Programas de monitoreo de medicamentos de prescripción en los Estados Unidos de América / Prescription drug monitoring programs in the United States of America

Desde finales de la década de los años noventa, el número de muertes por sobredosis que involucran analgésicos opioides se ha cuadriplicado en los Estados Unidos de América (de 4 030 muertes en 1999 a 16 651 en 2010). Los objetivos de este artículo son proporcionar una visión general del problema de sobredosis de medicamentos de prescripción en los Estados Unidos y discutir las acciones que podrían ayudar a reducir el problema, abordando en forma directa las características de los Programas de monitoreo de medicamentos de prescripción (PDMP). Estos programas están compuestos de bases de datos a nivel estatal que vigilan las sustancias controladas. La información recopilada en las bases de datos está a disposición de las personas autorizadas por el Estado (por ejemplo, los médicos, los farmacéuticos y otros proveedores de cuidado médico) y debe ser utilizada solo con propósitos profesionales. Los proveedores pueden utilizar dicha información para evitar la interacción con otros medicamentos, la duplicación terapéutica o la identificación de conductas de búsqueda de drogas. Las agencias del orden público pueden utilizar estos programas para identificar patrones de prescripción inadecuada, dispensación o desviación.

Since the late 1990s, the number of opioid analgesic overdose deaths has quadrupled in the United States of America (from 4 030 deaths in 1999 to 16 651 in 2010). The objectives of this article are to provide an overview of the problem of prescription drug overdose in the United States and to discuss actions that could help reduce the problem, with particular attention to the characteristics of prescription drug monitoring programs (PDMPs). These programs consist of state-level databases that monitor controlled substances. The information compiled in the databases is at the disposal of authorized persons (e.g., physicians, pharmacists, and other health-care providers) and may be used only for professional purposes. Suppliers can use such information to prevent interaction with other drugs or therapeutic duplication, or to identify drug-search behavior. Law enforcement agencies can use these programs to identify improper drug prescription or dispensing patterns, or drug diversion.

S100B protein expression in the heart of deceased individuals by overdose: a new forensic marker?

OBJECTIVE: The evaluation of S100B protein expression in the human heart and its correlation with drug-related death. METHOD: Left ventricular samples were collected from 74 serial forensic autopsies (15 overdose-related deaths; 59 non-overdose-related deaths) from 2007 to 2010. Tissue sections from each sample were immunostained for S100B protein by a commercial antibody. RESULTS: The S100B protein was detected in the heart samples of all 15 cases of drug-related deaths; S100B immunoreactivity was mainly observed in the cytoplasm of cardiomyocytes and as globular deposits in the interstitial spaces. No reactivity or weak reactivity was found in the cardiomyocytes of the 59 subjects who died of other causes. CONCLUSION: Our preliminary data show that the S100B protein accumulates in injured cardiomyocytes during drug-related sudden death. Given the near absence of S100B protein in the heart of subjects who died from causes other than drug overdose, S100B immunopositivity may be used as a new ancillary screening tool for the postmortem diagnosis of overdose-related cardiac death.

Poisoning : pattern and profile of admitted cases in a hospital in central Nepal.

An analysis of all poisoning cases admitted in medical and pediatric wards of Patan Hospital for one year (1st Jan to 31st Dec 2004) was carried out. A total of 154 cases were admitted which was 0.8% of total hospital admissions. Females outnumbered males and almost two-thirds patients were young adults (15-34 years). Seasonal variation in poisoning was observed with more cases in the summer months. Organophosphorus compounds (42%), drugs (25%), and zinc phosphide (6.5%) were common poisonings in total and in adult populations, whereas kerosene was the most frequent poisoning in pediatric age group. Paracetamol, benzodiazepines, and tricyclic antidepressants were the most frequently used drugs. The circumstances of poisoning were intentional (75%) and accidental (20%); most of the childhood poisonings were accidental in nature. The mean hospital stay for all type of poisoning was 7.5 days; whereas it was 10.2 days for organophosphorus, 2.5 days for paracetamol, and 1.5 days each for zinc phosphide and kerosene ingestion. Intensive care unit (ICU) service was required in 17% of patients; and almost 25% developed complications. Aspiration pneumonia and respiratory failure were the most frequently observed complications. Ninety four percent of admitted patients recovered completely; leaving a mortality rate of 5%.

Five years audit for presence of toxic agents / Drug of abuse at autopsy

To know the frequency of fatal poisoning in Peshawar regarding the toxic agents mostly involved and yearwise percentage. To know the age group and the gender that is most vulnerable to fatal poisoning. Design: Non-interventional [descriptive] type. Place and Duration of Study: This study was conducted over a period of five years [1997'2001] at Forensic Medicine Department, Khyber Medical College, Peshawar. Methodology: The study included 3508 autopsies conducted at Khyber Medical College, Peshawar. Out of these, 52 cases were those caused by fatal poisoning. These were analyzed according to age, gender and the toxic agent involved. t-test was applied as the test of significance. Poisoning was the cause of death in 1.48% of the total autopsies conducted during the five years. Males were more involved than the females, 90.38%. Suicidal poisoning was present in 17.30% of the total cases and accidental poisoning was found in 80.72% cases, while homicidal cases were 1.29% only. Diacetylmorphine [heroin] was the most commonly involved agent, 65.38%, of the total cases. The incidence of poisoning was more during the third and fourth decades of life. Diacetylmorphine [heroin] was the main causative agent involved in young males due to accidental over- dosage. Accidental and suicidal deaths should not be considered as inevitable. More elaborative studies are required in this area of recent research to adopt appropriate and adequate measures to save precious lives

Overdose por cocaína - uma revisäo crítica / Cocaine overdose - a critical review

A taxa de mortalidade entre usuários de droga é mais alta do que na populaçäo geral e está relacionada a overdose, tanto acidental quanto deliberada, a doenças fatais, tais como Aids, acidentes e homicídio. Overdose é o fator mais diretamente relacionada ao uso de droga. Apesar das taxas de mortalidade relacionadas ao uso de cocaína variarem entre os países, a disseminaçäo do seu uso coloca overdose por cocaína como um assunto importante para os profissionais de saúde. Esta revisäo é baseada na identificaçäo sistemática de estudos relevantes através do uso do banco de dados do MEDLINE. Ela fornece uma revisäo crítica das informaçöes à respeito da prevalência de overdose por cocaína, suas características clínicas, fatores que podem predispor a ela e princípios de tratamento.

A viagem de volta - parte 1 e 2 / The return trip - part 1 and 2

Parte 1 e 2: a história de uma dependente química que resolve buscar ajuda terapêutica quando presencia a morte por overdose de sua amiga. A descrença da família em sua possível recuperação representa um entrave durante o tratamento.Parte 2: os conflitos dentro do próprio grupo de terapia e os desafios da abstinência química rumo à recuperação, na tentativa de retormar a confiança dos outros e em si mesmo...