Tratamiento médico del body packer o mulas de drogas

Introducción: Durante el año 2020, más de 284 millones de personas en el mundo se afectaron por el consumo de drogas. Estas se transportan en diferentes formas de embalaje o en el propio cuerpo y son los llamados correos humanos. Las personas que utilizan el interior del cuerpo con esos fines se describen con varios términos, entre ellos body packers o mulas de drogas. Es una práctica peligrosa, con graves consecuencias médico-legales. Se realizó una revisión bibliográfica de documentos indexados en las bases de datos SciELO, PubMed y Google académico. Se incluyeron los artículos a texto completo, en español, portugués e inglés, publicados desde 2018 hasta 2022, relacionados con el tema. Objetivo: Examinar las formas de enfrentar desde el punto de vista médico un problema de salud como el body packer. Desarrollo: En la actividad de body packer participan individuos de ambos sexos, de todos los grupos etarios. Las sustancias trasportadas son: cocaína, heroína, anfetaminas, marihuana, hachís y drogas sintéticas. Se portan entre 50 a 200 cápsulas con 5 a 10 kilogramos de la sustancia total. Para su evaluación son necesarios estudios imagenológicos que varían en sensibilidad y disponibilidad. Más del 80 % de los casos son asintomáticos, resuelven con estricta vigilancia y uso de polietilenglicol para la evacuación intestinal; el resto de los casos, desarrollan el síndrome de body packer, requieren tratamiento quirúrgico y apoyo con tratamiento sintomático y específico. Conclusiones: Para el body packer está prevista la realización de estudios imagenológicos, así como el tratamiento médico o quirúrgico según las formas clínicas que se presenten.

Introduction: During the year 2020, more than 284 million people in the world were affected by the consumption of drugs, which are transported in different forms of packaging or using the body itself, called human couriers; people who use the inside of their body for these purposes are described by various terms, including body packers or drug mules, a dangerous practice, with serious medical-legal consequences. A bibliographic review of documents indexed in the SciELO, PubMed and academic Google databases is carried out. Full text articles, in Spanish, Portuguese and English, published from 2018 to 2022, related to the topic were included. Objective: To examine the ways to deal with a health problem such as body packer from a medical point of view. Development: Individuals of both sexes, of all age groups, participate in the body packer activity. The transported substances are: cocaine, heroin, amphetamines, marijuana, hashish and synthetic drugs. Between 50 and 200 capsules with 5 to 10 kilograms of the total substance are carried. Imaging studies that vary in sensitivity and availability are necessary for its evaluation. More than 80% of cases are asymptomatic, resolve with strict surveillance and use of polyethylene-glycol for bowel evacuation; the rest of the cases develop body packer syndrome and require surgical treatment and support with symptomatic and specific treatment. Conclusions: For the body packer, imaging studies are planned, as well as medical or surgical treatment according to the clinical forms that occur.

Nasal administration of the neuroprotective candidate NeuroEPO to healthy volunteers: a randomized, parallel, open-label safety study.

BACKGROUND: Delivery of therapeutic agents as erythropoietin (EPO) into Central Nervous System through intranasal route could benefit patients with neurological disorders. A new nasal formulation containing a non-hematopoietic recombinant EPO (NeuroEPO) has shown neuroprotective actions in preclinical models. In the current study, the safety of NeuroEPO was evaluated for the first time in humans. METHODS: A phase I, randomized, parallel, open-label study was carried out in healthy volunteers. They received, intranasally, 1 mg of NeuroEPO every 8 h during 4 days (Group A) or 0.5 mg of NeuroEPO (Group B) with the same schedule. The working hypothesis was that intranasal NeuroEPO produce <10% of severe adverse reactions in the evaluated groups. Therefore, a rigorous assessment of possible adverse events was carried out, which included tolerance of the nasal mucosa and the effect on hematopoietic activity. Clinical safety evaluation was daily during treatment and laboratory tests were done before and on days 5 and 14 after starting treatment. RESULTS: Twenty-five volunteers, 56% women, with a mean age of 27 yrs. were included. Twelve of them received the highest NeuroEPO dose. Twenty types of adverse events occurred, with headache (20%) and increase of hepatic enzymes (20%) as the most reported ones. Nasopharyngeal itching was the most common local event but only observed in four patients (16%), all of them from the lowest dose group. About half of the events were very probably or probably caused by the studied product. Most of the events were mild (95.5%), did not require treatment (88.6%) and were completely resolved (81.8%). No severe adverse events were reported. During the study the hematopoietic variables were kept within reference values. CONCLUSIONS: NeuroEPO was a safe product, well tolerated at the nasal mucosa level and did not stimulate erythropoiesis in healthy volunteers. TRIAL REGISTRATION: Cuban Public Registry of Clinical Trials RPCEC00000157 , June 10, 2013.

Intoxicaciones agudas por baclofeno consultadas al Centro Nacional de Toxicología en cinco años / Acute intoxications by baclofen consulted to Toxicology National Center in five years

Introducción: el baclofeno se indica como relajante muscular para el alivio de espasticidad grave y ejerce sus efectos como agonista selectivo del receptor GABA-B. Objetivo: caracterizar las intoxicaciones por baclofeno según reportes al Servicio de Información de Urgencia del Cenatox entre 2011 y 2015. Métodos: se realizó un estudio observacional retrospectivo con un universo de 16 notificaciones, en las que se estudiaron: el centro de salud que asistió al paciente, provincia de procedencia por año de estudio, grupo de edad, sexo, circunstancias del evento, manifestaciones clínicas y severidad de la intoxicación. Resultados: el año 2014 aportó la mayor cantidad de reportes y los niños las mayores frecuencias absolutas, no hubo diferencias en relación al sexo, aunque entre los hombres predominó la causa accidental y entre las féminas las intencionales suicidas. Todas las notificaciones procedieron de atención secundaria, aunque cinco de los pacientes habían sido previamente asistidos en áreas de salud. Todos los afectados presentaron manifestaciones neurológicas, la mayoría fueron reportados de grave y la mitad de los casos presentaron alteraciones cardiorrespiratorias con inestabilidad hemodinámica que llevó a la asistencia ventilatoria. La recuperación fue completa en todos los pacientes y no se reportaron fallecidos por esta causa durante el período de estudio. Conclusiones: la sobredosis de baclofeno es más común en niños y cursa con manifestaciones de neurotoxicidad e inestabilidad hemodinámica(AU)

Introduction: Baclofen is indicated as a muscle relaxant for the relief of severe spasticity and exerts its effects as a selective agonist of the GABA-B receptor. Objective: To characterize baclofen poisonings according to reports to the Cenatox emergency information service between 2011 and 2015. Methods: A retrospective observational study with a universe of 16 notifications, in which the health center that attended the patient and province of origin was studied by year of study, age group, gender, circumstances, clinical manifestations and severity of intoxication. Results: The bigger number of reports and the highest absolute frequencies occurred in the year 2014, there were no differences with regard to sex, although among the men, the accidental cause was predominant, and among women the suicides attemps were predominant. All reports came from secondary care, although five of the patients had previously been assisted in health care areas; all affected had neurological manifestations, most were reported as severe and half of the cases presented cardiorespiratory alterations with hemodynamic instability leading to ventilatory assistance. Recovery was complete in all patients and no deaths were reported for this cause during the study period. Conclusions: Baclofen overdose was more common in children and was characterized by neurotoxicity and hemodynamic instability(AU)

Parámetros bioéticos en el manejo del paciente drogodependiente / Parameters bioethical addict patient management

El consumo de drogas es una situación que se encuentra en ascenso a nivel mundial. Las cifras respectivas de los años de invalidez vinculadas al tabaco, alcohol y sustancias ilegales se elevan a 59, 58 y 20 millones de años cada 12 meses. Teniendo en cuenta los datos planteados se requiere enfrentar el problema desde todos los puntos y de manera intersectorial analizando a la persona de manera individual y social teniendo en cuenta los parámetros éticos y bioéticos que influyen en esta problemática. Este trabajo analizó los principales conflictos y dilemas éticos relacionados con el diagnóstico y tratamiento de pacientes adictos y valoró el papel de la competencia y los medios de sustitución en el manejo del adicto. El estudio fue descriptivo, evaluando el cumplimiento y deficiencias de los principios éticos en el manejo de este tipo de paciente. Se concluyó que los principales conflictos y dilemas éticos están con relación a problemas técnicos en el establecimiento del diagnóstico de drogodependencia, en el uso del diagnóstico de drogodependencia y en los fines y los medios en la asistencia a estos pacientes así como que la competencia, en algunas ocasiones requiere ser desplazada por las decisiones de sustitución(AU)

Drug use is a situation that is on the rise worldwide. The respective figures for the years of disability related to snuff, alcohol and illegal substances rise to 59, 58 and 20 million years every 12 months. Taking into account the data considered are required to face the problem from all points across sectors and analyze the person individually and taking into account social and ethical standards that affect this bioethical problem. This paper analyzes the main conflicts and ethical dilemmas related to the diagnosis and treatment of addicts and I appreciate the role of competition and media replacement in the management of the addict. The study was evaluating the performance and shortcomings of ethical principles in handling this type of patient. It was concluded that the main conflicts and ethical dilemmas are in relation to technical problems in establishing the diagnosis of drug dependence in the use of drug and diagnostic purposes and the media in assisting these patients as well as competition, sometimes needs to be displaced by substitution decisions(AU)