[Addicted Colleagues: A Blind Spot Amongst Physicians?].
[Addicted colleagues: a blind spot amongst physicians?].
Ned Tijdschr Geneeskd. 2013; 157(23): A5718
Rode H, de Rond M, Dam I
Physician impairment due to substance abuse or dependence is at least as prevalent as amongst non-physicians and is a real challenge. Not only for the impaired physicians themselves, but also for their colleagues, family members and patients. A 68-year-old physician describes her experiences of being an alcoholic as well as a patient with concomitant psychiatric disorders, including the hurdles she had to get over to deal with her disease and remain abstinent. Although colleagues knew what was going on, some of them took no action. The initial treatment by her general practitioner proved compromised. Addressing addiction amongst fellow physicians can be challenging and for this reason the Royal Dutch Medical Association (KNMG) has started the ABS Programme. On prompt and adequate intervention, treatment in specialised facilities has proved to be highly and durably effective. Addicted physicians who have been successfully treated should be monitored and supported, thus enabling their safe return to practice. HubMed – addiction
[Carbohydrate deficient transferrin and ethyl glucuronide: markers for alcohol use].
Ned Tijdschr Geneeskd. 2013; 157(23): A5713
Paling EP, Mostert LJ
In this article, we report on the usefulness of physicians testing for carbohydrate deficient transferrin (CDT) and ethyl glucuronide (EtG) when there are doubts about alcohol use by their patients. A 44-year-old male consulted his general practitioner with depressive symptoms and denied using alcohol. Laboratory examination revealed an elevated CDT value. The latter was caused by chronic alcohol use. The second patient, a 32-year-old female with known alcohol dependence and receiving inpatient treatment at an addiction clinic, came back from leave. She denied having consumed alcohol and her blood alcohol concentration was zero. Examination of her urine showed an elevated EtG/creatinine ratio. This was caused by having had a few drinks during her leave and could not have been caused by using mouthwash or disinfection soap. We describe how to use the results of CDT and EtG testing in the therapeutic process and give recommendations for patient communication before performing these two tests. HubMed – addiction
Viral molecular mimicry circumvents abortive infection and suppresses bacterial suicide to make hosts permissive for replication.
Bacteriophage. 2012 Oct 1; 2(4): 234-238
Blower TR, Short FL, Fineran PC, Salmond GP
The global interplay between bacteria and bacteriophages has generated many macromolecules useful in biotechnology, through the co-evolutionary see-saw of bacterial defense and viral counter-attack measures. Bacteria can protect themselves using abortive infection systems, which induce altruistic suicide in an infected cell and therefore protect the clonal population at the expense of the infected individual. Our recent paper describes how bacteriophage ?TE successfully subverted the activity of a plasmid-borne abortive infection system. ?TE evolved mimics of the small RNA antitoxin that naturally inhibits the active toxin component of this anti-viral mechanism. These mutant phages further manipulated the behavior of the host population, through transduction of the plasmid encoding the abortive infection system. Transductants thereby became enslaved by the abortive infection system, committing suicide in response to infection by the original phage population. In effect, the new host was infected by an “addictive altruism,” to the advantage of the resistant bacteriophage. HubMed – addiction
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