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1.
J Stroke Cerebrovasc Dis ; 30(5): 105675, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33677311

RESUMO

OBJECTIVES: Cocaine use has been linked to stroke in several studies. However, few studies have considered the influence of cocaine use on stroke mechanisms such as small vessel disease (SVD). We conducted a study to assess associations between the toxicology-confirmed use of multiple drugs, including cocaine, and a marker of SVD, white matter hyperintensities (WMH). MATERIALS AND METHODS: We conducted a nested case-control study (n = 30) within a larger cohort study (N = 245) of homeless and unstably housed women recruited from San Francisco community venues. Participants completed six monthly study visits consisting of an interview, blood draw, vital sign assessment and baseline brain MRI. We examined associations between toxicology-confirmed use of multiple substances, including cocaine, methamphetamine, heroin, alcohol and tobacco, and WMH identified on MRI. RESULTS: Mean study participant age was 53 years, 70% of participants were ethnic minority women and 86% had a history of cocaine use. Brain MRIs indicated the presence of WMH (i.e., Fazekas score>0) in 54% (18/30) of imaged participants. The odds of WMH were significantly higher in women who were toxicology-positive for cocaine (Odd Ratio=7.58, p=0.01), but not in women who were toxicology-positive for other drugs or had several other cerebrovascular risk factors. CONCLUSIONS: Over half of homeless and unstably housed women showed evidence of WMH. Cocaine use is highly prevalent and a significant correlate of WMH in this population, while several traditional CVD risk factors are not. Including cocaine use in cerebrovascular risk calculators may improve stroke risk prediction in high-risk populations and warrants further investigation.


Assuntos
Doenças de Pequenos Vasos Cerebrais/etiologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Usuários de Drogas , Pessoas em Situação de Rua , Habitação , Leucoencefalopatias/etiologia , Populações Vulneráveis , Saúde da Mulher , Adulto , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Feminino , Humanos , Leucoencefalopatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , São Francisco , Detecção do Abuso de Substâncias
3.
An Bras Dermatol ; 96(2): 188-195, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33640188

RESUMO

Pyoderma gangrenosum associated to the use of cocaine/levamisole is a rare condition associated to their consumption. Cocaine use is frequent in Colombia, and the substance is contaminated with levamisole, an anthelmintic that increases the psychotropic effects and enhances its side effects. We present three clinical cases of patients with ulcerated lesions, in which the diagnosis was pyoderma gangrenosum secondary to the use of cocaine contaminated with levamisole. This called the attention of the health staff to investigate the abuse of substances in gangrenous pyoderma and also evidence that the interruption of consumption was the basis of management.


Assuntos
Transtornos Relacionados ao Uso de Cocaína , Cocaína , Pioderma Gangrenoso , Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Colômbia , Humanos , Levamisol , Pioderma Gangrenoso/induzido quimicamente , Pioderma Gangrenoso/tratamento farmacológico
4.
BMJ Case Rep ; 14(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568413

RESUMO

Cocaine, an alkaloid, is an addictive drug and its abuse as a recreational drug is on the increasing side with its associated complications. Gastrointestinal complications, after cocaine abuse, are less known and need to be addressed since the abuse is on the rise and the existing evidence is scarce. We report a case of a 22-year-old male patient who presented with abdominal pain following a cocaine injection. On examination, signs of peritonitis were noted and laparotomy revealed a 2×1 cm perforation in the distal ileum. The unhealthy intestinal segment was resected and taken out as a double-barrel ileostomy. The patient had an episode of severe lower gastrointestinal bleeding on postoperative day 6. CT and colonoscopy revealed signs of ischaemic bowel and tissue biopsy showed oedematous, inflamed and haemorrhagic bowel mucosa. The patient was managed conservatively and is doing well under follow-up in a de-addiction centre.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/cirurgia , Perfuração Intestinal/induzido quimicamente , Perfuração Intestinal/cirurgia , Doenças Raras/diagnóstico , Doenças Raras/cirurgia , Adulto , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
5.
BMJ Case Rep ; 14(1)2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436360

RESUMO

Cocaine use causes profound vasoconstriction leading to various systemic complications. Gastrointestinal complications such as mesenteric ischaemia are difficult to recognise and may result in serious consequences if not treated promptly. We report on the case of a 47-year-old man presenting with mesenteric ischaemia on a background of acute on chronic cocaine consumption, where diagnosis was not evident until second presentation. He underwent an emergency laparotomy with small bowel resection and jejunostomy formation and made a good recovery with eventual reversal surgery. The literature on cocaine-induced bowel ischaemia shows significant variability in presentation and outcome. Laboratory investigations are non-specific, and early recognition is vital. Given the increasing recreational use of cocaine in the UK, it is imperative to have a high clinical index of suspicion for mesenteric ischaemia in patients presenting with non-specific abdominal pain, and to ensure a detailed social history covering recreational drug use is not forgotten.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Oclusão Vascular Mesentérica/etiologia , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Laparotomia , Masculino , Oclusão Vascular Mesentérica/cirurgia , Pessoa de Meia-Idade
7.
Monaldi Arch Chest Dis ; 90(3)2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32885626

RESUMO

'Tree-in-bud' (TIB) appearance in computed tomography (CT) chest is most commonly a manifestation of infection. We here describe an unusual cause of TIB during the COVID-19 pandemic. A young male patient who had a history of fever, cough, and respiratory distress presented in the emergency department. As these symptoms matched with coronavirus infection, the COVID-19 test was done, which was found negative. He was then moved to the intensive care unit where he developed severe acute respiratory distress syndrome and was put on mechanical ventilation. Further workup did not reveal any source of infection, as all his cultures were negative, but his CT chest showed a tree-in-bud appearance. After obtaining a detailed history from his friends, the patient was found a chronic abuser of inhaled cocaine and treated with intravenous steroids. Subsequently, he was weaned from the ventilator and discharged from the intensive care unit after becoming asymptomatic.


Assuntos
Fumar Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Infecções por Coronavirus/diagnóstico , Lesão Pulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico , /diagnóstico por imagem , Adulto , Betacoronavirus , Transtornos Relacionados ao Uso de Cocaína/complicações , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Lesão Pulmonar/etiologia , Lesão Pulmonar/terapia , Masculino , Metilprednisolona/uso terapêutico , Pandemias , Respiração Artificial , /terapia , Tomografia Computadorizada por Raios X
10.
Rev. Soc. Odontol. La Plata ; 30(58): 9-12, jul. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1119102

RESUMO

El abuso del consumo de cocaína puede ocasionar problemas físicos y mentales graves. Dicha droga puede ser utilizada de varias formas y sus efectos sobre la cavidad oral varían según la vía de administración, causando desde erosiones en las piezas dentarias, abrasiones cervicales, caries, enfermedad periodontal, disfunción temporomandibular, xerostomía, ulceraciones hasta la perforación del paladar duro y/o blando. Se describirá el caso clínico de un paciente cocainómano que concurrió al servicio de odontología del Hospital San Martin de La Plata, presentando dos perforaciones en el paladar duro debido al consumo crónico, y el tratamiento de urgencia correspondiente mediante una placa obturatríz que favorece la deglución y el habla del paciente (AU)


Abuse of cocaine use can cause serious physical and mental problems. is drug can be used in several ways and its effects on the oral cavity vary according to the route of administration, causing from erosions in the teeth, cervical abrasions, caries, periodontal disease, temporomandibular dysfunction, xerostomia, ulcerations to the perforation of the hard palate and / or soft.The clinical case of a cocaine patient who attended the dentistry service of the San Martin de La Plata Hospital will be described, presenting two perforations in the hard palate due to chronic consumption, and the corresponding emergency treatment by means of an obturator plate that favors swallowing and He speaks of the patient (AU)


Assuntos
Humanos , Masculino , Adulto , Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Palato Duro/lesões , Equipe de Assistência ao Paciente , Argentina , Ferimentos Penetrantes , Unidade Hospitalar de Odontologia , Tratamento de Emergência
11.
Rev Soc Bras Med Trop ; 53: e20200040, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578710

RESUMO

Mucocutaneous leishmaniasis (MCL) is a chronic infection that can affect the skin and mucous membranes. We report a case of oral, nasopharyngeal, and penile lesions in a 35-year-old cocaine user. The patient presented with ulcerated lesions in 2014. Histopathologic analysis revealed amastigotes, and serological test results were positive for leishmaniasis. Systemic therapy with meglumine antimoniate was administered; however, the patient failed to present for follow-up. In 2018, he returned with nasal collapse, and another histopathologic test confirmed MCL. This case illustrates the importance of careful differential diagnosis of skin and mucous ulcers to identify the particular pathology.


Assuntos
Antiprotozoários/administração & dosagem , Transtornos Relacionados ao Uso de Cocaína/complicações , Leishmaniose Mucocutânea/diagnóstico , Antimoniato de Meglumina/administração & dosagem , Adulto , Humanos , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/tratamento farmacológico , Masculino
12.
Reumatol. clín. (Barc.) ; 16(3): 239-241, mayo-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194358

RESUMO

El síndrome pulmón-riñón rara vez ha sido reportado como cuadro clínico de presentación de vasculitis causada por el consumo de cocaína contaminada con levamisol. Se reporta el caso de un paciente con este cuadro clínico y se señalan las dificultades que se presentaron durante el abordaje diagnóstico y terapéutico


Pulmonary-renal syndrome has rarely been reported as the clinical presentation of vasculitis caused by the consumption of cocaine adulterated with levamisole. We report the case of a patient in whom we detected the clinical manifestations and indicate the difficulties that arose in relation to the diagnostic and therapeutic approach


Assuntos
Humanos , Masculino , Adulto , Transtornos Relacionados ao Uso de Cocaína/complicações , Levamisol/efeitos adversos , Vasculite/induzido quimicamente , Vasculite/diagnóstico , Glomerulonefrite/induzido quimicamente , Pneumopatias , Nefropatias/diagnóstico , Vasculite/imunologia , Vasculite/terapia , Pulmão/patologia , Pulmão/diagnóstico por imagem , Tomografia
13.
J Laryngol Otol ; 134(5): 440-446, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32431257

RESUMO

BACKGROUND: Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients. METHODS: A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out. RESULTS: Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion. CONCLUSION: As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.


Assuntos
Cocaína/efeitos adversos , Inibidores da Captação de Dopamina/efeitos adversos , Levamisol/efeitos adversos , Antagonistas Nicotínicos/efeitos adversos , Doenças Nasais/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias/complicações , Vasculite/induzido quimicamente , Adulto , Transtornos Relacionados ao Uso de Cocaína/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perfuração do Septo Nasal/induzido quimicamente , Estudos Retrospectivos
14.
Am J Trop Med Hyg ; 103(2): 672-674, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32431277

RESUMO

We report a patient with risk factors for both microbial keratitis and endophthalmitis, which were initially challenging to distinguish. Cultures of corneal scrapings yielded several organisms, including an uncultivable Gram-negative rod, eventually identified as Kingella negevensis. Kingella negevensis is so named because most strains have been isolated in the Negev, a desert region of southern Israel. The epidemiology of K. negevensis remains incompletely understood. We found no other reports in the literature of this organism causing microbial keratitis.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/administração & dosagem , Inibidores da Captação de Dopamina/administração & dosagem , Endoftalmite/complicações , Ceratite/complicações , Infecções por Neisseriaceae/complicações , Infecções Estreptocócicas/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Administração Oftálmica , Adulto , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Ceftazidima/uso terapêutico , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Doxiciclina/uso terapêutico , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Kingella/genética , Kingella/isolamento & purificação , Linezolida/uso terapêutico , Moxifloxacina/uso terapêutico , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/tratamento farmacológico , Infecções por Neisseriaceae/microbiologia , Soluções Oftálmicas , Prednisona/uso terapêutico , Propionibacterium acnes/isolamento & purificação , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Tobramicina/uso terapêutico , Vancomicina/uso terapêutico , Voriconazol/uso terapêutico
16.
J Craniofac Surg ; 31(4): e418-e420, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32310872

RESUMO

Pott's puffy tumor (PPT) is a rare subperiosteal abscess of the frontal bone with osteomyelitis, which most commonly affects adolescents as a complication of frontal sinusitis or head trauma. The Authors describe a case of development of a PPT in a woman who abused of cocaine for at least five years and presented with a gradually enlarging mass of the forehead. The patient was treated surgically through combined endoscopic and open approach and medically with antibiotic therapy. The PPT, as rare complication of intranasal cocaine abuse, was described until now in four patients. Even rare it can be a fearsome complication, making of fundamental importance an early diagnosis and a correct management.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Neoplasias Nasais/diagnóstico por imagem , Tumor de Pott/diagnóstico por imagem , Administração Intranasal , Antibacterianos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Nasais/complicações , Tumor de Pott/complicações
17.
J Wound Ostomy Continence Nurs ; 47(2): 182-189, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150143

RESUMO

BACKGROUND: Levamisole is an immunomodulatory medication previously used to treat rheumatoid arthritis and some types of cancers; it was banned for use in humans in 2000 owing to its harmful side effects. Use of levamisole-laced cocaine is associated with a life-threatening syndrome characterized by a necrotizing purpuric rash leading to tissue destruction and necrotic wounds. This Clinical Challenges article summarizes our experience with the care of 2 adult women diagnosed with levamisole-related vasculitis. CASE: Case 1 is a 46-year-old woman who presented with joint pain in her hands and legs, along with bilateral ear pain, swelling, and bleeding. She was initially diagnosed with vasculitis and possible systemic lupus erythematosus. She experienced multiple recurrences and exacerbation of her condition over a period of months. She was ultimately diagnosed with levamisole-related vasculitis from recurrent cocaine use resulting in bilateral above the knee amputations. The second case is a 50-year-old woman who presented to our emergency department with redness and swelling of her bilateral lower extremities. She developed blisters and pustules that rapidly evolved into abscesses and red lesions over the course of several months. Her wounds also deteriorated despite topical therapy that occurred in a context of recurring use of cocaine. CONCLUSIONS: Our experience with these cases suggests that WOC nurses should consider levamisole-induced vasculitis in all patients presenting with unexplained vasculitis-type lesions, and particularly when these lesions occur in the context of known or suspected use of illicit substances such as cocaine. Given the absence of clinical guidelines for this increasingly prevalent condition, we recommend wound care based on principles of moist wound healing, combined with judicious use of therapies with antimicrobial activity and nonadherent dressings to reduce pain. Finally, we strongly recommend that care of these patients occurs as one part of a multidisciplinary care approach that focuses on cessation of the use of cocaine and all other illicit substances.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Levamisol/efeitos adversos , Vasculite/etiologia , Transtornos Relacionados ao Uso de Cocaína/fisiopatologia , Feminino , Humanos , Levamisol/farmacocinética , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/fisiopatologia
18.
Chest ; 157(2): e37-e40, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32033659

RESUMO

CASE PRESENTATION: A 50-year-old woman presented to the ED with a 3-day history of increasing confusion. Prior to her presentation, the patient had been in her usual state of health as reported by her family. She had a history of bipolar disorder and attention-deficit/hyperactivity disorder but had stopped her psychiatric medications for the past 4 days secondary to loss of insurance coverage. History was limited due to the patient's altered state and confusion, and was obtained from family. There was no history of headache, loss of consciousness, weakness of extremities, seizures, fever, or recent trauma. The patient's medical history also included cocaine abuse. The patient's family believed she had been abstinent from cocaine use for several years.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Confusão/induzido quimicamente , Contaminação de Medicamentos , Dermatoses Faciais/induzido quimicamente , Levamisol/efeitos adversos , Rabdomiólise/induzido quimicamente , Vasculite/induzido quimicamente , Cocaína , Inibidores da Captação de Dopamina , Equimose/induzido quimicamente , Equimose/diagnóstico , Dermatoses Faciais/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Rabdomiólise/diagnóstico , Vasculite/diagnóstico
20.
Am J Cardiol ; 125(2): 282-288, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31757354

RESUMO

Evidence linking cocaine to the risk of pulmonary hypertension (PH) is limited and inconsistent. We examined whether cocaine use, in the absence of other known causes of PH, was associated with elevated systolic pulmonary artery pressure (sPAP) and increased probability of PH. We compared patients with documented cocaine use to a randomly selected age, sex, and race-matched control group without history of cocaine use. All participants had no known causes of PH and underwent echocardiography for noninvasive estimation of sPAP. We used routinely reported echocardiographic parameters and contemporary guidelines to grade the probability of PH. In 88 patients with documented cocaine use (mean age ± standard deviation 51.7 ± 9.5 years), 33% were women and 89% were of Black race. The commonest route of cocaine use was smoking (74%). Cocaine users compared with the control group had significantly higher sPAP (mean ± standard deviation, 30.1 ± 13.1 vs 22.0 ± 9.8 mm Hg, p <0.001) and greater likelihood of PH (25% vs 10%, p = 0.012). In multivariable analyses adjusted for potential confounders including left ventricular diastolic dysfunction, cocaine use conferred a fivefold greater odds of echocardiographic PH (p = 0.006). Additionally, a stepwise increase in the likelihood of PH was noted across cocaine users with negative or no drug screen on the day of echocardiography to cocaine users with a positive drug screen (multivariable p for trend = 0.008). In conclusion, cocaine use was associated with a higher sPAP and an increased likelihood of echocardiographic PH with a probable acute-on-chronic effect.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/efeitos adversos , Ecocardiografia Doppler/métodos , Ventrículos do Coração/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Artéria Pulmonar/diagnóstico por imagem , Pressão Propulsora Pulmonar/efeitos dos fármacos , Cateterismo Cardíaco , Inibidores da Captação de Dopamina/efeitos adversos , Feminino , Seguimentos , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sístole
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