Possible hepatotoxicity of chronic marijuana usage

CONTEXTO: Hepatotoxidade é uma complicação potencial do uso de várias drogas ilícitas, possivelmente como conseqüência do seu metabolismo hepático. Entretanto, informações sobre tal possibilidade são escassas na bibliografia médica. OBJETIVO: Estudar a ocorrência de alterações clínicas e laboratoriais hepáticas que podem ocorrer em usuários crônicos de maconha, isoladamente ou associadas ao uso de outras drogas lícitas e ilícitas. TIPO DE ESTUDO: estudo transversal LOCAL: Hospital Espírita de Marília, Marília - SP, Brasil. PARTICIPANTES: Foram estudados 123 pacientes, internados no Hospital Espírita de Marília de outubro de 1996 a dezembro de 1998, divididos em três grupos: 26 (21%) usuários exclusivamente de maconha, 83 (67,5%) usuários de maconha e crack e 14 (11,4%) usuários de maconha e álcool. PROCEDIMENTOS E VARIAVEIS ESTUDADAS: Os pacientes foram examinados clinicamente, com especial ênfase nos aspectos relativos aos tipos de drogas usadas e rotas de usos, idade de início do uso, tempo e padrão de uso, presença ou ausência de tatuagem, icterícia, hepatomegalia e esplenomegalia. Foram determinados os níveis séricos de proteínas totais, albumina, globulina, bilirrubina total e frações, aspartato-aminotransferase (AST), alanina-aminotransferase (ALT), fosfatase alcalina (FA), gama-glutamiltransferase e atividade da protrombina. RESULTADOS: Entre os usuários exclusivos de maconha foram observados hepatomegalia em 57,7% e esplenomegalia em 73,1% dos casos, e estavam discretamente elevadas a AST (42,3%), ALT (34,6%) e FA (53,8%). Os três grupos não diferiram significativamente nas prevalências de hepatomegalia, esplenomegalia e hepatoesplenomegalia. No grupo maconha/álcool foram observadas as maiores prevalências de alterações e níveis mais elevados das aminotransferases. Os níveis médios da fosfatase alcalina estavam acima do valor normal em todos os grupos. CONCLUSÕES: O uso crônico de maconha, exclusivo ou associado a outras drogas, associou-se a alterações morfológicas e enzimáticas hepáticas, sugerindo serem os canabinóides substâncias possivelmente hepatotóxicas.

Mulheres alcoolistas: alterações eletrocardiográficas e distúrbios metabólicos e eletrolíticos associados / Female alcoholics: electrocardiographic changes and associated metabolic and electrolytic disorders

OBJECTIVE: To identify the electrocardiographic changes and their associations with metabolic and electrolytic changes in female alcoholics. METHODS: The study comprised 44 female alcoholics with no apparent physical disorder. They underwent the following examinations: conventional electrocardiography; serologic tests for syphilis, Chagas' disease, and hepatitis B and C viruses; urinary pregnancy testing; hematimetric analysis; biochemical measurements of albumin, fibrinogen, fasting and postprandial glycemias, lipids, hepatic enzymes, and markers for tissue necrosis and inflammation. RESULTS: Some type of electrocardiographic change was identified in 33 (75 percent) patients. In 17 (38.6 percent) patients, more than one of the following changes were present: prolonged QTc interval in 24 (54.5 percent), change in ventricular repolarization in 11(25 percent), left ventricular hypertrophy in 6 (13.6 percent), sinus bradycardia in 4 (9.1 percent), sinus tachycardia in 3 (6.8 percent), and conduction disorder in 3 (6.8 percent). The patients had elevated mean serum levels of creatine phosphokinase, aspartate aminotransferases, and gamma glutamyl transferase, as well as hypocalcemia and low levels of total cholesterol and LDL-cholesterol. The patients with altered electrocardiograms had a more elevated age, a lower alcohol consumption, hypopotassemia, and significantly elevated levels of triglycerides, postprandial glucose, sodium and gamma glutamyl transferase than those with normal electrocardiograms. The opposite occurred with fasting glycemia, magnesium, and alanine aminotransferase. CONCLUSION: The electrocardiographic changes found were prolonged QTc interval, change in ventricular repolarization, and left ventricular hypertrophy. Patients with normal and abnormal electrocardiograms had different metabolic and electrolytic changes

Histopathologic and biochemical liver test abnormalities in chronic asymptomatic or oligosymptomatic alcoholics: a review

PURPOSE: To review the medical literature regarding the histopathologic and biochemical liver test abnormalities in chronic asymptomatic or oligosymptomatic alcoholics. METHODS: Review of articles in the MEDLINE and LILACS databases regarding serum levels and prevalence of alterations in aspartate-aminotransferase, alanine-aminotransferase, alkaline phosphatase, and total bilirubin, in relation to liver histopathology, with or without discrimination of types of histopathologic alteration. RESULTS: Global mean prevalence rates of aspartate-aminotransferase and alanine-aminotransferase alterations were 86.3 percent and 51.1 percent; in cases with steatosis they were 79.1 percent and 38.5 percent; and in cases of hepatitis, 90.1 percent and 58 percent. In all studies, prevalence rates of aspartate-aminotransferase alterations were significantly higher with lower variability than those of alanine-aminotransferase. Mean aspartate-aminotransferase levels were higher than 2N (N is the upper normal limit of the method employed) in all cases with hepatitis histopathology, while those of alanine-aminotransferase were 1.48N, in the same cases. Prevalence of alkaline phosphatase and total bilirubin abnormalities were 74.5 percent and 74.9 percent globally; in cases of steatosis, they were 70.9 percent and 67.9 percent; and in cases of hepatitis, 75.9 percent and 77.7 percent. Mean alkaline phosphatase levels were above the upper normal limit in all cases, but those of total bilirubin were above normal in 4 of 7 hepatitis studies. CONCLUSIONS: Prevalence of aspartate-aminotransferase alteration was consistently related to presence of histopathologic abnormalities; an enzyme level higher than 2N suggests the diagnosis of alcoholic hepatitis