Uso de heroína inyectada y el riesgo de hepatitis C en tres ciudades de Colombia / Use of injected heroin and risk of hepatitis C in three cities in Colombia

RESUMEN: Introducción: La hepatitis C es uno de los grandes problemas de salud pública en el mundo, especialmente por su alta transmisibilidad por vía inyectada. Objetivo: Identificar la prevalencia de la infección por VHC, y factores asociados en usuarios de drogas psicoactivas inyectables en tres ciudades (Armenia, Bogotá y Cúcuta) de Colombia. Métodos: Estudio descriptivo transversal en 668 usuarios de drogas inyectables captados a través de muestreo guiado por el respondiente, a quienes se indagó sobre características demográficas y comportamientos de riesgo. Se utilizó la prueba de Anticuerpos, tomado en papel de filtro y se confirmaron los casos de VHC, con pruebas de carga viral de RNA. Se estimó la prevalencia de VHC y los factores asociados con pruebas estadísticas Chi-cuadrado y se calcularon razones de prevalencia crudas y ajustadas con regresión logística usando RDSAT y SPSS. Resultados: La prevalencia de infección por VHC fue del 17,5% y se encontraron como factores que aumentan la prevalencia de hepatitis: tener VIH, inyectarse con otra persona portadora del virus, utilizar dosis de una jeringa que estaba compartiendo, inyectarse con una jeringa casera y consumir marihuana. Como factor que reduce la prevalencia, el adquirir jeringas en droguerías u otras tiendas. Conclusión: Se evidencia un consumo establecido de drogas por vía inyectada, poniendo de relieve la importancia de generar intervenciones para la reducción de daños y la prevención de hepatitis C en estas tres ciudades del país.

ABSTRACT: Introduction: Hepatitis C is one of the most neglected diseases by governments internationally. Objective: Identify the prevalence of hepatitis C and associated injection drug users in three cities of factors Colombia. Methods: Cross-sectional study of 668 injecting drug users recruited through respondent-driven sampling, inquired about demographic characteristics and risk behaviors. Laboratory testing was used on filter paper and cases of hepatitis C viral load tests with RNA were confirmed. Hepatitis C prevalence and associated factors was estimated with Chi-square test statistics and reasons for crude and adjusted prevalence were calculated using logistic regression. Results: The prevalence of hepatitis C was 17.5% and were found as factors that increase the prevalence of hepatitis: having HIV, injecting another person carrying the virus dose used was sharing a syringe, injected with a syringe and consume marijuana. As a factor that reduces the prevalence, purchase syringes in drug stores or other stores. Conclusion: This research evidence established consumption of drugs by injection , and the presence of hepatitis C in social networks of IDUs and highlights the importance of developing interventions for harm reduction and prevention of hepatitis C in this population these three cities.

A fatal heroin addict with myocardial lesion.

This is a histological report of a myocardial lesion of a 44-year-old white man who was found dead in a hotel with circumstances strongly suggestive of heroin intoxication. Based on. autopsy findings and toxicologic analysis, the present case was an instance of straight forward heroin overdose in snorter. The most striking pathologic finding of the heart was a few patches of marked dark mottling appearance in the left ventricle and ventricular septum. Histological appearance of the lesions revealed marked congestion with intramyocardial extravasation of blood. Since the deceased had patent coronary arteries without evidence of atheroma, the lesions were thought to be the results ofcoronary artery spasm. There has also been substantial evidence in the previous reports to believe that the condition is secondary to heroin-induced coronary artery spasm. However its actual underlying mechanism remains unclear.

Maternal and Neonatal Effects of Substance Abuse during Pregnancy: Our Ten-year Experience

PURPOSE: The aim of the study was to assess perinatal outcome of pregnancy burdened with maternal addiction in comparison with an unselected population from a European transition country. MATERIALS AND METHODS: Data on pregnancies complicated by illicit drug abuse (n = 85) managed during a 10-year period (1997-2007) at Split University Hospital were analyzed. Data on the type of drug, course of gestation and labor, and on perinatal outcome were considered. Data on all non-dependence pregnancies recorded during the study period were used as a control group. RESULTS: During the study period, there were 85 dependence-complicated pregnancies (0.2%). Use of heroin alone during pregnancy was recorded in 51 women (50%), methadone alone in 6 (7%), and a combination of heroin and methadone in 9 (11%). Premature delivery was significantly more common in the group of pregnant addicts (21% vs. 6%); 49% of pregnant addicts were carriers of hepatitis C virus (HCV) and 14% of hepatitis B virus (HBV). Neonatal abstinence syndrome developed in 61 infants (7%) born to addicted mothers. There were 4 cases (4.6%) of early neonatal death; 7 neonates had 5-minute Apgar score < or = 7 (8%); 29 neonates had low birth weight for age (33%); and 7 neonates had congenital anomalies (8%). The risk of various congenital anomalies was 3-fold in the group of children born to addicted mothers. CONCLUSION: Addiction pregnancies present a small but high-risk group according to perinatal outcome. Appropriate obstetric and neonatal care can reduce the rate of complications in these pregnancies and improve perinatal outcome.

Perinatal effects of amphetamine and heroin use during pregnancy on the mother and infant.

OBJECTIVES: To determine the perinatal impacts of heroin and amphetamine on both mothers and infants. MATERIAL AND METHOD: This is a retrospective study on the influence of amphetamine and heroin on pregnant women and their newborn infants at King Chulalongkorn Memorial Hospital in Bangkok, Thailand, between January 1997 and December 2002. The medical and demographic data of both mothers and infants were evaluated. Comparison of the consistent drug effects of these 2 drugs on the mothers and infants were also performed RESULTS: Two hundred and eleven women were identified There were 178 (84.4%) and 33 (15.6%) women addicted to amphetamine and heroin respectively. Sixty one (28.9%) of them were polydrug users. There were more polydrug users among heroin addicts than amphetamine addicts, (43.7% vs 27.2%, p < 0.05). Poor obstetric history were noted in both groups of women including lack of prenatal care (74.9%), a high incidence of previous abortion (22.3%), positive HIV serology test (11.1%), pre-eclampsia (5.2%), infection (3.3%) and antepartum hemorrhage (1.9%). Drug intoxication was found in 11 amphetamine addicted mothers, whereas 2 heroin addicts developed withdrawal symptoms during intrapartum and postpartum periods. All infants were singleton. There was one stillbirth and 2 neonatal deaths. There was no statistical difference in terms of sex ratio, mean birth weight, gestational age, length, head circumference and Apgar score between the groups of amphetamine and heroin exposed infants. The incidence of prematurity, low birth weight, IUGR and microcephaly were not statistically different between both groups of infants. The overall incidence was 31.7%, 31.7%, 9.5% and 8.6% respectively. Congenital anomalies were found in 5 (2.8%) amphetamine exposed infants. Thirty one out of 33 heroin exposed infants (93.9%) and 4 out of 178 amphetamine exposed infants (2.2%) developed drug withdrawal symptoms with the mean onset of 21.5 +/- 16.5 hours and 10.3 +/- 7.5 hours respectively, p > 0.05. All heroin withdrawal infants were successfully treated with Phenobarbital with the mean duration of treatment of 23.7 +/- 11.5 days. None of the amphetamine withdrawal infants needed specific treatment. They recovered spontaneously within 6.0 +/- 5.3 days. Eighteen infants were left in an orphanage or under the custody of their relatives. CONCLUSION: Amphetamine or heroin use during pregnancy can cause many serious adverse effects on both mothers and infants. The findings in the present study are consistent with previous reports, although they seemed to be more common and severe. Increasing awareness and improving understanding of drug abuse in the medical, legal and social aspects are needed in order to reduce these impacts.

HIV risk behavior and practices among heroin addicts in Lahore, Pakistan.

While the numbers of reported and estimated cases of HIV are still relatively low in Pakistan, behavioral patterns that could lead to an HIV epidemic are reported to exist among injection drug users. Therefore, this cross sectional study was conducted to estimate the prevalence of injection drug use and to assess the level of HIV knowledge and practices among male heroin addicts in Lahore, Pakistan. A total number of 660 male heroin addicts were recruited from 22 drug user sites in the city; data were collected using a pre-tested structured questionnaire. Analysis revealed a poor knowledge of the disease, its modes of transmission and ways to limit transmission with only 30% of the respondents considering them at risk for acquiring the disease. A prevalence of 23.3% of injection drug use was noted. HIV risk injection practices included: group injecting (83.2%), sharing syringes (58.7%), and re-using used syringes (78%). Various risky sexual practices included multiple partners (24%), homosexuality (10.8%), sexual contacts with commercial sex workers (CSW) (20.8%), and with transvestites (3.3%). Condom use was low (11-50%). Of the subjects, 5.5% reported trading sex for drugs or money. We recommend HIV/STD prevention programs encompassing health education and health promotion strategies based on harm reduction techniques be used for drug users.

Manifestaciones y secuelas cutáneas de la drogadicción / Cutaneous manifestations and sequelae in drug addicts

Las lesiones dermatológicas producidas por la administración de drogas ilícitas y sus eventuales secuelas, tienen implicancias médico-legales y sumo valor para el diagnóstico retrospectivo de adicción. Estas lesiones son de origen multifactorial: combinan la reacción del huésped ante agentes químicos sensibilizantes e irritantes, traumatismos reiterados por técnicas de aplicación incorrectas e infección sobreagregada. Clínicamente, se observan como hiperpigmentaciones sobre trayectos vasculares indurados, cicatrices atróficas en áreas de inyección subcutánea, abscesos sépticos y granulomas por cuerpo extraño, en su mayoría provocados por excipientes y adulterantes, como lesiones más características. Se presentan casos clínicos y se hace revisión de estos procesos, enfatizando la situación particular en Argentina en relación a la bibliografía consultada, proveniente de países del Primer Mundo. Asimismo, se ilustra brevemente el léxico tan particular de los adictos, cuyos rudimentos se vuelven imposibles de obviar cuando se avanza en el estudio de estos pacientes

La historia toxicológica como predictora de déficit intelectual en politoxicómanos / Toxicological history as predictor of intellectual impairment in polydrug abusers

Estudiamos la influencia de las características de consumo de drogas en el funcionamiento intelectual de sujetos politotoxicómanos que utilizan la heroína como droga principal de abuso. Evaluamos a 62 sujetos (31 politoxicómanos y 31 no dependientes) mediante la aplicación del Test de Matrices Progresivas de Raven. Los resultados obtenidos revelan un rendimiento más pobre en los sujetos dependientes que el obtenido en grupo de sujetos no dependientes, de las mismas características personales, socioculturales y neuromédicas. La remisión del consumo, la duración de la dependencia, y el consumo de una segunda droga de abuso simultánea a la heroína no demostraron evidencia significativa de influir en los déficit intelectuales detectados

B vitamins status: effect of prolonged heroin addiction and methadone treatment.

Vitamin B1, B2 and B6 status were determined in 90 male heroin addicts admitted to Pramongkutklao Army Hospital. Their age (Mean +/- S.D.) was 25.5 +/- 7.8 years. Their activation coefficients of the enzyme transketolase, glutathione oxidoreductase and aspartate aminotransferase (ETK AC, EGR AC and EAST AC respectively) were significantly increased for addicts who were on drugs for a long time which indicated a biochemical deficiency. In addition, 26 follow-up cases treated with methadone for a period of one and two weeks were compared before and after treatment and it was found that ETK AC, EGR AC, and EAST AC were significantly decreased. This means that improvement in the vitamin B1, B2 and B6 status was obtained during admission.

La drogadicción y el sistema inmunológico / Drogaddiction and the inmune system

La presente revision pretende reunir algunas de la evidencias existentes acerca del efecto de marihuana, morfina, heroina y cocaina sobre el sistema inminologico. Se hace en primer lugar una breve introduccion sobre los aspectos farmacologicos de cada una de las drogas para luego presentar la informacion relacionada con parametros inmunologicos bien sea en humanos, en modelos animales o in vitro. La conclusion general es que todas estas sustancias tiene accion moduladora sobre la expresion de receptores a nivel de las membranas celulares. El efeto de la cocaina parece ser de modulacion positiva, es decir que mejora las respuestas lo cual se corelaciona con la poca evidencia de enfermedades de origen infeccioso en adictos a esta sustancia, a diferencia de los opiaceos y la marihuana. Es necesario, sinembargo, disenar experimentos con un control mas estricto de todas las variblaes involucradas en la drogadiccion a fin de depurar resultados aparentemente contradictorios que impiden llegar a conclusiones definitivas

This paper reviews some available evidence on the immunological effects of marijuana, morphine, heroine and cocaine. After a short introduction on the pharmacological aspects of these drugs, we present human, animal and In vitro data on different parameters related with the immune system. A general conclusion is that all these drugs modulate the expression of receptors on cellular membranes. Cocaine seems to be a positive modulator since it increases immune responses which agrees with the fact that cocaine addicts do not frequently develop infectious problems. On the contrary, the other drugs seem to induce some immuno suppression and those with addiction to them present infections with a higher frequency. Nevertheless, before a final conclusion can be made, more studies carefully controlling all variables involved in drug addiction should be done in order to solve some of the apparent contradictions frequently found In the Literature