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Maintenance Patients (maintenance + patient)

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Medical Sciences	71%

Selected Abstracts

Methadone dose and post-mortem blood concentration

DRUG AND ALCOHOL REVIEW, Issue 4 2002
Dr. JOHN R. M. CAPLEHORN
Abstract The relationship of methadone dose with post-mortem blood concentration was investigated using data collected from 1994 coronial cases in the Australian state of New South Wales. Data on 31 subjects were summarized using linear regression. The weight-adjusted methadone dose, gender, methadone maintenance treatment status and its interaction with adjusted-dose were all significant predictors of post-mortem blood methadone concentration. Data on the death of a young man from the toxic effects of three daily doses of 30mg methadone are used to give an example of a pair of observed (0.74 mg/l) and predicted (0.48 mg/l) post-mortem blood concentrations. The estimated post-mortem blood concentration for male maintenance patients is at least twice the trough plasma levels estimated from previously published studies of living maintenance patients. The estimated post-mortem blood concentration for female maintenance patients is at least three times the estimated trough level of living subjects. We conclude that post-mortem methadone redistribution is probably the principal cause of the observed differences between males and females in post-mortem blood concentrations and the differences between estimated concentrations for living and deceased subjects. [source]

Psychopathological changes and quality of life in hepatitis C virus-infected, opioid-dependent patients during maintenance therapy

ADDICTION, Issue 4 2009
Arne Schäfer
ABSTRACT Aims To examine among maintenance patients (methadone or buprenorphine) with and without hepatitis C virus (HCV) infection (i) the frequency of psychopathological symptoms at baseline and 1-year follow-up; (ii) the association between antiviral interferon (IFN) treatment and psychopathological symptoms; and (iii) to explore whether IFN therapy has an effect on 1-year outcome of maintenance treatment. Design Naturalistic prospective longitudinal cohort design. Setting A total of 223 substitution centres in Germany. Participants A nationally representative sample of 2414 maintenance patients, namely 800 without and 1614 with HCV infection, of whom 122 received IFN therapy. Measures HCV infection (HCV+/HCV - ), IFN (IFN+/IFN - ) treatment status and clinical measures. Diagnostic status and severity (rated by clinician), psychopathology (BSI,Brief Symptom Inventory) and quality of life (EQ-5D,EuroQol Group questionnaire). Findings HCV+ patients revealed indications for a moderately increased psychopathological burden and poorer quality of life at baseline and follow-up compared to HCV - patients. HCV+ patients showed a marked deterioration over time only in the BSI subscale somatization (P = 0.002), and the frequency of sleep disorders almost doubled over time (12.8% at baseline; 24.1% at follow-up; P < 0.01). IFN treatment, received by 10% of HCV+ patients, did not impair efficacy or tolerability of maintenance therapy and was associated overall with neither increased psychopathological burden nor reduced quality of life. Conclusions Findings suggest no increased risk among HCV+ patients on maintenance therapy for depressive or other psychopathological syndromes. In our patient sample, IFN treatment was not associated with increased psychopathological burden, reduced quality of life or poorer tolerability and efficacy of maintenance treatment. [source]

Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients

ADDICTION, Issue 6 2008
David M. Novick
ABSTRACT Aims Hepatitis C virus (HCV) infection is a common chronic complication of injection drug use. Methadone maintenance programs contain large numbers of patients infected with HCV. This paper reviews HCV infection with emphasis on the medical care of HCV-infected, or HCV and human immunodeficiency virus co-infected, patients on methadone or buprenorphine maintenance. Methods Literature searches using PubMed, PsycINFO and SocINDEX were used to identify papers from 1990,present on antiviral therapy for HCV in methadone maintenance patients and on liver transplantation in methadone maintenance patients. Results Injection drug use is the most significant risk factor for HCV infection in most western countries. The prevalence of HCV antibody is high in injection drug users (53,96%) and in patients enrolled in methadone maintenance programs (67,96%). Studies of antiviral therapy for HCV in methadone maintenance patients show rates of sustained virological response (SVR), defined as negative HCV-RNA 24 weeks after the end of treatment, of 28,94%. In studies with contrast groups, no significant differences in SVR between methadone and contrast groups were found. Excellent completion rates of antiviral therapy (72,100%) were found in five of six studies. There are many barriers to methadone maintenance patients' receiving antiviral therapy, and research on overcoming barriers is discussed. Liver transplantation has been successful in methadone maintenance patients but has not been utilized widely. Conclusion High quality medical care for all aspects of HCV infection can be provided to methadone maintenance patients. The literature supports the effectiveness of such services, but the reality is that most patients do not receive them. [source]

Long-term outcomes for cross-arch stabilizing bridges in periodontal maintenance patients , a retrospective study

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2010
Øystein Fardal
Fardal Ø, Linden GJ. Long-term outcomes for cross-arch stabilizing bridges in periodontal maintenance patients , a retrospective study. J Clin Periodontol 2010; 37: 299,304. doi: 10.1111/j.1600-051X.2009.01528.x. Abstract Background: Cross-arch bridges are used to stabilize teeth for patients with reduced periodontal support. Little is known about technical or biological complications, whether teeth and implants can be combined in this type of bridge and the long-term effects on tooth loss. Materials and methods: All patients treated in a specialist periodontal practice who received cross-arch stabilizing bridgework and were subsequently maintained for at least 7 years were included in the study. The patients were selected from all patients who underwent initial periodontal therapy after 1986 in a Norwegian periodontal practice. The bridges were assessed for biological and technical complications. Bridges retained by teeth or by a combination of teeth and implants were included in the study. Results: Ninety-four rigid fixed bridges (77 teeth supported, 17 teeth and implant supported) in 80 patients (46 females, 34 males) were observed for an average of 10 years (range 7,22 years). In four patients, a bridge became loose and had to be re-cemented, and in one case the metal framework of a bridge fractured and the bridge had to be remade. In total, eight abutment teeth were lost from five patients but no implant abutments were lost. Overall, a higher rate of tooth loss was observed for patients provided with stabilizing bridges compared with control maintenance patients not treated with bridgework (p<0.0001); however, the rates in both groups were very low. Conclusion: Cross-arch stabilizing bridges constructed for periodontal patients as part of their periodontal maintenance therapy had few complications and were associated with low rates of abutment tooth loss. Combining teeth and implants did not affect the performance of these bridges. [source]

Saliva concentrations of RANKL and osteoprotegerin in smoker versus non-smoker chronic periodontitis patients

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2008
Nurcan Buduneli
Abstract Objectives: To compare the salivary receptor activator of NF- ,B ligand (RANKL) and osteoprotegerin (OPG) concentrations in smokers versus non-smokers with chronic periodontitis. Material and Methods: Whole saliva samples were obtained from 67 untreated chronic periodontitis patients, of whom 34 were smokers, and from 44 maintenance patients, of whom 22 were smokers. Full-mouth clinical periodontal measurements were recorded. Saliva cotinine, sRANKL and OPG concentrations were determined by ELISA. Statistical analysis was performed using the Mann,Whitney U test, Bonferroni's correction for multiple comparisons and Spearman's correlations. Results: Untreated smokers exhibited significantly higher values of clinical periodontal recordings than untreated non-smokers (all p<0.05). Salivary cotinine level correlated with clinical attachment level (p=0.023). Smoker versus non-smoker maintenance groups showed no significant differences in clinical parameters. There were significant differences in sRANKL and OPG concentrations between untreated and maintenance groups (all p<0.01). Salivary OPG concentration was significantly lower (all p<0.01) and the sRANKL/OPG ratio was higher (all p<0.01) in smokers than in non-smokers. OPG concentration correlated positively with probing depth, clinical attachment level and bleeding on probing (all p<0.005) and negatively with pack-year, and cotinine level (p<0.05). Conclusion: Salivary RANKL and OPG concentrations are suggested to be affected by smoking as not only the untreated but also the treated smokers exhibited higher RANKL and lower OPG concentrations than non-smokers. [source]

Mutans streptococci in subgingival plaque of treated and untreated patients with periodontitis

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2001
W. A. Van Der Reijden
Abstract Background: The etiology of root caries is thought to be identical to coronal caries, though root caries seem to be more complicated because of the higher susceptibility of exposed roots (dentin) by periodontal therapy to demineralization than intact enamel. This implies that mutans streptococci are the most likely pathogens in the development of root caries. Although it is known that both the numbers of mutans streptococci and the frequency of isolation in root caries lesions are negatively correlated with the distance from the gingival margin, the subgingival sulcus has not been considered a possible habitat for mutans streptococci. However, subgingival occurence of mutans streptococci in both untreated and treated periodontal patients has not been documented well in the literature. Objective: To investigate the presence and levels of mutans streptococci in the subgingival plaque of patients (n=154) in different stages of periodontal therapy. The subgingival sulcus may be a possible habitat for mutans streptococci. This localisation of mutans streptococci may be of importance in the development of root caries after periodontal surgery. Materials and methods: In this cross-sectional study, subgingival plaque samples from 154 consecutive adult periodontitis patients were tested for presence and levels of mutans streptococci and putative periodontal pathogens by anaerobic cultures. These patients were divided into 4 groups based on their stage of periodontal treatment: (1) untreated patients; (2) patients after initial periodontal therapy only; (3) patients in the maintenance phase who not underwent periodontal surgery; (4) patients after periodontal surgery. Results: The prevalence of mutans streptococci in the 4 study groups varied from 82% in untreated patients to 94% in maintenance patients. The mean proportion of mutans streptococci was 6.65% in maintenance patients versus 1.86% in untreated patients (p=0.005) and 2.51% in patients after scaling and root planing (p=0.041). Conclusions: The subgingival area is a microbial habitat for mutans streptococci that may be of importance in the development of root caries in periodontitis patients. Zusammenfassung Hintergrund: Es wird angenommen, dass die Ätiologie der Wurzelkaries und der Kronenkaries übereinstimmen, obwohl die Entstehung von Wurzelkaries komplizierter zu sein scheint wegen der erhöhten Empfindlichkeit entblößter Wurzeln (Dentin) für Demineralisation im Vergleich zu gesundem Schmelz. Das bedeutet, dass MS die wahrscheinlichsten Pathogene für die Entstehung der Wurzelkaries sind. Obwohl bekannt ist, dass die Zahl der MS und die Häufigkeit ihres Nachweises aus Wurzelkariesläsionen negativ mit dem Abstand vom Gingivarand korrelieren, wurde die subgingivale Region bisher nicht als möglicher Lebensraum für MS erwogen. Das subgingivale Vorkommen von MS bei behandelten und unbehandelten Parodontitispatienten ist in der Literatur nicht gut dokumentiert. Die subgingivale Region könnte ein möglicher Lebensraum für MS und diese Lokalisation bedeutsam für die Entstehung von Wurzelkaries nach parodontaler Therapie sein. Zielsetzung: Untersuchung des Vorkommens und der Menge von MS in der subgingivalen Plaque von Patienten zu unterschiedlichen Zeitpunkten parodontaler Therapie. Material und Methoden: In einer Querschnittsstudie wurden subgingivale Plaqueproben von 154 Patienten mit Erwachsenenparodontitis auf das Vorkommen und den Anteil von MS und putativer Parodontalpathogene in anaerober Kultur untersucht. Die Patienten wurden nach dem Stadium der parodontalen Therapie in 4 Gruppen unterteilt: (1) unbehandelte Patienten (n=51), (2) Patienten nach abgeschlossener Initialtherapie (Mundhygieneunterweisungen sowie Scaling und Wurzelglättung [SRP]) (n=41), (3) Patienten in der unterstützenden Parodontitistherapie (UPT), die nicht parodontalchirurgisch behandelt worden waren (n=48), und (4) Patienten nach Parodontalchirurgie (n=14). Ergebnisse: Die Prävalenz der MS variierte in den 4 Untersuchungsgruppen von 82% bei unbehandelten bis 94% bei UPT-Patienten. Der mittlere Anteil der MS an subgingivaler Plaque lag bei 6.65% (UPT) im Vergleich zu 1.86% (unbehandelte Parodontitis) (p=0.005) bzw. zu 2.51% (SRP) (p=0.041) und 2.18% nach Parodontalchirurgie (n.s.) Schlußfolgerungen: Die subgingivale Region ist ein Lebensraum für MS, die eine Bedeutung für die Pathogenese der Wurzelkaries bei Patienten mit Parodontitis haben könnte. Résumé L'étiologie des caries radiculaires semble étre identique à celle des caries coronaires bien que les caires radiculaires paraîssent plus compliquées vu la susceptibilité plus importante des racines exposées (dentine) par le traitement parodontal à la même déminéralisation que ne l'est l'émail intact. Ceci a comme conséquence que les Streptocoques mutans sont vraisemblabement les pathogènes les plus problables dans le dévelopment des caries radicularies. Bien qu'il soit connu que les nombres de Streptocoques mutans autant que la fréquence de l'isolation des lésions carieuses radiculaires soient en corrélation négative avec la distance depuis la gencive marginale, le sulcus gingival n'a pas été considéré comme habitat possible pour les Streptocoques mutans. Cependant, l'occurence sous-gingivale des Streptocoques mutans chez les patients avec parodontite traitée ou non n'a pas été suffisamment documentée dans la littérature. Le but de cette étude a été d'analyser la présence et les niveaux de Streptocoques mutans dans la plaque sous-gingivale de 154 patients à différentes étapes de leur traitement parodontale. Le sillon sous-gingival pourrait dont être un habitat possible pour les Streptocoques mutans. Cette localisation peut être importante dans le dévelopment des caries radiculaires après le traitement parodontal. Dans cette étude croisée des échantillons de plaque sous-gingivale ont été prélevés chez 154 patients adultes avec parodontite pour vérifier la présence et les niveaux de Streptocoques mutans et d'autres pathogènes parodontaux putatifs par culture anaérobie. Les patients étaient divisés en 4 groupes suivant le stade de leur traitement parodontal: non-traité, traitement initial seulement, phase de maintien mais sans chirurgie, et patient après chirurgie parodontale. La fréquence globale des Streptocoques mutans dans les 4 goupes variaient de 82% chez les patients non-traités à 94% chez ceux au stade de maintenance. La proportion moyenne de Streptocoques mutansétaient de 6.65% chez les patients en maintenance versus 1.86% chez les patients non-traités (p=0.005) et de 2.51% chez les patients après détartrage et surfaçage radiculaire (p=0.041). L'aire sous-gingivale est donc un habitat microbien pour les Streptocoques mutans qui pourraient être assez importants dans le développement des caries radiculaires chez les patients souffrant de parodontite. [source]

Humoral immune response in early-onset periodontitis: influence of smoking

JOURNAL OF PERIODONTAL RESEARCH, Issue 4 2001
J. Mooney
Sixty-five patients with generalised early-onset periodontitis (G-EOP)(age range 16,42 years, 32 smokers and 33 non-smokers) were assessed for antibody titres and avidity to a panel of five suspected periodontal pathogens (Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Treponema denticola and Bacteroides forsythus). Thirty-four of these patients were untreated (17 smokers and 17 non-smokers), and thirty-one were in the maintenance phase of periodontal therapy (15 smokers and 16 non-smokers). Previous studies have investigated the effect of smoking on IgG levels in periodontitis patients in the context of the more extensive periodontal destruction seen in smokers. Based on this literature our hypothesis was that smokers would have depressed serum IgG levels directed against recognised periodontal pathogens compared with non-smokers. Antibody titres were measured by ELISA deploying fixed whole cells as coating. The IgG response was detected with biotin-anti-human IgG and avidin-peroxidase; avidity was determined by elution with ammonium thiocyanate. Median titres to A. actinomycetemcomitans, P. intermedia and T. denticola were significantly lower in maintenance patient smokers (p=0.02, 0.02 and 0.002 respectively) but not in untreated patients. Avidity to P. gingivalis was also lower in smoking maintenance patients (p=0.003) but not in untreated patients. These findings may imply some interruption of immune maturation in smokers following periodontal treatment. [source]

How common is delayed cyclosporine absorption following liver transplantation?

LIVER TRANSPLANTATION, Issue 2 2005
Silvina E. Yantorno
The mean time to peak absorption of cyclosporine (CsA) in liver transplant patients is approximately 2 hours, but in some patients the peak occurs later. The goal of this study was, therefore, to investigate the incidence of delayed absorption in 27 de novo liver transplant recipients receiving CsA ,10 mg/kg/day (C2 monitoring) and in 15 maintenance patients. Patients were categorized as ,normal' absorbers (C2 exceeding C4 and C6) or ,delayed' absorbers (C4 or C6 exceeding C2), and as ,good' (>800 ng/mL at C0, C2, C4, or C6) or ,poor' absorbers (C0, C2, C4 and C6 <800 ng/mL) on the day of study. Among de novo patients, 15 (56%) had ,normal' CsA absorption and 12 (44%) ,delayed' absorption. Good CsA absorption occurred in 16 patients (59%) and poor absorption in 11 (41%). The proportion of poor absorbers was similar in patients with normal (6 / 15, 40%) or delayed (5 / 12, 42%) absorption. Among the 12 delayed absorbers, 11 had peak CsA concentration at C4. Mean C0 level was significantly higher in delayed absorbers (282 ± 96 ng/mL) than in normal absorbers (185 ± 88ng/mL; P = .01). Delayed absorbers reverted to normal absorption (C2 > C4) after a median of 6 days from the day of study, and no cases of delayed absorption were found among maintenance patients. In conclusion, almost 50% of the patients had delayed CsA absorption early posttransplant; around half of these exhibited normal CsA exposure. Measurement of C4 in addition to C2 differentiates effectively between delayed and poor absorbers of CsA such that over- or underimmunosuppression can be avoided. (Liver Transpl 2005;11:167,173.) [source]

Development of a method to measure methadone enantiomers and its metabolites without enantiomer standard compounds for the plasma of methadone maintenance patients

BIOMEDICAL CHROMATOGRAPHY, Issue 7 2010
Sheng-Chang Wang
Abstract A liquid chromatography,photodiode array (LC-PDA) method using a chiral analytical column was developed to determine the plasma levels of enantiomers of methadone and its chiral metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), without the standard compounds of R -form or S -form enantiomers. This method was established by the characteristics of recombinant cytochrome P-450 (CYP) isozymes, where CYP2C19 prefers to metabolize R -methadone and CYP2B6 prefers to metabolize S -methadone. We incubated the racemic methadone standard with either enzyme for 24,h. We identified the retention times of R - and S -methadone to be around 10.72 and 14.46,min, respectively. Furthermore, we determined the retention times of R - and S -EDDP to be approximately 6.76 and 7.72,min, respectively. No interferences were shown through the retention times of morphine, buprenorphine and diazepam. With the high recovery rate of a solid-phase extraction procedure, this method was applied in analyzing plasma concentrations of seven methadone maintenance patients where R - and S -methadone and R - and S -EDDP were 233.4 ± 154.9 and 185.9 ± 136.3,ng/mL and 84.4 ± 99.4 and 37.6 ± 22.9,ng/mL, respectively. These data suggest that the present method can be applied for routine assay for plasma methadone and EDDP concentrations for patients under treatment. Copyright © 2009 John Wiley & Sons, Ltd. [source]