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3.
BMC Neurol ; 19(1): 260, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660902

RESUMO

BACKGROUND: Parkinsonism is a complex multifactorial neurodegenerative disorder, in which genetic and environmental risk factors may both play a role. Among environmental risk factors cocaine was earlier ambiguously linked to Parkinsonism. Former single case reports described Parkinsonism in chronic cocaine users, but an epidemiological study did not confirm an increased risk of Parkinson's disease. Here we report a patient, who developed Parkinsonism in young age after chronic cocaine use, in whom a homozygous LRRK2 risk variant was also detected. CASE PRESENTATION: The patient was investigated because of hand tremor, which started after a 1.5-year period of cocaine abuse. Neurological examination suggested Parkinsonism, and asymmetrical pathology was confirmed by the dopamine transporter imaging study. The genetic investigations revealed a homozygous risk allele in the LRRK2 gene. After a period of cocaine abstinence, the patient's symptoms spontaneously regressed, and the dopamine transporter imaging also returned to near-normal. CONCLUSIONS: This case report suggests that cocaine abuse indeed might be linked to secondary Parkinsonism and serves as an example of a potential gene-environmental interaction between the detected LRRK2 risk variant and cocaine abuse. The reversible nature of the DaTscan pathology is a unique feature of this case, and needs further evaluation, whether this is incidental or can be a feature of cocaine related Parkinsonism.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Interação Gene-Ambiente , Serina-Treonina Proteína Quinase-2 com Repetições Ricas em Leucina/genética , Doença de Parkinson/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Humanos , Masculino , Neuroimagem/métodos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/patologia , Fatores de Risco , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único
4.
J Pak Med Assoc ; 69(9): 1372-1375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511728

RESUMO

Myocardial calcification is a rare echocardiographic finding, which is often found in patients who have suffered from a myocardial infarction. Rarely, myocardial calcification may be present in individuals without a significant medical history. Until today, there has not been a published case report emphasising the relation between myocardial calcification and cocaine usage. Herein, we report a case of a young male with diffuse calcification of the left ventricular myocardium, who had an addiction to cocaine. This case highlights an uncommon etiology for myocardial calcification and it may lead to further studies about cardiotoxic effects of cocaine.


Assuntos
Calcinose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Transtornos Relacionados ao Uso de Cocaína/complicações , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Adulto , Suporte Vital Cardíaco Avançado , Calcinose/complicações , Cardiomiopatias/complicações , Colectomia , Cocaína Crack , Ecocardiografia , Infecções por Escherichia coli , Humanos , Masculino , Complicações Pós-Operatórias/tratamento farmacológico , Choque Cardiogênico/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Tomografia Computadorizada por Raios X , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/tratamento farmacológico , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia
5.
Medicina (B Aires) ; 79(4): 284-286, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487249

RESUMO

Endomyocardial fibrosis is a restrictive cardiomyopathy with high morbidity and mortality rates, prevalent in the sub-Saharan Africa region but infrequent in our population. It has a close relation with blood hypereosinophilia. Hypoxic hepatitis is frequently observed in intensive care units and its diagnosis is clinical. It shows a typical enzyme pattern with high mortality too. There are multiple mechanisms responsible for this condition, such as ischemia, passive congestion and dysoxia. We described the case of a 35 year-old cocaine addict woman diagnosed with endomyocardial fibrosis and hypereosinophilic syndrome who developed cardiogenic shock with hypoxic hepatitis. The patient evolved favorably with the appropriate treatment.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Fibrose Endomiocárdica/etiologia , Hepatite/complicações , Síndrome Hipereosinofílica/complicações , Choque Cardiogênico/complicações , Adulto , Fibrose Endomiocárdica/diagnóstico , Feminino , Humanos , Hipóxia/complicações
6.
AIDS Behav ; 23(9): 2467-2476, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31407212

RESUMO

This pilot randomized controlled trial examined the feasibility and acceptability of a Syndemics intervention targeting the intersection of stimulant use, trauma, and difficulties with HIV disease management in cocaine-using women. All participants received contingency management (CM) for 3 months with financial incentives for stimulant abstinence during thrice-weekly urine screening and refilling antiretroviral medications monthly. Sixteen participants were randomized to complete four expressive writing (n = 9) or four neutral writing (n = 7) sessions delivered during the CM intervention period. Completion rates for writing sessions were high (15 of 16 women completed all four sessions) and engagement in CM urine screening was moderate with women randomized to expressive writing providing a median of 11 non-reactive urine samples for stimulants. There were non-significant trends for those randomized to expressive writing to provide more CM urine samples that were non-reactive for stimulants, report greater decreases in severity of cocaine use, and display reductions in log10 HIV viral load at 6 months. Although the Syndemics intervention was feasible and acceptable to many women, qualitative interviews with eligible participants who were not randomized identified structural and psychological barriers to engagement. Further clinical research is needed to test the efficacy of Syndemics interventions with HIV-positive, cocaine-using women.


Assuntos
Antirretrovirais/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/complicações , Infecções por HIV/tratamento farmacológico , Motivação , Aceitação pelo Paciente de Cuidados de Saúde , Sindemia , Redação , Adulto , Terapia Comportamental , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/efeitos adversos , Estudos de Viabilidade , Feminino , Infecções por HIV/psicologia , Soropositividade para HIV , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pesquisa Qualitativa , Reembolso de Incentivo , Resultado do Tratamento , Carga Viral
8.
BMJ Case Rep ; 12(6)2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31177198

RESUMO

We report the case of a 43-year-old African American man with a history of hypertension and chronic kidney disease presenting with hypertensive emergency and bulbar paralysis in a descending fashion, which ultimately led to acute respiratory failure. He ingested pufferfish liver during the preceding 4 hours prior to presentation, as well as canned foods and cocaine over the prior 3 days. He had a complicated hospital course requiring intubation and mechanical ventilation, as well as the development of acute respiratory distress syndrome and acute renal failure requiring haemodialysis. This case exemplifies the classic manifestations of tetrodotoxin poisoning with some unique overlapping features, in the setting of an interesting social history.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Doenças Transmitidas por Alimentos/etiologia , Síndrome do Desconforto Respiratório do Adulto/induzido quimicamente , Tetrodotoxina/envenenamento , Lesão Renal Aguda/terapia , Adulto , Animais , Transtornos Relacionados ao Uso de Cocaína/complicações , Florida , Doenças Transmitidas por Alimentos/terapia , Humanos , Masculino , Diálise Renal , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/terapia , Tetraodontiformes
9.
Rev Mal Respir ; 36(5): 610-624, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31201016

RESUMO

INTRODUCTION: Cocaine use can be responsible for many respiratory complications including asthma. OBJECTIVES: Systematic literature review of data on asthma in cocaine users. DOCUMENTARY SOURCES: PubMed/Medline search, on the period 1980-2017 with the following keywords: "asthma*" or "bronchospasm" and "cocaine" or "freebase*" or "crack", limits "title/abstract"; the selected languages were English or French. Among 108 articles, 43 abstracts underwent dual reading to select 22 studies. RESULTS: In four case reports of asthma associated with cocaine use including 11 patients (mean age: 28.3 years [22-33 years]; sex-ratio: 2.5 [males: 71.5%]), cocaine was sniffed [snorted] (9%), smoked (36.5%) or both sniffed and smoked (54.5%). A medical history of childhood asthma was observed in 45.4% of the cases. Acute respiratory failure, requiring intubation and mechanical ventilation, was observed in 45.4% of the cases. Outcome was rapidly favorable in 82%; 9/11, progressively favorable in one patient, and fatal in another patient. Other studies included 6 cross-sectional studies, 4 case-control studies and 8 longitudinal studies (7 retrospective studies and one prospective study). The mean age was 36.6 years (women: 44.7%). Twenty percent of the subjects used cocaine exclusively, and 80% used cocaine combined with other addictive drugs (cocaine and heroin: 62%). The prevalence of cocaine users was higher in asthmatic subjects and the prevalence of asthma was higher in cocaine users. Cocaine use can be responsible for asthma onset and acute asthma exacerbation. In the case of asthma exacerbation, cocaine users were more likely to be admitted in intensive care units and to require intubation and invasive ventilation. Asthma exacerbations may be fatal in spite of resuscitation measures. Asthma treatment observance was lower in cocaine users. CONCLUSION: Cocaine use may be responsible for asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or death related to asthma. Cocaine use must be systematically considered in the case of asthma exacerbation and practitioners must help cocaine users to stop their consumption.


Assuntos
Asma/epidemiologia , Asma/etiologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Fatores de Risco , Adulto Jovem
10.
J Am Podiatr Med Assoc ; 109(2): 150-154, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31135196

RESUMO

BACKGROUND: Since 2006 there have been increased reports of severe agranulocytosis and vasculitis associated with levamisole use. Historically, levamisole was an immunomodulatory agent used in various cancer treatments in the United States. Currently the drug is used as an antihelminthic veterinary medication, but it is also used as an additive in freebase cocaine. There are multiple reports of levamisole-induced vasculitis in the head and neck but limited reported cases in the lower extremities. This article describes a 60-year-old woman who presented to the emergency department with multiple painful lower-extremity ulcerations. RESULTS: Radiographs, laboratory studies, and punch biopsy were performed. Physical examination findings and laboratory results were negative for signs of infection. Treatment included local wound care and education on cocaine cessation, and the patient was transferred to a skilled nursing facility. Her continued use of cocaine, however, prevented her ulcers from healing. CONCLUSIONS: Local wound care and cocaine cessation is the optimal treatment for levamisole-induced lesions. With the increase in the number of patients with levamisole-induced vasculitis, podiatric physicians and surgeons would benefit from the immediate identification of these ulcerations, as their appearance alone can be distinct and pathognomonic. Early identification of levamisole-induced ulcers is important for favorable treatment outcomes. A complete medical and social history is necessary for physicians to treat these lesions with local wound care and provide therapy for patients with addictions.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Levamisol/efeitos adversos , Extremidade Inferior , Vasculite/induzido quimicamente , Feminino , Humanos , Pessoa de Meia-Idade , Vasculite/patologia , Vasculite/terapia
11.
Neurobiol Learn Mem ; 161: 92-105, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30946882

RESUMO

Cocaine use disorder (CUD) is associated with prefrontal cortex dysfunction and cognitive deficits that may contribute to persistent relapse susceptibility. As the relationship between cognitive deficits, cortical abnormalities and drug seeking is poorly understood, development of relevant animal models is of high clinical importance. Here, we used an animal model to characterize working memory and reversal learning in rats with a history of extended access cocaine self-administration and prolonged abstinence. We also investigated immediate and long-term functional changes within the prelimbic cortex (PrL) in relation to cognitive performance and drug-seeking. Adult male rats underwent 6 days of short-access (1 h/day) followed by 12 days of long-access (6 h/day) cocaine self-administration, or received passive saline infusions. Next, rats were tested in delayed match-to-sample (DMS) and (non)match-to-sample (NMS) tasks, and finally in a single context + cue relapse test on day 90 of abstinence. We found that a history of chronic cocaine self-administration impaired working memory, though sparing reversal learning, and that the components of these cognitive measures correlated with later drug-seeking. Further, we found that dysregulated metabolic activity and mGlu5 receptor signaling in the PrL of cocaine rats correlated with past working memory performance and/or drug-seeking, as indicated by the analysis of cytochrome oxidase reactivity, mGlu5 and Homer 1b/c protein expression, as well as Arc mRNA expression in mGlu5-positive cells. These findings advocate for a persistent post-cocaine PrL dysfunction, rooted in ineffective compensatory changes and manifested as impaired working memory performance and hyperreactivity to cocaine cues. Considering the possible interplay between the neural correlates underlying post-cocaine cognitive deficits and drug-seeking, cognitive function should be evaluated and considered when developing neurobiologically-based treatments of cocaine relapse.


Assuntos
Transtornos Relacionados ao Uso de Cocaína , Cocaína/farmacologia , Disfunção Cognitiva , Inibidores da Captação de Dopamina/farmacologia , Giro do Cíngulo , Memória de Curto Prazo , Córtex Pré-Frontal , Receptor de Glutamato Metabotrópico 5/metabolismo , Animais , Comportamento Animal/efeitos dos fármacos , Comportamento Animal/fisiologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/metabolismo , Transtornos Relacionados ao Uso de Cocaína/fisiopatologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/metabolismo , Disfunção Cognitiva/fisiopatologia , Modelos Animais de Doenças , Giro do Cíngulo/efeitos dos fármacos , Giro do Cíngulo/metabolismo , Giro do Cíngulo/fisiopatologia , Masculino , Memória de Curto Prazo/efeitos dos fármacos , Memória de Curto Prazo/fisiologia , Córtex Pré-Frontal/efeitos dos fármacos , Córtex Pré-Frontal/metabolismo , Córtex Pré-Frontal/fisiopatologia , Ratos , Ratos Sprague-Dawley , Autoadministração
12.
QJM ; 112(7): 519-522, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30895319

RESUMO

BACKGROUND: Pneumothorax is one of the respiratory toxic effects of cocaine inhalation. The literature counts several cases, some associated to other respiratory conditions such as pneumomediastinum, haemoptysis and others not requiring surgical treatment. AIM: We present a series of nonHIV cocaine-inhaler subjects who underwent video-assisted thoracoscopic surgery (VATS) for isolated spontaneous pneumothorax. DESIGN: Nine subjects, with a mean age of 24 ± 4 years, admitting cocaine inhalation, developed spontaneous pneumothorax and underwent 10 surgical treatments by means of VATS, at our Institution. RESULTS: Previous pneumothorax occurred in six cases episodes ranged from 0 to 5 (mean 1.6 ± 1.6). Chest computed tomography (CT) scan showed abnormalities in seven cases. All subjects underwent lung apicectomy, apical pleurectomy and mechanical pleurodesis. Seven subjects had also bullectomy. In all cases the visceral pleura was partially covered by fibrinous exudate. Histology of the lung showed small foreign body granulomatous inflammation in fibrotic and/or emphysematous pulmonary parenchyma. Relapse of pneumothorax occurred in one subject at 60 days and it was surgically treated. Mean follow-up was 150 ± 38 months (range 120-239). All subjects are now well, with no evidence of pneumothorax. CONCLUSIONS: Spontaneous pneumothorax in cocaine-inhaler subjects is a reality of which physicians need to be aware. Chest CT scan might not reveal abnormalities. Macroscopically the lung might presents bullae and/or peculiar visceral pleura. Foreign body granulomas observed in the specimens suggest that the particulate component of inhaled substances can injure the lung. Surgical treatment of the bullous disease and mechanical pleurodesis can provide a long-term follow-up without relapse of pneumothorax.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/efeitos adversos , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida , Administração por Inalação , Adulto , Cocaína/administração & dosagem , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Corpos Estranhos/patologia , Humanos , Itália , Masculino , Pneumotórax/etiologia , Recidiva , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
13.
J Invasive Cardiol ; 31(4): E62-E63, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30927536
14.
J Acquir Immune Defic Syndr ; 81(1): 78-82, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30730359

RESUMO

BACKGROUND: Concomitant use of cocaine and HIV pre-exposure prophylaxis (PrEP) raises important clinical questions around adherence, retention in care, and renal toxicity. METHODS: We assessed the associations of confirmed cocaine use with PrEP adherence (both ascertained through objective measures), care engagement, and renal function in the iPrEx open-label extension. Cocaine use was measured in scalp hair samples and categorized as light (500-3000 pg/mg) and moderate to heavy (>3000 pg/mg). PrEP adherence in the first 3 months was measured through plasma tenofovir concentrations. Disengagement from PrEP care was defined as a gap in follow-up greater than 4 months. Serum creatinine was assessed at baseline and quarterly visits. RESULTS: Of the 400 participants included in this analysis, 90% were men who have sex with men, 10% transgender women, 74% Hispanic/Latino; 21% tested positive for cocaine use in the last 3 months. In adjusted analysis, light cocaine use [adjusted odds ratio 2.10 (95% confidence interval: 1.07 to 4.14)] and moderate to heavy use [adjusted odds ratio 2.32 (1.08 to 5.00)] were associated with greater odds of having plasma tenofovir concentrations below the level of quantitation. Participants with moderate to heavy use had a nearly 3-fold higher rate of disengagement from PrEP care compared with nonusers (adjusted hazard ratio 2.90 [1.48 to 5.66]). We found no statistically or clinically significant differences in creatinine clearance and serum creatinine between participants who tested positive for cocaine and those who did not. CONCLUSIONS: Cocaine use decreases PrEP adherence and care engagement. Comprehensive approaches are needed to reduce cocaine use and enhance engagement along the PrEP care continuum.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/complicações , Rim/efeitos dos fármacos , Adesão à Medicação/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Profilaxia Pré-Exposição , Adulto , Fármacos Anti-HIV/efeitos adversos , Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/psicologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Adesão à Medicação/psicologia , Participação do Paciente/psicologia , Profilaxia Pré-Exposição/métodos , Adulto Jovem
15.
Am Heart J ; 210: 39-48, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30731372

RESUMO

BACKGROUND: Persons living with HIV (PLHIV) have an increased risk of heart failure (HF). However, little is known about outcomes among PLHIV with HF. The study aim was to compare HF outcomes among PLHIV with HF versus individuals without HIV with HF. METHODS: Our cohort included 2,308 individuals admitted with decompensated HF. We compared baseline characteristics, 30-day HF readmission, and cardiovascular (CV) and all-cause mortality. Within PLHIV, we assessed outcomes stratified between CD4 count and viral load (VL), and tested the association between traditional and HIV-specific parameters with 30-day HF readmission. RESULTS: There were 374 (16%) PLHIV with HF. Among PLHIV, 92% were on antiretroviral therapy and 63% had a VL <200 copies/mL. Groups were similar with respect to age, sex, race/ethnicity, and CV risk factors. In follow-up, PLHIV had increased 30-day HF readmission (49% vs 32%) and CV (26% vs 13.5%) and all-cause mortality rates (38% vs 22%). Among PLHIV, cocaine use, HIV-specific parameters (CD4, VL), and coronary artery disease were predictors of 30-day HF readmission. Specifically, among PLHIV, those with detectable VL had higher 30-day HF readmission and CV mortality, whereas PLHIV with undetectable VL had a similar 30-day HF readmission rate and CV mortality to uninfected controls with HF. Similar outcomes were observed across strata of left ventricular ejection fraction and by CD4. CONCLUSIONS: PLHIV with a low CD4 count or detectable VL have an increased 30-day HF readmission rate as well as increased CV and all-cause mortality. In contrast, PLHIV with a higher CD4 count and undetectable VL have similar HF outcomes to uninfected controls.


Assuntos
Infecções por HIV/complicações , Sobreviventes de Longo Prazo ao HIV , Insuficiência Cardíaca/complicações , Readmissão do Paciente/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Causas de Morte , Transtornos Relacionados ao Uso de Cocaína/complicações , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária , Estados Unidos , Carga Viral
17.
J Vasc Surg ; 70(1): 60-66, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30792056

RESUMO

OBJECTIVE: To describe and compare the clinical and anatomical characteristics and outcomes of patients with and without known cocaine use who underwent thoracic endovascular repair for type B aortic dissections. METHODS: Between January 2012 and January 2017, 186 patients underwent thoracic endovascular repair for type B aortic dissection at our institution. Clinical data and anatomical characteristics were collected under an institutional review board-approved protocol. Survival, reintervention, complications, and characteristics of dissection were compared between patients with cocaine use (C+; n = 14) and those with no known cocaine use (C-; n = 172). RESULTS: Cocaine users were more likely to be young African American males who smoked. They tended to present with more extensive dissections as evidenced by larger false lumen diameters. They also had higher rates of endoleaks and more reinterventions. CONCLUSIONS: These results suggest that special care should be taken to provide close follow-up for these patients.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Afro-Americanos , Fatores Etários , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Endoleak/diagnóstico , Endoleak/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retratamento , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
19.
BMJ Case Rep ; 12(2)2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30796068

RESUMO

Although cocaine induced myopathy and myotoxicity are described in the literature, we report a rare case of cocaine induced paraspinal myositis presenting with acute sciatic symptoms. A 35-year-old man presented with acute left-sided sciatica and was discharged from the emergency department (ED). He subsequently attended ED the following day in severe pain and bilateral sciatic symptoms, but denied symptoms of neurogenic bowel/bladder disturbance. Clinical examination was limited by severe pain: focal midline lumbar tenderness was elicited on palpation, per rectal and limb examinations were within normal limits with no significant neurological deficit. He was admitted for observation and pain management. His blood tests revealed a leucocyte count of 21.5×109/L, C reactive protein of 89 mg/L and deranged renal function with creatinine of 293 µmol/L. An urgent lumbar spine MRI was arranged to rule out a discitis or epidural abscess. Lumbar MRI did not demonstrate any features of discitis but non-specific appearances of paraspinal inflammation raised the suspicion of a paraspinal myositis. Creatinekinase (CK) was found to be 66329 IU/L and a detailed history revealed he was a cocaine user. Paraspinal muscle biopsy confirmed histological features compatible with myositis. Other serological tests were negative, including anti-GBM, ANCA, ANA, Rheumatoid factor, Hep B, Hep C, myositis specific ENA, Treponema pallidum, Borrelia burgdorferi, Rickettsia, Leptospira, EBV and CMV. There was good clinical response to treatment with prednisolone 20 mg OD with an improvement in renal function, CK levels and CRP. He had resumed normal activities and return to work at 6-week follow-up. A detailed social history including substance misuse is important in patients presenting to the ED-especially in cases of severe musculoskeletal pain with no obvious localising features. Drug induced myotoxicity, although rare, can result in symptomatic patients with severe renal failure.


Assuntos
Fumar Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Região Lombossacral/patologia , Miosite/diagnóstico , Dor Intratável/etiologia , Prednisolona/uso terapêutico , Adulto , Fumar Cocaína/fisiopatologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/fisiopatologia , Diagnóstico Diferencial , Humanos , Região Lombossacral/diagnóstico por imagem , Masculino , Miosite/induzido quimicamente , Miosite/complicações , Miosite/fisiopatologia , Dor Intratável/diagnóstico por imagem , Dor Intratável/fisiopatologia , Ciática , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Int J Mol Sci ; 20(3)2019 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-30700023

RESUMO

Cardiac complications resulting from cocaine use have been extensively studied because of the complicated pathophysiological mechanisms. This study aims to review the underlying cellular and molecular mechanisms of acute and chronic effects of cocaine on the cardiovascular system with a specific focus on human studies. Studies have consistently reported the acute effects of cocaine on the heart (e.g., electrocardiographic abnormalities, acute hypertension, arrhythmia, and acute myocardial infarction) through multifactorial mechanisms. However, variable results have been reported for the chronic effects of cocaine. Some studies found no association of cocaine use with coronary artery disease (CAD), while others reported its association with subclinical coronary atherosclerosis. These inconsistent findings might be due to the heterogeneity of study subjects with regard to cardiac risk. After cocaine use, populations at high risk for CAD experienced coronary atherosclerosis whereas those at low risk did not experience CAD, suggesting that the chronic effects of cocaine were more likely to be prominent among individuals with higher CAD risk. Studies also suggested that risky behaviors and cardiovascular risks may affect the association between cocaine use and mortality. Our study findings highlight the need for education regarding the deleterious effects of cocaine, and access to interventions for cocaine abusers.


Assuntos
Sistema Cardiovascular/efeitos dos fármacos , Sistema Cardiovascular/patologia , Cocaína/toxicidade , Animais , Transtornos Relacionados ao Uso de Cocaína/complicações , Cardiopatias/induzido quimicamente , Humanos
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