Vulnerability of pregnant women using alcohol and other drugs in low-risk prenatal care / Vulnerabilidad de gestantes que consumen alcohol y otras drogas en el prenatal de bajo riesgo / Vulnerabilidade de gestantes usuárias de álcool e outras drogas em pré-natal de baixo risco

ABSTRACT Objective: to verify the contexts that enhance the dimensions of individual, social, and programmatic vulnerability associated with the use of alcohol and other drugs during pregnancy. Method: qualitative, descriptive, and exploratory, cross-sectional study. Participants were 38 pregnant women who used alcohol and other drugs, at a moderate and severe level, in low-risk prenatal care in the Primary Health Care of two cities in the Metropolitan Region of Maringá - Paraná. Data was collected from, December 2019 to March 2020. The Vulnerability analytical framework guided the discussion. Results: at the individual level, the vulnerability contexts were issues of gender, brown and black ethnicity/color, low education, reproductive period, and high parity. At the social level, the lack of insertion in the job market, family income below the poverty line, abusive intra-family relationships, addictive behavior in the family, and violence in the living community. In the programmatic plan, there was a low demand for health services, lack of welcoming for the treatment of drug use, screening for deficient drug use, low bond with family health teams, absence of dental, psychological, and social services, insertion in the inadequate level of prenatal care, usual risk, while they should have been classified as high risk, and mean prenatal consultations below recommended. Conclusion: the study made it possible to advance in the contexts of the vulnerability of these pregnant women. Recognizing these contexts makes it possible to formulate strategies to reduce harm and damages to maternal and fetal health related to drug use during pregnancy, leading to a favorable gestational outcome.

RESUMEN Objetivo: verificar los contextos que potencian las dimensiones de vulnerabilidad individual, social y programática asociadas al consumo de alcohol y otras drogas durante el embarazo. Método: estudio cualitativo, descriptivo y exploratorio, transversal. Participaron 38 gestantes que consumían alcohol y otras drogas, en grado moderado y severo, en el prenatal de bajo riesgo en la Atención Primaria de Salud de dos municipios de la Región Metropolitana de Maringá - Paraná. . Los datos se recopilaron desde diciembre de 2019 a marzo de 2020. El marco analítico de Vulnerabilidad orientó la discusión. Resultados: en el plano individual, los contextos de vulnerabilidad detectados fueron: cuestiones de género, raza/color pardo y negro, baja escolaridad, período reproductivo y alta paridad. A nivel social, la falta de inserción en el mercado laboral, ingresos familiares por debajo de la línea de pobreza, relaciones intrafamiliares abusivas, conductas adictivas en la familia y violencia en la comunidad de convivencia. En el plano programático se constató baja demanda de servicios de salud, falta de acogida para el tratamiento del consumo de drogas, rastreo por consumo deficiente de drogas, escasa vinculación con los equipos de salud de la familia, falta de atención odontológica, psicológica y del servicio social, inserción en nivel inadecuado de atención prenatal, clasificación como riesgo habitual, cuando correspondía la clasificación de alto riesgo, y promedio de consultas prenatales por debajo de lo recomendado. Conclusión: el estudio permitió avanzar en los contextos de vulnerabilidad de estas gestantes. El (re)conocimiento de estos contextos permite formular estrategias para reducir los daños y perjuicios a la salud materna y fetal relacionados con el uso de drogas durante el embarazo, lo que conduce a un resultado gestacional favorable.

RESUMO Objetivo: verificar os contextos que potencializam as dimensões de vulnerabilidade individual, social e programática associadas ao uso de álcool e outras drogas durante a gravidez. Método: estudo qualitativo, descritivo e exploratório, com corte transversal. Participaram 38 gestantes usuárias álcool e outras drogas, em nível moderado e grave, em atendimento pré-natal de baixo risco na Atenção Primária à Saúde de dois municípios da Região Metropolitana de Maringá - Paraná. Os dados foram coletados de dezembro de 2019 a março de 2020. O referencial analítico da Vulnerabilidade pautou a discussão. Resultados: no plano individual, os contextos de vulnerabilidade eram questões de gênero, raça/cor parda e preta, baixa escolaridade, período reprodutivo e alta paridade. No plano social, a ausência de inserção no mercado de trabalho, renda familiar na linha da pobreza, relações intrafamiliares abusivas, comportamento aditivo na família e violência na comunidade de convivência. No plano programático encontraram-se baixa procura a serviços de saúde, ausência de acolhimento para o tratamento do uso de drogas, rastreio para o uso de drogas deficitário, baixo vínculo com as equipes da saúde da família, ausência de atendimento odontológico, psicológico e do serviço social, inserção no nível de assistência pré-natal inadequado, risco habitual, enquanto deveriam ter sido classificadas como alto risco, e média de consultas pré-natal abaixo do preconizado. Conclusão: o estudo permitiu avançar nos contextos de vulnerabilidade dessas gestantes. O (re)conhecimento destes contextos possibilita a formulação de estratégias de redução de danos e de agravos à saúde materno fetal relacionados ao uso de drogas durante a gravidez, conduzindo a um desfecho gestacional favorável.

Modifying current thin-film microextraction(TFME)solutions for analyzing prohibited substances:Evaluating new coatings using liquid chromatography / 药物分析学报

For identifying and quantifying prohibited substances,solid-phase microextraction(SPME)continues to arouse interest as a sample preparation method.However,the practical implementation of this method in routine laboratory testing is currently hindered by the limited number of coatings compatible with the ubiquitous high-performance liquid chromatography(HPLC)systems.Only octadecyl(C18)and poly-dimethylsiloxane/divinylbenzene ligands are currently marketed for this purpose.To address this situ-ation,the present study evaluated 12 HPLC-compatible coatings,including several chemistries not currently used in this application.The stationary phases of SPME devices in the geometry of thin film-coated blades were prepared by applying silica particles bonded with various functional ligands(C18,octyl,phenyl-hexyl,3-cyanopropyl,benzenesulfonic acid,and selected combinations of these),as well as unbonded silica,to a metal support.Most of these chemistries have not been previously used as microextraction coatings.The 48 most commonly misused substances were selected to assess the extraction efficacy of each coating,and eight desorption solvent compositions were used to optimize the desorption conditions.All samples were analyzed using an HPLC system coupled with triple quadrupole tandem mass spectrometry.This evaluation enables selection of the best-performing coatings for quantifying prohibited substances and investigates the relationship between extraction efficacy and the physicochemical characteristics of the analytes.Ultimately,using the most suitable coatings is essential for trace-level analysis of chemically diverse prohibited substances.

Nivel de conocimientos sobre los daños del consumo de drogas en adolescentes / Level of knowledge about the harms of drug use in adolescents

Introducción: El consumo de sustancias de abuso por adolescentes y jóvenes, es un problema de salud que preocupa a profesionales de la salud, padres y educadores. Objetivo: Identificar el nivel de conocimientos sobre los daños del consumo de drogas en los adolescentes de la secundaria básica "Martín Klein" de Varadero. Método: Estudio descriptivo transversal en 228 estudiantes. Se recogieron las variables: nivel de conocimientos, nivel de escolaridad, lugar y frecuencia de consumo. Para medir el nivel de conocimientos se utilizó un cuestionario de seis preguntas, tres cerradas y tres mixtas. Resultados: El 64,9 por ciento de los estudiantes resultó con conocimientos medianos sobre los daños que ocasionan las drogas; el 98,2 por ciento reconoce como drogas al tabaco/cigarro, cocaína y marihuana. El 85,1 por ciento ha obtenido información sobre el tema a través de la televisión, la familia y profesor; el 94,7 por ciento reconoce que el consumo de sustancias es perjudicial para la salud. Predominan los no consumidores de sustancias (66,7 por ciento), y los que consumen, alcohol y cigarros, los fines de semana. Conclusiones: Poseen conocimientos medianos sobre los daños que para la salud ocasionan las drogas; reconocen al tabaco, la cocaína y la marihuana, como drogas. Las mayores fuentes de información fueron la televisión, la familia y el profesor. Identifican que el consumo de drogas deteriora la salud física y mental. Predominan los abstemios, seguido de los que usan alcohol y fuman cigarros en centros recreativos, los fines de semana(AU)

ABSTRACT Introduction: The abuse of substances by adolescents and young people is a health problem that worries health professionals, parents and educators. Objective: To identify the level of knowledge about the harms of drug use in adolescents of the "Martín Klein" secondary school in Varadero. Method: Cross-sectional descriptive study in 228 students. The variables were collected; level of knowledge, level of schooling, place and frequency of consumption. To measure the level of knowledge, a questionnaire of six questions, three closed and three mixed, was used. Results: 64.9 percent of the students were found with medium knowledge about the damage caused by drugs; 98.2 percent recognize tobacco / cigar, cocaine and marijuana as drugs. 85, 1 percent have obtained information on the subject through television, family and teacher; 94.7 percent acknowledge that the consumption of substances is harmful to health. Predominant non-consumers of substances (66.7 percent), and those who consume, alcohol and cigars, on weekends. Conclusions: They have medium knowledge about the damages caused by drugs to health; they recognize tobacco / cigar, cocaine and marijuana as drugs. The main sources of information were television, the family and the teacher. They identify that drug use impairs physical and mental health. The abstainers predominate, followed by those who use alcohol and smoke cigars in recreational centers, on weekends(AU)

Evaluation of the Triage TOX Drug Screen Assay for Detection of 11 Drugs of Abuse and Therapeutic Drugs

The demand for rapid and broad clinical toxicology screens is on the rise. Recently, a new rapid toxicology screening test, the Triage TOX Drug Screen (Alere Inc., USA), which can simultaneously detect 11 drugs of abuse and therapeutic drugs with an instrument-read cartridge, was developed. In the present study, we evaluated the efficacy of this new on-site immunoassay using 105 urine specimens; the results were compared with those obtained by using ultra-performance liquid chromatography with tandem mass spectrometry (UPLC-TMS). Precision was evaluated according to the CLSI EP12-A2 for analyte concentrations near the cutoff, including C₅₀ and±30% of C₅₀, for each drug using standard materials. The C₅₀ specimens yielded 35–65% positive results and the ±30% concentration range of all evaluated drugs encompassed the C₅–C₉₅ interval. The overall percent agreement of the Triage TOX Drug Screen was 92.4–100% compared with UPLC-TMS; however, the Triage TOX Drug Screen results showed some discordant cases including acetaminophen, amphetamine, benzodiazepine, opiates, and tricyclic antidepressants. The overall performance of the Triage TOX Drug Screen assay was comparable to that of UPLC-TMS for screening of drug intoxication in hospitals. This assay could constitute a useful screening method for drugs of abuse and therapeutic drugs in urine.

Animal models of alcohol and drug dependence

Drug addiction has serious health and social consequences. In the last 50 years, a wide range of techniques have been developed to model specific aspects of drug-taking behaviors and have greatly contributed to the understanding of the neurobiological basis of drug abuse and addiction. In the last two decades, new models have been proposed in an attempt to capture the more genuine aspects of addiction-like behaviors in laboratory animals. The goal of the present review is to provide an overview of the preclinical procedures used to study drug abuse and dependence and describe recent progress that has been made in studying more specific aspects of addictive behavior in animals.

Simultaneous Screening of 177 Drugs of Abuse in Urine Using Ultra-performance Liquid Chromatography with Tandem Mass Spectrometry in Drug-intoxicated Patients

OBJECTIVE: The demand for rapid and broad clinical toxicology screening methods to identify drugs of abuse and medicinal drugs is increasing steadily. Liquid chromatography-tandem mass spectrometry (LC-TMS) is increasingly used to screen for drugs of abuse and to identify a wide range of drugs and metabolites in clinical samples. We revised a high-throughput and rapid ultra-performance (UP) LC-TMS method for simultaneous screening of 177 of the most prevalent medicinal drugs and drugs of abuse in urine and validated the quality of performance using system suitability mixture (SSM) and quality control (QC) materials. METHODS: We assessed the limits of detection (LOD) using high concentrations of the test substances. The method was applied to 473 urine samples obtained from patients intoxicated with drugs who visited the emergency center. RESULTS: The retention time, peak area, and total ion chromatogram of the SSM and QC materials were within the acceptance criteria of the pre-defined acceptance interval. The LODs were <62 ng/ml for 12 commonly encountered drugs. In total, 418 patients (88.4%) tested positive for one or more medicinal drugs or drugs of abuse. Twenty-eight drugs were detected over ten times; the most commonly detected were zolpidem, ephedrine, paracetamol, and chlorpheniramine. CONCLUSION: The UPLC-TMS method provided excellent performance for simultaneous screening of a large number of the drugs of abuse in urine samples. We conclude that this robust technique is useful for screening for a large number of drugs and for rapid screening of the most commonly encountered substances in emergency cases.

Las adicciones, hallazgos genómicos / Addictions, genomic findings

The phrase "X is a gene for Y" and the preformationist concept of gene action that underlies it are inappropriate for psychiatric disorders such as depression, aggression, sexual orientation, obesity, infidelity, alcoholism, or schizophrenia. Drug addictions are complex, chronic, and mental diseases. Genetic studies of twins and families have suggested that genetic factors might account for 40 to 60% of the overall factors in the risk to the development of drug addictions. In addition, numerous studies aiming to discover genetic variants or candidate genes, including genome-wide linkage scans, candidate gene association studies, gene expression, and genome-wide association studies, have also suggested that multiple genes and genomic regions or markers might play important roles in the development of addictions. A primary behavioral pathology in drug addiction is the overpowering motivational strength and decreased ability to control the desire to obtain drugs. Among the most insidious characteristics of drug addiction is the recurring desire to take drugs even after many years of abstinence. Equally sinister is the compromised ability of addicts to suppress drug seeking in response to that desire even when confronted with seriously adverse consequences. The enduring vulnerability to relapse is a primary feature of the addiction disorder and has been identified as a point were pharmacotherapeutic intervention may be most effectively employed. In order to fashion rationale pharmacotherapy it is necessary to understand the neurobiological underpinnings of craving, relapse, choice, and control, and the last decade has seen significant advances, toward achieving this goal. The fact that the vulnerability to relapse in addicts can persist after years of abstinence implies that addiction is caused by long-lasting changes in brain function as a result of repeated drug use, genetic disposition, and environmental associations made with drugs use. Therefore, understanding neurobiological aspects of drug addiction requires the comprehension of the physiological mechanisms that convey to the enduring neuroplasticity. The goal of this review is to explore how the advances in ge-nomics and proteomics may unleash the understanding of the cellular underpinnings of drug addiction and how the recent advances in functional genomics and proteomics may be expected to improve dramatically the treatment of addictive disorders. Applying genomics and proteomics to drug addiction studies will lead to the identification of genes and their protein products that control the brain reward pathways of the brain and their adaptations to drugs of abuse, as well as variations in these genes and proteins that confer genetic risk for addiction and related disorders. Additionally, this review describes recent findings of addictive drugs-inducing altered changes in gene regulation which produce significant cellular modifications on neuronal function in both human and animal brains as detected in animal models of drug abuse. A major goal of drug abuse research is to identify and understand drug-induced changes in brain function that are common to most if not all drugs of abuse, as well as these may underlie drug dependence and addiction. This work describes recent studies whose purpose is to examine the drugs of abuse effect changes in gene and protein expression that converge in common molecular pathways. One of this recent reports using microarrays analysis to assay brain gene expression in the anterior prefrontal cortex (aPFC) of post mortem brains of 42 cocaine, cannabis and/or phencyclidine human cases compared to 30 individual cases, which were characterized by toxicology and drug abuse history. Another study depicted herewith is focused on how the use of drugs frequently begins and escalates during adolescence, with long-term adverse consequences. The study designed a rodent model of adolescence to mirror cocaine use patterns in teenagers. Microarrays analysis was employed to assay brain gene expression in post mortem PFC of rodents treated with cocaine during adolescence. Results from the study revealed that treatment caused acute alterations in the expression of genes encoding cell adhesion molecules and transcription factors within the PFC. Cocaine alters gene expression patterns and histone modification in the PFC. Furthermore observed decreases in histone metylation, which may indicate a role of chromatin remodeling in the observed changes in gene expression patterns. Chromatin remodeling is an important regulatory mechanism for cocaine-induced neural and behavioral plasticity in the striatum. Most of the gene expression changes induced by cocaine were transient. However, if early cocaine exposure triggered changes in cell structure/adhesion, the impact of those alterations could be long-lasting. It is important to consider that the PFC in humans is involved in a large range of different functions, including working memory, action planning, response inhibition, decision-making, reward processes, and social behavior. Any lasting impact cocaine has on these functions could be detrimental, particularly in adolescents. Findings suggest that exposure to cocaine during adolescence has far-reaching molecular and behavioral consequences in the rat PFC that develop over time and endure long after drug administration has ceased. These neuroadaptations could have serious implications, particularly in the developing brain. However, only a causal relationship between these cocaine-induced molecular and behavioral adaptations can be inferred at this time. Therefore, humans who abused cocaine, cannabis and/or phen-cyclidine share a decrease in transcription of calmoduline-related genes and increased transcription related to lipid/colesterol and Gol-gi/ER function. Acute exposure to drugs of abuse initiates molecular and cellular alterations in the central nervous system that lead to an increased overall vulnerability to addiction with subsequent drug exposures. These drug-induced alterations enhance molecular changes in gene transcription that result in the synthesis of new proteins. Therefore, one of the important goals of addiction research is to identify the drug-induced gene expression changes in specific brain structures shown to be vulnerable to the addictive properties of drugs of abuse. These changes represent common molecular features of drug abuse, which may underlie changes in synaptic function and plasticity that could have important ramification for decision-making capabilities in drug addiction. Eventually, all of these discoveries can be exploited for clinical applications as diverse as improved treatments diagnostic tests, and ultimately disease prevention and cure.

Una frase empleada en el argot científico en los primeros años de la era de la genética dictaba que "X es un gen para Y", en donde X representaba a un gen particular del genoma humano y Y correspondía a uno de los complejos trastornos de la conducta humana como la depresión, la agresión, la orientación sexual, la obesidad, la infidelidad, la esquizofrenia y la adicción. Sin embargo, ahora se sabe que la contribución genética a los trastornos psiquiátricos se debe a la acción conjunta de grupos de genes que de manera individual causarían sólo un pequeño impacto incapaz de desencadenar alteraciones conduc-tuales. La contribución de los grupos de genes aunada a un sinnúmero de factores ambientales y sociales es la causa de la amplia variedad de perturbaciones conductuales en el humano. De esta manera, la frase "X es un gen para Y", es inapropiado para los cuadros psiquiátricos. La conducta patológica más importante en la adicción es la búsqueda compulsiva de la droga y la pérdida del control en el deseo de obtenerla. Otra de las graves consecuencias de la adicción es el riesgo de recaídas de los individuos a pesar de tener varios años de abstinencia. Esta última característica ha sido el punto de elección para implementar medidas terapéuticas más eficientes. Para lograr que las terapias sean exitosas es necesario entender los mecanismos neurobiológicos que intervienen en los procesos de adquisición y consolidación del síndrome adictivo. Uno de los puntos que ha llamado la atención es el hecho de que el riesgo de las recaídas puede persistir durante varios años y ha permitido implicar la generación de cambios en la fisiología del cerebro que se mantienen por largos periodos. Así, es de suma relevancia comprender las bases neuro-biológicas de los procesos adictivos que ocasionan cambios en la plasticidad neural. La finalidad de esta revisión es analizar algunos ejemplos representativos de los recientes avances en el campo de las ciencias genó-micas que permiten ampliar el conocimiento de las implicaciones a nivel celular de los procesos adictivos y la importancia que tendrán dichos avances para mejorar la práctica psiquiátrica en general y, de manera específica, el tratamiento de las conductas adictivas. Se describen algunos de los trabajos recientes en los que se ha estudiado la modificación de la expresión génica como consecuencia de la administración de drogas de abuso en diferentes paradigmas de estudio, incluyendo estudios en los que se evalúa la similitud de los efectos ocasionado por tres drogas de abuso diferentes: cocaína, marihuana y fenilciclina. Finalmente se describen las implicaciones moleculares de las modificaciones en la expresión génica de proteínas que participan en diferentes procesos celulares, como el metabolismo del colesterol y los lípidos, las funciones del aparato de Golgi y el retículo endoplásmico, el tráfico intracelular en el citoesqueleto. Todos estos cambios representan modificaciones importantes en la función sináptica y la plasticidad neuronal. Esta información permitirá el desarrollo de aplicaciones clínicas que permitan implementar tratamientos efectivos, métodos de diagnóstico y en última instancia podrá ser de utilidad para prevenir, evitar o curar las adicciones.

Consumo de sustancias psicoactivas en profesionales de la salud (médicos y enfermeros) de dos IPS de primer nivel de atención en consulta externa de Bogotá / Drugs of abuse consumption in health professionals (physicians and nurses) from two outpatient services of first level attention in Bogota / Consumo de sustâncias psicoativas em profissionais da saúde (médicos e enfermeiros) de dois IPS de primeiro nível de atenção em consulta externa de Bogotá

Se realizó un estudio para establecer la prevalencia de consumo de sustancias psicoactivas (SPA) en médicos y enfermeros de dos Instituciones Prestadoras de Salud (IPS) de consulta externa de Bogotá, para identificar las frecuencias de consumo, para establecer la prevalencia de alcoholismo empleando el índice CAGE y para explorar el interés en participar en programas de prevención o reducción de consumo en el ambiente laboral. Materiales y métodos: se realizó un estudio de corte transversal mediante la aplicación de una encuesta anónima autodiligenciada. Resultados: se aplicaron cincuenta y ocho encuestas (treinta y ocho en médicos y veinte en enfermeros). Las sustancias más consumidas en ambos grupos fueron alcohol, cigarrillo y bebidas energizantes, seguidas en médicos por marihuana y en enfermeros por barbitúricos, antidepresivos, anfetaminas y opiáceos. La prevalencia de alcoholismo fue superior a 8% en ambos grupos. Un 58% de los médicos y 70% de los enfermeros participaría en el diseño de programas de salud ocupacional para reducir el consumo de sustancias psicoactivas. Conclusiones: el consumo de SPA está por encima del encontrado en la literatura para la mayoría de las sustancias en la población general y es similar al revisado para personal de salud. Se recomienda la formulación e implementación de una política empresarial dentro del marco de trabajo en salud ocupacional de estas instituciones, encaminada a la reducción y prevención del consumo de sustancias psicoactivas.

We conducted a study to establish the prevalence of drugs of abuse consumption in physicians and nurses in two health institutions in Bogota outpatient identify the frequency of consumption, to establish the prevalence of alcoholism using the CAGE questionnaire and explore the interest participate in prevention or reduction of consumption in the workplace. Materials and methods: A cross-sectional study by applying an anonymous survey. Results: There were 58 questionnaires (38 in physicians and 20 nurses). The substances most consumed in both groups were alcohol, cigarettes and energy drinks, followed on medical by marijuana in nursing followed by barbiturates, antidepressants, amphetamines and opiates. The prevalence of alcoholism was greater than 8% in both groups. 58% of physicians and 70% of nurses would participate in the design of occupational health programs to reduce the consumption of psychoactive substances. Conclusions: The use of drugs of abuse is higher that found in the literature for most of the substances in the general population and is similar to the revised health personnel. It recommends the formulation and implementation of corporate policy within the framework of occupational health work of these institutions, aimed at reducing and preventing the consumption of psychoactive substances.

Introdução:Se realizou um estudo para estabelecer a prevalência de consumo de sustâncias psicoativas (SPA) em médicos e enfermeiros de duas Instituições Prestadoras de Saúde (IPS) de consulta externa de Bogotá, para identificar as frequências de consumo, para estabelecer a prevalência de alcoolismo utilizando o índice CAGE e para explorar o interesse em participar em programas de prevenção ou redução de consumo no ambiente laboral. Metodologia: se realizou um estudo de corte transversal mediante a aplicação de uma sondagem anônima autodiligenciada. Resultados: aplicaram-se cinquenta e oito sondagens (trinta e oito a médicos e vinte a enfermeiros). As sustâncias mais consumidas nos dois grupos foram álcool, cigarro e bebidas energéticas, seguidas em médicos por maconha e em enfermeiros por barbitúricos, antidepressivos, anfetaminas e opiáceos. A prevalência de alcoolismo foi superior a 8% em ambos os grupos. Um 58% dos médicos e 70% dos enfermeiros participaria na criação de programas de saúde ocupacional para reduzir o consumo de sustâncias psicoativas. Conclusões: o consumo de SPA está por cima do encontrado na literatura para a maioria das sustâncias na população geral e é similar ao revisado para pessoal de saúde. Se recomenda a formulação e implementação de uma política empresarial dentro do marco de trabalho em saúde ocupacional destas instituições, encaminhada à redução e prevenção do consumo de sustâncias psicoativas.

Implicaciones metabólicas del consumo de opiáceos durante el embarazo: revisión cualitativa de la literatura / Metabolic implications of opiate use during pregnancy: a literature review

Objetivos: analizar el uso de opiáceos durante el embarazo, las implicaciones metabólicas y las posibles consecuencias que esta conducta adictiva puede ocasionar sobre la madre y el feto, así como estudiar los efectos del tratamiento para la adicción a los opiáceos en mujeres embarazadas. Metodología: se analizó toda la literatura disponible de los últimos 40 años en la base de datos PubMed, al igual que artículos históricos, textos y referencias citadas en trabajos públicos. Resultados: se obtuvo información pertinente relacionada con los objetivos propuestos en la presente revisión, por lo cual ésta se puede clasificar en 5 secciones: uso de opiáceos durante el embarazo, mecanismos de acción, consecuencias del uso de opiáceos en el embarazo, tratamiento de la adicción a los opiáceos en mujeres embarazadas y efectos sobre el recién nacido. Conclusión: el consumo de opiáceos durante el embarazo constituye un factor de riesgo para la madre y el niño relacionado con las posibles complicaciones durante la gestación y con la presencia de síndromes de abstinencia y muerte súbita neonatal. Ante esto, los tratamientos con metadona y buprenorfina disminuyen el riesgo; no obstante, deben controlarse rigurosamente con el fin de evitar posibles problemas relacionados con su uso.

Introduction: pregnant females consuming drugs of abuse is becoming a serious problem for pregnant women and for their babies as this habit increases the risk of complications during pregnancy and may permanently harm the infant (directly or indirectly). The present review was aimed at analysing opiate use during pregnancy, its mechanism of action, the metabolic implications and the possible consequences to this addictive behaviour for the mother and baby. It also analysed the effects of the opiate addiction treatment on pregnant women. Methodology: information from the last 40 years included in the PubMed database as well as historicalarticles, texts and references cited in work published to date were analysed. Results: important information related to the objectives proposed in the present review was found and analysed. It was then divided into four sections as follows: opiate use during pregnancy, mechanisms of action, consequences of using opiates during pregnancy and the effects on the newborn. Conclusions: opiates consumed during pregnancy represent a risk factor for both the mother and baby and are related to possible complications during pregnancy and the presentation of neonatal abstinence syndrome and sudden infant death. Treatment using methadone and/or buprenorphine reduces such risk but rigorous control must be imposed to avoid possible problems related to their use.

Exposición prenatal a drogas de abuso: efectos diferidos e imprinting (desprogramación celular) / Prenatal exposure to drugs of abuse: delayed effects and imprinting (Cell Deprogramming)

El uso de drogas de abuso es un grave problema de salud y problema social en todo el mundo. Se conocen muy bien los efectos en salud de la exposición aguda o crónica a drogas de abuso. También que causan efectos directos en la placenta o en órganos en desarrollo de los embriones, causando malformaciones congénitas. Existe sin embargo muy poca información sobre efectos diferidos de la exposición a estos agentes durante las últimas etapas del desarrollo fetal o las primeras etapas de desarrollo postnatal.Estos agentes causan alteraciones irreversibles en la diferenciación y programación celular, que pueden ser consideradas como malformaciones bioquímicas y funcionales, responsables de alteraciones funcionales orgánicas o neuroconductuales que favorecenel desarrollo de enfermedades más tarde en la vida. En el presente trabajo se describen los efectos persistentes de la exposición a drogas de abuso ilícitas (opiáceos, cocaína, ketamina, tolueno, cannabinoides y anfetamina y sus derivados) y a drogas de abusolegalmente permitidas (alcohol etílico - nicotina y consumo de tabaco no se describen por formar parte de publicación previa en Cuadernos). Exposición a estos agentes favorece el desarrollo de una serie de enfermedades y alteraciones de la conducta más tarde en la vida. Además, se presenta evidencia que la exposición prenatal a varios químicos (plomo, el plaguicida malatión, bisfenol) y a varias drogas de abuso (opioides, etanol, cannabinoides) determinan cambios persistentes que favorecen el desarrollo de adicciones a drogas de abuso más tarde en la vida. Se concluye que, además de los problemas sociales y de salud derivadas del uso por adultos de drogas de abuso, la exposición fetal causa cambios que determina el desarrollo de varias enfermedades más tarde en la vida, incluyendo adicción a drogas de abuso. En consecuencia, la legislación gubernamental que restrinja el acceso y uso de estas drogas...

The use of drugs of abuse is a serious health and social problem through all the world. The eff ects of acute and chronic exposure of drugs of abuse on health are well known. They also cause direct eff ects on placenta o the developing embryo organs, causing congenital malformations. There is however very scarce information on the delayed eff ects of exposure to these agents during the last stages of fetal development or the early stages of postnatal development. These agents cause irreversible alterations in cell diff erentiation and programming, that could be considered as biochemical and functional malformations, responsible of functional organic or neurobehavioral alterations that favors the development of diseases later in life. The present report describes persistent effects of prenatal exposure to illicit drugs of abuse (opiates, cocaine, ketamine, toluene, cannabinoids, and amphetamine derivates) and to legal drugs of abuse (ethyl alcohol; nicotine and tobacco smoking are not reviewed since they were analyzed in a previouspublication in Cuadernos). Exposure to these agents favors the development of a myriad of diseases and behavioral alterations later in life. In addition, evidence is presented that prenatal exposure to various chemicals (lead, the pesticide malathion, bisphenol) andseveral drugs of abuse (opioids, ethanol, cannabinoids) determine persistent changes that favor the development of addictions to drugs of abuse later in life. It is concluded that, besides the known health and social problems derived by adults use of drugs of abuse, fetal exposure causes changes that determine the development of various diseases later in life, including drug addiction.Therefore, the dictation of Governmental regulations to decrease access to and use of these drugs, including the “softest” drugs such as cannabinoids, is fundamental to protect future generations health...

O desafio de asssitir pacientes com transtornos de correntes de uso prejudicial e ou dependência de álcool e outras drogas / The challenge to assist patients wioth disorders caused by harmful use and or alcohol and or drug addiction

|a O objetivo deste estudo foi compreender os conceitos e estratégias que norteiam a assistência dos profissionais que atuam em um Centro de Atenção Psicossocial para atendimento de pacientes com transtornos, decorrentes do uso e dependência de substâncias psicoativas, na tentativa de subsidiar as ações dos demais serviços de saúde que atendem tais pacientes. Optou-se pela pesquisa qualitativa, seguindo a metodologia de estudo de caso; assim, nove profissionais foram entrevistados e o eixo norteador das questões foi referente à concepção de serviço e as ações assistenciais ali desenvolvidas. Os dados foram analisados à luz do conceito da representação social. Valendo-se dos temas emergentes foram elaboradas duas representações centrais da pesquisa: Concepção sobre o serviço de atenção psicossocial. Ações assistenciais aos pacientes com transtornos decorrentes de uso prejudicial e ou dependência de álcool e outras drogas. A análise final orienta-se para a compreensão de que o uso prejudicial do álcool e outras drogas decorrem de fatores multifacetados, propondo nessa linha de raciocínio a assistência psicossocial

The purpose of this study is to understand concepts and strategies that orient the assistance to professionals working in a Center of Psychosocial Attention to assist patients with disorders due to use and addiction of psychoactive substances, in the attempt to support actions of other health services which assist these patients. A qualitative research was our choice following the methodology of a case study. Nine professionals were interviewed and the interviews were based on questions aiming service and the assistance actions developed in the same institutions. Data were analyzed under the point of view of the social representation. Considering the emergent issue, two central representations of the research were elaborated: conception on the service of psychosocial attention. Assistance actions to patients with disorders due to the harmful use and/or addiction to alcohol and other drugs. The final analysis is oriented towards the comprehension that the harmful use of alcohol and other drugs are caused by varied factors, proposing a psychosocial assistance