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PubMedDate not supplied

The epidemiology of intentional burns.

We sought to present the epidemiology of intentional burns, both deliberate self-inflicted burns and assault burns. Patient records from the University of Alabama at Birmingham Burn Center were reviewed retrospectively. Information pertaining to demographic and injury characteristics were obtained. Ninety-six patients with intentional burns were identified. Patients sustaining intentional burn injury had larger mean TBSA burned (26.1% vs 13.8%), longer mean hospital length of stay (19.9 days vs 13.2 days), higher incidence of inhalational injury (20.8% vs 8.7%), higher rate of mortality (20.0% vs 9.8%), and were more likely to have an elevated blood alcohol content (14.6% vs 7%) when compared with all other burn patients. Patients with deliberate self-burns were more likely to be men (85.7% vs 55.7%) and more likely to have a positive drug screen test than assault burn patients (11.4% vs 0%). Patients who suffer intentional burns tend to have more severe burns and experience worse outcomes.

Adult↗
PubMed2004

Long-term neurobehavioral effects of alcohol or nicotine exposure in adolescent animal models.

Adolescent alcohol and nicotine abuse is common, but its neurodevelopmental consequences remain unclear. This laboratory utilized adolescent rodent models to assess the hypothesis that adolescents are highly susceptible to the effects of alcohol and nicotine. Rats were exposed to ethanol for 10-14 days using an intermittent vapor inhalation paradigm. Rats were continuously exposed to nicotine for 5 days using Nicoderm CQ transdermal patches. Alcohol or nicotine exposure altered neurobehavioral function when assessed after 3-7 weeks of abstinence. Alcohol-induced changes include increased electroencephalographic (EEG) frequency, decreased amplitude of the cortical N1 and hippocampal P3 event-related potential (ERP) components, enhanced anxiety-like behavior, and enhanced depressive-like behavior. Nicotine-induced changes include decreased slow-wave cortical EEG power, increased cortical N1 ERP amplitude, decreased motor activity, and increased anxiety-like behavior. These findings support the hypothesis that adolescents are uniquely susceptible to the effects of chronic alcohol and nicotine exposure.

Administration, Cutaneous↗
PubMed1986

[Comparative study of the effects of regular or on-demand salbutamol inhalation in the treatment of asthma].

52 asthmatic patients aged 18 to 70 years took part in a double-blind crossover trial comparing the effects of regular treatment of asthma with inhaled salbutamol (400 micrograms qds) versus irregular treatment (400 micrograms prn), each prescribed for 4 weeks. There were no differences between the two schedules regarding intensity of clinical symptoms, morning and evening values of peak expiratory flow rates and spirometric measurements. The mean daily consumption of salbutamol was higher in the period of regular treatment (2148 +/- 548 micrograms) than in the period of free treatment (800 +/- 700 micrograms). Patients expressed an obvious preference for the period of regular treatment (26 vs 13). Salbutamol given prn or on a regular qds regimen was shown to be equally effective and safe in controlling the signs and symptoms of asthma. No tolerance or drug abuse was observed. In view of the patients' preference for regular treatment, this schedule is a safe alternative in cases where low-dose symptomatic treatment given prn fails to alleviate symptoms.

Administration, Inhalation↗
PubMed1998

[Perfusion and metabolism of liver and splanchnic nerve area under sevoflurane anesthesia].

In common with other halogenated volatile anaesthetics, sevoflurane causes a dose-related cardiovascular depression and therefore the affection of blood flow of different organ systems is suggested. So far known, sevoflurane is not different compared to isoflurane in affecting liver and splanchnic blood flow. Concluded from former published studies there was no case of hepatic toxicity of sevoflurane been published so that this substance can be used in patients with reduced hepatic function. The primary organic metabolite of sevoflurane is hexafluorisopropanol (HFIP), which is readily and rapidly conjugated with glucuronic acid. No reactive intermediates are formed and HFIP appears to be an unlikely compound to form liver protein adducts. For this reasons sevoflurane "hepatitis" is not expected. Like most other inhalation agents sevoflurane increase the neuromuscular blockade after treatment with muscle relaxants in anaesthesia. The MAC values of Sevoflurane where reduced after the application of nitrous oxide, benzodiazepines and opiates. From human studies we know that chronic drug therapy with isoniazid induces the metabolism of sevoflurane, enflurane and isoflurane, markedly increasing peak plasma fluoride concentrations. However, barbiturates as well as phenytoin do not influence the metabolism of sevoflurane because these agents do not induce the major hepatic defluorinating enzyme cytochrome P450 2E1. Obesity, untreated diabetes mellitus and alcohol abuse increase the hepatic content and activity of cytochrome P450 2E1 and therefore enhanced anaesthetic defluorination is to be suspected. Until now, there are no studies about sevoflurane anaesthesia in patients after liver transplantation but the extremely low hepatotoxic potential as compared to isoflurane provides no argument to avoid this substance for anesthesia in liver transplanted patients.

Anesthetics, Inhalation↗
PubMed1994

HIV risk behavior and medical status of underprivileged youths in Belo Horizonte, Brazil.

METHODS: From June 1989 to April 1991, 394 adolescents aged 10-18 years randomly selected upon admission at a state shelter in Belo Horizonte, Brazil underwent health history interview, physical examination, serology for HIV, hepatitis B, and syphilis, and stool examination. Participants were classified as street-based youths (n = 195) or home-based youths (n = 199). The age distribution was similar in both groups, although males were overrepresented among street-based youths (79.5% versus 62.3%). RESULTS: Compared with home-based youths, street-based youths reported earlier onset (p = 0.009) and higher rates of sexual activity (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.4-3.3), sexual abuse (OR, 3.7; 95% CI, 1.2-10.1), and sexually transmitted diseases (OR, 2.9; 95% CI, 1.3-6.6). Overall condom use was low in both groups. Street-based youths were 7.8 times more likely to use drugs than home-based youths (95% CI, 4.9-12.7). Inhalants and marijuana were the more commonly used drugs. Intravenous drug use was low. CONCLUSIONS: Although chronic malnutrition and multiple parasitosis were common findings in both groups, street-based youths were more likely to present disorders related to trauma and poor hygienic conditions. Antibodies to HIV were detected in four (2%) street-based youths and in none of the home-based youths. This study confirms that street youths are at higher risk for HIV infection than their home-based peers and indicates a need for HIV prevention programs targeting this population.

Adolescent↗
PubMed2003

Changing cocaine use practices: neo-liberalism, HIV-AIDS, and death in an Argentine shantytown.

Cocaine consuming patterns are changing among young drug users who live in "The Villa," a shantytown located in Greater Buenos Aires. After years of drug injection dominance, cocaine snorting became the preferred drug consuming practice while deep and fast structural and cultural transformations have been taken place as part of the neoliberal program implemented in Argentina during the 1990s and the final economic default in 2001-2002. In this article, I analyze how drug users understand and explain these changing practices, including the following aspects: deteriorating economic conditions, the transformations of survival strategies, moral codes, social network organization, violence regulating mechanisms, criminal activity, and police repression. Based on an ethnographic study carried out during the last eight months in "The Villa," I suggest that intense and generalized cocaine injection in shantytowns has logistic, organizational, and structural requirements that cocaine snorting does not have. Particularly, I explore two main aspects associated with these changing cocaine consumption practices: the consequences of the many Acquired Immunodeficiency Syndrome (AIDS)-related deaths, which occurred among older drug injectors, and the progressive social fragmentation tied to the extreme economic deprivation, deepened social exclusion, and growing everyday violence.

Administration, Inhalation↗
PubMed2004

Drug abuse trends among youth in the United States.

Several years of survey data indicate that illicit drug use among U.S. youth was at its highest level in 1979. Generally, the use of some illicit drugs declined progressively throughout the 1980s, stabilized, and then decreased slightly. Reducing illicit drug use among U.S. youth continues to be a priority of federal, state, and local law enforcement agencies. The U.S. government tracks youth illicit drug use through three nationally representative surveys: National Household Survey on Drug Abuse, Monitoring the Future Study, and Youth Risk Behavior Survey. Other surveys include the Partnership Attitudes Tracking Study, conducted annually to assess youth and parental attitudes about drugs, and Drug Abuse Awareness Network (DAWN), a national surveillance system that monitors trends in drug-related emergency department visits and deaths. Although survey methods differ, similar trends in drug use are well documented by these surveys. Among American youth, illicit use of drugs such as tobacco, alcohol, inhalants, marijuana, LSD, cocaine, heroin, and methamphetamine has remained relatively stable. However, a noteworthy exception is the increased use of MDMA (methylenedioxymethamphetamine). The physical consequences of "club and recreational drug use" are evidenced in the increased numbers of emergency department visits, specifically those related to MDMA and gamma-hydroxy-butyrate use, which may represent a new and emerging trend in illicit drug use.

Adolescent↗
PubMed2006

Violent deaths in small children in northern Sweden.

OBJECTIVES: To identify causes and trends of violent deaths among children younger than 4 years in a northern region. STUDY DESIGN: Retrospective analysis of medico-legal autopsy and police data. METHODS: Data from all 72 deaths from "external causes" 1977-2004, in children < 4 years from the northern half of Sweden were analysed. RESULTS: The death rate was 7.1 per 100,000 children and year during the first half of the study period, and 5.2 during the second half. Vehicle- and drowning-related deaths were halved. Fifteen were struck by motor vehicles (in 8 cases by heavy vehicles), 14 car occupants were killed in car crashes, 12 were killed by intentional violence inflicted by an adult, and 9 each were killed by (i) carbon monoxide/smoke inhalation, (ii) asphyxiation, or (iii) drowning. The boy:girl ratio was 1:1 in all groups, except in the groups "drowning" and "run over by motor vehicle", where boys dominated. CONCLUSIONS: Medical professionals have a difficult but important task in identifying and taking action against child abuse and in promoting child safety especially in the traffic and home environments.

Cause of Death↗
PubMed1989

[Subacute myeloneuropathy after abuse of nitrous oxide: an electron microscopic study on the peripheral nerve].

We have experienced a case of myeloneuropathy following habitual abuse of nitrous oxide. We report clinical and pathological findings of this case with review of literatures. A 36-year-old dentist was first admitted to our hospital on August 17, 1983 because of numbness of both lower legs and unsteady gait. He had recreationally inhaled nitrous oxide 30 to 60 minutes everyday since a year ago. Neurological examination showed ataxic broad-based gait, moderate loss of pain and touch sensation in the lower limbs up to patella. Position and vibratory senses were more severely impaired. Deep tendon reflexes increased in the upper extremities and at the knees, but diminished at ankle jerks. Muscle strength was normal. Prominent Lhermitte's sign was present. Except for reduced serum vitamin B12 level, laboratory results were normal. Needle electromyography showed high amplitude and long duration NMU in the right quadriceps and anterior tibial muscles. Motor nerve conduction velocity was 34 m/sec at the right posterior tibial nerve and could not be detected at the left. Sural nerve biopsy was performed. The density of the myelinated fibre measured on transverse section was in normal range but degenerated fibres were occasionally recognized. Single teased nerve fibre showed various degree of myelin ovoid along the fibre. Myelin loss was shown to occur in some parts of the fibre. Electron microscopy showed myelin splitting and formation of intramyelinic vacuoles containing myelin debris. Axon was almost normal at least in the early stage of degeneration. Later, axon disappeared with destruction of myelin sheath. These nerve changes largely demonstrated demyelination but it was occasionally accompanied with axonal degeneration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

A comparison of the rates of development of functional hexane neuropathy in weanling and young adult rats.

Chronic inhalation exposure of adult rats to hexane causes neural toxicities to develop over a period of several weeks. Because the developing organism is in many cases more vulnerable to toxic insult than the adult, and children make up a substantial proportion of the population of solvent abusers, we compared the effects of exposing weanling and young adult rats to 1000 ppm of hexane for 24 hrs/day, 6 days/week, for 11 weeks. Within two weeks of exposure, significance decreases in body weight and grip strength were observed in rats of both ages. However, the subsequent effects of the treatment on these indices of toxicity were greater in the young adults than in the rats first exposed as weanlings. The older rats also exhibited earlier and more severe signs of hindlimb flaccid paralysis. In contrast, the effects of hexane on tail nerve conduction time and on the brainstem auditory-evoked response were about the same in rats of both ages, with latencies increasing compared to controls over the exposure period. The relative resistance of the weanling rats to hexane neuropathy may be due to shorter, smaller-diameter axons, or to a greater rate of growth and repair in their peripheral nerves compared to those of adults.

Action Potentials↗
PubMed1996

Longitudinal changes in alcohol and drug use among men seen at a gay-specific substance abuse treatment agency.

OBJECTIVE: This study describes changes over a 12-month period in prevalence and frequency of alcohol and other drug use and correlates of change at 12 months in a sample of gay/bisexual men entering gay-identified outpatient substance abuse treatment. METHOD: A sequential sample of gay/bisexual men (n = 455) were recruited for a study in which substance use, sexual risk and psychological factors were assessed every 3 months. Changes in substance use were evaluated in 321 men who used in the 90 days before entering treatment and who completed at least one follow-up interview, whether or not they continued in treatment. RESULTS: At baseline, 95% of the sample reported alcohol use in the prior 90 days; 64%, marijuana/hashish use; 46%, amphetamine use; 33%, inhalant nitrites use; and 31%, cocaine use. Most men were polydrug users: 10% reported using only one drug (including alcohol); 39% used > or = 4 drugs. A marked reduction occurred in prevalence of use over time; declines on the order of 50% occurred in the first 90 days; prevalence then stabilized in remaining assessments. Frequency of usage by those reporting use of any given class of drugs also declined. No consistent predictors of reduction or cessation of use across different drug categories were found at 1 year. CONCLUSIONS: Substance use declined considerably in this sample. Given the scope of substance abuse problems among gay/bisexual men, and linkages to the HIV epidemic, considerable resources need to be focused on treatment and prevention for gay/bisexual men.

Adult↗
PubMed2004

Neurological and cognitive impairment associated with leaded gasoline encephalopathy.

BACKGROUND: A toxic encephalopathy (or 'lead encephalopathy') may arise from leaded gasoline abuse that is characterised by tremor, hallucinations, nystagmus, ataxia, seizures and death. This syndrome requires emergency and intensive hospital treatment. METHODS: We compared neurological and cognitive function between chronic gasoline abusers with (n=15) and without (n=15) a history of leaded gasoline encephalopathy, and with controls who had never abused gasoline (n=15). RESULTS: Both groups of chronic gasoline abusers had abused gasoline for the same length of time and compared to controls, showed equivalently elevated blood lead levels and cognitive abnormalities in the areas of visuo-spatial attention, recognition memory and paired associate learning. However, where gasoline abusers with no history of leaded gasoline encephalopathy showed only mild movement abnormalities, gasoline abusers with a history of leaded gasoline encephalopathy showed severe neurological impairment that manifest as higher rates of gait ataxia, abnormal rapid finger tapping, finger to nose movements, dysdiadochokinesia and heel to knee movements, increased deep tendon reflexes and presence of a palmomental reflex. CONCLUSIONS: While neurological and cognitive functions are disrupted by chronic gasoline abuse, leaded gasoline encephalopathy is associated with additional and long-lasting damage to cortical and cerebellar functions.

Administration, Inhalation↗
PubMed1995

Cardiovascular effects of cocaine in humans: laboratory studies.

Studies in which healthy, carefully screened, experienced cocaine users receive cocaine under controlled laboratory conditions, although often overlooked by the medical community, are an excellent source of data on the cardiovascular effects of cocaine. Cocaine is generally self-administered in repeated-dose 'binges', and studies simulating this pattern provide interesting cardiovascular information, such as the selective development of acute tolerance or the unique effects of some drug combinations. Studies with intranasal, intravenous, and smoked cocaine all show that under conditions in which subjects are allowed to take cocaine repeatedly, heart rate generally returns to near baseline levels between doses despite gradually increasing cocaine blood levels. Blood pressure either shows the same pattern, or gradual increases with repeated dosing. Analyses of cardiovascular activity as a function of cocaine plasma level indicate the rapid development of acute (i.e., within session) tolerance to cocaine. Cocaine self-administration often occurs in the presence of behavioral stressors, or in combination with other drugs of abuse or cocaine abuse treatment medications. Performance of a behaviorally-demanding task increases heart rate and blood pressure. When cocaine is taken prior to task performance larger increases in heart rate are observed than with either drug or task alone. An unexpected cardiovascular interaction was observed in subjects who inhaled cocaine and drank ethanol-containing beverages. This combination resulted in heart rate increases that were significantly larger than observed with either drug alone. Combinations of i.v. cocaine and smoked marijuana also increased heart rate above levels seen with either drug alone. A single intravenous dose of cocaine and morphine in combination, however, produced cardiovascular effects similar to those produced by cocaine alone. The effects of these drug combinations on blood pressure were often equal to the effect of one drug alone. Since cocaine is frequently taken in combination with potential treatment drugs, these interactions can be assessed under controlled settings prior to large-scale treatment studies. For instance, maintenance on the antidepressant desipramine increased baseline heart rate and diastolic pressure. Cocaine administration engendered increases in heart rate and blood pressure above the desipramine-elevated baselines. Clearly, drug interactions can have unexpected cardiovascular effects, and laboratory studies provide a controlled setting for understanding and studying these interactions.

Alcohol Drinking↗
PubMed1996

Eight years experience of a regional burns unit in Saudi Arabia: clinical and epidemiological aspects.

A retrospective analysis of 435 consecutive admissions to a regional burns unit over an 8-year period is presented. The majority were domestic accidents, while a few were suicidal and two were due to child abuse. Scalds were commoner than flame burns, 70.6 per cent were children under 12 years, 12.4 per cent had > 40 per cent TBSA affected, 66.9 per cent were deep partial or full thickness burns, 24.4 per cent had signs of shock on admission, 13.6 per cent had smoke inhalation injury. In spite of these known adverse factors the overall outcome was satisfactory, with a case fatality rate of 7.4 per cent and a residual disability rate of 10.8 per cent. Good initial resuscitation, a low infection rate (18.4 per cent) and the ready availability of appropriate surgical intervention (35.6 per cent), with good intensive care support, could account for the satisfactory outcome.

Adolescent↗
PubMed1985

Discriminative stimulus properties and brain distribution of phencyclidine in rats following administration by injection and smoke inhalation.

Four male Sprague-Dawley rats were trained to discriminate IP injections of 3.0 mg/kg phencyclidine (PCP) from saline under a 2-lever fixed-ratio 32 schedule of food presentation. After reliable discriminative control of lever choice was established, other doses of injected PCP were tested resulting in dose-dependent increases in PCP-lever selection and dose-dependent decreases in rates of responding. When doses of PCP were administered by exposure to smoke from cigarettes containing PCP, a dose-dependent increase in PCP-lever responding was also observed. delta 9-Tetrahydrocannabinol administered via smoke exposure, up to doses which markedly suppressed response rates, did not result in PCP-appropriate responding, demonstrating the specificity of the PCP stimulus by the inhalation route. Brain levels and distribution of 3H-PCP were determined in rats administered doses calculated to result in 50% generalization by the IP injection or smoke inhalation routes. By both routes of administration roughly equivalent brain levels were attained and the distribution was relatively even across the seven brain areas analyzed. These results demonstrate the validity of using the injection route of administration when studying PCP experimentally, in spite of the fact that PCP is abused primarily by smoking.

Animals↗
PubMed1993

Cocaine abuse in North America: a milestone in history.

The euphoric effects of coca leaves have been known to mankind for thousands of years. Yet the first epidemic of cocaine use in America occurred during the late 19th century. Initially, there were no laws restricting the consumption or sale of cocaine. In fact, cocaine was freely available in drug stores, saloons, from mail-order vendors, and even in grocery stores. It is reported that one drug manufacturer, in 1885, was selling cocaine in 15 different forms, including cigarettes, cheroots, inhalants, cordials, crystals, and solutions. Many famous imported wines, such as "Vin Mariani," contained a mixture of wine and coca. For consumers on budgets, the wonder drug was available as Coca-Cola and dozens of other soda pops and pick-me-up drinks. One of them even had a simple and direct name, Dope. Soon enough, the ill effects of cocaine became apparent, and by the 1920s cocaine was the most feared of all illicit drugs. Most states began enacting laws against cocaine use. President William Taft proclaimed cocaine as Public Enemy No. 1, and in 1914 the Congress passed the Harrison act, which tightly regulated the distribution and sale of cocaine. By the late 1950s, cocaine use in the United States was simply considered a problem in the past. Unfortunately, the people who were aware of the nation's first cocaine epidemic gradually passed away, and America once again was ready for its fling with cocaine in the 1960s. Today, it is estimated that upwards of 50 million Americans, that is one in four, have used cocaine. In addition, another fifty thousand people use this substance for the first time each day. More than 6 million Americans use cocaine on a regular basis. Little wonder, then, that America as well as the other countries have declared a "War on Drugs." In this review, pharmacology of cocaine, major complications arising from its use, and efforts to curb its abuse are discussed.

Cardiovascular System↗