Cocaine-related ischemic priapism. Systematic review and presentation of a single center series.

INTRODUCTION: Ischemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing. This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism? METHODS: We conducted a systematic review according to PRISMA guidelines and described our case series. RESULTS: Eight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6 h, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75 h and 2, respectively. CONCLUSION: Cocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.

Substance use disorder: Epidemiology, medical consequences and treatment. / Trastorno por uso de sustancias: epidemiología, complicaciones médicas y tratamiento.

Substance use is a common health problem, and substance use disorder, which is its most severe presentation, is associated with multiple medical consequences and a negative impact on individual and on population health. Substance use disorder needs to be addressed as any chronic medical condition; therefore, it has to be detected at the early stages and has to be properly treated to prevent drug-related harm. Internists should be able to recognize and treat intoxication and abstinence. Internists should also be able to refer the patient to state of the art long term treatment, aimed to detoxification and treatment induction to promote abstinence and prevent relapse. In this narrative review we will discuss substance use epidemiology, its main medical consequences and its treatment, with a focus on alcohol, opiates, cocaine and other stimulants, cannabis and benzodiazepines.

Near-fatal cocaine intoxication in an infant with thrombotic microangiopathy associated with multiple organ failure / Intoxicação grave por cocaína em criança com microangiopatia trombótica associada à falência múltipla de órgãos

ABSTRACT Objective: To report a pediatric case of drug-induced thrombotic microangiopathy caused by cocaine Case description: We report a nine-month-old patient who developed thrombotic microangiopathies after extreme cocaine intoxication, multiple organ dysfunction syndrome with hemodynamic dysfunction, anuric renal failure, liver failure, encephalopathy, and myocardial injury, corresponding phenotypically to thrombocytopenia-associated multiple organ failure. The patient received continuous venous hemofiltration and therapeutic plasma exchange, recovering satisfactorily. She was discharged after 30 days of hospitalization under the guidance of the childcare service, and was healthy after one year of follow-up. Toxicological samples confirmed high levels of cocaine and derivatives in blood, urine and hair. Comments: To our knowledge, this is the first reported pediatric case. There are particularities of cocaine intoxication pathophysiology that can trigger thrombotic microangiopathies because of vasoconstriction, direct endothelial injury, platelet activation, and increasing von Willebrand factor and fibrinogen levels. All of which results in a prothrombotic state, inflammatory dysregulation, and microvascular thrombi. The increasing use of cocaine, especially among young adults, puts children at high risk of toxicity, either by passive unintentional exposure, or abuse due to the increased availability in homes.

RESUMO Objetivo: Relatar um caso pediátrico de microangiopatia trombótica induzida por drogas causada por cocaína Descrição do caso: Relatamos uma paciente de nove meses de idade que desenvolveu microangiopatia trombótica após intoxicação extrema por cocaína, síndrome de disfunção de múltiplos órgãos com disfunção hemodinâmica, insuficiência renal anúrica, insuficiência hepática, encefalopatia e lesão miocárdica, correspondendo fenotipicamente à falência múltipla de órgãos associada à trombocitopenia. A paciente recebeu hemofiltração venosa contínua e plasmaférese terapêutica, recuperando-se satisfatoriamente. Recebeu alta após 30 dias de internação sob orientação do serviço de puericultura e estava saudável após um ano de seguimento. Amostras toxicológicas confirmaram altos níveis de cocaína e derivados no sangue, urina e cabelos. Comentários: Até onde sabemos, este é o primeiro caso pediátrico relatado. Existem particularidades da fisiopatologia da intoxicação por cocaína que podem desencadear a microangiopatia trombótica devido à vasoconstrição, lesão endotelial direta, ativação plaquetária e aumento do fator de von Willebrand e dos níveis de fibrinogênio. Tudo isso resulta em um estado pró-trombótico, desregulação inflamatória e trombos microvasculares. O uso crescente de cocaína, principalmente entre adultos jovens, coloca as crianças em alto risco de toxicidade, seja por exposição passiva não intencional ou abuso devido à maior disponibilidade nas residências.

Detección de sustancias psicoactivas ilegales en orinade madres y recién nacidos en un hospital público. Comparación de quinquenios 2009-2013 y 2014-2018 / Detection of illicit psychoactive substances in the urine of mothers and newborn infants at a public hospital. Comparison between the 2009­2013 and 2014­2018 five-year periods

Introducción. El consumo de sustancias psicoactivas ilegales en el embarazo constituye un problema creciente. En pocas maternidades latinoamericanas se aplica una estrategia de detección y los datos publicados son escasos. Objetivos. Comparar dos quinquenios de resultados de una estrategia de detección de sustancias psicoactivas ilegales implementada en el posparto. Población y métodos. Estudio de corte transversal. Detección por inmunoensayo en orinas de binomios madre-hijo/a, en un hospital público argentino entre 2009 y 2018. Resultados. En 76/191 binomios se detectaron sustancias en 10 años. El criterio de detección más frecuente fue la comunicación o antecedente de uso de drogas: 25/37 y 32/39 en cada quinquenio. Predominaron cannabis (21/37 y 26/39) y cocaína (19/37 y 16/39) en ambos períodos. No hubo diferencias en datos demográficos, ginecológicos, del embarazo ni neonatales en los quinquenios comparados. Conclusiones. No se encontraron diferencias en la frecuencia ni en el tipo de sustancias detectadas a lo largo de 10 años.

Introduction. The use of illicit psychoactive substances during pregnancy is a growing problem. Few Latin American maternity centers implement a screening strategy, and published data are scarce. Objectives. To compare the outcomes of 2 five-year periods of a postpartum strategy to screen for illicit psychoactive drugs. Population and methods. This was a cross-sectional study. Immunoassay detection in urine of mothernewborn infant dyads in an Argentine public hospital between 2009 and 2018. Results. Substances were detected in 76/191 dyads over 10 years. The most frequent detection criterion was reporting or history of drug use: 25/37 and 32/39 in each five-year period. Cannabis (21/37 and 26/39) and cocaine (19/37 and 16/39) predominated in both periods. No differences were observed in demographic, gynecological, pregnancy, or neonatal data between both five-year periods. Conclusions. No differences were found in the frequency or type of substances detected over 10 years

Dolor torácico secundario al consumo de drogas atendido en urgencias hospitalarias en España / Chest pain secondary to drug use treated in hospital emergency departments in Spain

Objetivo Conocer las características de los pacientes con dolor torácico (DT) asociado al consumo reciente de drogas. Método Estudio de los casos del Registro REUrHE atendidos en urgencias de 11 hospitales españoles por DT tras el consumo de drogas de uso recreacional. Resultados El DT supuso el 8,97% de las asistencias (varones 82,9%, p<0,001). La cocaína estaba presente en el 70% de los casos, seguida del cannabis (35,7%) y las anfetaminas y derivados (21,4%). La clínica inicial más frecuente fue: palpitaciones (45,5%, p<0,001), ansiedad (42,5%, p<0,001), hipertensión (13,6%, p<0,001) y arritmias (5,9%, p<0,001). Recibieron más tratamiento los pacientes con DT (81,9% vs. 74,1%; p<0,001), aunque ingresaron menos (7,6%, p=0,0), sin diferencias en cuanto a maniobras de reanimación cardiopulmonar, sedación, intubación, o ingreso en cuidados intensivos (1,9%). Conclusiones En el DT tras una intoxicación aguda por drogas predomina el uso de la cocaína, aunque aumentan los casos por consumo de cannabis (AU)

Objective To determine the characteristics of patients with chest pain (CP) associated with recent drug use. Methods Study of cases from the REUrHE registry attended in the emergency department of 11 Spanish hospitals for CP following recreational drug use. Results CP accounted for 8.97% of attendances (males 82.9%, P<.001). Cocaine was present in 70% of cases, followed by cannabis (35.7%) and amphetamines and derivatives (21.4%). The most frequent initial symptoms were: palpitations (45.5%, P<.001), anxiety (42.5%, P<.001), hypertension (13.6%, P<.001) and arrhythmias (5.9%, P<.001). Patients with TD received more treatment (81.9% vs. 74.1%; P<.001), although they were admitted less (7.6%, P=.0), with no differences in terms of CPR manoeuvres, sedation, intubation, or admission to intensive care (1.9%). Conclusions In CP following acute drug intoxication, cocaine use predominates, although cases of cannabis use are increasing (AU)

Chest pain secondary to drug use treated in hospital emergency departments in Spain.

OBJECTIVE: To determine the characteristics of patients with chest pain (CP) associated with recent drug use. METHODS: Study of cases from the REUrHE registry attended in the emergency department of 11 Spanish hospitals for CP following recreational drug use. RESULTS: CP accounted for 8.97% of attendances (males 82.9%, p<0.001). Cocaine was present in 70% of cases, followed by cannabis (35.7%) and amphetamines and derivatives (21.4%). The most frequent initial symptoms were: palpitations (45.5%, p<0.001), anxiety (42.5%, p<0.001), hypertension (13.6%, p<0.001) and arrhythmias (5.9%, p<0.001). Patients with TD received more treatment (81.9% vs 74.1%; p<0.001), although they were admitted less (7.6%, p=0.0), with no differences in terms of CPR manoeuvres, sedation, intubation, or admission to intensive care (1.9%). CONCLUSIONS: In CP following acute drug intoxication, cocaine use predominates, although cases of cannabis use are increasing.

Daño nasal por abuso de cocaína. Reporte de caso clínico / Nasal damage cocaine abuse. Case report

La cocaína proviene de la hoja de coca, es una sustancia que cuando se consume por la vía inhalatoria puede producir lesiones graves a nivel nasal, con lesiones que se inician a nivel de la mucosa, perforación septal, con pérdida del soporte a nivel de la punta nasal, retracción alar, compromiso de y retracción de ambas alas, planos de cobertura y piso de fosas nasales. La reconstrucción es un desafío para el cirujano plástico. Abarcando un arsenal terapéutico que va desde solo confeccionar un marco cartilaginoso para soporte de la columela y dorso nasal con costilla, hasta cobertura interna y externa con colgajos más sofisticados. Creemos que estos pacientes para su tratamiento deben presentar conocimiento de que es un camino largo que requiere muchos tiempos quirúrgicos y que en estadios avanzados la cobertura de mucosa es el mayor desafío.

Cocaine comes from the coca leaf, it is a substance that when consumed by inhalation can cause serious injuries to the nose. With lesions that start at the level of the mucosa, septal perforation, with loss of support at the level of the nasal tip, alar retraction, compromise and retraction of both wings, coverage planes, and floor of the nostrils. Reconstruction is a challenge for the plastic surgeon. A therapeutic arsenal that goes from just making a cartilaginous framework to support the columella and nasal dorsum with rib, to internal and external coverage with more sophisticated flaps. We believe that in order to treat these patients, they must be aware that it is a long road that requires many surgical times and that in advanced stages mucosal coverage is the greatest challenge

Cuidado em saúde mental com gestantes usuárias de crack / Mental health care with pregnant crack users / Cuidadode salud mental con mujeres embarazadas que utilizan crack

Neste manuscrito, apresentamos uma pesquisa cujo objetivo foi o de compreender como vem sendo produzidas as práticas de cuidado às gestantes usuárias de crack nos serviços de saúde de um município do interior do Rio Grande do Sul. Este estudo de abordagem qualitativa, foi realizado junto a dois serviços públicos, o Programa de Redução de Danos (PRD) e o Centro de Atenção Psicossocial para Álcool e outras Drogas (CAPSad III), com cinco mulheres voluntárias para a pesquisa. As histórias de vida foram reconstruídas a partir de suas narrativas e também de profissionais da saúde que proveram algum tipo de cuidado às participantes. Após a exposição das histórias, refletimos sobre três pistas importantes para pensarmos as práticas de cuidado às gestantes usuárias de crack: saúde mental, uso de drogas e interseccionalidade; direitos humanos, hierarquias reprodutivas e concepções de maternidade; e as práticas de cuidado em saúde. Observamos que as concepções dos profissionais acerca da maternidade direcionam as práticas de cuidado em saúde, caracterizando-se como um cuidado no espectro da saúde materno-infantil, e não um cuidado direcionado à saúde da mulher. Conhecer as demandas de cuidado dessas mulheres é essencial para que possamos pensar em práticas de saúde pautadas pela clínica ampliada. (AU)

In this manuscript, we present a research whose objective was to understand how the practicesof care to the pregnant women users of crack have been being produced in the services of health in a town of Rio Grande do Sul. This study of qualitative approach it was developed jointly to two public services, the Program of Reduction of Harms (PRH) andPsychosocial Care Centers Alcohol and other Drugs (CAPSad), with five voluntary women for the research. The life histories were rebuilt starting from their narratives and also of health's professionals that provided some care to the participants.After exposing the stories, we reflected on three important clues to think about care practices for pregnant women who use crack: mental health, drug use and intersectionality; human rights, reproductive hierarchies and conceptions of motherhood; and health care practices. We observed that the professionals' conceptions about maternity guide health care practices, characterized as care in the spectrum of maternal and child health, and not care directed at women's health.Knowing the care demands of these women is essential for us to think about health practices guided by the expanded clinic. (AU)

En este manuscrito presentamos una investigación cuyoobjetivo fue comprender cómo se ha producidolas prácticas de atención a las embarazadas usuarias de crack en los servicios de salud de una ciudad del interior de Rio Grande do Sul. Este estudio cualitativo se realizó con dos servicios públicos, el Programa de Reducción de Daños (PRD) y el Centro de Atención Psicosocial de Alcohol y Otras Drogas (CAPSad III), con cinco mujeres voluntarias para la investigación. Las historias de vida fueron reconstruidas a partir de sus narrativas y también de profesionalesde la salud que brindaron algún tipo de atención a los participantes. Luego de exponer las historias, reflexionamos sobre tres claves importantes para pensar en las prácticas de cuidado de las embarazadas que consumen crack: salud mental, consumo de drogas y interseccionalidad; derechos humanos, jerarquías reproductivas y concepciones de la maternidad; y prácticas de atención de la salud.Observamos que las concepciones de los profesionales sobre la maternidad orientan las prácticas de atención de la salud, caracterizadas como cuidados en el espectro de la salud maternoinfantil, y no cuidados dirigidos a la salud de la mujer. Conocer las demandas de atención de estas mujeres es fundamental para que pensemos en las prácticas de salud guiadas por la clínica ampliada. (AU)

Consumo de drogas: enfrentamiento a un problema latente / Drug use: confronting a latent problem i: en

Algunas situaciones ponen en riesgo a Cuba en cuanto al uso de drogas, entre ellas el aumento del turismo, las relaciones con países que poseen altas tasas de consumo, la ubicación geográfica en corredores de narcotraficantes y la alta prevalencia de drogas porteras. Al respecto, el Sistema Nacional de Salud debe estar preparado para la prevención del problema y la atención a los afectados, de manera que resulta necesario mantener una información actualizada sobre los factores de riesgo y los principales productos utilizados por los consumidores. En la presente revisión bibliográfica sobre el tema se busca llamar la atención de los trabajadores de la salud en tal sentido, se ofrecen datos sobre la magnitud del problema y se abordan elementos de sus antecedentes, así como de la clasificación de las drogas, los factores de riesgo asociados a su consumo y las bases jurídicas para su control en Cuba.

Some situations put Cuba at risk for drug use, such as an increase in tourism, relations with countries that have high rates of substance abuse, the geographic location in drug trafficking corridors, and the high prevalence of "opening doors" drugs. In this regard, the National Health System must be prepared to prevent the problem and care for those affected, so it is necessary to maintain updated information on risk factors and main products used by consumers. In the present literature review on the subject, it is sought to draw the attention of health workers to this point, data on the magnitude of the problem and elements of its background are offered, as well as drug classification, the risk factors associated with its use and the legal bases for its control in Cuba.

Muerte accidental por consumo combinado de cocaína y etanol Revisión bibliográfica / Accidental death from combined cocaine and ethanol use. Literature review

La autopsia médico legal en Costa Rica, en casos sospechosos de intoxicación por cocaetileno se debe realizar bajo las normas establecidas en la Guía de estándares de trabajo para la Sección de Patología Forense del Departamento de Medicina Legal. El análisis del mecanismo fisiopatológico de cómo estas sustancias provocan alteraciones en el organismo que pueden conllevar a un eventual fallecimiento corresponde a parte del análisis requerido en la investigación ante la sospecha de esta causa de muerte. Por lo anterior, el objetivo de este artículo es describir los mecanismos fisiopatológicos que ocurren durante el consumo combinado de cocaína y etanol, los mecanismos que conllevan a la muerte de personas consumidoras de estas sustancias y las consideraciones médico legales a tomar en cuenta para el diagnóstico de esta causa de muerte. Se realizó revisión de artículos científicos, sobre los efectos del uso combinado de la cocaína y el etanol. La literatura describe que el uso combinado de cocaína y etanol potencia los efectos farmacocinéticos y bioquímicos de cada una de estas sustancias, que su derivado, el cocaetileno, es capaz de generar por sí mismo los mecanismos causantes de la muerte. Que los principales mecanismos fisiopatológicos que conllevan la muerte ante el uso combinado de estas sustancias son de origen cardiovascular y hepático. Como consideraciones médico legales a tomar en cuenta para el diagnóstico de esta manera de muerte accidental, en la Sección de Toxicología del Departamento de Ciencias Forenses de Costa Rica, la cuantificación del cocaetileno y las sustancias relacionadas no se realiza, aunque se encuentra actualmente en el desarrollo de un proyecto para la determinación de la estabilidad de las drogas en sangre bajo las condiciones de almacenamiento, con el fin de ofrecer la posibilidad de cuantificar ciertas drogas (en donde se podría incluir el cocaetileno) en un futuro próximo.

Medical-legal autopsy in Costa Rica, in suspected cases of cocaethylene poisoning must be performed under the regulations established in the Work Standards Guide for the Forensic Pathology Section of the Department of Legal Medicine. The analysis of the pathophysiological mechanism of how these substances cause alterations in the organism that can lead to eventual death corresponds to part of the analysis required in the investigation when this cause of death is suspected. Therefore, the objective of this article is to describe the pathophysiological mechanisms that occur during the combined consumption of cocaine and ethanol, the mechanisms that lead to the death of people who consume these substances, and the medico-legal considerations to be considered for the diagnosis. of this cause of death. A review of scientific articles was carried out on the effects of the combined use of cocaine and ethanol. The literature describes that the combined use of cocaine and ethanol enhances the pharmacokinetic and biochemical effects of each one of these substances, that its derivative, cocaethylene, can generate the mechanisms that cause death by itself. That the main pathophysiological mechanisms that lead to death in the combined use of these substances are of cardiovascular and hepatic origin. As legal medical considerations to take into account for the diagnosis of this type of accidental death, in the Toxicology Section of the Department of Forensic Sciences of Costa Rica, the quantification of cocaethylene and related substances is not carried out, although it is currently in the development of a project for the determination of the stability of drugs in blood under storage conditions, in order to offer the possibility of quantifying certain drugs (which could include cocaethylene) in the near future.

Cuadros cutáneo-mucosos asociados al consumo de cocaína / Cutaneous and Mucosal Conditions Associated With Cocaine Use

El consumo de cocaína, junto con algunos de sus adulterantes más frecuentes como el levamisol, puede provocar múltiples procesos cutáneos y mucosos, ya sean de índole isquémico, dermatosis neutrofílicas, lesiones destructivas de la línea media y vasculitis asociadas a ANCA, entre otros. Generalmente no se asocia clínica sistémica llamativa.Todos estos cuadros pueden presentar anticuerpos antinucleares, antifosfolípido y contra distintos antígenos de los neutrófilos, en ocasiones con un patrón característico. El estudio histológico suele mostrar cambios vasculares como vasculitis leucocitoclástica, necrosis de la pared y trombos. En este artículo revisamos las características clínicas, serológicas e histológicas de estas entidades, junto con los mecanismos fisiopatológicos implicados, el diagnóstico diferencial y su tratamiento. (AU)

Cocaine and some of its main adulterants, such as levamisole, can cause multiple cutaneous and mucosal manifestations, including ischemic complications, neutrophilic dermatoses, midline destructive lesions, and vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). Striking systemic symptoms are generally not seen.In all these conditions, positive test results may be observed for antinuclear antibodies, antiphospholipid antibodies, and various ANCAs, sometimes with characteristic staining patterns. Histology typically shows vascular changes, such as leukocytoclastic vasculitis, necrotizing vasculitis, and thrombi. We review the clinical, serologic, and histologic features of cutaneous and mucosal conditions associated with the use of cocaine and also look at pathophysiologic mechanisms, differential diagnoses, and treatments. (AU)

[Translated article] Cutaneous and Mucosal Conditions Associated With Cocaine Use / Cuadros cutáneo-mucosos asociados al consumo de cocaína

Cocaine and some of its main adulterants, such as levamisole, can cause multiple cutaneous and mucosal manifestations, including ischemic complications, neutrophilic dermatoses, midline destructive lesions, and vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). Striking systemic symptoms are generally not seen. In all these conditions, positive test results may be observed for antinuclear antibodies, antiphospholipid antibodies, and various ANCAs, sometimes with characteristic staining patterns. Histology typically shows vascular changes, such as leukocytoclastic vasculitis, necrotizing vasculitis, and thrombi. We review the clinical, serologic, and histologic features of cutaneous and mucosal conditions associated with the use of cocaine and also look at pathophysiologic mechanisms, differential diagnoses, and treatments. (AU)

El consumo de cocaína, junto con algunos de sus adulterantes más frecuentes como el levamisol, puede provocar múltiples procesos cutáneos y mucosos, ya sean de índole isquémico, dermatosis neutrofílicas, lesiones destructivas de la línea media y vasculitis asociadas a ANCA, entre otros. Generalmente no se asocia clínica sistémica llamativa. Todos estos cuadros pueden presentar anticuerpos antinucleares, antifosfolípido y contra distintos antígenos de los neutrófilos, en ocasiones con un patrón característico. El estudio histológico suele mostrar cambios vasculares, como vasculitis leucocitoclástica, necrosis de la pared y trombos. En este artículo revisamos las características clínicas, serológicas e histológicas de estas entidades, junto con los mecanismos fisiopatológicos implicados, el diagnóstico diferencial y su tratamiento. (AU)

Pancreatitis aguda asociada a cocaína, una complicación inusual. Serie de casos / Cocaine-induced acute pancreatitis, an unusual complication. Case serie / Pancreatite aguda associada à cocaína, uma complicação incomum. Número de casos

La cocaína es una de las sustancias ilegales más consumidas y Colombia no es la ex­cepción. Dentro de las sustancias ilegales es la segunda más consumida después del cannabis. Por su mecanismo mismo de acción, que produce aumento de aminas bióge­nas, se han asociado con la cocaína diferentes riesgos, tanto agudos como crónicos, y dentro de sus complicaciones se han descrito cambios comportamentales, compromiso cardiovascular y neurológico. La coingesta de cocaína y alcohol da lugar a un metabolito conocido como cocaetileno, que lleva a complicaciones cardiovasculares. Poco se ha descrito sobre el riesgo de la cocaína o la coingesta cocaína y alcohol, como un factor sumatorio, para la pancreatitis. Reportamos tres pacientes jóvenes consumidores del alcaloide que desarrollaron pancreatitis aguda, dos de ellos murieron. El objetivo de este reporte es sensibilizar a los trabajadores de la salud sobre otro riesgo para considerar en los pacientes consumidores de cocaína.

Cocaine is one of the most consumed illegal substances and Colombia is no exception. It is the second most consumed among the illegal substances after cannabis. Due to its very mechanism of action, which produces an increase in biogenic amines, different risks, both acute and chronic, have been associated with cocaine, and among its complications, behavioral changes, cardiovascular and neurological compromise have been described. The co-ingestion of cocaine and alcohol gives rise to a metabolite known as cocaethylene, which leads to cardiovascular complications. Little has been described about the risk of cocaine or cocaine and alcohol co-ingestion, as a summative factor, for pancreatitis. We report three young patients consuming the alkaloid who developed acute pancreatitis, two of whom died. The objective of this report is to sensitize health workers about another risk to consider in cocaine-consuming patients.

A cocaína é uma das substâncias ilícitas mais consumidas e a Colômbia não é exceção. Dentro das substâncias ilícitas é a segunda mais consumida depois da maconha. Devido ao seu próprio mecanismo de ação, que produz aumento de aminas biogênicas, diversos riscos, tanto agudos quanto crônicos, têm sido associados à cocaína e, entre suas complicações, têm sido descritas alterações comportamentais, comprometimento cardiovascular e neurológico. A co-ingestão de cocaína e álcool dá origem a um metabólito conhecido como cocaetileno, que leva a complicações cardiovasculares. Pouco tem sido descrito sobre o risco da co-ingestão de cocaína ou cocaína e álcool, como fator somativo, para pancreatite. Relatamos 3 pacientes jovens consumindo o alcalóide que desenvolveram pancreatite aguda, dois dos quais morreram. O objetivo deste relatório é sensibilizar os profissionais de saúde sobre outro risco a ser considerado em pacientes consumidores de cocaína.

Cutaneous and Mucosal Conditions Associated With Cocaine Use. / Cuadros cutáneo-mucosos asociados al consumo de cocaína.

Cocaine and some of its main adulterants, such as levamisole, can cause multiple cutaneous and mucosal manifestations, including ischemic complications, neutrophilic dermatoses, midline destructive lesions, and vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). Striking systemic symptoms are generally not seen. In all these conditions, positive test results may be observed for antinuclear antibodies, antiphospholipid antibodies, and various ANCAs, sometimes with characteristic staining patterns. Histology typically shows vascular changes, such as leukocytoclastic vasculitis, necrotizing vasculitis, and thrombi. We review the clinical, serologic, and histologic features of cutaneous and mucosal conditions associated with the use of cocaine and also look at pathophysiologic mechanisms, differential diagnoses, and treatments.

Changes in lung function in adolescents with substance use disorders: an exploratory study / Alterações da função pulmonar em adolescentes com transtornos relacionados ao uso de substâncias: estudo exploratório

ABSTRACT Objective: To compare lung function between adolescents with and without substance use disorder (SUD). Methods: This was an observational, cross-sectional exploratory study. The sample consisted of 16 adolescents with SUD and 24 age-matched healthy controls. The adolescents in the clinical group were recruited from a psychiatric inpatient unit for detoxification and rehabilitation; their primary diagnosis was SUD related to marijuana, cocaine, or polysubstance use. Questionnaires and pulmonary function tests were applied for clinical evaluation. Results: We found that FVC, FEV1, and their percentages of the predicted values were significantly lower in the adolescents with SUD than in those without. Those differences remained significant after adjustment for BMI and the effects of high levels of physical activity. The largest effect size (Cohen's d = 1.82) was found for FVC as a percentage of the predicted value (FVC%), which was, on average, 17.95% lower in the SUD group. In addition, the years of regular use of smoked substances (tobacco, marijuana, and crack cocaine) correlated negatively with the FVC%. Conclusions: This exploratory study is innovative in that it demonstrates the early consequences of smoked substance use for the lung health of adolescents with SUD.

RESUMO Objetivo: Comparar a função pulmonar de adolescentes com e sem transtornos relacionados ao uso de substâncias (TUS). Métodos: Trata-se de um estudo exploratório transversal observacional. A amostra foi composta por 16 adolescentes com TUS e 24 controles saudáveis emparelhados pela idade. Os adolescentes do grupo clínico foram recrutados em uma unidade de internação psiquiátrica para desintoxicação e reabilitação; seu diagnóstico primário era o de TUS (maconha, cocaína ou polissubstâncias). Foram aplicados questionários e testes de função pulmonar para a avaliação clínica. Resultados: A CVF, o VEF1 e seus valores em porcentagem do previsto foram significativamente mais baixos nos adolescentes com TUS do que naqueles sem TUS. Essas diferenças permaneceram significativas após os ajustes para levar em conta o IMC e os efeitos de altos níveis de atividade física. O maior tamanho de efeito (d de Cohen = 1,82) foi o observado em relação à CVF em porcentagem do previsto (CVF%), que foi, em média, 17,95% menor no grupo TUS. Além disso, os anos de uso regular de substâncias fumadas (tabaco, maconha e crack) correlacionaram-se negativamente com a CVF%. Conclusões: Este estudo exploratório é inovador na medida em que demonstra as consequências precoces do uso de substâncias fumadas para a saúde pulmonar de adolescentes com TUS.

Unlocking the secrets of saliva: the promising potential of salivary biomarkers for evaluating crack use / Desvendando os segredos da saliva: o potencial promissor dos biomarcadores salivares para avaliar o uso de crack

The forthcoming letter will encompass the following highlights: Crack cocaine use involves smoking a highly addictive form of cocaine, which is a significant concern in Brazil, particularly in urban areas. This addiction is linked to various health problems, including cardiovascular issues, sexually transmitted infections (STIs) like AIDS and syphilis, tuberculosis, and a notable increase in mortality, largely due to violent causes. Furthermore, crack cocaine users are particularly vulnerable to dental caries, gingival inflammation, oral mucosa lesions, and xerostomia (AU)

A próxima carta incluirá os seguintes destaques: O uso de crack envolve fumar uma forma altamente viciante da cocaína, o que é uma preocupação significativa no Brasil, especialmente em áreas urbanas. Esta dependência está ligada a vários problemas de saúde, incluindo problemas cardiovasculares, infecções sexualmente transmissíveis (IST), como a AIDS e a sífilis, a tuberculose e um aumento notável da mortalidade, devido, em grande parte, a causas violentas. Além disso, os usuários de crack são particularmente vulneráveis a cáries dentárias, inflamação gengival, lesões na mucosa oral e xerostomia (AU)

Representações Sociais do planejamento da maternidade em gestantes usuárias de drogas / Social representations of maternity planning in pregnant drug users / Representaciones sociales de la planificación de la maternidad en embarazadas usuarias de drogas

Objetivo: compreender as Representações Sociais do planejamento e do desejo de exercer a maternidade em gestantes usuárias de drogas que vivencia/vivenciou a gravidez na adolescência. Método: estudo qualitativo, descritivo, fundamentado na Teoria das Representações Sociais. Foram entrevistadas 10 adolescentes que vivenciaram a gestação e o uso de drogas. A análise dos dados foi realizada a partir da Análise Textual Discursiva. Resultados: os resultados apontaram falta de conhecimento sobre aspectos da vida sexual e uso de anticoncepcionais. A droga ocupou o espaço vazio de solidão e medo, sendo uma forma encontrada pelas adolescentes de lidar com os problemas da vida. Apesar de muitas não terem planejado a gestação, esse processo motivou a diminuição do uso da substância. Conclusão: o estudo revelou a necessidade de diálogo sobre o processo gestacional na adolescência e uso de drogas, bem como, a importância de pesquisas e ações governamentais que abordem este problema de saúde pública

Objective: to understand the Social Representations of planning and the desire to exercise motherhood. Method: qualitative, descriptive study, based on the Theory of Social Representations.10 adolescents who experienced pregnancy and drug use were interviewed. Data analysis was performed using Discursive Textual Analysis. Results: lack of knowledge about aspects of sexual life and use of contraceptives was observed. The drug occupied an empty space of loneliness and fear, a found way of dealing with life's problems. Although many did not plan the pregnancy, this process motivated the decrease in substance use/dependence. Conclusion: the study revealed the need for dialogue about the pregnancy process in adolescence and drug use, as well as the importance of research that problematize this public health problem

Objetivos: comprender las Representaciones Sociales de la planificación y el deseo de ejercer la maternidad. Método: estudio cualitativo, descriptivo, basado en la Teoría de las Representaciones Sociales. Se entrevistaron 10 adolescentes que vivieron el embarazo y el consumo de drogas. El análisis de los datos se realizó mediante análisis textual discursivo. Resultados: se observó desconocimiento sobre aspectos de la vida sexual y uso de anticonceptivos. La droga ocupaba un espacio vacío de soledad y miedo, una forma encontrada de afrontar los problemas de la vida. Aunque muchas no planificaron el embarazo, este proceso motivó la disminución del uso / dependencia de sustancias. Conclusión: el estudio reveló la necesidad de dialogar sobre el proceso del embarazo en la adolescencia y el consumo de drogas, así como la importancia de las investigaciones que problematizan este problema de salud pública

Hematoma cerebral intraparenquimatoso e intraventricular por cocaína: reporte de un caso

Introducción: La cocaína es una de las sustancias psicoactivas más consumidas mundialmente. Es altamente adictiva y puede producir cuadros graves por su consumo, esporádico o habitual o, por su abstinencia, a nivel sistémico y neurológico. La exposición aguda a esta sustancia desencadena manifestaciones psiquiátricas inmediatas, como cambios en el afecto o conducta: sensación de irritabilidad, hiperactividad, ansiedad, desasosiego, euforia o psicosis. Esta sintomatología contrasta con inducción en ciertos casos de depresión, aislamiento o tristeza con la cronificación en su consumo. Además de los diversos efectos sensoperceptuales descritos, la sustancia puede generar daños neurológicos y/o cardiovasculares graves, como trastornos del ritmo cardíaco, arritmias malignas, emergencias hipertensivas, síndromes coronarios y enfermedades cerebrovasculares. Métodos: Presentamos el caso de un paciente quien ingresó al Hospital Universitario del Valle, en la ciudad de Santiago de Cali, departamento del Valle del Cauca, en Colombia, por un cuadro neurológico que permitía sospechar origen central. Este paciente no tenía factores de riesgo cardiovasculares, pero sí antecedentes de síndrome de Guillain Barré y de consumo de cocaína desde su adolescencia. Resultados: Al mencionado paciente se le realizaron múltiples estudios, destacándose los imagenológicos (tomografía, resonancia y angiorresonancia magnética de cerebro) y la estrategia invasiva de angiografía cerebral, en la cual logró documentarse que las manifestaciones neurológicas del paciente obedecían a una enfermedad cerebrovascular hemorrágica severa secundaria al consumo de cocaína. Conclusiones: Siempre indagar en pacientes con sangrados intraparenquimatosos el consumo de psicoactivos, en especial la cocaína, por su efecto lesivo sobre la vasculatura cerebral.

Introduction: Cocaine is one of the most widely consumed psychoactive substances worldwide. It is highly addictive and can produce serious systemic and neurological symptoms due to sporadic or habitual use or withdrawal. Acute exposure to this substance triggers immediate psychiatric manifestations such as changes in affect or behavior: feelings of irritability, hyperactivity, anxiety, restlessness, euphoria or psychosis; this symptomatology contrasts with induction in certain cases of depression, isolation or sadness with the chronification of its consumption. In addition to the various sensory-perceptual effects described, the substance can cause serious neurological and/or cardiovascular damage, such as heart rhythm disorders, malignant arrhythmias, hypertensive emergencies, coronary syndromes and cerebrovascular diseases. Methods: We present the case of a patient who was admitted to the Hospital Universitario del Valle, in the city of Santiago de Cali, department of Valle del Cauca, in Colombia, for a neurological condition that suggested a central origin. This patient had no cardiovascular risk factors, but had a history of Guillain Barré syndrome and cocaine use since adolescence. Results: The aforementioned patient underwent multiple studies, highlighting the imaging studies (CT, MRI and MRA of the brain) and the invasive strategy of cerebral angiography, in which it was possible to document that the patient's neurological manifestations were due to severe hemorrhagic cerebrovascular disease secondary to cocaine consumption. Conclusions: Always inquire in patients with intraparenchymal bleeds the consumption of psychoactives, especially cocaine, for its injurious effects on the cerebral vasculature.

Lesiones dentales por el uso de cocaína / Dental lesions due to the use of cocaine

El consumo, abuso y adicción de sustancias ilícitas, como por ejemplo la cocaína, es uno de los problemas de salud pública más preocupante en nuestro país, con diferentes índices en el conurbano. El uso de cocaína en estos medios produce daños en distintos órganos, entre los cuales podemos mencionar, corazón, cerebro, riñón y también en tejidos duros como los dientes, daños y lesiones a las que haremos referencia en este artículo. El caso presentado en este trabajo es el de un paciente de 21 años, que ingresa a la guardia por traumatismo de cráneo moderado producido por una colisión moto-autobús. Sus familiares no refieren antecedentes de enfermedades previas. Se interna en la Unidad de terapia intensiva; y llama la atención, al realizar el examen físico, las lesiones observadas en los dientes incisivos y premolares de la arcada dentaria superior.

The consumption, abuse, and addiction of illicit substances, such as cocaine, is one of the most worrying public health problems in our country, with different indices in the conurbano. The use of cocaine in these media produces damage to different organs, among which we can mention, heart, brain, kidney and also in hard tissues such as teeth, damage and injuries to which we will refer to this article. The case presented in this work is that of a 21-year-old patient, who enters the guard for moderate skull trauma produced by a motorcycle-autobus collision. His relatives do not refer to a history of previous diseases. It goes into the Intensive Therapy Unit; And it attracts attention, when performing the physical exam, the lesions observed in the incisive and premolars of the upper dental arcade

Vasculitis inducida por cocaína-levamisol con manifestaciones cutáneas, articulares y abdominales: reporte de caso / Cocaine-levamisole induced vasculitis with cutaneous, joint and abdominal manifestations: case report

Resumen El levamisol es un antiparasitario de uso veterinario que actualmente es empleado para aumentar el volumen y la potencia de la cocaína. La mezcla de estas dos sustancias puede causar un cuadro caracterizado por lesiones propias de la cocaína, como la afección del cartílago septal con perforación del tabique nasal, y vasculitis cutánea de pequeños vasos con afectación de los pabellones auriculares y del cartílago nasal, afección conocida como vasculitis inducida por cocaína-levamisol (VICOL) que puede avanzar a necrosis e incluso ulceraciones cutáneas, asociadas a agranulocitosis, artralgias y glomerulonefritis . En el presente artículo se describe el caso de un paciente con historia de consumo de sustancias en quien se encontraron lesiones purpúricas palpables en miembros superiores, tronco, pabellones auriculares y miembros inferiores. Se consideró una clínica sugestiva de VICOL dado el antecedente de consumo de sustancias. En el proceso diagnóstico se descartaron entidades como la vasculitis por anticuerpos contra el citoplasma de los neutrófilos (ANCAs) y crioglobulinemia, entre otras posibles afecciones. Se llevó a cabo un tratamiento con esteroides y con ello presentó una respuesta adecuada, pero luego recurrieron los síntomas, particularmente abdominales, los cuales se consideraron asociados con vasculitis. Se le brindó manejo adicional con ciclofosfamida y nuevos pulsos de esteroides, con que se logró el control total de los síntomas. A través este caso se resaltan entonces los ejercicios diagnósticos y clínicos en la vasculitis cocaína- levamisol, y se sugiere la consideración de los síntomas abdominales como posible componente del cuadro vasculítico.

Abstract Levamisole is an antiparasitic agent for veterinary use. Currently it is used to increase the volume and potency of cocaine. Levamisole and cocaine combined result in the septum nasal perforation and small-vessel vasculitis in the ears and nasal cartilage. These findings are known as cocaine levamisole-induced vasculitis and can progress to necrosis and even skin ulceration, which is associated with agranulocytosis, arthralgia, and glomerulonephritis. This article describes the case of a patient with a history of substance abuse in whom palpable purpuric lesions were found in the upper and lower limbs, trunk, and ears. A clinical condition suggestive of vasculitis induced by cocaine-levamisole was considered, given the history of substance consumption. In the diagnostic process, entities such as Anti-neutrophil Cytoplasmic Antibodiy (ANCA) vasculitis and cryoglobulinemia, among other possible conditions, were ruled out. Steroid treatment was carried out, to which the patient had an adequate response, but then symptoms recurred, particularly abdominal, which were associated with vasculitis. Additional management with cyclophosphamide and new steroid pulses were provided, and with those symptom control was achieved. In this case report highlights the diagnostic and clinical exercises in cocaine levamisole vasculitis and is suggested the consideration of abdominal symptoms as a possible component of the vasculitis flare.