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Background: Preclinical studies show that clavulanic acid (CLAV) inhibits cocaine self-administration. This study investigates the effect of CLAV on regions of brain activation in response to cocaine cues during functional magnetic resonance imaging (fMRI) in participants with cocaine use disorder (CUD). Methods: A double-masked, placebo-controlled clinical trial with thirteen individuals with severe CUD who were randomized to treatment with CLAV (N = 10, 9 completers) 500 mg/day or matched placebo (PBO) (N = 3) for 3 days. fMRI was used to assess brain reactivity to 18 alternating six-second video clips of cocaine or neutral scenes. In this paradigm, participants were exposed to three different stimulus conditions: NEUTRAL, WATCH (passive watching), and DOWN (actively inhibiting craving while watching). Results: Participants who received CLAV demonstrated a significant reduction in brain activity in the anterior cingulate gyrus (p = 0.009) and the caudate (p = 0.018) in response to DOWN cocaine cues. There was a trend toward lessened cue reactivity in other regions implicated in CUD. Conclusion: CLAV reduced the response of the brain regions associated with motivation and emotional response during the DOWN condition compared to PBO, suggesting CLAV may strengthen voluntary efforts to avoid cocaine use. This pilot data supports the use of CLAV for CUD. (Trial registered in ClinicalTrials.gov NCT04411914).

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BACKGROUND: Psychoactive substance use among pregnant women has reached alarmingly high rates. Our aim was to characterize the psychiatric and clinical profiles of pregnant crack users in Brazil. METHODS: This was a cross-sectional study of 24 pregnant crack users admitted to a referral hospital for psychiatric disorders in pregnant women, in Porto Alegre, Brazil, over three years. The following instruments were applied: a clinical-obstetric questionnaire; the condensed version of the Addiction Severity Index; a diagnostic interview for psychoactive substance use based on DSM-5; the Mini International Neuropsychiatric Interview for DSM-IV; and the Semi-Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). RESULTS: Most patients had severe crack dependence and used other substances, such as tobacco, cannabis, and alcohol. The median duration of crack use was three years, ranging between three and 12 years. Most women subsisted from illegal or informal activities; a fifth had previously been arrested and often had relationship problems. Twenty percent had HIV (n = 5), and 37.5% (n = 9) had syphilis. Borderline personality disorder was the most prevalent mental condition (62.5%), followed by suicidal tendencies (45.8%), hypomanic episodes due to substance use (37.5%), and past major depressive episodes (33.3%). CONCLUSIONS: An alarmingly high prevalence of consumption of other drugs, psychiatric disorders, and difficult-to-treat personality disorders was observed in our study. Investigating the psychiatric profile of women who use substances is essential to minimize the impacts on the mother and child, optimize therapeutic approaches to comorbidities, and enable more effective relapse prevention.

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OBJECTIVE: In this multicentric study involving three London hospitals, we compared ANCA-positive and ANCA-negative cocaine-induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may correlate with disease severity. Our secondary aims are to better classify etiology centered around ANCA positivity and, consequently, better disease management. METHODS: A retrospective review was performed to identify patients with CIMDL seen between January 2019 and December 2022. Population data including age, sex, presentation, endoscopic findings, duration of cocaine use and active use of cocaine, type of treatment, laboratory (including ANCA serology), radiological, and histological findings were collected. RESULTS: Forty CIMDL patients (25 male, median age of 42 years) were identified. The majority of them (72.5%) presented with either a septal perforation, a saddle nose deformity (22.5%), and/or a palatal fistula (20.0%). ANCA was positive in 71.1% of cases (66.7% p-ANCA). No statistically significant differences in the general characteristics, type of treatment, laboratory results, radiological or histological findings were observed when comparing ANCA-positive and ANCA-negative CIMDL patients or when comparing p-ANCA and c-ANCA patients. Similarly, no statistically significant difference was obtained when comparing the pattern of distribution of lesions between the two groups. CONCLUSIONS: A large percentage of CIMDL patients showed positive ANCA test (71.1%) and in the majority of the cases a p-ANCA pattern specifically targeting PR3 (p-ANCA, PR3 + MPO-). However, ANCA positivity or presence of a specific ANCA pattern was not associated with more severe presentation or more aggressive disease. Given its similarities to granulomatosis with polyangiitis (GPA), we recommend the use of the term "cocaine-induced ENT pseudo-GPA" instead of CIMDL. LEVEL OF EVIDENCE: IV Laryngoscope, 2023.

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La cocaína es una de las sustancias ilegales más consumidas y Colombia no es la ex­cepción. Dentro de las sustancias ilegales es la segunda más consumida después del cannabis. Por su mecanismo mismo de acción, que produce aumento de aminas bióge­nas, se han asociado con la cocaína diferentes riesgos, tanto agudos como crónicos, y dentro de sus complicaciones se han descrito cambios comportamentales, compromiso cardiovascular y neurológico. La coingesta de cocaína y alcohol da lugar a un metabolito conocido como cocaetileno, que lleva a complicaciones cardiovasculares. Poco se ha descrito sobre el riesgo de la cocaína o la coingesta cocaína y alcohol, como un factor sumatorio, para la pancreatitis. Reportamos tres pacientes jóvenes consumidores del alcaloide que desarrollaron pancreatitis aguda, dos de ellos murieron. El objetivo de este reporte es sensibilizar a los trabajadores de la salud sobre otro riesgo para considerar en los pacientes consumidores de cocaína.

Cocaine is one of the most consumed illegal substances and Colombia is no exception. It is the second most consumed among the illegal substances after cannabis. Due to its very mechanism of action, which produces an increase in biogenic amines, different risks, both acute and chronic, have been associated with cocaine, and among its complications, behavioral changes, cardiovascular and neurological compromise have been described. The co-ingestion of cocaine and alcohol gives rise to a metabolite known as cocaethylene, which leads to cardiovascular complications. Little has been described about the risk of cocaine or cocaine and alcohol co-ingestion, as a summative factor, for pancreatitis. We report three young patients consuming the alkaloid who developed acute pancreatitis, two of whom died. The objective of this report is to sensitize health workers about another risk to consider in cocaine-consuming patients.

A cocaína é uma das substâncias ilícitas mais consumidas e a Colômbia não é exceção. Dentro das substâncias ilícitas é a segunda mais consumida depois da maconha. Devido ao seu próprio mecanismo de ação, que produz aumento de aminas biogênicas, diversos riscos, tanto agudos quanto crônicos, têm sido associados à cocaína e, entre suas complicações, têm sido descritas alterações comportamentais, comprometimento cardiovascular e neurológico. A co-ingestão de cocaína e álcool dá origem a um metabólito conhecido como cocaetileno, que leva a complicações cardiovasculares. Pouco tem sido descrito sobre o risco da co-ingestão de cocaína ou cocaína e álcool, como fator somativo, para pancreatite. Relatamos 3 pacientes jovens consumindo o alcalóide que desenvolveram pancreatite aguda, dois dos quais morreram. O objetivo deste relatório é sensibilizar os profissionais de saúde sobre outro risco a ser considerado em pacientes consumidores de cocaína.

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OBJECTIVE: The cingulate gyrus is implicated in the neurobiology of addiction, such as chronic cocaine consumption. Early life stress (ELS) is an important moderator of cocaine use disorder (CUD). Therefore, we investigated the effect of CUD on cingulate cortical thickness and tested whether a history of ELS could influence the effects of CUD. METHODS: Participants aged 18-50 years (78 with CUD due to crack cocaine consumption and 53 healthy controls) underwent magnetic resonance imaging and the cingulate thickness (rostral anterior, caudal anterior, posterior, and isthmus regions) was analysed. The clinical assessment comprised the Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index. Group comparisons adjusting by sex, age, and education were performed. Mediation models were generated where lifetime cocaine use, CTQ score, and cortical thickness corresponded to the independent variable, intermediary variable, and outcome, respectively. RESULTS: Group comparisons revealed significant differences in six out of eight cingulate cortices, showing lower thickness in the CUD group. Furthermore, years of regular cocaine use was the variable most associated with cingulate thickness. Negative correlations were found between CTQ scores and the isthmus cingulate (right hemisphere), as well as with the rostral anterior cingulate (left hemisphere). In the mediation analysis, we observed a significant negative direct effect of lifetime cocaine use on the isthmus cingulate and an indirect effect of cocaine use mediated by CTQ score. CONCLUSION: Our findings suggest that a history of ELS could aggravate the negative effects of chronic cocaine use on the cingulate gyrus, particularly in the right isthmus cingulate cortex.

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Objective: To compare the prevalence and subtypes of childhood maltreatment (CM) between individuals with and without substance use disorder (SUD) and investigate the influence of different traumas on the preferential use of substances and the severity of dependence. Methods: The sample consisted of 1,040 men with SUD (alcohol users [n=315], crack-cocaine users [n=406], multiple-substance users [n=319]) and 201 controls. The Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index-6 (ASI-6) were used to assess CM and drug-use patterns. Results: Individuals with SUD had a higher prevalence of CM than controls (63.4 vs. 28.1%, respectively). Exposure to physical trauma was associated with alcohol use disorder and severity of alcohol use. In contrast, emotional trauma was associated with use of multiple substances and severity of drug use in crack-cocaine users. Conclusions: This study corroborates the association of CM with SUD susceptibility. Our results suggest that the type of CM may influence preferential substance use and addiction severity. In this sense, physical traumas are more associated with alcohol use, while emotional and sexual traumas favor use of multiple drugs, especially crack cocaine. These findings may help the development of tailored prevention and intervention strategies.

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Abstract Introduction: Cocaine is one of the most often used psychoactive drugs worldwide, being extracted from the leaves of Erytroxylus coca plant. Its abusive use can trigger several consequences for the human body, including the oral cavity. Objective: To identify the oral disorders that are most commonly found in individuals who abuse cocaine, in addition to the main diagnostic and treatment methods. Methods: An integrative review was carried out on the databases: LILACS, BBO, LIS, MEDLINE, SciELO, Science Direct and PubMed. The following keywords were used: ‟Cocaína", ‟Boca", ‟Palato" and ‟Odontologia", together with their synonyms and variations in English, obtained from DeCS andMeSH. The inclusion criteria were original articles, articles in Portuguese, English and Spanish, studies involving individuals, without restriction related to the year of publication. Animal studies, literature reviews, book chapters, theses and dissertations were excluded. Results: In total, 1373 records were identified. Of these, 22 articles were selected to comprise the review. Several oral alterations caused by cocaine abuse were found, primarily perforation of the palate, predisposition to periodontal diseases, temporomandibular disorders, bruxism, damage to oral tissues, dental caries, destructive lesions of the facial midline, xerostomia and ageusia. Among the diagnostic methods used by the professionals, anamnesis, intraoral examinations and head and neck computed tomography were the most frequently mentioned. As for treatment, in patients with palatal perforation, the reconstruction of the affected area or the use of prosthetic obturators is carried out. Conclusion: The management of these patients is not an easy task, as many of the users do not even seek professional help. The health professionals must be able to recognize these manifestations and alterations to establish timely and accurate diagnosis and treatment planning. © 2021 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/). HIGHLIGHTS Integrative review aiming to detect oral changes in cocaine abusers. The main oral changes, methods of diagnosis and treatment were identified. Good anamnesis and qualified health professionals are necessary.

Resumo Introdução: A cocaína é uma das drogas psicoativas mais usadas no mundo, é extraída das folhas da Erytroxylus coca. Seu uso abusivo pode desencadear inúmeras consequências para o corpo humano, inclusive na cavidade oral. Objetivo: Identificar quais as alterações orais mais comumente encontradas nos indivíduos que fazem uso abusivo de cocaína, além das principais formas de diagnóstico e tratamento. Método: Fez-se uma revisão integrativa nas bases de dados Lilacs, BBO, LIS, Medline, Sci-ELO, Science Direct e PubMed. Foram usados os descritores ‟cocaína", ‟boca", ‟palato" e ‟odontologia" junto de seus sinônimos e variações em inglês, retirados do DeCS e MeSH. Os critérios de inclusão foram artigos originais, artigos nas línguas portuguesa, inglesa e espanhola, estudos que envolveram pessoas e sem restrição quanto ao ano de publicação. Foram excluídos estudos feitos em animais, revisões da literatura, capítulos de livros, teses e dissertações. Resultados: Foram identificados 1.373 registros. Desses, 22 artigos foram selecionados para compor a revisão. Diversas alterações orais causadas por uso abusivo de cocaína foram encontradas. As principais foram perfuração do palato, predisposição para doenças periodontais, desordens temporomandibulares, bruxismo, danos aos tecidos orais, cárie dentária, lesões destrutivas da linha média facial, xerostomia e ageusia. Entre as formas de diagnóstico usadas pelos profissionais, a anamnese, exames físicos intraorais e a tomografia computadorizada da região da cabeça e pescoço foram as mais mencionadas. Como tratamento, nos pacientes com perfuração palatina, é feita a reconstrução da área afetada ou o uso de obturadores protéticos. Conclusão: O manejo desses pacientes não é tarefa fácil, pois muitos usuários sequer procuram ajuda profissional. Os profissionais da saúde devem ser capazes de reconhecer tais alterações e manifestações para que sejam feitos diagnósticos e planejamentos de tratamentos oportunos e precisos. DESTAQUES Revisão integrativa que visa detectar alterações orais em usuários de cocaína. Identificaram-se as principais manifestações orais, formas de diagnóstico e tratamento. Necessidade da feitura de boa anamnese e profissionais da saúde capacitados.

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OBJECTIVE: To compare the prevalence and subtypes of childhood maltreatment (CM) between individuals with and without substance use disorder (SUD) and investigate the influence of different traumas on the preferential use of substances and the severity of dependence. METHODS: The sample consisted of 1,040 men with SUD (alcohol users [n=315], crack-cocaine users [n=406], multiple-substance users [n=319]) and 201 controls. The Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index-6 (ASI-6) were used to assess CM and drug-use patterns. RESULTS: Individuals with SUD had a higher prevalence of CM than controls (63.4 vs. 28.1%, respectively). Exposure to physical trauma was associated with alcohol use disorder and severity of alcohol use. In contrast, emotional trauma was associated with use of multiple substances and severity of drug use in crack-cocaine users. CONCLUSIONS: This study corroborates the association of CM with SUD susceptibility. Our results suggest that the type of CM may influence preferential substance use and addiction severity. In this sense, physical traumas are more associated with alcohol use, while emotional and sexual traumas favor use of multiple drugs, especially crack cocaine. These findings may help the development of tailored prevention and intervention strategies.

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BACKGROUND: Cocaine use disorder (CUD) is associated with various cognitive deficits that impede patients' functionality, prognosis and therapeutic outcomes. New pharmacological treatments for CUD that could improve cognition are needed. OBJECTIVE: To explore whether cannabidiol (CBD) is superior to placebo to improve cognitive functioning in individuals with CUD. METHODS: We conducted an exploratory analysis of a single site, randomized, double-blind, placebo-controlled trial evaluating CBD's efficacy in reducing craving, cocaine use and relapse in individuals with CUD. Seventy-eight individuals diagnosed with CUD were randomized to receive either CBD (800 mg) or placebo for 92 days. We used the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess inhibition (Stop Signal Task; SST), risky decision making (Cambridge Gambling Task; CGT) and visual memory (Pattern Recognition Memory; PRM). This assessment was made on day 1, day 7 and at week 6. We controlled for sex, severity of dependence and baseline cognitive scores in our generalized estimating equation models. RESULTS: Both groups performed similarly on the PRM (correct answers: p = 0.080), SST (stop signal reaction time: p = 0.644) and CGT (quality of decision making: p = 0.994; deliberation time: p = 0.507; delay aversion: p = 0.968; risk taking: p = 0.914) tests. CONCLUSIONS: We found no evidence for 800 mg of CBD to be more efficacious than placebo for improving cognitive outcomes. Clinical trials evaluating pharmacological treatments for CUD should continue to be a research priority.

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Resumen Introducción: el consumo de cocaína se ha incrementado y con ello el número de consultas a urgencias y hospitalizaciones por intoxicación aguda. El objetivo fue describir las características y complicaciones de los pacientes intoxicados por cocaína que acudieron al servicio de urgencias de un hospital de alta complejidad de Colombia. Método: estudio de corte transversal. Se incluyeron pacientes atendidos durante 2016 y 2019 con intoxicación por cocaína, según historia clínica y test de cocaína positivo y sin enfermedad de base que afectara directamente la supervivencia. Se describieron las características sociodemográficas y clínicas y se estimó la mortalidad y prevalencia de complicaciones. Resultados: se incluyeron 159 pacientes, en su mayoría hombres, con bajo nivel educativo y mediana de edad de 31 años. La mortalidad fue 3.8%. La prevalencia de lesión renal aguda (LRA) fue de 29.6% (IC95% 22.6-37.3%), 8.8% (IC95% 4.3-14.3%) para insuficiencia hepática aguda (IHA), 4.4% (IC95% 1.8-8.9%) para infarto agudo de miocardio (IAM) y 4.4% (IC 95% 1.8-8.9%) para ataque cerebrovascular (ACV). Los niveles elevados de fosfocreatinquinasa (CPK) fueron encontrados con valores mayor a mil en 80% de pacientes con LRA, 100% de IHA, y en 50% de ACV. Conclusión: la intoxicación aguda por cocaína produce alteraciones multiorgánicas principalmente renales y hepáticas, que pueden ser por daño directo y también posiblemente por daño muscular reflejado en la elevación de CPK. Esto puede indicar la necesidad de vigilancia estricta de esta enzima y su investigación como variable pronóstica. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2256).

Abstract Introduction: the use of cocaine has increased, and, with it, the number of emergency room visits and hospitalizations due to acute intoxication. The objective was to describe the characteristics and complications of patients with cocaine intoxication who were seen in the emergency room of a tertiary care hospital in Colombia. Materials and methods: a cross-sectional study. Patients seen from 2016 to 2019 with cocaine intoxication, according to the medical chart and a positive cocaine test, and with no underlying diseases which would directly affect survival, were included. The sociodemographic and clinical characteristic were described, and the mortality and prevalence of complications were estimated. Results: a total of 159 patients were included, mostly males, with a low educational level and a median age of 31 years. The mortality was 3.8%. The prevalence of acute kidney injury (AKI) was 29.6% (95%CI 22.6 - 37.3%), 8.8% (95%CI 4.3 - 14.3%) for acute liver failure (ALF), 4.4% (95%CI 1.8 - 8.9%) for acute myocardial infarction (AMI) and 4.4% (95% CI 1.8-8.9%) for cerebrovascular accident (CVA). Elevated creatine phosphokinase (CPK) levels were found to be greater than 1,000 in 80% of patients with AKI, 100% of those with ALF, and 50% of those with CVA. Conclusion: acute cocaine intoxication causes multiple organ dysfunction, mainly of the kidneys and liver, which may be due to direct injury and possibly also due to muscle damage reflected in the elevated CPK. This could indicate the need for strict monitoring of this enzyme and research of its use as a prognostic variable. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2256).

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INTRODUCTION: Cocaine is one of the most often used psychoactive drugs worldwide, being extracted from the leaves of Erytroxylus coca plant. Its abusive use can trigger several consequences for the human body, including the oral cavity. OBJECTIVE: To identify the oral disorders that are most commonly found in individuals who abuse cocaine, in addition to the main diagnostic and treatment methods. METHODS: An integrative review was carried out on the databases: LILACS, BBO, LIS, MEDLINE, SciELO, Science Direct and PubMed. The following keywords were used: "Cocaína", "Boca", "Palato" and "Odontologia", together with their synonyms and variations in English, obtained from DeCS and MeSH. The inclusion criteria were original articles, articles in Portuguese, English and Spanish, studies involving individuals, without restriction related to the year of publication. Animal studies, literature reviews, book chapters, theses and dissertations were excluded. RESULTS: In total, 1373 records were identified. Of these, 22 articles were selected to comprise the review. Several oral alterations caused by cocaine abuse were found, primarily perforation of the palate, predisposition to periodontal diseases, temporomandibular disorders, bruxism, damage to oral tissues, dental caries, destructive lesions of the facial midline, xerostomia and ageusia. Among the diagnostic methods used by the professionals, anamnesis, intraoral examinations and head and neck computed tomography were the most frequently mentioned. As for treatment, in patients with palatal perforation, the reconstruction of the affected area or the use of prosthetic obturators is carried out. CONCLUSION: The management of these patients is not an easy task, as many of the users do not even seek professional help. The health professionals must be able to recognize these manifestations and alterations to establish timely and accurate diagnosis and treatment planning.

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BACKGROUND: Cocaine is a synthetic alkaloid initially viewed as a useful local anesthetic, but which eventually fell out of favor given its high addiction potential. Its predominantly sympathetic effects raise concern for cardiovascular, respiratory, and central nervous system complications in patients undergoing procedures. Peri-procedural cocaine use, often detected via a positive urine toxicology test, has been mostly addressed in the surgical and obstetrical literature. However, there are no clear guidelines on how to effectively risk stratify patients found to be positive for cocaine in the pre-operative setting, often leading to costly procedure cancellations. Within the field of gastroenterology, there is no current data available regarding safety of performing esophagogastroduodenoscopy (EGD) in patients with recent cocaine use. AIM: To compare the prevalence of EGD related complications between active (≤ 5 d) and remote (> 5 d) users of cocaine. METHODS: In total, 48 patients who underwent an EGD at John H. Stroger, Jr. Hospital of Cook County from October 2016 to October 2018 were found to have a positive urine drug screen for cocaine (23 recent and 25 remote). Descriptive statistics were compiled for patient demographics. Statistical tests used to analyze patient characteristics, procedure details, and preprocedural adverse events included t-test, chi-square, Wilcoxon rank sum, and Fisher exact test. RESULTS: Overall, 20 periprocedural events were recorded with no statistically significant difference in distribution between the two groups (12 active vs 8 remote, P = 0.09). Pre- and post-procedure hemodynamics demonstrated only a statistically, but not clinically significant drop in systolic blood pressure and increase in heart rate in the active user group, as well as drop in diastolic blood pressure and oxygen saturation in the remote group (P < 0.05). There were no significant differences in overall hemodynamics between both groups. CONCLUSION: Our study found no significant difference in the rate of periprocedural adverse events during EGD in patients with recent vs remote use of cocaine. Interestingly, there were significantly more patients (30%) with active use of cocaine that required general anesthesia as compared to remote users (0%).

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Abstract Neutrophilic dermatoses encompass a wide spectrum of diseases characterized by a dense infiltration mainly composed of neutrophils. Neutrophilic dermatosis of the dorsal hands is currently considered a localized variant of Sweet syndrome. Cocaine abuse has been related to a wide range of mucocutaneous manifestations, including neutrophilic dermatoses such as pyoderma gangrenosum. The authors of this study present a patient with neutrophilic dermatosis of the dorsal hands, in which cocaine abuse was identified as a probable trigger.

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Neutrophilic dermatoses encompass a wide spectrum of diseases characterized by a dense infiltration mainly composed of neutrophils. Neutrophilic dermatosis of the dorsal hands is currently considered a localized variant of Sweet syndrome. Cocaine abuse has been related to a wide range of mucocutaneous manifestations, including neutrophilic dermatoses such as pyoderma gangrenosum. The authors of this study present a patient with neutrophilic dermatosis of the dorsal hands, in which cocaine abuse was identified as a probable trigger.

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Antecedentes: El consumo de cocaína es un creciente problema de saluden todo el mundo. Además, los pacientes con trastorno por consumode cocaína (TCC) presentan una alta comorbilidad con el trastornodepresivo mayor (TDM). Estos pacientes pueden presentar dos tipos deTDM: trastorno depresivo mayor primario (TDM-P) y trastorno depresivo mayor inducido por cocaína (TDM-IC). El objetivo de este estudio esevaluar las diferencias en la sintomatología depresiva (TDM-P vs. TDMIC) en los pacientes con TCC para mejorar su tratamiento. Métodos: Sellevó a cabo un análisis secundario en una muestra transversal de 160pacientes que presentaban TCC y algún TDM. La evaluación clínica,así como el diagnóstico diferencial entre TDM-P y TDM-IC, se realizóutilizando la entrevista PRISM. Resultados: Los hombres representaronel 80% de la muestra con una edad media de 38,61 años y el 64,5%sólo tenía estudios primarios. El diagnóstico de TDM-IC (61,3%) fuemás frecuente que el de TDM-P (38,7%). Los pacientes con TDM-ICmostraron una edad de aparición más temprana para el TCC. El 79,4%de los pacientes cumplían criterios para otro trastorno por consumo desustancias. Únicamente el criterio “Cambios en el peso o en el apetito” fueestadísticamente más prevalente (57,1%) en los pacientes con TDM-P.Conclusiones: Existen diferencias en el criterio “Cambios en el peso o en elapetito” entre TDM-P y TDM-IC. Se necesita más investigación a fin deobtener un diagnóstico diferencial entre los dos tipos de depresión yproporcionar un mejor tratamiento para los pacientes con TCC. (AU)

Background: Cocaine use is a growing global health problem and patients with cocaine use disorders (CUD) present several complications, including high rates of major depression. These subjects present two types of major depressive disorder (MDD): primary majordepressive disorder (P-MDD) and cocaine-induced major depressivedisorder (CI-MDD). To improve treatment, it is necessary to distinguish between both types. The aim of this study was to assess the differences in depressive symptomatology criteria (P-MDD vs CI-MDD)in CUD patients. Methods: Secondary data analysis was carried out witha cross-sectional sample of 160 patients presenting CUD and MDD.Clinical assessment was performed using the Psychiatric ResearchInterview for Substance and Mental Disorders (PRISM). A differential diagnosis was obtained between P-MDD and CI-MDD. Results: Menrepresented 80% of the sample, the mean age was 38.61 years, and64.5% had elementary studies. CI-MDD diagnosis (61.3%) was morefrequent than P-MDD (38.7%). There was a younger age of CUD onset in CI-MDD patients. In addition, 79.4% of the patients had anothersubstance use disorder diagnosis. The criterion “Changes in weight orappetite” was more prevalent (57.1%) in P-MDD group. Conclusions:We found differences in the criterion “Changes in weight or appetite”.Further research is needed in this field to establish a differential diagnosis and thus provide better treatment for CUD patients. (AU)

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INTRODUCTION: Cocaine use is known to be associated with an increased risk for vascular diseases. It is likely to trigger or increase the risk for an aortic dissection. We conducted an analysis of 45 cases of cocaine-related aortic dissection to further characterize the clinical features and outcomes of this patient cohort. METHODS: Our study cohort of 45 patients consisted of 11 cases from our institutional database and 34 published case reports. RESULTS: The observed cases of acute aortic dissection related to cocaine use showed a high proportion of young (41.3±8.67 years) and male (88.9%) patients. Most of the cases (75%) were classified as Stanford type A. Also, in 75% of the cases, cocaine use was prevalent for more than one year. Median time from last cocaine use to onset of symptoms was one hour. In-hospital mortality was 21.4%, while additional 11.9% of the cases died before arriving at the hospital. CONCLUSION: Acute aortic dissection related to cocaine use occurs in predominantly young male patients and has a dismal outcome when compared to all comer series.

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Abstract Introduction: Cocaine use is known to be associated with an increased risk for vascular diseases. It is likely to trigger or increase the risk for an aortic dissection. We conducted an analysis of 45 cases of cocaine-related aortic dissection to further characterize the clinical features and outcomes of this patient cohort. Methods: Our study cohort of 45 patients consisted of 11 cases from our institutional database and 34 published case reports. Results: The observed cases of acute aortic dissection related to cocaine use showed a high proportion of young (41.3±8.67 years) and male (88.9%) patients. Most of the cases (75%) were classified as Stanford type A. Also, in 75% of the cases, cocaine use was prevalent for more than one year. Median time from last cocaine use to onset of symptoms was one hour. In-hospital mortality was 21.4%, while additional 11.9% of the cases died before arriving at the hospital. Conclusion: Acute aortic dissection related to cocaine use occurs in predominantly young male patients and has a dismal outcome when compared to all comer series.

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El abuso del consumo de cocaína puede ocasionar problemas físicos y mentales graves. Dicha droga puede ser utilizada de varias formas y sus efectos sobre la cavidad oral varían según la vía de administración, causando desde erosiones en las piezas dentarias, abrasiones cervicales, caries, enfermedad periodontal, disfunción temporomandibular, xerostomía, ulceraciones hasta la perforación del paladar duro y/o blando. Se describirá el caso clínico de un paciente cocainómano que concurrió al servicio de odontología del Hospital San Martin de La Plata, presentando dos perforaciones en el paladar duro debido al consumo crónico, y el tratamiento de urgencia correspondiente mediante una placa obturatríz que favorece la deglución y el habla del paciente (AU)

Abuse of cocaine use can cause serious physical and mental problems. is drug can be used in several ways and its effects on the oral cavity vary according to the route of administration, causing from erosions in the teeth, cervical abrasions, caries, periodontal disease, temporomandibular dysfunction, xerostomia, ulcerations to the perforation of the hard palate and / or soft.The clinical case of a cocaine patient who attended the dentistry service of the San Martin de La Plata Hospital will be described, presenting two perforations in the hard palate due to chronic consumption, and the corresponding emergency treatment by means of an obturator plate that favors swallowing and He speaks of the patient (AU)

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