ABSTRACT
La intoxicación por 3,4-metilendioximetanfetamina (MDMA), ha tenido un dramático resurgimiento desde 1980, se ha extendido por gran parte de los Estados Unidos, Europa y América, ha sido ampliamente utilizada como drogas con fines recreativos, actualmente Las catinonas sintéticas se venden como "euforizantes legales" para eludir las leyes existentes, lo que resulta en toxicidad grave y muertes. Presentamos un caso clínico de un adulto joven, quien debuto con intoxicación aguda severa MDMA, con falla multiorgánica, el cual se realizó atención y manejo agudo de la intoxicación en el servicio de urgencias, con posterior manejo de complicaciones en la unidad de cuidados intensivo y finalmente con sobrevida a pesar del mal pronóstico.
3,4-methylenedioxymethamphetamine (MDMA) intoxication, has had a dramatic resurgence since 1980, has spread throughout much of the United States, Europe and America, has been widely used as a recreational drug, currently Synthetic cathinones are they sell as "legal highs" to circumvent existing laws, resulting in severe toxicity and deaths. We present a clinical case of a young adult, who debuted with severe acute MDMA poisoning, with multiple organ failure, who underwent care and acute management of the poisoning in the emergency department, with subsequent management of complications in the intensive care unit and finally with survival despite the poor prognosis.
ABSTRACT
Resumen El análisis por toxicomanía representa un proceso común solicitado por la Autoridad Judicial para determinar si un usuario presenta hallazgos compatibles con el uso de una droga a nivel clínico, componentes histológicos, patológicos y toxicológicos que puedan generar su uso. Es necesario destacar las limitaciones del ambiente clínico donde se pueden generar múltiples hallazgos, y de la toxicología forense donde a pesar de la especificidad a la que se asocia; también se encuentra limitada por la capacidad de sus equipos tecnológicos. La resonancia magnética nuclear cuantitativa de hidrógeno representa grandes ventajas al demostrar la presencia de una droga ilegal, así como la posibilidad de disminuir costos y tiempo laboral. El uso del MDMA como tratamiento con una reciente aprobación para un estudio de fase III por la FDA, también requiere que se valore el motivo de su uso, por lo que para realizar un análisis médico legal se contemplaron diversos elementos de juicio a fin de satisfacer la evaluación sobre la toxicomanía por MDMA en un usuario que presentó un tejido granular blanco tipo polvo en la sección distal del tabique nasal y negó el consumo de metanfetaminas.
Abstract The analysis for drug addiction represents a common process requested by the Judicial Authority to determine if a user presents findings compatible with the use of a drug at a clinical level, histological, pathological and toxicological components that may generate its use. It is necessary to highlight the limitations of the clinical environment where multiple findings can be generated, and of forensic toxicology where despite the specificity to which it is associated; it is also limited by the capacity of its technological equipment. Quantitative hydrogen nuclear magnetic resonance represents great advantages when demonstrating the presence of an illegal drug, as well as the possibility of reducing costs and labor time. The use of MDMA as a treatment with a recent approval for a phase III study by the FDA, also requires that the reason for its use be assessed, therefore, in order to carry out a legal medical analysis, various elements of judgment were considered in order to satisfy evaluation of MDMA drug addiction in a user who presented with white powder-like granular tissue in the distal section of the nasal septum and denied the use of methamphetamine.
Subject(s)
Humans , N-Methyl-3,4-methylenedioxyamphetamine , Substance-Related Disorders/diagnosis , Central Nervous System Stimulants/analysis , Costa RicaABSTRACT
Objective To evaluate the influence of amphetamine-type stimulants on serum rapid plasma reagent (RPR) tiler and negative conversion rate of RPR in patients with syphilis. Methods Thirty-six patients with syphilis who took amphetamine-type stimulants (ATS) were recruited in this study together with 44 patients with syphilis who never took ATS and 30 normal human controls. Benzathine benzylpenicillin was given intramuscularly to all patients at a dose of 2 400 000 unit per week for 3 weeks. RPR and treponema pallidum particle agglutination (TPPA) assay were performed before treatment, 3, 6, 9 and 12 months after the therapy. Radioimmune assay and ncphelometry were used to detect the serum level of IgG, lgM and IgA. The capability of peripheral blood mononuclear cells (PBMCs) to product interferon-T (IFN-γ) and interleukin-4 (IL-4) was evaluated with ELISA. Results Before treatment, RPR titcr was significantly lower in the stimulant-taking group than in the non-taking group (χ2 = 14.93, P < 0.05). The negative conversion rates were 5.56%, 16.67% and 52.78% in stimulant-taking group 6, 9 and 12 months after the treatment, respectively, significantly lower than those in the control group (all P < 0.05). As for the serum level of IgG, IgM and IgA, there was no significant difference among the stimulant-taking group, non-taking group and normal control group (all P > 0.05). The capability of PBMCs to product IFN-γ was highest in the stimulant-taking group, followed by the non-taking group and normal control group (all P < 0.05). No significant difference was observed in the capability of PBMCs to produce IL-4 between the stimulant-taking group and non-taking group, but a significant increment was noted in these patients compared with the normal human controls (all P < 0.01). Conclusion Amphetamine-type stimulants could reduce serum RPR titer and negative conversion rate of RPR in patients with syphilis, likely by impairing cellular immunity of patients.
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OBJETIVO: Analisar o conteúdo dos comentários enviados espontaneamente por usuários de ecstasy que responderam a um questionário on-line correspondente à primeira etapa de um projeto de redução de danos (projeto Baladaboa) para usuários dessa droga. MÉTODO: Dos 1 140 indivíduos que responderam o questionário, 412 enviaram comentários. Os comentários foram segmentados em cinco categorias (irrelevante, drogas, depoimentos, questionário e projeto) e submetidos à análise de conteúdo. A categoria "irrelevante" incluiu saudações, comentários irreverentes e manifestações ideológicas. A categoria "drogas" incluiu considerações sobre as causas, os efeitos e as conseqüências do uso de ecstasy ou de outras drogas, solicitações de esclarecimentos sobre a droga ou comentários que apontavam a informação como uma questão fundamental relacionada a seu uso. A categoria "depoimentos" incluiu comentários acerca de vivências pessoais. A categoria "questionário" incluiu comentários sobre o questionário propriamente dito, a formulação das questões, o uso de certos critérios e a solicitação de acesso aos resultados da pesquisa. A categoria "projeto" incluiu comentários relativos ao projeto Baladaboa. RESULTADOS: Identificaram-se 915 segmentos nos 412 comentários. A porcentagem de segmentos classificados em cada categoria foi: irrelevante, 9,8 por cento; drogas, 16,4 por cento; depoimentos, 18,1 por cento; questionário, 25,1 por cento; e projeto, 30,6 por cento. A maior parte dos comentários foi positiva em relação ao questionário e ao projeto. CONCLUSÕES: A quantidade e o teor dos comentários espontaneamente enviados indicaram expressiva receptividade ao projeto e aprovação da estratégia de redução de danos pelo público- alvo. O envolvimento dos participantes pôde ser observado em todos os comentários, sugerindo que a continuidade do projeto é urgente e oportuna.
OBJECTIVE: To analyze the contents of spontaneous comments posted by ecstasy users participating in an online survey that constitutes phase one of a harm reduction project (projeto Baladaboa) aimed at users of this drug. METHOD: Of the 1 140 individual respondents, 412 posted unprompted comments. These comments were grouped into five categories (irrelevant, drugs, testimonies, survey, and project) and submitted to content analysis. Salutations, irreverent comments, and ideological remarks were considered "Irrelevant." Comments on the causes, effects, and consequences of using ecstasy or other drugs; requests for information on the drug; or comments indicating that information is a crucial issue associated with the use of ecstasy were labeled "Drugs." Personal stories made up the group called "Testimonies." Any comments concerning the questionnaire itself, the formulation of questions, the use of certain criteria, and requests to see survey results were designated "Survey." Comments specifically about the Baladaboa project were categorized as "Project." RESULTS: Content analysis revealed 915 segments among the 412 comments. The percent distribution of segments among the groups were: irrelevant, 9.8 percent; drugs, 16.4 percent; testimonies, 18.1 percent; survey, 25.1 percent; and project, 30.6 percent. Most of the comments concerning the survey and the project were positive. CONCLUSIONS: The number and content of the spontaneous comments indicate that the project, as well as the harm reduction strategy, were being well received by the target audience. The participants expressed their engagement with the project and suggested that its continuation is both timely and urgent.