Antitussives and substance abuse.

Abuse of antitussive preparations is a continuing problem in the United States and throughout the world. Illicit, exploratory, or recreational use of dextromethorphan and codeine/promethazine cough syrups is widely described. This review describes the pharmacology, clinical effects, and management of toxicity from commonly abused antitussive formulations.

Pregnancy leads to lasting changes in foot structure.

Objective: Women are disproportionately affected by musculoskeletal disorders. Parous women seem to be at a particularly elevated risk for structural and functional changes in the lower limbs. The combination of increased weight on the joints with potentially greater laxity during pregnancy could lead to permanent structural changes in the feet.

Association between chair stand strategy and mobility limitations in older adults with symptomatic knee osteoarthritis.

Objective: To determine which lower limb strength and joint kinetic and kinematic parameters distinguish sit-to-stand (STS) performance of older adults with symptomatic knee osteoarthritis (OA) with higher and lower chair stand time.

Design: Cross-sectional.

Setting: Motion analysis laboratory.

Correlates of safety outcomes during patient ambulance transport: a partial test of the Haddon matrix.

The Haddon Matrix has been cited in a recent review of patient safety as a useful framework for understanding Emergency Medical Services (EMS) provider and patient injury prevention and safety during ambulance response and transport. The research goal of this study was to test part of the Haddon matrix, specifically variables within the pre-event host and event host cells, for explaining three multi-item ambulance-related safety outcomes: i.e.

Medial knee joint loading during stair ambulation and walking while carrying loads.

Carrying loads while walking or using stairs is a common activity of daily living. Knee osteoarthritis is associated with increased external knee adduction moment (KAM) during walking, so understanding how the additional challenges of stairs and carrying loads impact these moments is of value. Sixteen healthy individuals performed three types of MOTION (walking, stair ascent, stair descent) under three LOAD conditions (no load, carrying a 13.

Nasopharyngeal necrosis after chronic opioid (oxycodone/acetaminophen) insufflation.

Nasopharyngeal necrosis resulting from narcotic insufflation is a recognized phenomenon, but cocaine use is more commonly associated with this pathology than opioid abuse. Physical exam findings associated with severe tissue destruction are not routinely seen on physical examination or available in the medical literature. We present a case of chronic oxycodone/acetaminophen insufflation and images of a defect in the soft palate.

Preliminary efforts directed toward the detection of craving of illicit substances: the iHeal project.

Many behavioral interventions, whether for the management of chronic pain, overeating, medication adherence, or substance abuse, are ineffective outside of the clinic or office environments in which they are taught. This lack of utility has spawned interest in enabling technologies that are capable of detecting changes in affective state that potentially herald a transition to risky behaviors. We have therefore undertaken the preliminary development of "iHeal", an innovative constellation of technologies that incorporates artificial intelligence, continuous biophysical monitoring, wireless connectivity, and smartphone computation.

HIV and club drugs in emerging adulthood.

Purpose Of Review: To evaluate the incidence of club drug use in pediatric patients, especially those aged 13-25, and how it relates to the spread of HIV.

Recent Findings: Transmission of HIV among younger patients has become largely associated with risky sexual behaviors, as the rate of transmission from vertical infection and intravenous drug use has decreased. Use of club drugs in emerging adult populations contributes to the HIV epidemic through a combination of decreased inhibitions as well as physiological effects that increase high-risk sexual practices.

Ethylene glycol elimination kinetics and outcomes in patients managed without hemodialysis.

Study Objective: Ethylene glycol remains an important toxic cause of metabolic acidosis and acute renal failure. Traditionally, inhibition of alcohol dehydrogenase along with hemodialysis has been used for treatment. Because of reported long elimination half-life of ethylene glycol during alcohol dehydrogenase inhibition, hemodialysis has been used in patients who are otherwise doing well to clear ethylene glycol.

Extraction of soluble fiber from distillers' grains.

The feasibility of using coproducts from dry grind corn ethanol production as a substrate for the production of soluble fiber was examined. Acid- and base-catalyzed hydrolysis experiments were performed using sulfuric acid and sodium hydroxide to partially hydrolyze hemicellulose content of whole stillage, a precursor to distillers' grains, to soluble fiber. The influences of temperature, reaction time, and hydrolyzing agent concentration on the formation of soluble fiber were studied.

Herbal medicines for the management of opioid addiction: safe and effective alternatives to conventional pharmacotherapy?

Striking increases in the abuse of opioids have expanded the need for pharmacotherapeutic interventions. The obstacles that confront effective treatment of opioid addiction - shortage of treatment professionals, stigma associated with treatment and the ability to maintain abstinence - have led to increased interest in alternative treatment strategies among both treatment providers and patients alike. Herbal products for opioid addiction and withdrawal, such as kratom and specific Chinese herbal medications such as WeiniCom, can complement existing treatments.

Advanced molecular biologic techniques in toxicologic disease.

The advancement of molecular biologic techniques and their capabilities to answer questions pertaining to mechanisms of pathophysiologic events have greatly expanded over the past few years. In particular, these opportunities have provided researchers and clinicians alike the framework from with which to answer clinical questions not amenable for elucidation using previous, more antiquated methods. Utilizing extremely small molecules, namely microRNA, DNA, protein, and nanoparticles, we discuss the background and utility of these approaches to the progressive, practicing physician.

Toxicology in the ICU: Part 1: general overview and approach to treatment.

Poisonings, adverse drug effects, and envenomations continue to be commonly encountered. Patients often present critically ill and warrant ICU admission. Many other patients who are initially stable have the potential for rapid deterioration and require continuous cardiopulmonary and neurologic monitoring.

Dabigatran: review of pharmacology and management of bleeding complications of this novel oral anticoagulant.

Dabigatran (Pradaxa) is a competitive direct thrombin inhibitor approved by the US FDA for prevention of embolic stroke in patients with nonvalvular atrial fibrillation. Dabigatran has a pharmacokinetic profile that produces predictable anticoagulation responses, does not undergo CYP 450 metabolism, has few drug-drug and drug-food interactions, and does not require frequent laboratory monitoring of clotting parameters. Clinicians are rapidly prescribing this agent as a replacement for warfarin therapy.

Sulfur mustard exposure presenting to a community emergency department.

We report dermal exposure to a chemical warfare agent, sulfur mustard, in a 28-year-old commercial fisherman. Chemical warfare agents such as sulfur mustard are considered potential terrorist weapons, and suspected exposure requires notification of federal authorities. We address potential pitfalls when alerting authorities and methods to avoid such obstacles, and we describe the clinical management of sulfur mustard toxicity.

Partial response to anakinra in life-threatening Henoch-Schönlein purpura: case report.

Henoch-Schönlein purpura is one of the most common forms of systemic vasculitis of childhood. We report the response to anakinra, the interleukin-1 receptor antagonist, in a 9 year old girl without prior medical problems who developed life-threatening Henoch-Schönlein vasculitis that produced renal failure, pulmonary hemorrhage and vasculitis of the brain. Her response supports the theory that interleukin-1 may be an important mediator in this disease.

Designing interventions to overcome poor numeracy and improve medication adherence in chronic illness, including HIV/AIDS.

Numeracy is an element of health literacy that refers to the ability to understand numerically related information. When applied to health behaviors, it describes the degree to which individuals have the capacity to access, process, interpret, and act on graphical and probabilistic health information. As a cognitive and functional skill, low numeracy correlates with poor outcomes in the management of chronic diseases; numeracy is therefore an essential component of patients' capacity to adhere to medication regimens.

Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies.

Treating chronic pain in the context of opioid misuse can be very challenging. This paper explores the epidemiology and potential treatments for chronic pain and opioid misuse and identifies educational and regulation changes that may reduce diversion of opioid analgesics. We cover the epidemiology of chronic pain and aberrant opioid behaviors, psychosocial influences on pain, pharmacological treatments, psychological treatments, and social treatments, as well as educational and regulatory efforts being made to reduce the diversion of prescription opioids.

Silhouette Segmentation in Multiple Views.

In this paper, we present a method for extracting consistent foreground regions when multiple views of a scene are available. We propose a framework that automatically identifies such regions in images under the assumption that, in each image, background and foreground regions present different color properties. To achieve this task, monocular color information is not sufficient and we exploit the spatial consistency constraint that several image projections of the same space region must satisfy.

Mitragyna speciosa, a psychoactive tree from Southeast Asia with opioid activity.

Mitragyna speciosa Korth. (Rubiaceae) is a tree that is commonly found in Southeast Asia. Leaves from this tree have been traditionally been used for both their stimulant properties as well as an opium substitute.

Wireless Technologies, Ubiquitous Computing and Mobile Health: Application to Drug Abuse Treatment and Compliance with HIV Therapies.

Beneficial advances in the treatment of substance abuse and compliance with medical therapies, including HAART, are possible with new mobile technologies related to personal physiological sensing and computational methods. When incorporated into mobile platforms that allow for ubiquitous computing, these technologies have great potential for extending the reach of behavioral interventions from clinical settings where they are learned into natural environments.

Topology-adaptive mesh deformation for surface evolution, morphing, and multiview reconstruction.

Triangulated meshes have become ubiquitous discrete surface representations. In this paper, we address the problem of how to maintain the manifold properties of a surface while it undergoes strong deformations that may cause topological changes. We introduce a new self-intersection removal algorithm, TransforMesh, and propose a mesh evolution framework based on this algorithm.

Administration of ondansetron is associated with lethal outcome.

We report here the case of a child with a known muscular abnormality and susceptibility to malignant hyperthermia who abruptly died after receiving a therapeutic dose of ondansetron. Also, we discuss the pharmacodynamic relationship of ondansetron to malignant hyperthermia in a susceptible host.