Isquemia miocárdica por consumo de dibutilona / Myocardial ischemia from dibutylone use / Isquemia miocárdica por uso de dibutilona

Resumen: Las catinonas sintéticas son drogas estimulantes de síntesis, comercializadas en el mercado ilegal por sus propiedades estimulantes y perturbadoras del sistema nervioso central, para su uso recreativo, solas, o como adulterantes de cocaína y derivados anfetamínicos. A nivel mundial existe un número creciente de reportes de intoxicaciones agudas y complicaciones por consumo de estas sustancias. En Uruguay fueron detectadas por primera vez en el año 2015, existiendo una información epidemiológica muy limitada. Las catinonas sintéticas no se detectan por las técnicas inmunocromatográficas disponibles en los laboratorios de los servicios de urgencias de nuestro país. Se describe el primer caso de intoxicación por una catinona sintética (dibutilona) en Uruguay, en un paciente de 45 años, por consumo de un polvo vendido como "éxtasis", presentando como complicación un síndrome coronario agudo, con una buena evolución posterior. La confirmación diagnóstica se realizó mediante su detección en orina por cromatografía de gases acoplada a espectrometría de masas. La estructura química de la dibutilona y su mecanismo de acción explican las manifestaciones clínicas y la complicación isquémica por vasoespasmo coronario. En ausencia de una noción clara de exposición y ante la situación epidemiológica actual, la presencia de un cuadro clínico compatible con una droga estimulante y resultado negativo para cocaína y anfetaminas en estudios inmunocromatográficos, debe hacer plantear la sospecha de otros estimulantes de síntesis como las catinonas, tal como ocurrió en este caso.

Summary: Synthetic cathinone are stimulating synthetic drugs used for recreational purposes on their own or as adulterants in cocaine and amphetamines derivatives that are traded in illegal markets given their stimulating and disturbing properties on the central nervous system. Globally, there is a growing number of acute intoxications and complications as a consequence of consumption of these substances. In Uruguay they were first detected in 2015, there being limited epidemiological data. Synthetic cathinone are not detected by the immunochromatographic tests available at the laboratories of the emergency services in our country. The study describes the first case of intoxication by a synthetic cathinone (dibutylone) in Uruugay, in a 45 year old patient as a result of powder sold as "ecstasy". The patient presented an acute coronary syndrome, subsequent evolution being good. Diagnostic confirmation was made in urine using gas chromatography coupled with mass spectrometry. The chemical structure of dibutylone and its action mechanism explain the clinical manifestations and the coronary vasospasm causing ischemia. When there is no clear sign of a patient having been exposed to this substance and upon the current epidemiological state, the presence of clinical symptoms that are compatible with a stimulating drug and a negative result for cocaine and amphetamines in immunochromatographic tests must lead us to be suspicious about the presence of synthetic stimulating substances as cathinone, as in the case studied.

Resumo: Catinonas sintéticas são drogas estimulantes sintéticas, comercializadas no mercado ilegal por suas propriedades estimulantes e perturbadoras do sistema nervoso central, para uso recreativo isoladamente ou como adulterantes da cocaína e derivados de anfetaminas. Em todo o mundo cresce o número de relatos de intoxicações agudas e complicações decorrentes do uso dessas substâncias. No Uruguai, foram detectados pela primeira vez em 2015 com informações epidemiológicas muito limitadas. As catinonas sintéticas não são detectadas pelas técnicas imunocromatográficas disponíveis nos laboratórios de pronto-socorro de nosso país. Descreve-se o primeiro caso de intoxicação por catinona sintética (dibutilona) em nosso país, em um paciente de 45 anos, devido ao consumo de um pó vendido como "ecstasy", apresentando como complicação uma síndrome coronariana aguda, com boa evolução posterior. A confirmação diagnóstica foi feita por sua detecção na urina por cromatografia gasosa acoplada à espectrometria de massa. A estrutura química da dibutilona e seu mecanismo de ação explicam as manifestações clínicas e complicações isquêmicas devido ao vasoespasmo coronariano. Na ausência de uma noção clara de exposição e dada a situação epidemiológica atual, a presença de quadro clínico compatível com droga estimulante e resultado negativo para cocaína e anfetaminas em estudos imunocromatográficos, deve levantar a suspeita de outros estimulantes sintéticos como as catinonas, como aconteceu neste caso.

Actualización en abuso de drogas por vía nasal / Update on drug abuse by nasal route

La vía nasal, ya sea mediante la inhalación o aspiración, se ha convertido en una ruta atractiva para quienes abusan de sustancias, principalmente por la fácil accesibilidad y la rápida absorción sistémica, además de evitar las consecuencias asociadas al uso de drogas intravenosas (enfermedades de transmisión). El objetivo de esta revisión es presentar una actualización de diversas sustancias que son utilizadas por esta vía, enfocándose en aquellas en las que se ha documentado daños en la anatomía nasal.

The nasal route, either by inhalation or aspiration, has become an attractive route for substances abusers, mainly because of its easy accessibility, rapid systemic absorption and also to avoid the consequences associated with intravenous drug use (transmitted diseases). The objective of this review is to present an update of various substances that are used by this route, focusing on those in which damage to the nasal anatomy has been documented.

Estudo da estabilidade de novas substâncias psicoativas (NPS) em amostras de sangue seco em papel (DBS), e sua aplicação em toxicologia forense / Stability of new psychoactive substances (NPS) in dried blood spots (DBS), and its application in forensic toxicology

Resumo: Introdução: A classe de drogas de abuso conhecida como novas substâncias psicoativas ou, ainda, drogas desenhadas (do inglês new psychoactive substances (NPS) ou designer drugs) é composta por substâncias químicas obtidas a partir de alterações estruturais de substâncias ou mistura de substâncias psicoativas já existentes (e ilícitas), a fim de mimetizar e/ou potencializar os efeitos proporcionados por estas, com a vantagem de circundar a legislação antidrogas vigente. Dentro da classe das NPS, os grupos de maior destaque atualmente são das catinonas sintéticas, dos canabinóides sintéticos e dos NBOMes (feniletilaminas N-2-metoxibenzil substituídas). As catinonas sintéticas, vendidas pela internet como "sais de banho" ou bath salts, são substâncias estruturalmente relacionadas a catinona, um alcalóide presente no Catha edulis (Khat), com propriedades estimulantes. A classe dos NBOMes é derivada da classe dos alucinógenos 2C, a partir da adição de um grupo N-2-metoxibenzil na amina primária. Os NBOMes possuem ação agonista nos receptores de serotonina, especialmente do subtipo 5-HT2A, o que confere os efeitos alucinógenos. Objetivos: Desenvolver e validar métodos para identificação e quantificação de algumas das NPS de maior relevância em amostras de manchas de sangue seco em papel (do inglês dried blood spots, DBS) e comparar a estabilidade entre dois tipos de amostras (DBS e sangue total), em três diferentes temperaturas (ambiente, 4 °C e -20 °C) e períodos de armazenamento. Metodologia: As amostras de DBS e sangue total foram analisadas em cromatógrafo líquido acoplado à espectrômetro de massas com analisador de massas triplo quadrupolar (LC-MS/MS), utilizando os métodos primeiramente desenvolvidos e validados para cada classe de NPS (catinonas sintéticas e NBOMes). Resultados: A técnica de DBS apresentou um aumento significativo da estabilidade das NPS em comparação à técnica convencional de armazenamento de sangue total. Para os NBOMes, observou-se que os compostos eram estáveis no DBS por período de tempo de até 6 meses, nas três temperaturas estudadas, enquanto que no sangue total, os analitos tiveram uma queda maior que 20% da concentração em 15 ou 30 dias em temperatura ambiente e 180 dias para 4 °C. Para as catinonas, em temperatura ambiente, observou-se baixa estabilidade nas duas matrizes. Porém, para armazenamento à 4 °C, observou-se uma queda na concentração inicial maior que 20% com 60 e 90 dias para mefedrona e benzedrona em DBS, respetivamente, contra 45 e 25 dias. Catinonas que possuem grupamento metilenodioxi em sua estrutura, como a butilona e a pentilona, foram mais estáveis, independente da matriz, em comparação àquelas com grupamento alquila no anel aromático, como mefedrona e benzedrona. Conclusão: A técnica de DBS se mostrou vantajosa para análises forenses em comparação à técnica convencional de armazenamento de sangue total. Além de facilitar o armazenamento (por ocupar menos espaço), sua extração se torna mais rápida e facilitada, já que envolve menos etapas, além de tornar possível a identificação dos analitos de interesse por um maior período de tempo, podendo facilmente ser aplicada na rotina laboratorial(AU)

Abstract: Introduction: New psychoactive substances (NPS) or designer drugs is a class of drugs of abuse composed of chemical substances obtained from structural alterations of substances or mixture of existing psychoactive substances (and illicit), in order to mimic and/or maximize their effects, with the advantage of circumventing existing anti-drug legislation. Within the NPS class, the most prominent groups currently are synthetic cathinones, synthetic cannabinoids and NBOMes (phenylethylamines N-2-methoxybenzyl substituted). Synthetic cathinones, sold by the internet as "bath salts", are substances structurally related to cathinone, an alkaloid present in Catha edulis (Khat), with stimulant properties. The class of NBOMes is derived from the hallucinogen class 2C, from the addition of an N-2-methoxybenzyl group to the primary amine. NBOMes have agonist action at serotonin receptors, especially the 5-HT2A subtype, which confers the hallucinogenic effects. Objectives: To develop and validate methods to identify and quantify some of the most relevant NPS in dried blood spots (DBS) samples and to compare the stability between two matrixes (DBS and whole blood), at three different temperatures (ambient, 4 °C and -20 °C) and storage periods. Method: DBS and whole blood samples were analyzed using a liquid chromatography tandem mass spectrometer with a triple quadrupole analyzer (LC-MS/MS), using the developed and validated methods for each class of NPS (synthetic cathinones and NBOMes). Results: The DBS technique showed a significant increase in the NPS stability compared to the conventional whole blood storage technique. For the NBOMes, the compounds were found to be stable in DBS for a time period of up to 6 months, at the three temperatures studied, whereas in whole blood, the analytes had a decreased higher than 20% of the initial concentration in 15 or 30 days at room temperature and 180 days at 4 °C. For the cathinones, at room temperature, low stability was observed in both matrixes. However, for storage at 4 °C, the initial concentration decreased more than 20% at 60 and 90 days for mephedrone and benzedrone in DBS, respectively, against 45 and 25 days. Cathinones having methylenedioxy group in their structure, such as butylone and pentylone, were more stable, independent of the matrix, compared to those with alkyl group on the aromatic ring, such as mephedrone and benzedrone. Conclusion: The DBS technique proved to be advantageous for forensic analysis compared to the conventional storage technique. In addition to occupying less storage space, DBS extraction becomes faster and easier, since it involves fewer steps, besides to make possible to identify the analytes of interest for a longer period of time, which can easily be applied in the laboratory routine(AU)

Uso de drogas de diseño en fiestas electrónicas: aspectos clínicos, neuropsiquiátricos, epidemiológicos y de intervención prehospitalaria / Use of designer drugs in electronic parties: clinical, neuropsychiatric, epidemiological and prehospital intervention aspects

Introducción: Las llamadas "fiestas electrónicas" permitieron la generalización del uso de drogas de diseño (DdD) para disminuir el cansancio, las inhibiciones y aumentar la empatía entre los asistentes. Objetivo: Presentar los resultados de prevalencia, aspectos neuropsiquiátricos, clínicos y epidemiológicos del uso de DdD en fiestas electrónicas. Material y método: Realizamos un estudio de campo, observacional y transversal, mediante encuesta estandarizada, normatizada y anónima para consignar parámetros clínicos y neuropsiquiátricos en 138 asistentes a fiestas electrónicas que mediante demanda espontánea o requerida por terceros fueron evaluados por médicos y refirieron consumo de DdD. Se aplicaron parámetros estadísticos y se cumplieron normas éticas. Resultados: Objetivamos un alto consumo de alcohol, con alta prevalencia de uso comórbido con otras sustancias de diseño como el éxtasis y GHB. Los consumidores de GHB presentaron disminución de parámetros clínicos con un síndrome inhibitorio, en contraste con los valores aumentados en usuarios de éxtasis. Conclusión: La diferencia en las manifestaciones clínico-neuropsiquiátricas tienen sustento en aspectos neurobiológicos del mecanismo de acción y condicionan el tratamiento prehospitalario.

Introduction: The so-called "electronic parties" allowed the widespread use of designer drugs (DOD) to reduce fatigue, inhibitions and increase empathy among participants. Objective: To present the results of prevalence, neuropsychiatric, clinical and epidemiological aspects of the use of DoD in electronic parties. Material and Methods: We conducted a field study, observational and transversal, through standardized, Normatized and anonymous survey to record clinical and neuropsychiatric parameters 138 attendees electronic parties that by spontaneous or required by third application were evaluated by physicians and reported consumption of DOD. Statistical parameters were applied and ethical standards were met. Results: We objectify a high consumption of alcohol, with high prevalence of comorbid use design with other substances like ecstasy and GHB. GHB consumers had decreased clinical parameters with an inhibitory syndrome, in contrast to the values increased in users of ecstasy. Conclusions The difference in clinical and neuropsychiatric manifestations have support in neurobiological aspects of the mechanism of action and determine the prehospital treatment.

Identification of New Designer Benzodiazepine Diclazepam in Drug Facilitated Sexual Assault / 法医学杂志

OBJECTIVES@#To identify the new designer drugs which are totally unknown and not in the routine testing list by the technologies such as high-resolution mass spectrometry in drug facilitated sexual assault, in order to solve the problem in actual cases.@*METHODS@#The milky fluid from an actual case was extracted and analyzed using LC-QE, ¹H-NMR and GC-MS, respectively. The accurate masses and cluster ions isotope patterns of unknown compound were obtained by LC-QE. The molecular formula was confirmed as C₁₆H₁₂C₂N₂O based on the protons number of ¹H-NMR. The isomers diclazepam and 4-chlorodiazepam were separated and detected with GC-MS.@*RESULTS@#The new designer benzodiazepine as diclazepam in the milky fluid was identified. The results provided direct evidence for the investigation and qualitative analysis of such cases.@*CONCLUSIONS@#The combined application of various methods, including LC-QE, ¹H-NMR and GC-MS, can be used to detect unknown new psychoactive substances.

Synthetic cannabinoids in the kidneys

Summary Acute kidney injury is an important cause of mortality and morbidity today and can occur due to several reasons. As time, geographic regions, and living conditions change, various etiological agents arise with nephrotoxic effects. Awareness of such nephrotoxic effects has been raised with the increasing frequency of addictive substance use, especially among young people in society.

A study on syphilis and HSV-2 infection and related behaviors among female sex workers who take new types of drugs in Jiaozhou city / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the prevalence of syphilis and HSV-2 among female sex workers (FSWs) who use new types of drugs in Jiaozhou city.</p><p><b>METHODS</b>Through convenient sampling, an anonymous questionnaire survey was conducted among female sex workers to collect demographic characteristics, new-type drugs abusing characteristics and related sexual behaviors from October to December, 2013. Blood specimens were drawn for serological tests of syphilis antibody and HSV-2 antibody. Urine specimens of the subjects surveyed were collected to test for methamphetamine. Differences in demographic characteristics, new-type drug abusing characteristics, and sexual behaviours between drug-abusing FSWs and non-drug-abusing FSWs were compared by t-test and χ(2)-test.</p><p><b>RESULTS</b>A total of 460 FSWs were recruited in this study, and 105 FSWs admitted their drug abuse history. Among the 341 urine specimens confirmed to be methamphetamine positive, there were 3 FSWs claimed that they never abuse new-type drugs. The rate of new-type drug abuse was 23.5% (108/460). A total of 71.4% (75/105) of the new drug-abusing FSWs started using drugs under 25 years old. The main reasons for drug abuse were clients request (24, 22.9%), making more money (23, 21.9%) and companion temptations (22, 21.0%). Totally, 41.9% of them (44/105) took drugs with 4-5 persons, 32.4% (34/105) had sex with 2-3 men after taking drugs, and 60.2% of new-type drug-abusing FSWs (65/108) used condoms in the latest commercial intercourse, while only 7.4% FSWs (8/108) used condoms every time during their commercial sex activities in the recent month. Compared with FSWs having no drug abuse behavior, drug-abusing FSWs had higher single proportion (73.2% (79/108) vs 63.6% (224/352), χ(2) = 8.64, P < 0.05), lower condom use rate in the recent month (7.4% (8/108) vs 22.7% (80/352), χ(2) = 12.53, P < 0.01) and higher pregnancy rate in the recent 6 months (24.1% (26/108) vs 8.8% (31/352), χ(2) = 17.74, P < 0.01) and most of them come from the middle and high-level entertainmens (78.7% (85/108) vs 65.1% (229/352), χ(2) = 13.09, P < 0.01). Among the new-type drug-abusing FSWs, the prevalence rates of syphilis and HSV-2 were 12.0% (13/108) and 55.6% (60/108) , respectively. A total of 33 FSWs claimed that they were diagnosed with STDs in the recent year (30.6%) . The rates of syphilis(12.0% (13/108) vs 4.0% (14/352), χ(2) = 9.72, P < 0.01), HSV-2(55.6% (60/108) vs 39.2% (138/352), χ(2) = 9.01, P < 0.01) and diagnosed STDs (30.6% (33/108) vs 17.9% (63/352), χ(2) = 8.02, P < 0.01) among the drug-abusing FSWs were significantly higher than those of non-drug-abusing FSWs.</p><p><b>CONCLUSION</b>There is a higher proportion of new-type drug abuse among the FSWs in Jiaozhou, with significantly higher prevalence rates of syphilis and HSV-2 infection, compared with non-new types of drug abusing FSWs. Prevalent risk sexual behaviors and ignorance of new-types drugs' harm were seen among them.</p>

Rewriting the Narrative of the Epidemiology of HIV in Sub-Saharan Africa

The fight against HIV remains complicated with contracting donor resources and high burden of HIV among reproductive age adults still often limiting independent economic development. In the widespread HIV epidemics of sub-Saharan Africa (SSA); it is proposed that key populations with specific HIV acquisition and transmission risk factors; such as men who have sex with men (MSM); female sex workers (FSW); and people who use drugs (PUD); are less relevant because HIV transmission is sustained in the general population with average HIV acquisition and transmission risks. However; the understanding that key populations are less relevant in the epidemics of Africa is based on the surveillance system from which these populations are mostly excluded. Outside of SSA; the epidemics of HIV are generally concentrated in the same populations that are excluded from the primary HIV surveillance systems in SSA. The manuscripts included in this special issue present convincing data that FSW; MSM; and PUD carry disproportionate burdens of HIV wherever studied in SSA; are underrepresented in HIV programs and research; and require specific HIV prevention services. These manuscripts collectively suggest that the only effective path forward is one that transcends denial and stigma and focuses on systematically collecting data on all populations at risk for HIV. In addition; there is a need to move to a third generation of HIV surveillance as the current one inadvertently devalues HIV surveillance among key populations in the context of widespread HIV epidemics. Overall; the data reviewed here demonstrate that the dynamics of HIV in Africa are complex and achieving an AIDS-free generation necessitates acceptance of that complexity in all HIV surveillance; research; and prevention; treatment; and care programs

Demand for Programs for Key Populations in Africa from Countries Receiving International Donor Assistance

There has been increasing attention in recent years to the HIV prevention; treatment; and care needs of key populations in Africa; in particular men who have sex with men (MSM); injection drug users (IDU); and female sex workers (FSW). While several major donors have undertaken efforts to prioritize these groups; it remains unclear which African countries are actively seeking donor support for these programs. For this analysis; we reviewed publicly available proposal and budget documentation from the US PEPFAR for fiscal years 2007 through 2010 and Rounds 1 through 10 of the Global Fund to Fight AIDS; Tuberculosis and Malaria for 40 countries in sub-Saharan Africa. Of the 164 searchable documents retrieved; nearly two-thirds contained at least one program serving FSW (65; 107 proposals); less than one-third contained at least one program serving MSM (29; 47 proposals); and a minority proposed programming for IDU (13; 21 proposals). Demand for these programs was highly concentrated in a subset of countries. Epidemiological data for at least one key population was included in a majority of these proposals (63; 67 proposals); but in many cases these data were not linked to programs

Club drugs: review of the ‘rave’ with a note of concern for the Indian scenario.

'Club drugs’ which include Ecstasy, gamma-hydroxybutyrate (GHB), ketamine, and Rohypnol (flunitrazepam) have become popular with participants in ‘raves’, because they are perceived to enhance energy, endurance, sociability and sexual arousal. These drugs vary in their pharmacologic properties, physiological and psychological effects, and potential consequences. The use of club drugs by young people has increased in the last decade, and continue to get modified and evolve, making them very difficult to monitor. Further, these drugs are not picked up by routine drugs screening procedures, thereby making these popular with the criminals. India, which is in a phase of social transition, also faces this rising menace. Despite the nature and extent of this problem, this area has been under-researched. Data from India are sparse barring a few newspaper and police reports. Keeping abreast of current trends in club drug use prepares the clinician to recognize the clinical effects of club drug use, to manage club drug related emergencies, and to generate social awareness.

Experiencias y significados sobre el fenómeno de las drogas en estudiantes de enfermería / Experiências e significados sobre o fenômeno das drogas entre estudantes de enfermagem / Experiences and meanings of the drugs phenomenon in nursing students

Este estudio procuró identificar los significados y experiencias de estudiantes de enfermería sobre el fenómeno de las drogas. La recolección de la información se hizo mediante entrevista semi-estructurada. El análisis se realizó mediante 5 categorías temáticas. De los 40 sujetos de la muestra, con edad entre 19 y 24 años, 28 fueron mujeres, 3 nunca recibieron informaciones sobre drogas, y la mayoría había tenido experiencias con consumidores o habían consumido. Este problema, en Costa Rica, está asociado a la estigmatización y al tráfico. Reconocen que la responsabilidad es de todos, mientras identifiquen contradicción del Estado consintiendo la publicidad de las empresas tabacaleras y su complicidad con fábricas de licores. Reconocen la importancia de la prevención y consideran que la forma de abordar el problema no es adecuada. Les gustaría que el tema se incorporara en sus estudios enseñando estrategias de cómo actuar y relacionarse con las personas que consumen drogas.

Este estudo procurou identificar significados e experiências de estudantes de enfermagem sobre o fenômeno das drogas. Utilizou-se entrevista semiestruturada para a coleta dos dados. A análise considerou cinco categorias temáticas. Dos 40 sujeitos da amostra, com idade entre 19 e 24 anos, 28 eram mulheres. Três nunca receberam informação sobre drogas e a maioria teve experiências com consumidores ou consumiram. Esse problema na Costa Rica está associado à estigmatização e ao tráfico. Os sujeitos reconhecem que a responsabilidade é de todos, embora identifiquem contradição do Estado, consentindo com a publicidade do cigarro e sua cumplicidade com as fábricas de bebidas. Reconhecem a importância da prevenção e consideram que a forma de abordar o problema não tem sido adequada. Gostariam que o tema fosse incorporado aos seus estudos, ensinando como atuar e se relacionar com pessoas que consomem drogas.

The aim of this study was to identify the meanings and experiences of nursing students regarding the drugs phenomenon. Data were collected through a semi-structured interview. Data analysis showed five theme categories. Of the 40 subjects in the sample, between 19 and 24 years old, 28 were women. Three had never received information about drugs, and most had had experiences with consumers or had consumed drugs. In Costa Rica, this problem is associated with stigma and traffic. They recognize that everyone is responsible, and consent with the State's contradictory attitude through tobacco company advertisements and complicity with distilleries. They acknowledge the importance of prevention and consider that the current approach of this issue is not appropriate. They would like it to be incorporated in their education, providing strategies on how to act and relate with drugs consumers.

Drogas modificadoras de la artritis reumatoide, DMAR / Disease modifying antirheumatic drugs, DMARD

El nuevo paradigma terapéutico de la artritis reumatoide establece que todo paciente con actividad de la enfermedad debe recibir alguna droga modificadora de la artritis reumatoide. Estas drogas reciben este nombre ya que han demostrado en estudios clínicos controlados modificar el curso natural de la enfermedad.

Drogas: hijos en peligro / Drugs: children in danger

Esta obra se halla dirigida especialmente a educadores, padres y docentes que buscan informarse sobre la problemática del consumo de drogas y bebidas alcohólicas en los jóvenes. Se encuentran descriptas las características del consumidor experimental, así como las del abusador, el drogadependiente y el adicto. Se agregan aspectos relacionados con la creciente incidencia del paco y de drogas de diseño como el éxtasis.

Illicit drug use in South Africa: Findings from a 2008 national population-based survey

Objective. The aim of this secondary analysis of the South African National HIV; Incidence; Behaviour and Communication (SABSSM) 2008 survey is to provide current data on illicit drug use that could assist in the development and implementation of effective substance abuse policies and intervention programmes aimed at these populations in South Africa.Method. A multistage random population sample of 15 828 people age ?15 (56.3 women) was included in the survey. Illicit drug use was assessed by 2 sections of the Alcohol; Smoking and Substance use Involvement Screening Test (ASSIST). Frequency analyses for different age groups; geolocality; educational level; income; and population group were calculated; as were odds ratios for these variables regarding combined illicit drug use.Results. Current cannabis use was reported by 3.3 of the population sample - 6.1 of the men and 1.2 of the women - and the use of combined all-other illicit drugs (cocaine; amphetamines; inhalants; sedatives; hallucinogens; opiates) was reported by 1.8 of the participants. Coloured men (14.3) were most likely; and Indian or Asian women (0.6) least likely; to be cannabis users. Illicit drug use (combined) among men was associated with the 20 - 34 year age group and the coloured and white population groups; and among women in the younger age groups; the coloured and white population groups; and low and higher income.Conclusion. An increase of cannabis and other illicit drug prevalence rates was observed from 2005 (2.1) to 2008 (3.3) in the population sample. Multilevel interventions are required to target illicit drug users; in addition to creating awareness in the general population of the problems associated with illicit drug use. There is a need to address illicit drug use in national and provincial policy planning and intervention efforts and; in terms of treatment; a need to ensure that treatment practitioners are adequately trained to address illicit drug use. Future prospective studies are necessary to assess the impact of illicit drug use

Androgen abuse in sports / 亚洲男科学杂志(英文版)

Androgens remain the most effective and widely abused ergogenic drugs in sport. Although androgen doping has been prohibited for over 3 decades with a ban enforced by mass spectrometric (MS)-based urine testing for synthetic and exogenous natural androgens, attempts continue to develop increasingly complex schemes to circumvent the ban. A prominent recent approach has been the development of designer androgens. Such never-marketed androgens evade detection because mass spectrometry relies on identifying characteristic chemical signatures requiring prior knowledge of chemical structure. Although once known, designer androgens are readily detected and added to the Prohibited List. However, until their structures are elucidated, designer androgens can circumvent the ban on androgen doping. To combat this, in vitro androgen bioassays offer powerful new possibilities for the generic detection of unidentified bioactive androgens, regardless of their chemical structure. Another approach to circumvent the ban on androgen doping has been the development of indirect androgen doping, the use of exogenous drugs to produce a sustained increase in endogenous testosterone (T) production. Apart from estrogen blockers, however, such neuroendocrine active drugs mostly provide only transient increases in blood T. Finally the ban on androgen doping must allow provision for rare athletes with incidental, proven androgen deficiency who require T replacement therapy. The Therapeutic Use Exemption mechanism makes provision for such necessary medical treatment, subject to rigorous criteria for demonstrating a genuine ongoing need for T and monitoring of T dosage. Effective deterrence of sports doping requires novel, increasingly sophisticated detection options calibrated to defeat these challenges, without which fairness in sport is tarnished and the social and health idealization of sporting champions devalued.

Alianza terapéutica en pacientes adictos de dos instituciones de Antofagasta / Therapeutic alliance in addict patients of two institutions of Antofagasta

Objetivos: 1) Evaluar Alianza Terapéutica en pacientes adictos del Servicio de Psiquiatría del Hospital de Antofagasta y de la Comunidad Terapéutica CREA; 2) Observar el comportamiento de las diferentes subescalas que componen la Alianza Terapéutica -Vínculo, Metas y Tareas-, en este grupo de pacientes. Metodología: Estudio descriptivo en que se aplicó el Inventario de Alianza de Trabajo a una casuística de 50 pacientes de las dos instituciones citadas. Se definieron criterios de inclusión para la casuística. Resultados: El mayor porcentaje de casos fueron hombres (84 por ciento). Más de dos tercios son pacientes menores de 40 años. La droga principal más consumida es el alcohol, mientras que la droga secundaria es el tabaco. El 92 por ciento de los casos consumía dos o más drogas. En el IAT la subescala mejor evaluada en el grupo total fue Vínculo seguido de Tareas y Metas. Conclusiones: El IAT demostró ser un instrumento útil y fácil de aplicar. Los resultados en las subescalas varían de acuerdo a la institución, lo cual obliga a preguntarse por las razones de estas diferencias. Probablemente estas pueden radicar en los estilos de los psicoterapeutas y las diferencias en los modelos de las instituciones. La experiencia arrojada en esta investigación nos permite decir que se hace necesario investigar más en este tema dada la importancia que tiene la Alianza Terapéutica en este grupo de pacientes.

Objectives: 1) To evaluate the therapeutic alliance in addict patients of the Psychiatry Unit of the Hospital of Antofagasta and the Therapeutic Community CREA; 2) To observe the results of the scales of the Working Alliance Inventory -Bond, Goals and Tasks- in this group of patients. Methodology: This is a descriptive study, in which the Working Alliance Inventory was applied to a group of 50 patients of the two institutions. Inclusion criteria were defined. Results: The most of the cases were men (84 percent). More than two third of patients were less than 40 years of age. The main drug consumed was alcohol. The secondary drug consumed was tobacco. Ninety two percent of the cases consumed more than two drugs. In the whole group the best evaluated scale was bond, followed by tasks and goals. Conclusions: WAI was a useful and easy to use instrument. The results of the scales put the necessary question about the reasons of the observed differences. These may be due to different approaches of the psychotherapist and different the models of the institutions. These results allow us to conclude the necessity of more research in this area given the importance of this topic.

Banco de drogas antineoplasicas: vademecum 2006-2007 / Antineoplasms bank of durgs: vademecum 2006-2007

Desde el año 1982 se publica esta edición, la cual se ha distribuido al publico especializado, enfermeras, residentes de postgrado de hematología, oncología, medicinina interna, raioterapia y farmaceutas. A todo el personal que de alguna manera tenga relación con los medicamentos y antineoplasicos y el tratamiento del cáncer le será de gran utilidad. Por primera vez de sipone de los esquemas de tratmiento de tumores sólidos en adulton.