursor drugs such as less potent stimulants, tranquillizers, analgesics, and sedatives or natural plant ingredients. The Internet underpins the facilitation of this practice as recipes, and diverted pharmaceutical sales are available widely online, and currently, ease of access to the Internet is evident worldwide. This review highlights the necessity of prevention, education, and also harm reduction related to home-produced drugs and also recommends consistent monitoring of online drug fora, online drug marketplaces, and unregulated pharmacies

Screening for patients with mild Alzheimer disease using frequency doubling technology perimetry

We compared the visual field performances of patients with mild Alzheimer disease (AD) with normal subjects and detected visual field impairment attributable to the magnocellular pathway using frequency doubling technology - Matrix (FDT-Matrix). We recruited 43 patients with mild AD (mean age: 68.0±7.2 years) and 33 controls who are visually and cognitively normal (mean age: 64.1±6.4 years). All participants had at least two reliable FDT-Matrix 30-2 tests. Reliability indices, global indices (mean deviation and pattern standard deviation), and glaucoma hemifield test results were measured with FDT-Matrix. The mean test duration was significantly longer in patient group compared with controls (p=0.002). Among the reliability indices, false negatives were higher in patient group than controls (p=0.003). There were statistically significant differences in mean deviation and pattern standard deviation values (p<0.0001 and p<0.0001, respectively) and glaucoma hemifield test results (p<0.001) between the patient and the control group. Our results imply that the pathogenesis of cognitive deterioration may not only be confined to the cortical area but also to the magnocellular pathway. We underline that FDT testing can be useful for the identification of early impairment and the follow-up of patients with AD. © Informa Healthcare USA, Inc

Ischemia modified albumin and plasma oxidative stress markers in Alzheimer's disease

Objectives: The objective of this study was to determine ischemia modified albumin (IMA) and oxidant status in Alzheimer's disease (AD). Therefore, we evaluated the IMA and oxidant status by measuring serum uric acid, albumin and gamma-glutamyltransferase (GGT) in AD. Methods: The plasma albumin, uric acid, GGT and IMA levels were measured by spectrophotometric methods in 32 AD patients and 32 healthy controls. The Mini Mental Status Examination and Clinical Dementia Rating Scale were used to evaluate the cognitive functions of AD patients. Results: AD patients had significantly higher IMA levels as compared to those of the controls respectively. Uric acid concentrations were significantly decreased and GGT values were significantly increased in AD when compared with control group. Albumin levels of the patients were also compared and no significant difference was detected. Conclusion: Oxidative stress and IMA levels rise in AD. However, large prospective studies are required to understand the mechanisms leading to increased IMA levels during AD, whether preceded or not by AD. © 2013 S. Karger AG, Basel

Altered diastolic function and aortic stiffness in Alzheimer&rsquo;s disease

Ali Nazmi &Ccedil;alik,3 Kazim Serhan &Ouml;zcan,4 G&uuml;lb&uuml;n Y&uuml;ksel,2 Baris G&uuml;ng&ouml;r,1 Emre Arugarslan,1 Figen Varlibas,2 Ahmet Ekmekci,1 Damirbek Osmonov,1 Mustafa Adem Tatlisu,1 Mehmet Karaca,1 Osman Bolca,1 Izzet Erdinler1 1Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey; 2Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey; 3Department of Cardiology, Yozgat State Hospital, Yozgat, Turkey; 4Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey Background: Alzheimer&rsquo;s disease (AD) is closely linked to cardiovascular risk factors.Methods: Echocardiographic studies were performed, including left ventricular diastolic functions, left and right atrial conduction times, and arterial stiffness parameters, namely stiffness index, pressure-strain elastic modulus, and distensibility, on 29 patients with AD and 24 age-matched individuals with normal cognitive function.Results: The peak mitral flow velocity of the early rapid filling wave (E) was lower, and the peak velocity of the late filling wave caused by atrial contraction (A), deceleration time of peak E velocity, and isovolumetric relaxation time were higher in the AD group. The early myocardial peak (Ea) velocity was significantly lower in AD patients, whereas the late diastolic (Aa) velocity and E/Ea ratio were similar between the two groups. In Alzheimer patients, stiffness index and pressure-strain elastic modulus were higher, and distensibility was significantly lower in the AD group compared to the control. Interatrial electromechanical delay was significantly longer in the AD group.Conclusion: Our findings suggest that patients with AD are more likely to have diastolic dysfunction, higher atrial conduction times, and increased arterial stiffness compared to the controls of same sex and similar age. Keywords: diastolic dysfunction, atrial conduction timeA Letter to the Editor has been received and published for this article