ObjectiveDrug use and receipt of highly active antiretroviral therapy (HAART) were assessed in HIV-infected persons from the Comprehensive Care Center (CCC; Nashville, TN) and Johns Hopkins University HIV Clinic (JHU; Baltimore, MD) between 1999 and 2005.MethodsParticipants with and without injection drug use (IDU) history in the CCC and JHU cohorts were evaluated. Additional analysis of persons with history of IDU, non-injection drug use (NIDU), and no drug use from CCC were performed. Activity of IDU and NIDU also was assessed for the CCC cohort. HAART use and time on HAART were analyzed according to drug use category and site of care.Results1745 persons were included from CCC: 268 (15%) with IDU history and 796 (46%) with NIDU history. 1977 persons were included from JHU: 731 (35%) with IDU history. Overall, the cohorts differed in IDU risk factor rates, age, race, sex, and time in follow-up. In multivariate analyses, IDU was associated with decreased HAART receipt overall (OR = 0.61, 95% CI: [0.45–0.84] and OR = 0.58, 95% CI: [0.46–0.73], respectively for CCC and JHU) and less time on HAART at JHU (0.70, [0.55–0.88]), but not statistically associated with time on HAART at CCC (0.78, [0.56–1.09]). NIDU was independently associated with decreased HAART receipt (0.62, [0.47–0.81]) and less time on HAART (0.66, [0.52–0.85]) at CCC. These associations were not altered significantly whether patients at CCC were categorized according to historical drug use or drug use during the study period.ConclusionsPersons with IDU history from both clinic populations were less likely to receive HAART and tended to have less cumulative time on HAART. Effects of NIDU were similar to IDU at CCC. NIDU without IDU is an important contributor to HAART utilization.
Thiamine deficiency (TD) in rats produces lesions similar to those found in humans suffering from Wernicke's encephalopathy, an organic mental disorder associated with alcoholism. Male Sprague-Dawley rats (n = 29) were deprived of thiamine via a regimen of thiamine-deficient chow and daily intraperitoneal injections of the thiamine antagonist pyrithiamine hydrobromide. Spectra were obtained by using the STEAM sequence. No significant change occurred in the ratio of Cr/NAA, while the ratio of Cho/NAA declined significantly (60 +/- 11%) on Day 14. Eleven rats received intraperitoneal injections of thiamine hydrochloride at the end of 12 days, and dose-dependent recovery in Cho/NAA was observed.
i%e authors examined the synergism between pathologic patterns of alcohol consumption and traumatic brain injury ( T i 3 0 and its implications for psychiatric practice. The information that forms the basis of this review was identified by a computer-assisted search of the English-language literature for appropriate articles. Tbe literature suggests that alcohol abuseldependence can precipitate behavior resulting in head trauma and that cbronic alcohol abuse potentiates the mechanical and neurochemical processes involved in TBI, often resulting in a subsequent dual diagnosis of alcohol dependence and organic mental disorder. i%e magnitude of clinical morbidity, as documented by a broad range of epidemiologic studies associated with this topic, is considerable, and the authors hope it may be signifiicantIy reduced with increased education of health care professionals and with tbe education and psychiatric treatment of patients who are at risk? for this condition. "Where n o indications for operation are present, the avoidance of alcohol and irritating factors is of decided importance."-Meyer' his passage from Adolph Meyer ap-T peared in his 1904 article on "traumatic insanity," in which he sought to link brain injury patterns with posttraumatic psychi-atric complications. Implicit in his formulation was the role of alcohol as a factor in this chain of events. In the decades of research after that publication, the fields of psychiatry, public health, neurosurgery, neurology, and rehabilitation medicine have all made significant contributions that have reaffirmed and expanded on Meyer's inference within the context of his own
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