Incidencia del síndrome de abstinencia en niños críticamente enfermos / Incidence of withdrawal syndrome in critically ill children

Objetivo: determinar la incidencia del síndrome de abstinencia (SA), describir presentación clínica e identificar la presencia de factores de riesgo. Metodología: se realizó un estudio prospectivo, observacional, de evaluaciones reiteradas usando la Sophia Observation Withdrawal Symptoms Scale (SOWS), en la Unidad de Cuidado Intensivo de Niños (UCIN) de 20 camas, del Centro Hospitalario Pereira Rossell (CHPR). Se incluyeron los niños ingresados en UCIN entre el 1 de noviembre de 2013 y el 30 de setiembre de 2014 tratados con benzodiacepinas y/o opiáceos por cinco días o más. Se registró: duración de la estadía, fármacos utilizados para sedación y analgesia, días de uso, máximo de dosis, dosis total acumulada. El diagnóstico de SA se realizó a través del uso de la SOWS. Los pacientes fueron divididos en dos grupos, con y sin SA. Se analizaron y compararon las características de ambos grupos. Resultados: se incluyeron 39 niños. La incidencia de SA fue 18% (7/39). Los ítems del SOWS más frecuentes fueron ansiedad y sueño menor a 1 hora. Los niños que desarrollaron SA presentaron dosis acumulativas más elevadas tanto de midazolam (54,1 mg/kg vs 44,2 mg/kg) como de fentanilo (464,2 mg/kg vs 380,1 mg/kg). Conclusiones: el SA fue frecuente en este grupo de niños. Las dosis acumulativas fueron mayores en el grupo con SA. La SOWS es una herramienta útil y de fácil aplicación para el diagnóstico de SA.

Objective: The study aims to determine the incidence of withdrawal syndrome, its clinical features and the presence of risk factors. Methodology: An observational and prospective study. Assessment was repeated and the Sophia Observation Withdrawal Symptoms Scale (SOWS) was used. The study was conducted at the Pediatric Intensive Care Unit (PICU) of Centro Hospitalario Pereira Rossell (CHPR). Hospitalized children in PICU between 1/11/2013- 30/9/2014 and treated with benzodiazepines and opioids during 5 days or more were included in the study. Days of stay at the PICU, agents used for sedation (dose, duration) and cumulative doses were recorded. Withdrawal syndrome diagnosis was done using the SOWS. Results: 39 children were included in the study. The incidence of withdrawal syndrome was 18% (7/39). Children who developed withdrawal syndrome presented higher cumulative doses of midazolam (54.1 mg/kg vs. 44.2 mg/kg) and fentanyl (464.2µg/kg vs. 380.1 µg/kg) than those without withdrawal syndrome. Conclusions: the withdrawal syndrome was frequent in this population. Cumulative doses of midazolam and fentanyl were higher in those with withdrawal symptoms. The SOWS is a useful resource for diagnosis.

Falacias, controversias y realidades acerca del consumo de marihuana: [revisión] / Cannabis consumption: falacies, controversies and reality: [review]

La marihuana es la droga ilegal más ampliamente consumida a nivel mundial, tan sólo por detrás de las legales alcohol y tabaco. A pesar de que las encuestas entre usuarios señalan un buen conocimiento de los efectos que produce, la impresión de los profesionales que atienden a los consumidores es que tal información es claramente escasa, parcial, cuando no directamente incorrecta. Lamentablemente, esta misma desinformación se advierte en algunos profesionales que atienden a los pacientes, o entre educadores y padres de jóvenes consumidores. En el presente artículo se abordan de manera científica una serie de controversias respecto del consumo de marihuana y sus consecuencias, con el objetivo de clarificar la información y ayudar a la prevención y tratamiento del consumo de dicha sustancia. Se persigue, igualmente, llamar la atención sobre la gravedad de su consumo, no sólo en cuanto a prevalencia sino también en cuanto a sus consecuencias.

A Study of Psychiatric Comorbidity in Opioid Dependence.

Aim: To assess psychiatric comorbidity in patients of opioid dependence Method: All the patients of opioid dependence attending alcohol and drug deaddiction OPD and adult psychiatry OPD on specific days, were screened. Those fulfilling the selection criteria were included in the study. A detailed evaluation was done for socio-demographic variables and history of drug using semi-structured proforma especially prepared for the study. Diagnosis of opioid dependence was made according to DSM-IV-TR criteria. The patients were seen for co-morbid psychiatric illness by applying Structured Clinical Interview for DSM-IV-TR I & II (SCID I & II). Results: Out of 25 patients 19 (76.0) were found to have comorbid psychiatric illness. Axis I and Axis II comorbidity was found in 76% and 20% of the samples, respectively. Patients of cluster B personality were dominating in the sample. Patients with more than one comorbidity accounted for 60% of the sample. Conclusion: Psychiatric comorbidity in opioid dependence are very high, other substance in particular. Number of comorbid diagnoses in a person may as high as four.

Técnicas para determinación cuali/cuantitativa de drogas de abuso en fluidos biológicos / Techniques for qualitative and quantitative determination of drugs of abuse in biologic fluids

Se han desarrollado varios métodos para determinar drogas de abuso en orina, plasma/suero, bilis, pelo y otros en muestras clínicas y forenses. En este trabajo se discute la importancia de la aplicación de la técnica de cromatografía gas-líquido y espectrometría de masa en sus diferentes tipos, con énfasis en la preparación de la muestra. Anfetaminas, canabinoides, cocaína y benzoílecgonina, morfina y matabolitos, fenciclidina, benzodiazepinas, antidepresivos tricíclicos, barbitúricos, opiatos, anestésicos locales y metadona se han analizado y ciantificado adecuadamente mediante esta metodología.

Emergencias en adicciones y abusos de psicofármacos / Substance-related disorders abuse and adictions emergency

El abuso y dependencia de sustancias psicoactivas es una causa frecuentemente oculta de consultas en servicios de urgencias. Si bien, ciertos consumos de drogas se han estabilizado en la última década, ha habido un aumento sostenido del consumo de todas las drogas, tabaco y alcohol. El abuso de psicofármacos se ha mantenido estable en los últimos años, pero irrumpe una nueva droga en el panorama nacional que es el éxtasis. En los servicios de urgencia hasta un 27 por ciento de los consultantes declaran haber usado alguna droga y/o alcohol. Además, un 7 por ciento de los consultantes mostró una muestra positiva para cocaína. Los pacientes no consultan por problemas adictivos sino por causas traumatológicas, intoxicaciones y otros. Se discute en el presente artículo la necesidad de evaluación práctica y clínica evaluando correspondientemente la existencia o no de problemas adictivos. Se analizan aspectos relacionados con el consumo, intoxicación y desintoxicación del paciente de acuerdo a cada paso. Se analiza además el manejo farmacológico y/o psicológico para cada una de las sustancias y situaciones clínicas y criterios para el manejo de estas emergencias.

Frequency distribution of opiate poisoning according to individual characteristics and clinical manifestations

Opiates include natural alkaloids and synthetic derivates. Their pharmacologic effects are based on bounding opiate receptors. Peak toxic and therapeutic effect of opiate is 90 minutes after oral administration. Acute presentations of opiate poisoning are CNS, respiratory and Gl involvements. In long term, opiate can change numbers and sensitivity of their receptors, and result in tolerance or withdrawal syndrome. In opiate over dosage, morbidity and mortality decrease with careful therapeutic and supportive managements. Study of frequency distribution of opiate poisoning according to individual characteristics and clinical manifestations are the main objectives of recent investigation. in this retrospective descriptive study, 2520 patients were enrolled in 2001-2002. Information including demographic and clinical characteristics of the subjects was collected. 263 cases of 2520 [10.4%] were poisoned with opiates. The most frequent age group was 21-30 years old [38.3%] and the most common hospital stay was 1-7 days [55.8%]. The males were more poisoned than female [71.4%] and respiratory support was used for 29 patients [18%]. Poisoning route was often [68.8%] by ingestion [181 cases]. The most common clinical presentation was CNS involvement [74.1%]. The most common type of used narcotic substances was opium [60.4%]. Mortality rate was 4.5% [12 cases]. Opiate poisoning can result in morbidity and mortality. Complications were more among those who referred to hospital with delay or used high dose or potent agents. The main cause of mortality in opiate overdose was hypoxia with respiratory depression

Validity of self-report of recent opiate use in treatment setting.

Self-report validity of recent drug use among heroin abusers depends on many factors including the population being studied and the setting in which the study is carried out. This study was conducted by the treating physicians to assess the self-report validity of recent heroin use by heroin dependent patients in the outdoor setting using 'thin layer chromatography' (TLC) and two highly sensitive methods of urinalysis viz. 'gas liquid chromatography' (GLC) and 'high performance liquid chromatography' (HPLC). Out of seventy-six heroin dependent patients who entered the study, 64 provided urine sample on the same day. Patients' self-report about recent opiate use was found to have a moderate agreement with urinalysis report. However, it is important to validate it with urinalysis during the treatment process because a substantial proportion of patients fails to report recent opiate use. It is recommended that all drug dependence treatment centres should be equipped with a sensitive urinalysis facility. Otherwise, the outcome of the treatment process should be considered with caution.