RESUMEN
The current opioid overdose crisis is characterized by the presence of unknown psychoactive adulterants. Xylazine is an alpha-2 receptor agonist that is not approved for human use but is commonly used in veterinary medicine due to its sedative and muscle-relaxant properties. Cases of human intoxication due to accidental or voluntary use have been reported since the 1980s. However, reports of adulteration of illicit opioids (heroin and illicit fentanyl) with xylazine have been increasing all over Western countries. In humans, xylazine causes respiratory depression, bradycardia, and hypotension-posing individuals, using xylazine-adulterated opioids. We present a narrative review of the latest intoxication cases related to xylazine, to bring awareness to readers and also to help pathologists to detect and deal with xylazine cases.
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Analgésicos Opioides , Xilazina , Humanos , Xilazina/farmacología , Agonistas de Receptores Adrenérgicos alfa 2 , Hipnóticos y Sedantes , BradicardiaRESUMEN
Abstract: Recently, there has been a worldwide rise in the popularity and abuse of synthetic cathinones. The spectrum of side effects caused by the intake of these drugs of abuse is very wide since they act on different systems with various mechanisms of action, they appear to be involved in different cardiac events, including myocardial infarction and sudden cardiac death due to fatal arrhythmias. Overall, khat users have a higher risk of death, recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia, and stroke compared with non-khat user.
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Alcaloides , Infarto del Miocardio , Humanos , Cardiotoxicidad/etiología , Alcaloides/efectos adversos , Arritmias Cardíacas/inducido químicamenteRESUMEN
Abstract: The continuous emergence of New Psychoactive Substances enter-ing the illegal markets poses always new challenges to forensic and clinical toxicology laboratories facing the lack of analytical methods capable of determining the newer parent compounds and eventual metabolites. More than 50 new molecules have been reported by the European Monitoring Centre for Drugs and Drug Addiction only in 2021, further expanding the panel of target analytes. However, the implementation of new detection methodologies may not be viable due to time constraints and inadequate resources. To this concern, the updatable analytical screening methods constitute a powerful tool for pharmacotoxicological laboratories investigating both non biological seizure materials and conventional and non conventional matrices coming from intoxications and fatalities of drugs consumers.
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Psicotrópicos , Trastornos Relacionados con Sustancias , Toxicología Forense/métodos , Humanos , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
Gamma-hydroxybutyrate (GHB) is a central nervous system depressant, primarily used as a recreational drug of abuse and as a therapeutic substance both in U.S.A. and Europe for the treatment of narcolepsy with cataplexy in adult patients and as adjuvant in the control of alcohol withdrawal syndrome. Several cases of GHB related deaths have been reported in the literature and GHB was found alone or in association to other drugs of abuse. However, only few biological matrices are often analyzed, therefore data on GHB distribution are lacking. Here we report a case involving a 45-year-old man, who was found dead in his bedroom.
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Oxibato de Sodio/envenenamiento , Trastornos Relacionados con Sustancias/mortalidad , Adulto , Autopsia , Cocaína/envenenamiento , Europa (Continente) , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Narcolepsia/tratamiento farmacológico , Oxibato de Sodio/análisis , Oxibato de Sodio/uso terapéutico , Síndrome de Abstinencia a Sustancias/tratamiento farmacológicoRESUMEN
Drug-facilitated sexual assaults (DFSA) currently represent overwhelming issue in its multidisciplinary approach. They occur when alcohol or drugs are used to compromise an individual's ability to consent to a sexual act. These substances facilitate a perpetrator to commit sexual assault because they inhibit a person's ability to resist and can prevent them from remembering the assault. If on the one hand alcohol remains the most commonly used drug in crimes of sexual assault, on the other hand drugs being used by perpetrators in crimes of sexual assault include, but are not limited to, Rohypnol (but also other benzodiazepines can be used), GHB (Gamma Hydroxybutyric Acid), GBL (Gamma-Butyrolactone), ketamine and others. The authors briefly examine the main issues of GHB-facilitated sexual assault in forensic investigation, drawing the attention of the whole scientific community to the importance of a correct assessment of each GHB-FSA, even when it is only suspected and by providing some practical advices.
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Víctimas de Crimen/psicología , Víctimas de Crimen/estadística & datos numéricos , Drogas Ilícitas , Delitos Sexuales/estadística & datos numéricos , Oxibato de Sodio/administración & dosificación , Adulto , Femenino , Humanos , MasculinoRESUMEN
Performance enhancing drug use in sport arguably constitutes a crisis, and as such, targeted measures are needed in order to stem it. Substance abuse in professional sports and competitions has besmirched many world-class athletes' reputations and standing, in addition to jeopardizing their health. Furthermore, there are many instances of amateur athletes and school-aged competitors who have taken to using such substances as well, significantly exacerbating the overall picture. The widespread acknowledgement of the potentially life-threatening consequences of performance-enhancing drug use has prodded sports organizations and governments into cooperating on many different levels to preserve the ethical grounding and soundness of sport competitions; unlawful substance abuse is in fact liable to undermine the very core of fairness in competition. Doping, along with various forms of cheating, has been recorded throughout the history of sport: prohibition in itself is all but ineffective without reliable and systematic detection strategies and enforcement of sanctions.
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Atletas , Doping en los Deportes/ética , Deportes/ética , Trastornos Relacionados con Sustancias/epidemiología , Humanos , Relaciones Interpersonales , Instituciones AcadémicasRESUMEN
AIM: The aim of this paper was to compare hospital outcomes in patients undergoing elective surgery of the thoracic aorta using the right axillary artery (RAA) and the innominate artery (IA) as a cannulation site for cardiopulmonary bypass (CPB) arterial inflow. METHODS: Between September 2009 and October 2011, 71 patients underwent elective aortic procedures with RAA (N.=27) and IA (N.=44) cannulation. Selection of RAA vs. IA was not randomized, but rather based on surgical judgment of best indication in each patient. Pre-, intra-, and postoperative variables were compared according to cannulation site. RESULTS: Preoperative comorbidities, underlying aortic pathology, and surgical procedures were similar in RAA and IA patients. Hospital mortality was 11.1% and 6.8% in RAA and IA patients, respectively (P=0.243). Overall, 4 brain infarctions occurred, all left sided (RAA: 3.7% vs. IA: 6.8%; P=0.508). One brachial plexus injury, and 1 arterial dissection occurred in RAA group. No cannulation-related morbidity was observed in IA patients. Theoretical CPB flow could be reached in all patients, but resistances through the cannulation sites were more favourable in IA patients. CONCLUSION: RAA and IA were associated with similarly valid results. The choice between the two, based on the specific patient's characteristics, can improve outcomes after aortic surgery.