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1.
Br J Oral Maxillofac Surg ; 59(4): 398-406, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33789811

RESUMO

Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition to treat. It has primarily been associated with anti-resorptive and anti-angiogenic drugs, which are increasingly being used to prevent adverse skeletally-related complications in patients with cancer and bone pathologies. Although these medications have been proven to cause osteonecrosis of the jaws (ONJ) there are also a number of other drugs that could potentially cause this condition. The aim of this systematic review is to ascertain whether there is an associated risk of osteonecrosis of the jaw (ONJ) in recreational drug users (RDU). Three authors independently searched PubMed, MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials for published reports of osteonecrosis of the jaw (ONJ) in recreational drug users (RDU) or illicit drug users (IDU) who had no history of treatment with anti-angiogenic or anti-resorptive agents. Only 30 studies were eligible for analysis, and all were independently assessed for risk of bias. There was a total of 101 patients with ONJ attributed solely to illicit drug consumption. The most common site of ONJ was the maxilla (n=54). The most common illicit drug related to ONJ was desmorphine, known as 'Krokodil', this was followed by cocaine, methamphetamine, anabolic steroids, and hydrocodone/acetaminophen. In 52 of the cases, the ONJ resolved following treatment, however, eight showed a recurrence. Although all the studies were judged to be at a high risk of bias, the limited data suggest that some patients are at risk of developing ONJ as a result of illicit drug usage. Studies of higher quality are needed to establish the relative risk of ONJ in this patient group.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Drogas Ilícitas , Doenças Maxilomandibulares , Osteonecrose , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/epidemiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Difosfonatos , Humanos , Drogas Ilícitas/efeitos adversos , Osteonecrose/induzido quimicamente
2.
Accid Anal Prev ; 152: 105987, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33549974

RESUMO

The purpose of this research was to reanalyze data collected from the National Highway Traffic Safety Administration's Drug and Alcohol Crash Risk Study to investigate whether driving under the influence of cannabis (THC-positive) was associated with elevated crash risk for younger and older drivers. The data came from a case-control relative risk study collected from Virginia Beach, VA, over a 20-month period. Data collectors gathered driver information from the scene of vehicle crashes and, in some cases, from hospitals. Non-crash controls were sampled from the same locations, days, and times as crashes. Key data items included driver demographics and oral fluid and blood samples, which were assayed for licit and illicit drugs. We found no overall association between cannabis use and risk of crash involvement. However, when age and age2 were allowed to interact with THC, significant interaction effects emerged. THC was associated with increased risk of crash involvement for older drivers. Difference between THC-positive and sober drivers emerged as significant at age 64. The research underscores the value of examining drugged driving in the context of driver age. Age-related declines in neurocognitive and psychomotor functioning were not measured but might be important in explaining the results.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Envelhecimento , Condução de Veículo/psicologia , Cannabis/efeitos adversos , Acidentes de Trânsito/psicologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Cannabis/química , Dronabinol/efeitos adversos , Feminino , Humanos , Drogas Ilícitas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Risco , Virginia/epidemiologia , Adulto Jovem
3.
Orv Hetil ; 162(8): 306-313, 2021 02 21.
Artigo em Húngaro | MEDLINE | ID: mdl-33611266

RESUMO

Összefoglaló. A methaemoglobinaemia az oxigén szállítására képtelen methemoglobin szintjének kóros emelkedését jelenti a vérben, ami jelentos szöveti oxigénhiányt okozhat, súlyos, akár életveszélyes tünetekhez vezethet. Methaemoglobinaemiát számos, oxidáló hatású exogén anyag idézhet elo, ezek közé tartoznak a partidrogként használt alkil-nitritek, az ún. "popperek" is. A "poppereket" korábban "alacsony rizikójú" drogként tartották számon, azonban számos esetet közöltek, amikor súlyos, idonként fatális kimenetelu methaemoglobinaemiát okoztak. A folyadékok gozének belélegzése euforizáló, szexuálisvágy-fokozó és simaizom-lazító hatású, ezért a "popperek" igen népszeruek a homo- és biszexuális férfiak körében, de fiatal felnottek és tinédzserek is használják. A folyadékok szájon át való fogyasztása különösen veszélyes. A szerzok két esetet ismertetnek, amelyekben a "popperek" használatát követoen methaemoglobinaemia alakult ki. Mindkét betegnél, a jó általános állapot mellett, centrális és perifériás cyanosis tüneteit észlelték. Az alkalmazás módja (inhaláció/lenyelés), a methaemoglobinaemia súlyossága (16,4% és 57%) és a terápia eltéro volt a két betegnél. Az elso beteg oxigén adása és tüneti kezelés mellett gyógyult, a másodiknál antidotum (metilénkék) adására is szükség volt. Mindketten panaszmentesen távoztak a kórházból. A szerzok célja az volt, hogy felhívják a figyelmet az illékony alkil-nitrit-származékok által okozott methaemoglobinaemiára, annak felismerésére, kezelésére, és bemutassák azok kevésbé ismert szövodményeit is. Orv Hetil. 2021; 162(8): 306-313. Summary. Methemoglobinemia means the abnormally elevated level of methemoglobin in the blood, which is incapable of oxygen transport, accordingly it can cause significant tissue hypoxia, leading to severe or even life-threatening clinical symptoms. Several exogen oxidative agents can induce methemoglobinemia, including alkyl-nitrites which are also used as party drugs, the so-called 'poppers'. The 'poppers' were previously considered 'low-risk' drugs, however, several cases have been published when they caused severe, sometimes fatal methemoglobinemia. Inhaling vapours from liquids has euphoric, smooth-muscle relaxing and aphrodisiac effects, therefore 'poppers' are extremely popular among gay and bisexual men but also used by young adults and teenagers. Oral consumption of the fluids is particularly dangerous. The authors present two cases when methemoglobinemia developed after 'poppers' usage. Both patients were in good general condition and symptoms of central and peripheral cyanosis were detected. The method of application (inhalation/ ingestion), the severity of methemoglobinemia (16,4% and 57%) and the treatment were different in the two patients. The first patient recovered with inhalation of oxygen and symptomatic treatment; the second patient required administration of antidote (methylene blue). Both patients left the hospital without complaints. The authors' aim was to attract attention to methemoglobinemia caused by volatile alkyl-nitrites, its recognition, treatment and to present their lesser-known complications. Orv Hetil. 2021; 12(8): 306-313.


Assuntos
Drogas Ilícitas/efeitos adversos , Metemoglobinemia , Nitritos/efeitos adversos , Adolescente , Antídotos , Humanos , Masculino , Metemoglobinemia/induzido quimicamente , Adulto Jovem
4.
Vnitr Lek ; 66(5): 52-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32942870

RESUMO

Lifetime prevalence of illicit drug use is high in the Czech Republic (CR) - it reached 31.2 % of the population in the age group 15-64 years in 2017. Diabetes mellitus (DM) applies to 8.8 % of the Czech population. Risks of illicit drug use in diabetic patients are related both to their effect on glucose metabolism and to the lifestyle associated with illicit drug use, which might lead to worsened glycemic control and increased morbidity and mortality of the patients. Cannabis use, being the most common illicit drug use in the CR, presumably does not have a direct effect on glucose metabolism. However, it increases appetite and decreases self-control. Opioids/opiates disrupt insulin secretion, which consequently leads to hyperglycaemia. On the other hand, hypoglycaemia might be an adverse effect of opioid treatment in diabetic patients. Cocaine and other stimulants such as MDMA increase a blood glucose level and increase the risk of diabetic ketoacidosis in Type 1 DM. Patients with DM who use illicit drugs should therefore be sufficiently informed about health risks related to illicit drug use in combination with DM.


Assuntos
Diabetes Mellitus Tipo 1 , Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias , Glicemia , República Tcheca , Humanos , Drogas Ilícitas/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
6.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32661188

RESUMO

Cannabinoids, the psychoactive compounds in marijuana, are one of the most commonly used substances in the United States. In this review, we summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice. We review the changing epidemiology of cannabis use and provide an update on medical use, routes of administration, synthetic marijuana and other novel products, the effect of cannabis on the developing brain, other health and social consequences of use, and issues related to marijuana legalization.


Assuntos
Cannabis , Uso da Maconha , Adolescente , Comportamento do Adolescente/efeitos dos fármacos , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/embriologia , Encéfalo/crescimento & desenvolvimento , Canabidiol/farmacologia , Canabidiol/uso terapêutico , Canabinoides/efeitos adversos , Canabinoides/síntese química , Canabinoides/farmacologia , Cannabis/efeitos adversos , Cannabis/química , Cannabis/envenenamento , Criança , Comportamento Infantil/efeitos dos fármacos , Interações Medicamentosas , Endocanabinoides/fisiologia , Feminino , Feto/efeitos dos fármacos , Humanos , Drogas Ilícitas/efeitos adversos , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/terapia , Uso da Maconha/efeitos adversos , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Uso da Maconha/psicologia , Meios de Comunicação de Massa , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Leite Humano/química , Transtornos Neurocognitivos/induzido quimicamente , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Receptores de Canabinoides/efeitos dos fármacos , Receptores de Canabinoides/fisiologia , Uso de Tabaco/epidemiologia
7.
Rev. int. androl. (Internet) ; 18(2): 75-78, abr.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193763

RESUMO

OBJETIVOS: La utilización con fines recreativos de sustancias de abuso asociadas a algunos medicamentos también empleados en estos contextos obliga al profesional a conocer la posibilidad de interacciones entre ambos. El objetivo de la presente revisión sistemática es actualizar la información disponible sobre la seguridad cardiovascular de la asociación de cannabis y sildenafilo. MATERIALES Y MÉTODOS: Se llevó a cabo una revisión sistemática en las bases de datos PubMed, PreMedline, Medline, Embase, ChemID, HSRPROJ, POPLINE y TOXLINE, desde el inicio de las bases de datos hasta el 1 de marzo del 2018 con los términos clave «sildenafil», «vardenafil», «tadalafil», «phosphodiesterase inhibitors» y «cannabis», combinándolos y cruzándolos mediante operadores booleanos con «adverse effects» y «cardiovascular». No se restringió por idioma ni por tipo de estudio. RESULTADOS: Se encontraron 13 publicaciones, de las cuales 5 analizaban la combinación de cannabis y sildenafilo como un nuevo estilo de uso recreativo, no médico, del consumo conjunto de ambas sustancias, pero solo 3lo relacionaban con alteraciones cardiacas: un infarto posterior sin onda Q, otro sin elevación ST y un síndrome coronario agudo. CONCLUSIONES: La gravedad de los eventos cardiovasculares de sildenafilo asociado a cannabis obliga al profesional a tenerlos en cuenta ante cuadros de miocardiopatía isquémica de difícil filiación


OBJECTIVES: The recreational use of drugs of abuse associated to therapeutically used drugs in sexual contexts forces the health care professional to know the possibility of drug-drug interactions among them. The aim of this review is updating the available information on cardiovascular safety of recreational use of sildenafil and cannabis. MATERIALS AND METHODS: A systematic search in databases PubMed, PreMedline, Medline, Embase, ChemID, HSRPROJ, POPLINE and TOXLINE, from the start of the databases until to March 1, 2018 was made. Search terms were "sildenafil", "vardenafil", "tadalafil", "phosphodiesterase inhibitors" and "cannabis", combining and crossing them by means of Boolean operators with "adverse effects" and "cardiovascular". No restrictions for language or type of study were made. RESULTS: Thirteen papers were found, 5out of them analyzed cannabis and sildenafil combination as a new style of recreational non-medical use. Only 3papers related sildenafil-cannabis association with cardiovascular events: one posterior myocardial infarction without Q wave, one myocardial infarction without ST elevation and one acute coronary syndrome. CONCLUSIONS: Severity of sildenafil-cannabis-related cardiovascular events forces the healthcare professionals to take them into account and considering them in clinical pictures of an ischemic cardiomyopathy hard to classify


Assuntos
Humanos , Masculino , Uso da Maconha/efeitos adversos , Citrato de Sildenafila/efeitos adversos , Interações Medicamentosas , Vasodilatadores/efeitos adversos , Drogas Ilícitas/efeitos adversos , Doença das Coronárias
8.
BMC Infect Dis ; 20(1): 381, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460792

RESUMO

BACKGROUND: Clinicians may be less inclined to consider a diagnosis of cryptococcal meningitis in people without HIV infection or transplant-related immunosuppression. This may lead to a delay in diagnosis particularly if disseminated cryptococcal disease mimics cerebral septic emboli in injection drug use (IDU) leading to a search for endocarditis or other infectious sources. Though, IDU has been described as a potential risk for disseminated cryptococcal disease. CASE PRESENTATIONS: We present two cases of cryptococcal meningitis in IDU without HIV or other obvious immune deficits. Both patients presented with at least 2 weeks of headache and blurred vision. They developed central nervous system (CNS) vasculitis, one of which mimicked septic cerebral emboli, but both resulted with poor neurologic outcomes. CONCLUSIONS: IDU likely induces an underappreciated immune deficit and is a risk factor for developing cryptococcal meningitis. This diagnosis, which can mimic cerebral septic emboli through involvement of a CNS vasculitis, should be considered in the setting of IDU.


Assuntos
Drogas Ilícitas/efeitos adversos , Embolia Intracraniana/microbiologia , Meningite Criptocócica/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Cryptococcus neoformans/genética , Cryptococcus neoformans/isolamento & purificação , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Embolia Intracraniana/imunologia , Masculino , Meningite Criptocócica/etiologia , Meningite Criptocócica/imunologia , Meningite Criptocócica/microbiologia , Pessoa de Meia-Idade , Projetos de Pesquisa , Fatores de Risco
11.
AIDS Behav ; 24(9): 2650-2655, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32140876

RESUMO

Diversion of antiretroviral therapy (ART) for recreational use is concerning for countries with high HIV prevalence. This paper presents reports of recreational use of ART among adolescents from two HIV prevention studies in South Africa: (1) a cross-sectional survey of N = 200 adolescents and (2) a qualitative study of pre-exposure prophylaxis with N = 57 adolescents and N = 25 clinicians. Among adolescents, 3% used and 14% knew someone who used non-prescribed ART for recreational purposes. Administration included smoking (71%), snorting (15%), injecting (15%), ingesting (15%), and inserting (3%). Participants predicted increased crime as recreational use of ART increased. Future studies should investigate prevalence, composition, and diversion of ART from HIV prevention and treatment.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Antirretrovirais/administração & dosagem , Infecções por HIV/prevenção & controle , Drogas Ilícitas/efeitos adversos , Profilaxia Pré-Exposição , Adolescente , Adulto , Fármacos Anti-HIV/efeitos adversos , Antirretrovirais/uso terapêutico , Comportamento Aditivo , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Prevalência , Pesquisa Qualitativa , Assunção de Riscos , África do Sul/epidemiologia , Inquéritos e Questionários
12.
Clin Ter ; 171(2): e107-e109, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32141480

RESUMO

Extensive scientific evidence shows that there is a broad spectrum of substances used as adulterants, whose effects on the user's health may be extremely harmful. The degree of purity of the drugs most commonly abused is highly variable depending on the region or epidemiological context. Practices of drug adulteration have been substantially evolving over the years: a significant trend has been observed in the last decade indicating a decline in the average purity of most drugs. Although the most frequent adulterants of common street drugs have long been well known, the rise of synthetic opioids has inevitably entailed gaps in knowledge in terms of the substances being used and their composition, which constitutes an even greater threat to public health.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/síntese química , Contaminação de Medicamentos , Drogas Ilícitas/efeitos adversos , Drogas Ilícitas/síntese química , Humanos , Saúde Pública , Transtornos Relacionados ao Uso de Substâncias , Medicamentos Sintéticos/efeitos adversos , Medicamentos Sintéticos/síntese química
13.
JAMA Netw Open ; 3(3): e200895, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32163167

RESUMO

Importance: Alcohol screening may be associated with health outcomes that cluster with alcohol use (ie, alcohol-clustering conditions), including depression, anxiety, and use of tobacco, marijuana, and illicit drugs. Objective: To quantify the extent to which alcohol screening provides additional information regarding alcohol-clustering conditions and to compare 2 alcohol use screening tools commonly used for this purpose. Design, Setting, and Participants: This longitudinal cohort study used data from the Veterans Aging Cohort Study. Data were collected at 8 Veterans Health Administration facilities from 2003 through 2012. A total of 7510 participants were enrolled, completed a baseline survey, and were followed up. Veterans with HIV were matched with controls without HIV by age, race, sex, and site of care. Data were analyzed from January 2019 to December 2019. Exposures: The Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were used to assess alcohol use, with 4 risk groups delineated for each test: score 0 to 7 (reference), score 8 to 15, score 16 to 19, and score 20 to 40 (maximum score) for the full AUDIT and score 0 to 3 (reference), score 4 to 5, score 6 to 7, and score 8 to 12 (maximum score) for the AUDIT-C. Main Outcomes and Measures: Alcohol-clustering conditions, including self-reported symptoms of depression and anxiety and use of tobacco, marijuana, cocaine, other stimulants, opioids, and injection drugs. Results: A total of 6431 US patients (6104 [95%] men; median age during survey years 2003-2004, 50 years [range, 28-86 years; interquartile range, 44-55 years]) receiving care in the Veterans Health Administration completed 1 or more follow-up surveys when the AUDIT was administered and were included in the present analyses. Of the male participants, 4271 (66%) were African American, 1498 (24%) were white, and 590 (9%) were Hispanic. The AUDIT and AUDIT-C scores were associated with each alcohol-clustering condition. In particular, an AUDIT score of 20 or higher (vs <8, the reference) was associated with symptoms of depression (odds ratio [OR], 8.37; 95% CI, 6.20-11.29) and anxiety (OR, 8.98; 95% CI, 6.39-12.60) and with self-reported use of tobacco (OR, 14.64; 95% CI, 8.94-23.98), marijuana (OR, 12.41; 95% CI, 8.61-17.90), crack or cocaine (OR, 39.47; 95% CI, 27.38-56.90), other stimulants (OR, 21.31; 95% CI, 12.73-35.67), and injection drugs (OR, 8.67; 95% CI, 5.32-14.13). An AUDIT score of 20 or higher yielded likelihood ratio (sensitivity / 1 - specificity) values greater than 3.5 for depression, anxiety, crack or cocaine use, and other stimulant use. Associations between AUDIT-C scores and alcohol-clustering conditions were more modest. Conclusions and Relevance: Alcohol screening can inform decisions about further screening and diagnostic assessment for alcohol-clustering conditions, particularly for depression, anxiety, crack or cocaine use, and other stimulant use. Future studies using clinical diagnoses rather than screening tools to assess alcohol-clustering conditions may be warranted.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Drogas Ilícitas/efeitos adversos , Programas de Rastreamento/métodos , Saúde Mental , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos/epidemiologia
14.
PLoS One ; 15(3): e0229713, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32134973

RESUMO

BACKGROUND: Across North America, the opioid overdose epidemic is leading to increasing hospitalizations of people who use drugs (PWUD). However, hospitals are ill-prepared to meet the needs of PWUD. We focus on illicit drug use while admitted to hospital and how PWUD and health care providers describe, respond, and attempt to manage its use. METHODS AND FINDINGS: Using varied purposive methods in Toronto and Ottawa, we recruited n = 24 PWUD (who self-reported that they were living with HIV and/or HCV infection; currently or had previously used drugs or alcohol in ways that were harmful; had a hospital admission in the past five years) and n = 26 health care providers (who were: currently working in an academic hospital as a physician, nurse, social worker or other allied health professional; and 2) providing care to this patient group). All n = 50 participants completed a short, socio-demographic questionnaire and an audio-recorded semi-structured interview about receiving or providing acute care in a hospital between 04/2014 and 05/2015. Patient participants received $25 CAD and return transit fare; provider participants received a $50 CAD gift card for a bookseller. All participants provided informed consent. Audio-recordings were transcribed verbatim, corrected, and uploaded to NVivo 10. Using the seven-step framework method, transcripts were coded line-by-line and managed using NVvivo. An analytic framework was created by grouping and mapping the codes. Preliminary analyses were presented to advisory group members for comment and used to refine the interpretation. Questionnaire data were managed using SPSS version 22.0 and descriptive statistics were used to describe the participants. Many but not all patient participants spoke about using psycho-active substances not prescribed to them during a hospital admission. Attempts to avoid negative experiences (e.g., withdrawal, boredom, sadness, loneliness and/or untreated pain) were cited as reasons for illicit drug use. Most tried to conceal their illicit drug use from health care providers. Patients described how their self-reported level of pain was not always believed, tolerance to opioids was ignored, and requests for higher doses of pain medications denied. Some health care providers were unaware of on-site illicit drug use; others acknowledged it occurred. Few could identify a hospital policy specific to illicit drug use and most used their personal beliefs to guide their responses to it (e.g., ignore it, increase surveillance of patients, reprimands, loss of privileges/medications, threats of immediate discharge should it continue, and substitution dosing of medication). CONCLUSIONS: Providers highlighted gaps in institutional guidance for how they ought to appropriately respond to in-hospital substance use. Patients attempted to conceal illicit drug use in environments with no institutional policies about such use, leading to varied responses that were inconsistent with the principles of patient centred care and reflected personal beliefs about illicit drug use. There are increasing calls for implementation of harm reduction approaches and interventions in hospitals but uptake has been slow. Our study contributes to this emerging body of literature and highlights areas for future research, the development of interventions, and changes to policy and practice.


Assuntos
Hospitalização , Drogas Ilícitas/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Feminino , Redução do Dano , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Transtornos Relacionados ao Uso de Substâncias/complicações
16.
Spine (Phila Pa 1976) ; 45(12): 843-850, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32004230

RESUMO

STUDY DESIGN: Retrospective review of the Healthcare Cost and Utilization Project National Inpatient Sample, 2000 to 2013. OBJECTIVE: To determine the proportion of spinal epidural abscess (SEA) cases that were related to injection drug use (IDU) and to compare length of stay, leaving against medical advice, paralysis, cauda equina syndrome, radiculitis, and in-hospital mortality between SEA cases with and without IDU. SUMMARY OF BACKGROUND DATA: The US opioid epidemic impacts all aspects of healthcare, including spinal surgeons. Although injection drug use (IDU) is a risk factor for spinal epidural abscess (SEA), IDU among SEA patients and its effect on clinical outcomes is not well understood. METHODS: Cases aged 15 to 64 with principal diagnosis of SEA were classified as IDU-related (IDU-SEA) or non-IDU-related (non-IDU-SEA) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for illicit drug use and hepatitis C. We determined the proportion of SEA patients with IDU and compared length of stay, leaving against medical advice, paralysis, cauda equina syndrome, radiculitis, and in-hospital mortality between IDU-SEA and non-IDU-SEA patients. RESULTS: From 2000 to 2013, there were 20,425 admissions with a principal diagnosis of SEA (95% confidence interval (CI), 19,281-21,568); 19.1% were associated with IDU (95% CI, 17.7%-20.5%). The proportion of white IDU-SEA cases increased by 2.4 percentage points annually (95% CI, 1.4-3.4). After adjusting for age, sex, and race, IDU-SEA patients stayed a mean of 6.7 more days in the hospital (95% CI, 5.1-8.2) and were 4.8 times more likely to leave against medical advice (95% CI, 2.9-8.0). Mean hospital charges for IDU-SEA patients were $31,603 higher (95% CI: $20,721-$42,485). Patients with IDU-SEA were less likely to have cauda equina syndrome (adjusted odds ratio, 0.48, 95% CI, 0.26-0.87). CONCLUSION: IDU-SEA patients stay in the hospital longer and more often leave against medical advice. Providers and hospitals may benefit from exploring how to better facilitate completion of inpatient treatment and achieve superior outcomes. LEVEL OF EVIDENCE: 3.


Assuntos
Abscesso Epidural/epidemiologia , Drogas Ilícitas/efeitos adversos , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
17.
PLoS One ; 15(1): e0228316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32004349

RESUMO

Although harmful consumption of alcohol and other drugs (both illicit and pharmaceutical) significantly contribute to global burden of disease, not all harms are captured within existing morbidity data sources. Indeed, harms occurring in the community may be missed or under-reported. This paper describes the National Ambulance Surveillance System, a unique Australian system for monitoring and mapping acute harms related to alcohol and other drug consumption. Data are sourced from paramedic electronic patient care records provided by ambulance services from across Australia. Coding occurs in a purpose-built system, by a team of specialised research assistants. Alcohol, and specific illicit and pharmaceutical drugs, rather than broad drug classes, are manually coded and the dataset is reviewed and cleaned prior to analysis. The National Ambulance Surveillance System is an ongoing, dynamic surveillance system of alcohol and other drug-related harms across Australia. The data includes more than 140 output variables per attendance, including individual substances, demographics, temporal, geospatial, and clinical data (e.g., Glasgow Coma Scale score, naloxone provision and response, outcome of attendance). The National Ambulance Surveillance System is an internationally unique population-level surveillance system of acute harms arising from alcohol and other drug consumption. Dissemination of National Ambulance Surveillance System data has been used to inform and evaluate policy approaches and potential points of intervention, as well as guide workforce development needs and clinical practice at the local and national level. This methodology could be replicated in other countries.


Assuntos
Drogas Ilícitas/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Ambulâncias , Austrália/epidemiologia , Codificação Clínica , Bases de Dados Factuais , Humanos , Registros Médicos , Medicamentos sob Prescrição/efeitos adversos , Gestão da Segurança
18.
Rev. Rol enferm ; 43(2): 124-126, feb. 2020.
Artigo em Espanhol | IBECS | ID: ibc-198917

RESUMO

El término Chemsex hace referencia al uso intencionado de drogas psicoactivas para mantener relaciones sexuales (antes o durante la actividad sexual), generalmente entre hombres que tienen sexo con hombres, y durante largos períodos de tiempo, desde varias horas a varios días, denominados sesiones. La práctica del Chemsex se asocia a un aumento del riesgo de infección por VIH y otras infecciones de transmisión sexual, así como a un incremento de los problemas de salud mental y de drogodependencia. Los usuarios de drogas recreativas presentan a menudo un funcionamiento y ajuste en su entorno socio-familiar y laboral aparentemente normal. Por tanto, ni el usuario de Chemsex ni su entorno afectivo tienen una demanda clara de ayuda profesional. Muchas de las personas que lo practican no tienen contacto con los servicios de salud, excepto en situaciones puntuales. Este fenómeno ha despertado preocupación por parte de los profesionales de la salud. En nuestro medio sanitario, actualmente, se tratan por separado a pacientes con enfermedades de transmisión sexual y a pacientes con drogodependencias. Para su cobertura resulta imprescindible un abordaje multidisciplinar


The term Chemsex refers to the intentional use of psychoactive drugs for sexual intercourse (before or during sexual activity), usually between men who have sex with men, and for long periods of time, from several hours to several days, called sessions. The practice of Chemsex is associated with an increased risk of HIV infection and other sexually transmitted infections, as well as an increase in mental health and drug dependence problems. Recreational drug users often have functioning and adjustment in their apparently normal socio-family and work environment. Therefore, neither the Chemsex user nor their emotional environment have a clear demand for professional help. Many of the people who practice it do not have contact with the health services, except in specific situations. This phenomenon has aroused concern on the part of health professionals. In our healthcare environment, currently, patients with sexually transmitted diseases and patients with drug dependence are treated separately. A multidisciplinary approach is essential for its coverage


Assuntos
Humanos , Masculino , Psicotrópicos/efeitos adversos , Comportamento Sexual/efeitos dos fármacos , Doenças Sexualmente Transmissíveis/transmissão , Drogas Ilícitas/efeitos adversos , Homossexualidade Masculina , Infecções por HIV/transmissão , Comportamentos de Risco à Saúde/efeitos dos fármacos
19.
Lancet Diabetes Endocrinol ; 8(3): 239-248, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31958403

RESUMO

As the prevalence of type 1 and type 2 diabetes increases and population-level patterns of alcohol and illicit drug use evolve, clinicians will continue to encounter people with diabetes whose substance use is affecting health outcomes. Substance use contributes substantially to the population-level prevalence of cardiovascular events, cerebrovascular events, cancers, mental health conditions, road trauma, and domestic violence. Alcohol and drug use also have a measurable effect on diabetes incidence and the development of both acute and chronic diabetes-related complications. In this Review, we examine the effect of alcohol and illicit drug use on people with type 1 or type 2 diabetes. We describe evidence for substance use as a risk factor for new-onset diabetes, prevalence of use in people with diabetes, evidence linking substance use with diabetes-related health outcomes, and evidence on the management of these co-occurring conditions.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Drogas Ilícitas/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Idoso , Austrália/epidemiologia , Complicações do Diabetes/etiologia , Complicações do Diabetes/psicologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Incidência , Masculino , Prognóstico , Fatores de Risco , Fumar/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
20.
Forensic Sci Int ; 306: 110093, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31816483

RESUMO

Studies on the mortalities of drug abusers in China are scarce. This study explores the deaths of methamphetamine, opioid, and ketamine abusers in Shanghai (2004-2017) and Wuhan (2005-2017). Chi-square/Fisher's exact tests were used to compare the differences in terms of region, gender, age, cause of death, and the method used in the last drug abuse. Poisson regression models were used to estimate the rate ratios ("RRs") and annual percentage changes ("APCs"). 314 heroin, 43 methamphetamine, and 4 ketamine abusers were included. Furthermore, simultaneously, 6 abusers used heroin and methamphetamine, and 7 abusers used methamphetamine and ketamine. Heroin-related deaths have declined in Shanghai (APC, -16.1; 95 % CI, -18.4 to -11.3) and Wuhan (APC, -16.0; 95 % CI, -18.9 to -10.6), whereas methamphetamine-related deaths have increased in Wuhan (APC, 12.8; 95 % CI, 0.0 to 29.2). On the whole, in the two cities, males were more frequently observed than females in heroin-related deaths (4.4, 230/52). However, the gender ratios for methamphetamine- (1.8, 34/19) and ketamine-related deaths (1.2, 6/5) were close to one. In view of the mortality rates of the drug abusers in most Chinese cities were still unclear, it is thus important to improve mortality surveillance of the drug abusers at the national level.


Assuntos
Analgésicos Opioides/envenenamento , Ketamina/envenenamento , Metanfetamina/envenenamento , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Adolescente , Adulto , Distribuição por Idade , Analgésicos Opioides/efeitos adversos , Intoxicação por Monóxido de Carbono/mortalidade , China/epidemiologia , Feminino , Heroína/efeitos adversos , Heroína/envenenamento , Humanos , Drogas Ilícitas/efeitos adversos , Drogas Ilícitas/envenenamento , Ketamina/efeitos adversos , Masculino , Metanfetamina/efeitos adversos , Pessoa de Meia-Idade , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Adulto Jovem
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