Efeitos da Heroína nos Parâmetros Eletrocardiográficos / Effect of Heroin on Electrocardiographic Parameters

Resumo Fundamento Atualmente, o vício em heroína é um problema de saúde preocupante, e as informações sobre os efeitos eletrocardiográficos da heroína são limitadas. Objetivos O objetivo do presente estudo é investigar os efeitos da dependência de heroína em parâmetros eletrocardiográficos. Métodos Um total de 136 indivíduos, incluindo 66 indivíduos que fumam heroína como grupo de estudo e 70 indivíduos saudáveis sem dependência de drogas como grupo de controle, foram incluídos no estudo. Indivíduos que injetam heroína foram excluídos. A avaliação eletrocardiográfica (ECG) dos usuários de heroína foi realizada e comparada com as do grupo controle. Além disso, os ECGs pré e pós-tratamento do grupo usuário de heroína foram comparados. Um valor de p<0,05 foi aceito como estatisticamente significativo. Resultados A frequência cardíaca (77,2±12,8 versus 71,4±11,2; p=0,02) foi maior no grupo usuário de heroína em comparação com o grupo controle. Os intervalos QT (341,50±25,80 versus 379,11±45,23; p=0,01), QTc (385,12±29,11 versus 411,3±51,70; p<0,01) e o intervalo do pico ao fim da onda T (Tpe) (65,41±10,82 versus 73,3±10,13; p<0,01) foram significativamente menores no grupo usuário de heroína. Nenhuma diferença foi observada entre os grupos com respeito às razões Tpe/QT e Tpe/QTc. Na análise de subgrupo do grupo usuário de heroína, os intervalos QT (356,81±37,49 versus 381,18±40,03; p<0,01) e QTc (382,06±26,41 versus 396,06±29,80; p<0,01) foram significativamente mais curtos no período pré-tratamento. Conclusão O vício em heroína afeta significativamente os intervalos de tempo QT, QTc e Tpe. Os efeitos de arritmia desses parâmetros já são conhecidos. Os parâmetros eletrocardiográficos desses indivíduos merecem mais atenção. (Arq Bras Cardiol. 2020; 115(6):1135-1141)

Abstract Background Heroin addiction is currently a significant health problem, and information on the electrocardiographic effects of heroin is limited. Objetivo The aim of the present study is to investigate effects of heroin addiction on electrocardiographic parameters. Methods A total of 136 individuals, including 66 individuals who smoke heroin as the study group and 70 healthy individuals with no drug addiction as the control group, were included in the study. Individuals who inject heroin were excluded. Electrocardiographic (ECG) evaluation of those using heroin was performed and compared with those of the control group. In addition, pre-treatment and post-treatment ECG of the heroin group were compared. A p-value of <0.05 was accepted as statistically significant. Results Heart rate (77.2±12.8 versus 71.4±11.2; p=0.02) were found to be higher in the heroin group compared to the control group. QT (341.50±25.80 versus 379.11±45.23; p=0.01), QTc intervals (385.12±29.11 versus 411.3±51.70; p<0.01), and T peak to end time (Tpe) (65.41±10.82 versus 73.3±10.13; p<0.01) were significantly shorter in the heroin group. No difference was observed between the groups with regard to Tpe/QT and Tpe/QTc ratios. In the subgroup analysis of the heroin group, QT (356.81±37.49 versus 381.18±40.03; p<0.01) and QTc (382.06±26.41 versus 396.06±29.80; p<0.01) intervals were significantly shorter in the pre-treatment period. Conclusion Heroin addiction significantly affects the QT, QTc, and Tpe time intervals. The arrhythmia effects of these parameters are well known. More attention to the electrocardiographic parameters of these individuals should be given. (Arq Bras Cardiol. 2020; 115(6):1135-1141)

Effects of purine nucleotide administration on purine nucleotide metabolism in brains of heroin-dependent rats

ABSTRACT Heroin is known to enhance catabolism and inhibit anabolism of purine nucleotides, leading to purine nucleotide deficiencies in rat brains. Here, we determined the effect of exogenous purine nucleotide administration on purine nucleotide metabolism in the brains of heroin-dependent rats. Heroin was administrated in increasing doses for 9 consecutive days to induce addiction, and the biochemical changes associated with heroin and purine nucleotide administration were compared among the treated groups. HPLC was performed to detect the absolute concentrations of purine nucleotides in the rat brain cortices. The enzymatic activities of adenosine deaminase (ADA) and xanthine oxidase (XO) in the treated rat cortices were analyzed, and qRT-PCR was performed to determine the relative expression of ADA, XO, adenine phosphoribosyl transferase (APRT), hypoxanthine-guaninephosphoribosyl transferase (HGPRT), and adenosine kinase (AK). Heroin increased the enzymatic activity of ADA and XO, and up-regulated the transcription of ADA and XO. Alternatively, heroin decreased the transcription of AK, APRT, and HGPRT in the rat cortices. Furthermore, purine nucleotide administration alleviated the effect of heroin on purine nucleotide content, activity of essential purine nucleotide metabolic enzymes, and transcript levels of these genes. Our findings therefore represent a novel, putative approach to the treatment of heroin addiction.

Maternal and Neonatal Effects of Substance Abuse during Pregnancy: Our Ten-year Experience

PURPOSE: The aim of the study was to assess perinatal outcome of pregnancy burdened with maternal addiction in comparison with an unselected population from a European transition country. MATERIALS AND METHODS: Data on pregnancies complicated by illicit drug abuse (n = 85) managed during a 10-year period (1997-2007) at Split University Hospital were analyzed. Data on the type of drug, course of gestation and labor, and on perinatal outcome were considered. Data on all non-dependence pregnancies recorded during the study period were used as a control group. RESULTS: During the study period, there were 85 dependence-complicated pregnancies (0.2%). Use of heroin alone during pregnancy was recorded in 51 women (50%), methadone alone in 6 (7%), and a combination of heroin and methadone in 9 (11%). Premature delivery was significantly more common in the group of pregnant addicts (21% vs. 6%); 49% of pregnant addicts were carriers of hepatitis C virus (HCV) and 14% of hepatitis B virus (HBV). Neonatal abstinence syndrome developed in 61 infants (7%) born to addicted mothers. There were 4 cases (4.6%) of early neonatal death; 7 neonates had 5-minute Apgar score < or = 7 (8%); 29 neonates had low birth weight for age (33%); and 7 neonates had congenital anomalies (8%). The risk of various congenital anomalies was 3-fold in the group of children born to addicted mothers. CONCLUSION: Addiction pregnancies present a small but high-risk group according to perinatal outcome. Appropriate obstetric and neonatal care can reduce the rate of complications in these pregnancies and improve perinatal outcome.

Effect of opium and heroin misuse on chronic motor tic disorder

Tics are sudden, recurrent and stereotyped motor movements or vocalizations. Dopamine blockers are the main pharmacological agents used in the management of tics. Opioid antagonists have been reported to be effective in the management of tics. In this article, two patients with chronic motor tic disorder are reported, whose symptoms were disappeared by using opioid substances

Effect on plasma testostrone level by heroin addiction and its restoration by withdrawal

Heroin is considered to be the most addictive of all known drugs. It has adverse effects on all major systems of the body including impairment of sexual functions. The current investigation explores the relationship of heroin addiction with plasma testosterone levels in addicted persons. The effect of withdrawal of the drug on plasma testosterone level has also been investigated. Plasma testosterone levels in subjects with heroin addiction [n=15] were determined on presentation, and after 15 and 30 days of heroin withdrawal. The plasma testosterone level of addicts was significantly lower than that age and sex matched control group [p<0.001] on presentation. Progressive increase in the level was observed after 15 days [p>0.05] and 30 days of withdrawal [p<0.01]. In young adult group [age 19-29 years] there was significant increase in testosterone level after 15 and 30 days of withdrawal. However the level in older groups [30-39 and 40-50 years] did not change after 15 and 30 days of withdrawal

Heroin associated priapism

Priapism is a pathologically prolonged and painful penile erection, usually unassociated with sexual desire or intercourse. Causes include certain oral medication, although the mechanism for drug-induced priapism is unknown. We describe one case of priapism attributed to penile heroin injection

Heroína / Heroin

O consumo de heroína se tem revelado preocupante dentro do cenário mundíal Complicações clínicas e psiquiátricas graves têm sido relatadas entre os usuários. Nos Estados Unidos da América do Norte, a prevalência de abuso de heroína é menor do que 1 porcento; entretanto, os efeitos negativos deste consumo asseguram a severidade do problema. No Brasil, o uso deste opiáceo vem despontando como um fenômeno íncipiente, porém não menos preocupante.

Manifestaciones y secuelas cutáneas de la drogadicción / Cutaneous manifestations and sequelae in drug addicts

Las lesiones dermatológicas producidas por la administración de drogas ilícitas y sus eventuales secuelas, tienen implicancias médico-legales y sumo valor para el diagnóstico retrospectivo de adicción. Estas lesiones son de origen multifactorial: combinan la reacción del huésped ante agentes químicos sensibilizantes e irritantes, traumatismos reiterados por técnicas de aplicación incorrectas e infección sobreagregada. Clínicamente, se observan como hiperpigmentaciones sobre trayectos vasculares indurados, cicatrices atróficas en áreas de inyección subcutánea, abscesos sépticos y granulomas por cuerpo extraño, en su mayoría provocados por excipientes y adulterantes, como lesiones más características. Se presentan casos clínicos y se hace revisión de estos procesos, enfatizando la situación particular en Argentina en relación a la bibliografía consultada, proveniente de países del Primer Mundo. Asimismo, se ilustra brevemente el léxico tan particular de los adictos, cuyos rudimentos se vuelven imposibles de obviar cuando se avanza en el estudio de estos pacientes

Patologías médicas en la adicción a la heroína / Medical pathologies in heroin addiction

Se presenta un análisis de las patologías médicas motivo de hospitalización de los heroinómanos de la Provincia de Vizcaya, País Vasco, España, en el lapso 1982 a 1987, y su posible asociación a la infección por el virus de la inmunodeficiencia humana, VIH. Se observó que existe un franco incremento en los ingresos hospitalarios desde 1982, y que las patologías infecciosas constituyen la principal entidad nosológica en este grupo de sujetos. La infección VIH se encontró en un porcentaje superior al 90% de los individuos estudiados y con patologías infecciosas. Es de particular significación el aumento de casos de tuberculosis y de candidiasis. Se discute la posible asociación y repercusión del aumento en la susceptiblidad a infecciones no oportunistas y su asociación a la infección VIH