Objective
Rapid relapses after successful withdrawal occur even in apparently motivated benzodiazepine (BZD)-dependent patients. Regardless of known personality or biological (re-adaptation) issues, ...the aim of this open-label, single-arm, seminaturalistic study was to search for any detoxification errors contributing to failures.
Methods
The data came from 350 inpatients. Based on serum-BZD evolution criteria, the procedure was divided into four stages: substitution, accumulation, elimination and post-elimination observation. After switching the patients to a long-acting substitute (diazepam), to prevent data falsification due to unwanted overaccumulation, the doses were expeditiously reduced under laboratory feedback until accumulation stopped. With the start of effective elimination, the tapering rate slowed and was individually adjusted to the patient’s current clinical state. The tracking of both serum-BZD concentration and the corresponding intensity of withdrawal symptoms was continued throughout the entire elimination phase, also following successful drug withdrawal. Detoxification was concluded only after the patient's post-elimination stabilization.
Results
Regardless of various initial serum-BZD concentration levels and the customized dose-reduction rate, and despite the novel lab-driven actions preventing initial overaccumulation, elimination was systematically proven to be protracted and varied within the 2- to 95-day range after the final dose. Within this period, withdrawal syndrome culminated several times, with varying combinations of symptoms. The last crisis occurrence (typically 2–3 weeks after withdrawal) correlated with the final serum-BZD elimination. The factors that prolonged elimination and delayed the final crisis were patient age, duration of addiction, adjunct valproate medication and elimination stage start parameters growing with former overaccumulation.
Conclusions
The low-concentration detoxification stage is critical for patients’ confrontations with recurring withdrawal symptoms. Underestimated elimination time following drug withdrawal and premature conclusions of detoxification expose patients to unassisted withdrawal crises. Concentration tracking defines proper limits for medical assistance, preventing early relapses.
Purpose
Many harms secondary to benzodiazepine (BZD) dependence force users towards detoxification treatment. However, even strongly motivated patients tolerate the process badly or experience early ...relapse. The detoxification procedure has not yet been standardized. The objective of this paper is to examine the hypothesis that faulty detoxification routines may have caused some failures.
Methods
The detoxification approaches found in the literature were compared stage by stage. The review was used to identify possible common, across-the-board systematic errors.
Results
The presented literature review confirms that the widespread divergence in the BZD metabolism rate is effectively neglected during detoxification routines. Without laboratory measurements, these differences, additionally interfered with by auxiliary drugs, undermine not only the scheduled but even the symptom-driven procedures. An initial substitution with a long-acting BZD, although recommended, may lead to over-accumulation. This excess, varying between patients and incompatible with the current tapering stage, may lead to repeated overestimation of the patient’s adjustments to reduced doses. Consequently, the patient’s good clinical presentation at withdrawal, resulting in a conclusion of detoxification, may actually reflect a persistently high serum BZD concentration. The low-concentration stage, if shifted past the end of treatment, exposes patients to unexpected, unassisted withdrawal crises. With laboratory feedback, these crises, unlike the symptoms related to deficient re-adaptation mechanisms, could be prevented. Moreover, by minimizing the high-concentration phase, time can be saved for properly assisted low-concentration challenges.
Conclusion
A customized detoxification procedure driven not only by the intensity of withdrawal symptoms but also by serum BZD monitoring may prevent some failures. As the standard regimen, it would make detoxification from BZDs more reliable and effective.
Objective
In the majority of approaches, detoxification of patients with benzodiazepine (BZD) addiction is preceded by conversion to long-acting BZDs. Resulting BZD accumulation, however, is neither ...monitored nor prevented. An unrecognized shift of the key low-concentration phase beyond the nominal treatment period may underlie delayed unassisted crises and treatment failures. This open, single-arm, semi-naturalistic study examines the anti-accumulation paradigm to minimize the high-concentration treatment phase and to regain time for medical assistance during the low-concentration phase.
Methods
In 133 of 165 patients with BZD dependency, after conversion to diazepam by titration up to the satiation state, the loading dose and satiating concentration were recorded. The subsequent anti-accumulation procedure consisted of aggressive daily dose reductions under laboratory feedback (serum BZD concentration, radioimmunoassay) until accumulation stopped. The final overaccumulation ratio (OA) and maintenance-dose/loading-dose ratio (MTN) were estimated. The post-conversion peak-concentration/loading-dose ratio was illustratively compared with the concentration/dose ratio in 32 long-term diazepam users demonstrating the natural plateau.
Results
Despite gender- and age-related differences in loading and maintenance doses and in satiating and peak concentrations (higher in younger and male patients), their quotients remained similar. The MTN ratio had an average value of 0.29 and a median value of 0.25, with OA ratios of 1.54 and 1.39, respectively. The concentration/dose ratio was approximately 3 times lower than that in regular diazepam users. With effective elimination starting (on average) from the 6th day, the treatment, including post-elimination recovery, lasted on average 52 days.
Conclusions
The MTN values show how harmfully popular tapering schedules intensify and extend the high-concentration stage during alleged detoxification, leading to unrecognized delays in elimination, and delayed withdrawal crises. The common errors are discussed. An individual MTN, estimated from laboratory feedback (the anti-accumulation paradigm), expeditiously moves patients to the onset of actual detoxification. This action regains time to maintain medical assistance until treatment is properly completed.
Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater–cooler units (HCUs) used ...during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease.
We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes.
Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree.
HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety.
Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection Research Units on Healthcare Associated Infection and Antimicrobial Resistance.
In Polish and Czech pedagogy, there have not been many studies on the social, cultural and educational functioning of academic youth in a culturally diversified environment. The analysis of identity ...behaviours presented by university students from the Polish-Czech borderland and of their learning potentialities will provide a chance for mutual recognition, understanding and the enrichment of both cultures – along with providing a chance for cultural sensitization. Due to the applied culturalization attitudes, this will also enhance the participation in the culture of the neighbouring country and the shortening of cultural distance. Such studies are also associated with a reflection upon the way in which a contemporary human understands cultural dimensions, the role they play in human life and the scope in which they shape the individual’s own and their social/cultural identity.
The properties of the starch-amylolytic complex of commercial low-extract rye flour were determined based on the traditional method, such as falling number and amylograph test as well as differential ...scanning calorimetry (DSC). The starch, pentosans and protein had a significant effect on the thermal properties of the tested rye flours. Based on the falling number, it was revealed that rye flours were characterized by medium and low alpha-amylase activity. The falling number and amylograph test are not sufficient methods to determine the suitability of currently produced rye flours for bread making. The gelatinization process of the rye flour starch could be evaluated by the DSC test, which, together with the falling number and amylograph test, may allow a better way to evaluate the usefulness of rye flours for bread making. Many significant correlations between parameters determined by DSC endotherm and quality parameters of rye bread, such as volume and crumb hardness, were reported. Breads made from flour with higher enthalpy in DSC were characterized by higher volume and softer crumb.
Seventy-three strains of Sorangium have been isolated from soil samples collected from all over the world. The strains were characterized using a polyphasic approach and phenotypic, genotypic and ...chemotype analyses clarified their taxonomic relationships. 16S rRNA, xynB1, groEL1, matrix-assisted laser desorption/ioniziation time-of-flight mass spectrometry and API-ZYM analyses were conducted. In addition, from selected representative strains, fatty acids, quinones and phospholipids were analysed. In silico DNA-DNA hybridization and DNA-DNA hybridization against the current type species of Sorangiumcellulosum strain Soce 1871
(DSM 14627
) completed the analyses. Finally, our study revealed seven new species of Sorangium: Sorangium ambruticinum (Soce 176
; DSM 53252
, NCCB 100639
, sequence accession number ERS2488998), Sorangium arenae (Soce 1078
; DSM 105768
, NCCB 100643
, ERS2489002), Sorangium bulgaricum (Soce 321
; DSM 53339
, NCCB 100640
, ERS2488999), Sorangium dawidii (Soce 362
; DSM 105767
, NCCB 100641
, ERS2489000), Sorangium kenyense (Soce 375
; DSM 105741
, NCCB 100642
, ERS2489001), Sorangium orientale (Soce GT47
; DSM 105742
, NCCB 100638
, ERS2501484) and Sorangium reichenbachii (Soce 1828
; DSM 105769
, NCCB 100644
, ERS2489003).
Malted gluten-free cereal grains and pseudo-cereals are interesting raw materials for producing fermented foods. The aim of the work was to assess selected technological quality characteristics and ...antioxidant properties of special malts in terms of use in the production of fermented foods. The research material consisted of malts made from oat, buckwheat, and brewing barley. Malting was performed on a microtechnical scale according to the standard scheme for brewing barley grain. The basic quality parameters of cereal grains obtained malts, and laboratory wort were assessed according to methods applicable in brewing. Atypical brewing malts were characterized by parameters such as malt extractability, protein solubilization, diastatic force, mash filtration time, and wort viscosity. The best results, comparable to barley malt, were obtained for naked oat malt. Malted buckwheat grains turned out to be the least biochemically modified, although their use in the production of beer and/or other fermented beverages is supported by the high content of bioactive substances and antioxidant potential. As the malting process of cereal plants improves their antioxidant properties and increases their nutritional value, oat and buckwheat malts can be successfully used to produce gluten-free fermented beverages or as an addition to fermented products, e.g., in baking and confectionery.
This study aimed to determine the baking quality of rye flour in terms of the content and properties of its polysaccharides, i.e., starch and pentosans. The study materials were low- and high-extract ...rye flours produced in industrial mills from the rye grain of two growing seasons (2019 and 2020). The results of the starch content, falling number, amylograph properties, DSC test, content of pentosans, swelling curve test, and laboratory baking test were determined. It was found that the type of flour had a greater impact on the baking quality of rye flour than the year of its production. Research has shown that the most frequently used parameters, such as the falling number and the maximum viscosity of starch paste, are not good indicators for assessing the baking value of currently produced rye flours. From the parameters used for evaluating the properties of the starch–amylolytic complex, the initial and onset temperatures for starch gelatinization were the best indicators for evaluating the baking quality of rye flour. This study revealed a significant correlation between the pentosan content (total, water soluble, and insoluble), swelling curve parameters and quality parameters of rye bread, such as the specific bread volume, bread crumb moisture, and bread crumb hardness. Assessment of the baking value of rye flour based only on the evaluated properties of the starch–amylolytic complex is currently not sufficient to determine the baking quality of rye flour and predict the quality of rye bread. This study on the baking quality of rye flour should be extended to include the assessment of the dough properties related to the pentosan content and the enzymes that degrade these components. It was shown that the properties of rye dough related to the content of pentosan can be characterized based on the swelling curve test as a method that, together with the initial and onset starch gelatinization temperatures, allows better assessment of the baking quality of the commercial rye flour and its suitability for the good-quality rye bread production.
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