Bebidas energizantes / No disponible

El consumo de bebidas energéticas ha experimentado una difusión enorme en su consumo y ventas en la última década. Estas bebidas estimulantes poseen una composición no homogénea en donde el principal ingrediente activo responsable de los efectos estimulantes es la cafeína en cantidades más elevadas que en las bebidas refrescantes cafeinadas. Su consumo predominante es por adolescentes y adultos jóvenes. El abuso en el consumo de este tipo de bebidas, con dosis altas y asociado al consumo de alcohol ha emergido recientemente con la finalidad de disminuir los efectos depresores del alcohol sobre el sistema nervioso central y el aumento de efectos estimulantes. Esta percepción subjetiva de disminución de los efectos depresores del alcohol puede condicionar un aumento del consumo del mismo y la realización de conductas de riesgo como la conducción. Existe una controversia científica importante en los últimos años sobre el impacto para la salud por el abuso en el consumo de este tipo de bebidas y su asociación con el consumo de alcohol. No existen datos epidemiológicos en España sobre estos patrones de consumo y su repercusión en la salud. Los efectos adversos por el abuso de las bebidas energizantes están ligados principalmente a su contenido de cafeína, al igual que los efectos buscados con su consumo. El número de publicaciones sobre el impacto en la salud por el abuso de este tipo de bebidas ha ido en aumento en los últimos años, reflejando la enorme difusión en su consumo y los potenciales daños secundarios al abuso. Esta breve revisión tiene por objetivo valorar aspectos epidemiológicos, composición, efectos perjudiciales para la salud por su abuso y el fenómeno del consumo concomitante con alcohol (AU)

Energy drinks have experienced a huge rise in sales and consumption over the last decade. These stimulant drinks have a non-homogeneous composition: the main active ingredient responsible for their stimulant effects is caffeine, found in larger amounts in energy drinks than in soft caffeine beverages. The abusive intake of this type of drinks at high doses and added to alcohol consumption has recently emerged, with the aim of decreasing the depressor effects of alcohol on the central nervous system and increasing the stimulant effects. The subjective perception of lower depressor effects of alcohol may lead to an increase in its use and of high-risk activities such as driving.There has been major scientifi c controversy in recent years about the health impact due to abusive consumption of energy drinks and alcohol. There is no epidemiologic data about Spanish patterns of consumption and their impact on health. The adverse effects of the abusive use of energy drinks are mainly linked to the amount of caffeine, as are the desired effects of their consumption. The number of studies on the impact on health due to the abuse of these types of beverages has increased in the last years, refl ecting the huge rise in consumption and potential secondary damage of abuse. This short review sets out to assess epidemiological aspects, composition, effects on health of abuse and the phenomenon of concomitant use with alcohol (AU)

Implicación de la cocaína en la patología vascular cerebral / Involvement of cocaine in cerebral vascular pathology

Objetivo. Describir la implicación de la cocaína en la patología vascular cerebral en pacientes jóvenes. Pacientes y métodos. Es un estudio descriptivo del papel de la cocaína en pacientes con ictus agudo menores de 50 años ingresados en el servicio de neurología durante cuatro años. Se analizan 18 pacientes con niveles de cocaína positivos en el momento del ingreso y 79 pacientes con niveles negativos. Se recogen y analizan distintas variables que definen el perfil de riesgo vascular, características del ictus y morbimortalidad asociada a éstos. Resultados. Se obtiene un predominio de varones y mayor proporción de factores de riesgo vascular no significativa en el grupo control (55,6% frente a 64,6%). El grupo de consumidores presenta de manera significativa una menor edad media (35,2 ± 8,9 frente a 41,5 ± 7,7 años), mayor consumo de tóxicos (tabaco, alcohol y cannabis), hiperCKemia (27,8% frente a 5,1%) y trastorno psiquiátrico (16,7% frente a 3,8%) (p < 0,05). Predomina el subtipo de ictus isquémico en territorio anterior para ambos grupos. Hay una clara tendencia a la normalidad de las pruebas complementarias, mayor índice de complicaciones (33,3% frente a 15,2%) y mortalidad (11,1% frente a 3,8%) en los consumidores (p > 0,05). Conclusiones. La cocaína es un factor de riesgo que hay que tener en cuenta en adultos jóvenes, asociado a ictus a edades más tempranas de lo habitual, con tendencia a la normalidad de las pruebas complementarias y una mayor morbimortalidad hospitalaria (AU)

Aim. To describe the involvement of cocaine in cerebral vascular pathology in young patients. Patients and methods. The work consists in a descriptive study of the role of cocaine in patients with acute stroke under the age of 50 years admitted to the neurology service over a period of four years. Eighteen patients with positive levels of cocaine on admission and 79 patients with negative levels were analysed. Different variables that define the profile of vascular risk, characteristics of the stroke and the morbidity and mortality associated to them are collected and analysed. Results. Males were predominant and there was a non-significant higher proportion of vascular risk factors in the control group (55.6% versus 64.6%). The group of consumers presented a significantly lower mean age (35.2 ± 8.9 versus 41.5 ± 7.7 years), higher consumption of toxic substances (tobacco, alcohol and cannabis), hyperCKemia (27.8% versus 5.1%) and psychiatric disorders (16.7% versus 3.8%) (p < 0.05). The ischaemic stroke in the anterior territory subtype was predominant in both groups. There was a clear tendency towards normality in complementary tests and a higher rate of complications (33.3% versus 15.2%) and mortality (11.1% versus 3.8%) among consumers (p > 0.05). Conclusions. Cocaine is a risk factor that must be taken into account in young adults: it is associated to stroke at earlier ages than is considered normal, with a tendency towards normality in complementary tests and a higher rate of hospital morbidity and mortality (AU)

[Involvement of cocaine in cerebral vascular pathology]. / Implicación de la cocaína en la patología vascular cerebral.

AIM: To describe the involvement of cocaine in cerebral vascular pathology in young patients. PATIENTS AND METHODS: The work consists in a descriptive study of the role of cocaine in patients with acute stroke under the age of 50 years admitted to the neurology service over a period of four years. Eighteen patients with positive levels of cocaine on admission and 79 patients with negative levels were analysed. Different variables that define the profile of vascular risk, characteristics of the stroke and the morbidity and mortality associated to them are collected and analysed. RESULTS: Males were predominant and there was a non-significant higher proportion of vascular risk factors in the control group (55.6% versus 64.6%). The group of consumers presented a significantly lower mean age (35.2 ± 8.9 versus 41.5 ± 7.7 years), higher consumption of toxic substances (tobacco, alcohol and cannabis), hyperCKemia (27.8% versus 5.1%) and psychiatric disorders (16.7% versus 3.8%) (p < 0.05). The ischaemic stroke in the anterior territory subtype was predominant in both groups. There was a clear tendency towards normality in complementary tests and a higher rate of complications (33.3% versus 15.2%) and mortality (11.1% versus 3.8%) among consumers (p > 0.05). CONCLUSIONS: Cocaine is a risk factor that must be taken into account in young adults: it is associated to stroke at earlier ages than is considered normal, with a tendency towards normality in complementary tests and a higher rate of hospital morbidity and mortality.

[Descriptive study of alcohol detoxifications in an Internal Medicine Service]. / Estudio descriptivo de las desintoxicaciones de alcohol en un Servicio de Medicina Interna.

Alcohol dependence is a chronic disease whose treatment begins with detoxification, followed by rehabilitation. We present a descriptive and retrospective study of 147 patients admitted to our unit during the period 2003-2005. Median age was 46.07 years, with 77.6% men and 22.4% women. Admission diagnosis was alcohol withdrawal syndrome in 31 patients (21.1%) and programmed alcohol detoxification in 116 patients (78.9%). On the CIWA-Ar scale: mild withdrawal, 100 patients (68.5%), moderate, 35 patients (24%), severe, 11 patients (7.5%). Mild group showed a statistically significantly lower proportion of hepatopathy, by comparison with the moderate and severe groups. Statistically significant differences were found between the mild and severe groups on comparing mean age, duration of stay, quantity of alcohol and parameters of chronic consumption (ferritine, fe, VCM, UBE, AST, bilirubin and Mg) for AST and bilirubin. There were 11 seizures: 4 patients from the programmed group, with mild withdrawal on the CIWA-Ar scale, and 7 patients with moderate-severe withdrawal. No relationship was found between patients intensity of withdrawal syndrome, age or sex. There was higher intensity on the CIWA-Ar score (moderate and severe) among patients who had already begun withdrawal syndrome, compared to those admitted on a planned detoxification programme. The CIWA-Ar is a useful tool for assessing withdrawal symptoms and risks of complication and for planning treatment. Clinical practice must provide patients with access to health resources for the appropriate treatment of their addiction, with standardized assistance during their stay in hospital.

Estudio descriptivo de las desintoxicaciones de alcohol en un Servicio de Medicina Interna / No disponible

La dependencia al alcohol es una enfermedad crónica y su tratamiento comienza con la desintoxicación, continuándose con la rehabilitación. Se presenta un estudio descriptivo y retrospectivo de las desintoxicaciones de alcohol en 147 pacientes ingresados en nuestra unidad en el periodo 2003-2005. La media de edad es de 46.07 años, 77.6% hombres y 22.4% mujeres. Ingreso por síndrome de deprivación alcohólica en 31 pacientes (21.1%), desintoxicación programada en 116 pacientes (78.9%). Según la escala CIWA-Ar: abstinencia grado leve 100 pacientes (68.5%), moderada35 (24%), grave 11 (7.5%). La estancia media global fue de 11.5 días, sin diferencias estadísticamente significativas. Grupo Leve con proporción significativamente menor de hepatopatía, grupos Moderado y Grave proporción significativamente alta. Al compararla media de la edad, estancia, cantidad de alcohol y parámetros de consumo crónico (ferritina, fe, VCM, UBE, GPT, GGT, bilirrubina y Mg), se encuentran diferencias significativas entre las medias de los grupos Leve y Grave para la GPT y bilirrubina total. Se produjeron crisis epilépticas en 11 pacientes, 4 pertenecían al grupo programado,7 con intensidad moderada-grave. No se ha evidenciado relación entre la intensidad del síndrome de deprivación, edad y sexo. Mayor intensidad en la escala CIWA-Ar (grados moderado y grave) entre los pacientes con síndrome de deprivación ya iniciado comparados con los ingresados programados, que predominantemente presentaban un grado leve. La CIWA-Ar es un instrumento útil para evaluar los síntomas de deprivación, el riesgo de complicaciones y planificar el tratamiento. La actitud clínica debe facilitar el acceso del paciente a los recursos sanitarios para el tratamiento de su adicción, normalizando la asistencia durante el ingreso hospitalario

Alcohol dependence is a chronic disease whose treatment begins with detoxification, followed by rehabilitation. We present a descriptive and retrospective study of 147 patients admitted to our unit during the period 2003-2005. Median age was 46.07 years, with 77.6% men and 22.4% women. Admission diagnosis was alcohol with drawal syndrome in 31 patients (21.1%) and programmed alcohol detoxification in 116 patients (78.9%). On the CIWA-Ar scale: mild withdrawal, 100 patients (68.5%), moderate, 35 patients (24%), severe, 11 patients (7.5%). Mild group showed a statistically significantly lower proportion of hepatopathy, by comparison with the moderate and severe groups. Statistically significant differences were found between the mild and severe groups on comparing mean age, duration of stay, quantity of alcohol and parameters of chronic consumption (ferritine, fe, VCM, UBE,AST, bilirubin and Mg) for AST and bilirubin. There were 11 seizures: 4 patients from the programmed group, with mild with drawal on the CIWA-Ar scale, and 7 patients with moderate-severe with drawal. No relationship was found between patients’ intensity of with drawal syndrome, age or sex. There was higher intensity on the CIWA-Ar score (moderate and severe) among patients who had already begun with drawal syndrome, compared to those admitted on a planned detoxification programme. The CIWA-Ar is a useful tool for assessing with drawal symptoms and risks of complication and for planning treatment. Clinical practice must provide patients with access to health resources for the appropriate treatment of their addiction, with standardized assistance during their stay in hospital

Complicaciones neurológicas por cocaína / Neurological damages due to cocaine abuse

La información sobre los riesgos del uso de cocaína no llega a calar entre los usuarios, la población general, ni siquiera entre los profesionales sanitarios. En el presente trabajo hemos hecho una breve revisión bibliográfica sobre los aspectos en que la cocaína afecta neurológicamente. Además de los daños tóxicos y estructurales por la cocaína y sus metabolitos, debemos tener presente la acción sobre el sistema cardiovascular y los posibles accidentes que pueden padecerse. Entre esos aspectos debemos mencionar: los accidentes cerebrovasculares (hemorragias, infartos) por la acción vasoconstrictora y los efectos activadores sobre corazón. Otros daños y alteraciones son las crisis convulsivas debidas a fenómenos toxicometabólicos y por incremento de catecolaminas. Fenómenos de repetición por la intoxicación cocaínica son las cefaleas provocadas por diferentes causas desde las hemorragias e infartos cerebrales, hipertensión arterial, etc. También están las crisis de agitación que pueden aparecer en el transcurso de la intoxicación. Se han podido detectar procesos catatónicos o distónicos atribuibles al uso de cocaína. La hipertermia es otro fenómeno frecuente entre los consumidores de cocaína, sobre todo cuando se consume en espacios que pueden producir incremento de temperatura. Además se han descrito daños de tipo neuropsicofarmacológico como el síndrome serotoninérgico Los efectos desmielinizantes son por el efecto tóxico y actúan sobre la sustancia blanca La rabdomiolisis son daños musculares por la hipertermia, la hiperestimulación simpática, vasoconstricción, etc

The information about the risks of the use of cocaine doesn't end up soaking among the users, the general population, not even among the sanitary professionals. In the present work we have made a brief bibliographical revision on the aspects in that the cocaine affects neurologically. Besides the toxic and structural damages for the cocaine and their metabolites, we would have present the action on the cardiovascular system and the possible accidents that they can be suffered. Among those aspects we must present and mention: the cerebrovascular accidents (haemorrhage, coronaries) due the vasoconstrictive action and the activator effects of cocaine on heart. Other damages and alterations are the due spastic crises for toxic and metabolic phenomena and for catecholamine increment. Repetition phenomena due the cocaine intoxication are the migraines caused by different problems from the haemorrhages and cerebral coronaries, arterial hypertension, etc. the crises of agitation (seizures) that can appear also in the course of the intoxication. They have been able to detect catatonic processes or dystonia attributable to the use of cocaine. The hyperthermia is another frequent phenomenon among the consumers of cocaine, mainly when wastes away in spaces that can produce increment of temperature. Also we can found neuropsycopharmacological damages like the serotoninergic syndrome. The demyelation effects have been described due the toxic effect and the rabdomiolisis on the white substance, as muscular damages for the hyperthermia, the sympathetic hyperestimulation, vasoconstrictive phenomena, etc