[Use of zolpidem and zopiclone on private prescriptions between 1993 and 2007]

OBJECTIVE

Aim of this study was to analyse the amount of so-called private prescriptions of zolpidem and zopiclone (Z drugs) over a 15-year period in Germany. Any doctor can prescribe drugs privately. Private prescriptions are fully funded by the patients. At present the total number of doctors' prescriptions in Germany is undocumented because this information is not recorded in insurance claims data. This may be one reason why physicians prescribe drugs that are associated with abuse and dependence (such as Z drugs) more frequently on private prescriptions.

METHODS

We compared utilization data from statutory health insurance claims with the purchasing statistics from public pharmacies over the years 1993-2007.

RESULTS

Throughout the study period, purchases of zolpidem and zopiclone increased from 1.4 million to 3.7 million packages and 0.8 million to 3.9 million packages, respectively. A constantly rising proportion of private prescriptions for zolpidem resp. zopiclone were issued between 1993 (+6% resp. +6%), 1999 (+43% resp. +34%), and 2007 (+122% resp. +72%).

CONCLUSION

Since their approval in Germany, zopiclone and especially zolpidem have frequently been dispensed on private prescriptions.

Patulin biodegradation using Pichia ohmeri and Saccharomyces cerevisiae

The effectiveness of Pichia ohmeri and Saccharomyces cerevisiae in the biodegradation of patulin was evaluated in vitro. Patulin is a toxin produced by Penicillium expansum, the predominant fungal contaminant in post-harvest apple. The biodegradation experiment was carried out in culture medium (Yeast Medium broth, YM) and commercial apple juice. These substrates were artificially contaminated with patulin previously produced by P. expansum strain 2 in malt extract broth and purified over a silica gel column. The YM broth was inoculated with P. ohmeri 158 with proved anti-P. expansum activity, whereas the apple juice was inoculated with dried Saccharomyces cerevisiae cells. The residual patulin in contaminated substrates was determined by reversed-phase HPLC. P. ohmeri 158 in YM broth degraded over 83% of the initial 223 µg (8.92 µg/ml) of patulin after incubation at 25 °C for two days under static conditions; after five days of incubation, this percentage was greater than 99%, and patulin levels fell below the limit of detection after 15 days. In the apple juices inoculated with 0.25 g/l of commercial dried S. cerevisiae cells (corresponding 1.8 x 107 cells/ml), 96% of patulin was degraded (initial contamination of 4.5 µg/ml of patulin) after 143 hours of incubation at 25 °C under static conditions. However, 90% degradation occurred when the juice was contaminated with 7.0 µg/ml under the same conditions, indicating that the biodegradation rate is concentrationdependent. The effective biodegradation of patulin using P. ohmeri 158 and S. cerevisiae demonstrates a promising application for innocuous yeast isolated from natural microbiota in the biological control, which can prevent both fruit spoilage and P. expansum mycotoxin contamination.

Seizures, psychosis and coma: severe course of hashimoto encephalopathy in a six-year-old girl

Hashimoto encephalopathy (HE) is a rare steroid-responsive encephalopathy associated with elevated antithyroid antibodies and is a well recognised complication of autoimmune thyroid disease. The clinical picture is pleomorphic, presenting with variable symptoms like coma, seizures, neuropsychiatric changes (impairment of cognitive functions, behavioural and mood disturbances, hallucinations) or focal neurological deficits. HE is mainly diagnosed in adults, but also a rare differential diagnosis of encephalopathy or epilepsy in children. The diagnosis is often overlooked at presentation but is crucial as it is a treatable disease. We report on the youngest patient described up to now presenting with progressive epilepsy resistant to anticonvulsive treatment and unclear encephalopathy related to Hashimoto thyroiditis.

Delayed neuronal death after brain trauma involves p53-dependent inhibition of NF-kappaB transcriptional activity

Acute and chronic neurodegeneration, for example, following brain injury or Alzheimer's disease, is characterized by programmed death of neuronal cells. The present study addresses the role and interaction of p53- and NF-kappaB-dependent mechanisms in delayed neurodegeneration following traumatic brain injury (TBI). After experimental TBI in mice p53 rapidly accumulated in the injured brain tissue and translocated to the nucleus of damaged neurons, whereas NF-kappaB transcriptional activity simultaneously declined. Post-traumatic neurodegeneration correlated with the increase in p53 levels and was significantly reduced by the selective p53 inhibitor pifithrin-alpha (PFT). Strikingly, this protective effect was observed even when PFT treatment was delayed up to 6 h after trauma. Inhibition of p53 activity resulted in the concomitant increase in NF-kappaB transcriptional activity and upregulation of NF-kappaB-target proteins, for example X-chromosomal-linked inhibitor of apoptosis (XIAP). It is interesting to note that inhibition of XIAP abolished the neuroprotective effects of PFT in cultured neurons exposed to camptothecin, glutamate, or oxygen glucose deprivation. In conclusion, delayed neuronal cell death after brain trauma is mediated by p53-dependent mechanisms that involve inhibition of NF-kappaB transcriptional activity. Hence, p53 inhibition provides a promising approach for the treatment of acute brain injury, since it blocks apoptotic pathways and concomitantly triggers survival signaling with a therapeutic window relevant for clinical applications.

Hochverbrauch von Zolpidem und Zopiclon

BACKGROUND

Case reports indicate dose increase, abuse, and dependence concerning zolpidem and zopiclone (so-called Z-drugs).

METHODS

We conducted a cross-sectional study between 1 July and 31 December 2004 using claims data of the German health insurer Gmuender ErsatzKasse to examine high usage of these drugs.

RESULTS

A total of 6959 subjects bought at least one packet of zolpidem or zopiclone, including 20.9% containing 90 daily doses (DDD) or more. High usage, defined as at least 180 DDD, was identified in 501 subjects (7.2%). Compared to other use, high usage was associated with GP visits only for the prescription of Z-drugs (odds ratio 2.01, 95% confidence interval 1.52-2.67), neuroleptics (odds ratio 2.53, 95% confidence interval 2.02-3.18), and polypharmacy (odds ratio 2.40, 95% confidence interval 1.84-3.15).

CONCLUSION

Zolpidem and zopiclone are often prescribed in higher doses or for long-term use. Such therapy regimens should be viewed critically.

Typisierung beim HLA-Matching

Matching of human leukocyte antigens of donors and recipients (HLA matching) plays a significant role in kidney, heart, lung, and stem cell transplantation. New data demonstrate that HLA matching also significantly prolongs the survival of corneal grafts. The reasons for the late recognition of the significance of HLA matching in corneal transplantation are on the one hand the immune privilege of the eye, which allows corneal transplantation under certain conditions without immunosuppressive therapy, and on the other hand highly erroneous serological typing. Recent molecular DNA typing is almost without errors, and the selection of grafts on the basis of results obtained using this method will improve the long-time survival of future corneal grafts. Today, there are several reasons arguing for the general practice of HLA matching in keratoplasty.