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Introduction: Although psychoactive medicines (PMed) are needed in several psychiatric conditions, their use and misuse bear risks. We aimed at estimating the prevalence of PMed use and misuse. Methods: Data on all PMed prescribed in 2017 and dispensed in community pharmacies of the Lisbon and Tagus Valley region of Portugal (ARSLVT) were extracted from ARSLVT medicines' dispensing database. For 21 PMed among prescription opioids, benzodiazepines and z-drugs (BZDR), antidepressants (AD) and anticonvulsants (AC), we estimated the number of users of each PMed, and assessed PMed misuse by a set of proxy indicators for studying this practice: chronic use (use of ≥180 DDD during the study period) of PMed intended for short-term treatments, concomitant use of several PMed, in particular if involving long-term (≥ 30 days) opioid analgesic (OA) use, and doctor shopping (patients consulting several physicians in order to have access to a quantity higher than intended by each prescriber). Data were analysed using descriptive statistics and hypothesis testing, and multivariate logistic regression was used to explore potential factors affecting long-term concomitant treatment of chronic OA with other PMed. Results: PMed use prevalence was 21.7%: 6.6% for OA, 12.7% for benzodiazepines (BZD), 5.3% for AD and 2.8% for AC. BZDR were mainly prescribed in primary care and OA in hospital outpatients. Chronic use of PMed was observed in 25%, especially with sertraline and buprenorphine for opioid use disorder (long-term treatment), and lorazepam (short-term treatment). About 56.6% of OA chronic users were long-term concurrent users with other PMed, mainly BZDR. Risk of abuse was low for BZDR, whilst four opioids had meaningful doctor shopping indicators - fentanyl, opioid use disorder buprenorphine, morphine and hydromorphone. Conclusions: BZD are the main PMed used in ARSLVT, often chronically, especially lorazepam. Prevalence of OA use is low, although with higher risk of misuse than BZDR. Concomitant use of several PMed is frequent.
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In January 2023, the province of British Columbia (BC) decriminalized the possession of certain illegal drugs for personal use. The province's primary intent was to reduce the stigma associated with drug use, as well as barriers for people who use drugs (PWUD) to access treatment and supports. However, less than ten months into the decriminalization policy, due to growing concerns about public safety voiced by municipal governments and communities, the provincial government made amendments to the policy to ban the public consumption of illicit drugs in additional locations, and subsequently introduced additional legislation, Bill 34, aimed at regulating public consumption of drugs in public spaces. Some communities have also implemented local bylaws similarly regulating public drug use. Bill 34 and local bylaws may serve as tools to promote community health and safety and minimize direct and indirect harms associated with public drug use. However, such legislation may re-criminalize PWUD and reinforce negative perceptions surrounding drug use, especially if these policies are not paired with strategies to expand the availability and accessibility of critical harm reduction and housing services. Without ample access to these services, limitations on public drug use can potentially displace individuals to areas where they are more likely to use alone, further exposing them to substance use-related harms, and undermining the goals of decriminalization. The potential effects of these restrictions may also disproportionately impact marginalized populations. As of April 2024, Bill 34 remains on hold. Moving forward, it will be important to monitor this bill, as well as other public consumption bylaws and legislation, and their impact on BC's overall decriminalization initiative. Decision-makers are urged to increase engagement with PWUD and relevant stakeholders in the design and implementation of policies pertaining to public consumption to ensure that they effectively address the evolving needs and realities of PWUD, and align with decriminalization goals.
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Reducción del Daño , Drogas Ilícitas , Trastornos Relacionados con Sustancias , Humanos , Colombia Británica , Drogas Ilícitas/legislación & jurisprudencia , Salud Pública , Política Pública , Consumidores de Drogas/legislación & jurisprudencia , Política de Salud , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Uso Recreativo de DrogasRESUMEN
A female patient in her middle childhood presented to the paediatric emergency room (ER) after a bicycle accident with an abdominal impact on the bicycle handlebar. On physical examination, a painful ecchymosis on the upper left quadrant was the only abnormal finding. Abdominal ultrasound showed no intra-abdominal lesions, and the patient was discharged home after 24 hours under monitoring. Nine days after the accident, she returned to the ER due to the emergence of an abdominal mass around the area of impact. Abdominal examination detected a tender non-fluctuating mass on the epigastric and left hypochondrium, and abdominal ultrasound revealed a muscle and aponeurosis disruption of the rectus muscle, with fat herniation and cytosteatonecrosis. A conservative approach was chosen, with ambulatory follow-up. One month after the accident, the patient was asymptomatic, no abdominal mass was palpable, and an abdominal CT showed a reduction of the muscle disruption and hernial content.
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Ciclismo , Hernia Abdominal , Humanos , Ciclismo/lesiones , Femenino , Hernia Abdominal/etiología , Hernia Abdominal/diagnóstico por imagen , Niño , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía , Pared Abdominal/diagnóstico por imagenRESUMEN
INTRODUCTION: Misuse of psychoactive medicines, especially prescription opioids, but also benzodiazepines, hypnotics and sedatives, has become a significant public health issue in some countries, especially in the USA, where it has been extensively documented, as well as in Canada and Australia. However, in the European Union (EU) published literature on the topic is scarce and heterogeneous regarding definitions, sources of data, tools and methods of analysis.The aim of this scoping review is to map the key concepts on psychoactive medicines' misuse and examine the existing body of evidence on this topic in the EU. Data on the possible consequences of medicines' misuse-adverse drug reactions, poisonings, hospitalisations and deaths-will also be analysed. METHODS AND ANALYSIS: The scoping review will follow the framework of Arksey and O'Malley, further developed by Levac et al and the Joanna Briggs Institute. The search strategy, developed by the authors, includes querying three electronic databases-PubMed, Web of Science and Scopus-using keywords and the Medical Subject Headings, for evidence published in English, French, Spanish or Portuguese between 2011 and 2020. Additionally, articles from PubMed alerts and other sources will also be considered. The results of the scoping review will describe the currently available evidence regarding misuse of medicines at EU level. ETHICS AND DISSEMINATION: Since the scoping review methodology focuses on published data, this study does not require ethical approval. We will publish our findings in a peer-reviewed journal and plan to disseminate our work in conferences and scientific meetings. REGISTRATION DETAILS: This scoping review protocol is registered in the Open Science Framework (OSF; see https://osf.io/fzr9u) and has also been shared as a preprint in this free and open-source project management repository. It is available at https://doi.org/10.31219/osf.io/y3s4q.
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Revisión por Pares , Proyectos de Investigación , Benzodiazepinas/efectos adversos , Bases de Datos Factuales , Humanos , Hipnóticos y Sedantes , Literatura de Revisión como AsuntoRESUMEN
BackgroundPeople who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes.AimWe aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe.MethodsAggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006-2020; n = 52,368 HIV+/-; n = 47,268 HCV+/-). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR.ResultsUnivariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52-2.42). Pooled PR was 1.66 (95% CI 1.38-1.98), giving a PAR of 25.8% (95% CI 16.7-34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17-2.91). Pooled PR was 1.42 (95% CI: 1.28-1.58) and PAR 16.7% (95% CI: 11.8-21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe.ConclusionIn univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release ('throughcare').
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Consumidores de Drogas , Infecciones por VIH , Hepatitis C , Abuso de Sustancias por Vía Intravenosa , Europa (Continente)/epidemiología , Infecciones por VIH/epidemiología , Hepatitis C/epidemiología , Humanos , Prevalencia , Abuso de Sustancias por Vía Intravenosa/epidemiologíaRESUMEN
CONTEXT: Keloids are fibroproliferative scars characterized by excessive collagen deposition beyond the margins of the original wound. Although many treatment modalities were described in the literature, no single first-line therapy is recommended, and its recurrence rate remains high. AIMS: The aim of this study was to investigate the efficacy rate in treating auricle keloids after fillet flap excision combined with adjuvant intralesional steroid injections. SETTINGS AND DESIGN: This was a retrospective study. MATERIALS AND METHODS: Between 2012 and 2019, a total of 16 auricle keloids were treated at our center with fillet flap excision and adjuvant steroid injections. Intralesional steroid injections were given at the end of the first week and then administered at 4-week intervals until the lesions were soft and flat. Postoperative efficacy, complications, recurrence, and patient satisfaction were analyzed. RESULTS: A high improvement of the keloid was observed in 13 (81.2%) lesions. No major complications and no recurrence of the keloid were detected during the follow-up period (mean, 35 months). Regarding patient satisfaction, nine (81.8%) considered their result as excellent. CONCLUSION: This study showed that this approach is effective regardless of the keloid location at the auricle.
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BACKGROUND: The anterior surface of the auricle is especially susceptible to a variety of traumatic insults and cutaneous malignancies. However, given the unique anatomy of this structure and the lack of local tissue available, the reconstruction of these defects is still a challenge. Despite of their positive outcomes, tunneled flaps have not been thoroughly explored in the literature. OBJECTIVES: To review the clinical utility of tunneled flaps in reconstructing anterior auricle defects. MATERIALS AND METHODS: A review of the literature on surgical reconstruction of the anterior auricle surface was performed in PubMed, with specific reference to tunneled flaps. CONCLUSIONS: When designed and executed properly, tunneled flaps offer unrivalled opportunities to reconstruct anterior auricle defects, with maximal preservation of the symmetry.
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BACKGROUND: Recently, the interest in minimally invasive techniques in the management of the pilonidal sinus has been rising. The main goal is to avoid the prolonged recovery period associated with traditional surgeries. OBJECTIVE: To evaluate the safety and efficacy of a radial diode laser probe in the destruction of the pilonidal sinus. METHODS: Twenty-seven patients with pilonidal sinus were treated with a radial 1,470-nm diode laser between July 2018 and August 2020 and were examined retrospectively. Charts were reviewed and patients were questioned by telephone about their postlaser recovery period. RESULTS: Twenty-five patients were included. The overall success rate was 84%. Recurrence rate was 9.5%, after a mean follow-up of 8.3 months. The mean duration of analgesia intake was 2.5 days, and the mean period required to return to daily activities was 5.8 days. Sixteen percent of the patients developed a small postoperative hemorrhage as a complication. CONCLUSION: This study demonstrated that radial diode laser is safe, effective, and associated with a low recurrence rate in the treatment of mild pilonidal sinus disease. Dermatologists can perform it easily in the outpatient clinic, with minimal postoperative pain and a fast return to the patients' daily activities.
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Terapia por Láser/métodos , Láseres de Semiconductores , Seno Pilonidal/cirugía , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Os defeitos nas pálpebras resultantes da excisão do câncer de pele são comuns na prática diária dos cirurgiões dermatológicos. O objetivo desta revisão é resumir os métodos mais relevantes para o reparo da pálpebra, propondo algoritmos reconstrutivos para as pálpebras inferiores e superiores. Ambos os algoritmos foram projetados de acordo com decisões dicotômicas baseadas na espessura (espessura parcial versus total) e no tamanho do defeito da pálpebra (menor que 1/3, menor que 2/3 ou maior que 2/3 do comprimento da pálpebra).
Eyelid defects resulting from skin cancer excision are common in the daily practice of dermatologic surgeons. The aim of this review is to summarize the most relevant methods for eyelid repair, proposing reconstructive algorithms for both lower and upper eyelids. Both algorithms were designed according with dichotomic decisions based on the thickness (partial- versus full-thickness) and the size of the eyelid defect (less than 1/3, less than 2/3 or larger than 2/3 of the eyelid length).
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Algoritmos , PárpadosRESUMEN
Abstract Metastatic ovarian cancer uncommonly presents with skin metastasis. When present, skin metastases of ovarian cancer are usually localized in the vicinity of the primary tumor. We report a case of a 58-year-old woman with a rapid growing erythematous, well-defined nodule localized on the left nasal ala. A skin biopsy was performed and histopathological and immunohistochemical findings were compatible with a cutaneous metastasis of adenocarcinoma. A systematic investigation revealed a bilateral ovarian cystadenocarcinoma associated with visceral dissemination, likely associated with nose cutaneous metastasis. We report a very uncommon case because of the presentation of ovarian carcinoma as cutaneous metastasis. To our knowledge, this atypical localization on the nose has not been described yet in the literature.
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Humanos , Femenino , Persona de Mediana Edad , Neoplasias Ováricas/patología , Neoplasias Cutáneas/secundario , Carcinoma/secundario , Neoplasias Nasales/secundario , Neoplasias Ováricas/diagnóstico por imagen , Piel/patología , Neoplasias Cutáneas/patología , Biopsia , Carcinoma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Neoplasias Nasales/patologíaRESUMEN
An 86-year-old woman was referred for treatment of a lentigo maligna melanoma on the left earlobe, confirmed by cutaneous biopsy. The resulting surgical defect involved the earlobe's full thickness. The authors outline a simple method for reconstructing the entire lobe in one stage, without grafts, whilst offering a pleasant appearance. Earlobe deformity may be congenital or, more often, acquired due to trauma, burns or surgery. Ear lobules are an important reference point for facial symmetry and they serve decorative purposes like wearing earrings. Losing them represents an obvious aesthetic abnormality. Several methods developed to reconstruct this deformity have presented various advantages and disadvantages.
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Procedimientos Quirúrgicos Dermatologicos/métodos , Deformidades Adquiridas del Oído/cirugía , Oído Externo/cirugía , Anciano de 80 o más Años , Neoplasias del Oído/cirugía , Femenino , Humanos , Melanoma/cirugía , Colgajos Quirúrgicos/cirugíaRESUMEN
Abstract: An 86-year-old woman was referred for treatment of a lentigo maligna melanoma on the left earlobe, confirmed by cutaneous biopsy. The resulting surgical defect involved the earlobe's full thickness. The authors outline a simple method for reconstructing the entire lobe in one stage, without grafts, whilst offering a pleasant appearance. Earlobe deformity may be congenital or, more often, acquired due to trauma, burns or surgery. Ear lobules are an important reference point for facial symmetry and they serve decorative purposes like wearing earrings. Losing them represents an obvious aesthetic abnormality. Several methods developed to reconstruct this deformity have presented various advantages and disadvantages.
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Humanos , Femenino , Anciano de 80 o más Años , Deformidades Adquiridas del Oído/cirugía , Oído Externo/cirugía , Procedimientos Quirúrgicos Dermatologicos/métodos , Colgajos Quirúrgicos/cirugía , Neoplasias del Oído/cirugía , Melanoma/cirugíaAsunto(s)
Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Internacionalidad , Políticas de Control Social , Trastornos Relacionados con Sustancias/prevención & control , Congresos como Asunto , Contaminación de Equipos , Infecciones por VIH/transmisión , Accesibilidad a los Servicios de Salud , Hepatitis Viral Humana/transmisión , Humanos , Aplicación de la Ley , Salud Pública , Asunción de Riesgos , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/rehabilitación , Naciones UnidasRESUMEN
Metastatic ovarian cancer uncommonly presents with skin metastasis. When present, skin metastases of ovarian cancer are usually localized in the vicinity of the primary tumor. We report a case of a 58-year-old woman with a rapid growing erythematous, well-defined nodule localized on the left nasal ala. A skin biopsy was performed and histopathological and immunohistochemical findings were compatible with a cutaneous metastasis of adenocarcinoma. A systematic investigation revealed a bilateral ovarian cystadenocarcinoma associated with visceral dissemination, likely associated with nose cutaneous metastasis. We report a very uncommon case because of the presentation of ovarian carcinoma as cutaneous metastasis. To our knowledge, this atypical localization on the nose has not been described yet in the literature.