Cocaine Inhalation Research Articles

Cocaine use and head and neck cancer risk: A pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.

Cocaine is an illegal recreational drug used worldwide, yet little is known about whether cocaine inhalation (smoking/snorting) increases the risk of head and neck cancer (HNC). The analyses were conducted by pooling data from three case-control studies with 1639 cases and 2506 controls from the International Head and Neck Cancer Epidemiology Consortium. Epidemiologic data, including cocaine use histories, were obtained in face-to-face interviews. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using hierarchical logistic regression models. Controlling for cumulative tobacco and alcohol use, we observed a weak positive association between cocaine use and HNC (ORever vs. never = 1.35, 95% CI: 0.96, 1.90). In stratified analysis, while we did not detect associations among never tobacco or alcohol users due to the limited sample size, the association with cocaine use was observed among tobacco users and alcohol drinkers. ORs for ever and high cumulative use (>18 times) versus never use were 1.40 (95% CI: 0.98, 2.00) and 1.66 (95% CI: 1.03, 2.69) among tobacco users, and 1.34 (95% CI: 0.93, 1.92) and 1.59 (95% CI: 1.00, 2.51) among alcohol drinkers, respectively. In this pooled analysis, we observed a weak positive association between cocaine inhalation and HNC risk. Our findings provide preliminary evidence of the potential carcinogenic effect of cocaine on HNC. Because of study limitations, including limited number of cocaine users, confounding, and heterogeneity across studies, future investigations will require larger studies with more detailed information on cocaine use history.

Possible Triggers of Supraventricular Tachycardia in a Toddler Rescued from a Garage Fire: A Case Report

AbstractWe describe the case of a previously healthy toddler with the finding of supraventricular tachycardia after being rescued from a garage fire. The patient's initial presentation was concerning for inhalational injury and a 2% total body surface area burn to the forehead. Additionally, the patient was noted to be extremely agitated in the trauma bay. Given the patient's agitation and the mysterious circumstances surrounding the fire, a urine toxicology was performed shortly after admission and was positive for cocaine. Passive cocaine inhalation, possibly during the fire, is a likely explanation for the child's arrhythmia.

Individuals Reporting Past 3-month Smoked Stimulant Use Are Placed at Risk for Infection and Injury Amid COVID-19.

Smoking stimulants, such as methamphetamine and "crack" cocaine, can spread infections, including hepatitis C and COVID-19, and lead to injuries, particularly when individuals share or use makeshift pipes. The purpose of the study was to assess the practices of people who inhale ("smoke") stimulants to guide future clinical harm reduction efforts. Anonymous surveys were administered to participants reporting inhalation of crack cocaine and/or methamphetamine in the past 3 months. Participants were eligible if they sought services from an outreach team staffed by a municipal syringe service program (SSP) or if they were patients at a low-threshold substance use disorder treatment program, the Massachusetts General Hospital Bridge Clinic. The survey was administered to 68 total participants, 30% of whom were recruited in the Massachusetts General Hospital Bridge Clinic and 70% through SSP outreach. Unsafe smoking practices were reported by 93% of participants. Among the 46% of participants surveyed who both smoked and injected stimulants, 61% of those participants stated that they injected instead of smoked stimulants because of lack of access to pipes. Amid COVID-19, 35% of participants adopted safer smoking practices. Most participants reported that they would be more likely to attend an SSP or health center if pipes were provided. Inhalational practices that place participants at risk of injury and illness are common. Providing safer smoking equipment may promote health and engage individuals in care.

988 A Case of Cocaine Associated Pneumomediastinum: An Unusual Diagnosis

Abstract Cocaine inhalation is an extremely rare but previously described association of spontaneous pneumomediastinum. We describe an unusual case of a previously well 20-year-old female who presented with a five-day history of central, pleuritic chest pain beginning one week after last cocaine inhalation. Blood tests were within the normal limits except for a positive d-dimer. Clinical examination was unremarkable, and a chest X-ray appeared grossly normal. A CT pulmonary angiogram revealed an extensive pneumomediastinum extending into the soft tissues of the neck and down to the peri-oesophageal region at the hiatus, without evidence of pneumothorax. The lungs and oesophagus appeared intact. The patient was admitted for observation and discharged within 48 hours. There is limited literature on this phenomenon, but almost all previous case reports suggest a benign, self-limiting course and resolution of radiological findings within 30 days. Invasive procedures are only considered if there is suspicion of oesophageal rupture or bronchial tree laceration. Spontaneous pneumomediastinum associated with cocaine inhalation is a relatively benign but uncommon condition with a predictable clinical course.

Risk factors for HCV transmission in HIV-positive men who have sex with men in México.

PurposeIn the last two decades transmission of hepatitis C virus (HCV) in HIV positive men who have sex with men (MSM) has been reported globally. Chemsex and specific sexual practices have been identified as risk factors. Our study aimed to identify risk factors for HCV transmission in MSM living with HIV attending in Mexico.MethodsWe conducted a case-control study from April to December 2019 at the Hospital de Infectología “La Raza” National Medical Center, in Mexico City. A case was defined as an HIV-infected MSM with positive HCV-antibody test. For each case, 3 controls were included, defined as HIV infected MSM with negative HCV-antibody test. A self-questionnaire covering sexual practices and other risk factors for HCV transmission was applied. Bivariate analysis was performed to obtain odds ratio (OR) using Chi-square test. Independent risk factors were identified in a subsequent analysis performing a logistic regression model.ResultsA total of 324 patients participated in the study, 81 cases and 243 controls. Median age was 30.5 years (IQR: 18–52) and 28.8 years (IQR: 21–45) in the case and control group, respectively. Most prevalent HCV genotype was 1a (79%). In the logistic regression model, sharing straw during cocaine inhalation (OR: 9.03; 95% CI; 1.35–13.52; P = 0.003), sharing sex toys (OR: 17.53, 95% CI; 6.85–44.86; P = 0.002), and ethyl chloride use for chemsex (OR: 2.26; 95% CI; 1.29–5.56; P = 0.037) were significant risk factors for HCV infection.ConclusionThis study identifies risk factors for HCV transmission in Mexico in HIV positive MSM in congruence with the findings of many studies performed worldwide. This is the first study that indicates a possible association between ethyl chloride use in chemsex and HCV infection. Assessment of local populations for risk factors for HCV transmission may help to develop specifically targeted behavioral interventions to reduce HCV transmission.

Stuck in my head as an old song

A 61-year-old piano man was admitted to the emergency department for loss of consciousness, aphasia and Glasgow coma scale of 13 points. His past medical history included hypertension, non-insulin-dependent diabetes mellitus and occasional inhalation of cocaine.

HAMMAN'S SYNDROME: A RARE CONSEQUENCE FOR A COMMON VICE

TOPIC: Disorders of the Mediastinum TYPE: Medical Student/Resident Case Reports INTRODUCTION: Roughly 42 million Americans have reported trying cocaine via myriad methods in their lifetime. Since the early 2000s, spontaneous pneumomediastinum as a result of intranasal cocaine use has been demonstrated though it remains a relatively rare occurrence. Though complications such as coronary vasospasm and thrombosis may prove a greater threat to life, it should remain a part of the clinician's differential when treating a patient with a history of cocaine abuse and chest pain. CASE PRESENTATION: A healthy 20-year-old male presented with chest pain, cough, and neck pain for 3 days. He was drinking with a friend and "snorted" cocaine a few times on the same night. A few hours into the evening, he experienced a sudden, sharp retrosternal chest pain, without radiation, and exacerbated by deep breathing. He denied trauma and denied vomiting, dry heaving, gagging, or other symptoms to cause concern for GI perforation as cause, despite drinking heavily that night.On evaluation, his oxygen saturation measured 98% on room air with normal pulse, blood pressure and temperature. Physical examination revealed extensive neck and chest wall subcutaneous emphysema. Electrocardiogram demonstrated normal sinus rhythm without arrhythmias or segmental changes. CT of the chest demonstrated large amounts of air in the superior mediastinum. Based on his history, severity of presentation, and laboratory investigations, there was no concern for mediastinitis or esophageal rupture. He did not require oxygen supplementation and his pain was well controlled, so he was discharged to his home. DISCUSSION: In 1939, Louis Virgil Hamman (1877–1946) described the co-occurrence of subcutaneous emphysema with spontaneous pneumomediastinum, thus coining the term Hamman's Syndrome for this particular malady. Subcutaneous emphysema occurs primarily within the head and neck due to anatomical proximity to the airway and pneumomediastinum as a result of cocaine insufflation is thought to be due to barotrauma, with rapid changes in intrathoracic and intra-alveolar pressures as the individual snorts and performs Valsalva maneuver. Though typically self-limited, complications of spontaneous pneumomediastinum to be aware of include airway compression, pneumopericardium, and mediastinitis. CONCLUSIONS: In a case of Hamman's Syndrome without a history of illicit drug use or trauma, it is prudent to investigate other secondary causes of spontaneous pneumomediastinum, such as esophageal or tracheobronchial rupture, that can prove fatal. Particularly in young males who abuse cocaine, the astute clinician must search for underlying causes of chest pain with recent drug use: coronary artery spasm or thrombosis, arrhythmia, pneumothorax, or pneumomediastinum. REFERENCE #1: Dadhwal R, Bulathsinghala C P, Choudhry I, et al. Cocaine-Induced Bronchial Laceration: A Rare Incidence. Cureus, 2021, 13(4): e14252. doi:10.7759/cureus.14252 REFERENCE #2: Jaensch, S.; Hwang, S.; Kuo, T. Spontaneous pneumomediastinum and subcutaneous emphysema following cocaine inhalation and ecstasy ingestion. Case Reports in Otolaryngology, 2019, Article ID 6972731: 1-4. https://doi.org/10.1155/2019/6972731 REFERENCE #3: Soares et al. Subcutaneous emphysema and pneumomediastinum following cocaine inhalation: a case report. Journal of Medical Case Reports, 2015, 9(195): 1-4. DOI 10.1186/s13256-015-0683-8 DISCLOSURES: No relevant relationships by Kendall Creed, source=Web Response No relevant relationships by Navkiran Randhawa, source=Web Response No relevant relationships by Sabrina Siddiqui, source=Web Response No relevant relationships by Victor Test, source=Web Response

Uno stato infiammatorio dell’ugula

Isolated uvulitis has been described in the literature following ‘crack’ cocaine and cannabis inhalation. The authors describe the case of a 16-year-old boy with isolated uvulitis associated to dyspnoea, tachycardia and vomiting probably due to cocaine inhalation.

Pneumomediastinum Secondary to Cocaine Use

Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema are rare complications of illicit drug abuse. Thorough history, examination, and investigations are required to rule out fatal complications such as oesophageal perforation. We present a case of a 22 year-old male presenting with pleuritic chest pain one day after cocaine inhalation and ingesting ecstasy. Conservative supportive management is appropriate when this occurs spontaneously without radiological evidence of visceral perforation.

Pulmonary talcosis related to cocaine inhalation.

Pulmonary talcosis related to cocaine inhalation.

WHIPPIT - WHIPPED THE LUNG

SESSION TITLE: Medical Student/Resident Disorders of the Pleura Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pneumothorax (PTX) can be a complication of invasive mechanical ventilation due to abrupt changes in pressure within the thoracic cavity. It can also occur due to sudden change in the intra-thoracic pressure as a complication of inhaled illicit substances such as cocaine and 3,4-Methylenedioxymethamphetamine (MDMA) (1,2). The recreational use of inhaled nitric oxide continues to rise, with prolonged inhalation leading to neurological complications (3). Here, we present a case of a PTX after inhalation of pressurized nitric oxide in a patient without any prior lung disease, a complication not previously reported. CASE PRESENTATION: A 25-year-old man with history of cannabis use disorder presented with sudden onset left sided chest pain and dyspnea that started after inhaling two canisters of Whippits (pressurized whipped cream chargers filled with nitric oxide). He was tachycardic and tachypneic upon presentation and was noted to have absent breath sounds over left hemi-thorax. Initial laboratory investigations including a complete blood count and comprehensive metabolic panel were unremarkable. Chest X-ray (CXR) revealed a large left PTX with complete collapse of the left lung. A chest tube was inserted on the left hemithorax with resolution of his symptoms and the PTX on imaging. A computed tomography of the chest showed no underlying lung disease. The patient was discharged with recommendations to abstain from inhaled nitric oxide use. DISCUSSION: PTX due to nitric oxide inhalation is uncommon, and to our knowledge no cases have been previously reported. However, PTX and pneumomediastinum from Valsalva maneuvers after use of inhaled drugs have been reported and have been associated with marijuana use (4,5,6). Although, there is no direct role of marijuana in the development of emphysema, high burden of inflammatory cells leading to lung injury and subsequent emphysema has been described (5). In our patient, who had no prior underlying lung disease, the development of PTX most likely resulted from sudden and rapid change in intra-alveolar pressure secondary to forced lung expansion from a Valsalva maneuver after inhalation of pressurized nitric oxide. CONCLUSIONS: Nitric oxide induced PTX has not been previously reported in the literature. In our patient, PTX in the absence of underlying primary lung disease can be explained by barotrauma from rapid inhalation of nitric oxide via Whippits. Further studies are warranted to evaluate the risk factors and incidence of PTX with pressurized nitric oxide inhalation. Reference #1: Ioannidis G, Lazaridis G, Baka S, et al. Barotrauma and pneumothorax. J Thorac Dis. 2015;7(Suppl 1):S38–S43. doi:10.3978/j.issn.2072-1439.2015.01.31 Reference #2: 2) Jaensch S, Hwang S, Shih-Wei-Kuo T. Spontaneous Pneumomediastinum and Subcutaneous Emphysema following Cocaine Inhalation and Ecstasy Ingestion. Case Reports in Otolaryngology. 2019; doi: 10.1155/2019/6972731 Reference #3: 3) Thompson AG, Leite MI, Lunn MP, Bennett DL. Whippits, nitrous oxide and the dangers of legal highs. Pract Neurol. 2015;15(3):207–209. doi:10.1136/practneurol-2014-001071 4) Hauben M, Hung EY. Pneumothorax as an adverse drug event: an exploratory aggregate analysis of the US FDA AERS database including a confounding by indication analysis inspired by Cornfield's condition. Int J Med Sci. 2013;10(8):965–973. Published 2013 Jun 13. doi:10.7150/ijms.5377 5) Mishra R, Patel R, Khaja M. Cannabis-induced bullous lung disease leading to pneumothorax: Case report and literature review. Medicine (Baltimore). 2017;96(19):e6917. doi:10.1097/MD.0000000000006917 6) Miller, W. Eugene, et al. “Pneumomediastinum Resulting from Performing Valsalva Maneuvers during Marihuana Smoking.” Chest, vol. 62, no. 2, 1972, pp. 233–234., doi:10.1378/chest.62.2.233. DISCLOSURES: No relevant relationships by Moeezullah Beg, source=Web Response No relevant relationships by Tasnim Islam, source=Web Response Consultant relationship with GSK Please note: $5001 - $20000 Added 04/23/2020 by Diego Maselli Caceres, source=Web Response, value=Consulting fee Consultant relationship with AstraZeneca Please note: $5001 - $20000 Added 04/23/2020 by Diego Maselli Caceres, source=Web Response, value=Consulting fee Consultant relationship with Sanofi/Regeneron Please note: $5001 - $20000 Added 04/23/2020 by Diego Maselli Caceres, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Sunovion Please note: $5001 - $20000 Added 04/23/2020 by Diego Maselli Caceres, source=Web Response, value=Honoraria Consultant relationship with Novartis Please note: $1001 - $5000 Added 04/23/2020 by Diego Maselli Caceres, source=Web Response, value=Consulting fee

Pneumomediastinum, subcutaneous emphysema and pneumorrhachis following cocaine insufflation: a case report

A case report on a 36-year-old male patient presenting to the emergency department (ED) with chest tightness, nasal sounding voice and subcutaneous emphysema 72 hours after the nasal insufflation of approximately 0.5g of cocaine. A plain radiograph of the chest demonstrated an extensive pneumomediastinum with subcutaneous emphysema extending into his neck. A computerised tomography (CT) scan confirmed the above findings, along with a pneumorrhachis of the thoracic spine. He was admitted locally for further investigation and observation. Cocaine is the second most used illicit drug in the UK. The associated complications of cocaine can vary from acute coronary syndrome to acute psychosis. Pulmonological trauma secondary to cocaine misuse is commonly associated with inhalation of cocaine; we present this rare case of subcutaneous emphysema, pneumomediastinum and pneumorrhachis secondary to nasal insufflation. It is believed that deep nasal insufflation of cocaine is followed by forceful Valsalva manoeuvre, which allows for the rapid absorption of the drug and increases the euphoric effect. This forceful inhalation can lead to barotrauma and leakage of air into the posterior mediastinum.

Spontaneous pneumothorax in cocaine users.

Pneumothorax is one of the respiratory toxic effects of cocaine inhalation. The literature counts several cases, some associated to other respiratory conditions such as pneumomediastinum, haemoptysis and others not requiring surgical treatment. We present a series of nonHIV cocaine-inhaler subjects who underwent video-assisted thoracoscopic surgery (VATS) for isolated spontaneous pneumothorax. Nine subjects, with a mean age of 24 ± 4 years, admitting cocaine inhalation, developed spontaneous pneumothorax and underwent 10 surgical treatments by means of VATS, at our Institution. Previous pneumothorax occurred in six cases episodes ranged from 0 to 5 (mean 1.6 ± 1.6). Chest computed tomography (CT) scan showed abnormalities in seven cases. All subjects underwent lung apicectomy, apical pleurectomy and mechanical pleurodesis. Seven subjects had also bullectomy. In all cases the visceral pleura was partially covered by fibrinous exudate. Histology of the lung showed small foreign body granulomatous inflammation in fibrotic and/or emphysematous pulmonary parenchyma. Relapse of pneumothorax occurred in one subject at 60 days and it was surgically treated. Mean follow-up was 150 ± 38 months (range 120-239). All subjects are now well, with no evidence of pneumothorax. Spontaneous pneumothorax in cocaine-inhaler subjects is a reality of which physicians need to be aware. Chest CT scan might not reveal abnormalities. Macroscopically the lung might presents bullae and/or peculiar visceral pleura. Foreign body granulomas observed in the specimens suggest that the particulate component of inhaled substances can injure the lung. Surgical treatment of the bullous disease and mechanical pleurodesis can provide a long-term follow-up without relapse of pneumothorax.

AN UNUSUAL PRESENTATION OF TRACHEAL STENOSIS FOLLOWING 22 HOURS OF ENDOTRACHEAL INTUBATION IN A COCAINE ABUSER

SESSION TITLE: Critical Care 5 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Tracheal stenosis following intubation is a relatively rare but a serious problem. Thermal airway injury from cocaine inhalation resulting in tracheal stenosis has been rarely reported. We present an unusual case of tracheal stenosis in a cocaine abuser which developed following twenty two hours of endotracheal intubation. CASE PRESENTATION: An 18 year old female with history of depression was brought to the hospital due to acute encephalopathy secondary to suspected Benzodiazepine (BDZ) overdose. She was found unresponsive and was intubated for airway protection. This was her first intubation. She was also getting treatment for aspiration pneumonia. Urine toxicology tested positive for BDZ and cocaine. She was extubated the next day after her mentation improved. After 4 days, she went into respiratory distress associated with significant stridor. The possibility of bronchial asthma or allergic reaction to medication was sought. Emergency intubation was done to secure the airway but there was no apparent tongue swelling, vocal cord edema or paralysis. Because of persistent stridor despite of aggressive bronchodilator treatment, flexible bronchoscopy was done. It showed endotracheal circumferential growth (4-5 cm above carina) which narrowed 50% of the lumen. Biopsy from the growth was negative for viral, fungal and bacterial etiology. Tissue pathology showed fragments of fibrin, acute inflammatory changes suggestive of tracheal stenosis. Patient was transferred to higher level of care. She underwent cryotherapy and dilation of stenosis and was successfully extubated. DISCUSSION: Recent endotracheal intubation and history of cocaine inhalation are important risk factors for tracheal stenosis in our patient. It seems unlikely that trauma at the time of intubation induced tracheal stenosis. Another important risk factor is cocaine inhalation, which can cause thermal injury, mucosal damage to trachea and consequent tracheal stenosis. Thermal airway injury secondary to cocaine smoking may result from either (a) inhalation injury from chemical byproducts transported in the smoke, or (b) intratracheal combustion of highly inflammable solvents used in the production process. We think that cocaine inhalation initiated injury to mucosa and recent intubation aggravated development of tracheal stenosis. CONCLUSIONS: Tracheal stenosis should be kept in a differential diagnosis in patient with post extubation stridor who has history of cocaine abuse despite of short duration of intubation. Treatment options include cryotherapy, balloon tracheoplasty, laser therapy and surgery. Reference #1: Carlos S. Restrepo, MD, Jorge A. Carrillo, MD, Santiago Martínez, MD, Paulina Ojeda, MD, Aura L. Rivera, MD, and Ami Hatta, MD Pulmonary Complications from Cocaine and Cocaine-based Substances: Imaging Manifestations Reference #2: Post intubation tracheal stenosis, Sajal De and Sarmishtha De Reference #3: Taylor, RF and Bernard, GR. Airway complications from freebasing cocaine. Chest. 1989; 95: 476–477 DISCLOSURES: No relevant relationships by Muhammad Habib, source=Web Response No relevant relationships by Mohammad Islam, source=Web Response No relevant relationships by Manish Patel, source=Web Response No relevant relationships by Thien Vo, source=Web Response

Cocaine Inhalation as a Risk Factor of Methicillin-Resistant Staphylococcus aureusNasal Colonization for Subjects Attending a Mexican Clinic

Background: Since Fleming detected growth inhibition in S. aureus mouldy culture plates, bacteria and humans have come a long way in the antibiotic resistance race. The increasing incidence of community-associated MRSA (Methicillin-Resistant Staphylococcus aureus) led the scientific community to identify risk factors for its carriage. Somers et al. obtained specimens from subjects attending a methadone clinic, and could not correlate inhalation of cocaine with nasal carriage. This study aims to gather data on the subject to determine if inhaling cocaine has an effect on MRSA carriage. Methods & Materials: For a 16-month period, patients attending our emergency unit were asked if they had ever inhaled cocaine. Those who had, were asked to respond a questionnaire regarding substance use and medical factors. Subjects with imprisonment, recent antibiotic use, hospitalization in the previous year, intravenous drug use, diabetes, HIV infection, renal or heart disease were excluded. Nasal, pharyngeal and inguinal swabs were obtained and the samples were plated on Mannitol Salt agar and incubated. S. aureus specimens were tested for susceptibility using the VITEK2 system and cefoxitin disk screen test. The study was designed so that variables were compared between those subjects with and without MRSA colonization using Pearson's Chi-squared test. All variables of interest were to be considered in a logistic regression analysis. Due to the lack of information regarding MRSA colonization in our local population, the authors decided to recruit non illegal drug users as matched controls. Results: Out of 150 specimens submitted for culture and identification, zero grew MRSA. Methicillin-sensitive S. aureus (MSSA) carriage had a 28% prevalence in the studied group (32% for matched controls). Out of the MSSA isolates, 11% were found exclusively in the inguinal samples. Males composed 92% of the subjects, with a mean age of 31 years. Only 56% of them had at least secondary education and 28% lived in overcrowded conditions. Due to the absence of MRSA isolates it was impossible to perform a logistic regression analysis. Conclusion: Our findings indicate that, in our community, inhaling cocaine does not represent a risk factor for MRSA carriage. Continued vigilant surveillance for carriage and infection among this population group is vital.

Impairment of spatial working memory and oxidative stress induced by repeated crack cocaine inhalation in rats

Crack cocaine is a highly toxic drug with great potential to induce addiction. It produces more intense effects than cocaine powder, with its use having grown worldwide. However, few studies have focused on the cognitive and biochemical consequences that result from crack cocaine inhalation. This study examined the effects of direct crack cocaine inhalation on spatial working memory and brain oxidative stress parameters in rats. Male adult Wistar rats, well-trained in an eight-arm radial maze (8-RM), underwent five sessions of crack cocaine inhalation (crack cocaine group) once a day or inhalation simulation (sham group), being tested in 1-h delayed tasks 24 h after the last inhalation. An additional inhalation session was carried out the following day, with the prefrontal cortex, hippocampus and striatum being removed five minutes afterwards in order to assess oxidative damage such as lipid peroxidation, thiobarbituric acid-reactive species (TBARS) levels, and advanced oxidation protein products (AOPP), as well as the activity of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). Animals from the crack cocaine group showed more errors (p < 0.01) in the 1-h post-delay performance in the 8-RM when compared to the sham group. The crack cocaine group showed decreased (p < 0.05) lipid peroxidation in the hippocampus and increased (p < 0.001) levels of AOPP and SOD activity (p < 0.05) in the striatum when compared to the sham group. Therefore, the repeated inhalation of crack cocaine impaired long-term spatial working memory and elicited oxidative stress in the hippocampus and striatum of rats.

Cocaine Allergy in Drug-Dependent Patients and Allergic People

Adverse reactions to local anesthetics (LAs), especially esters, are not uncommon, but true allergy is rarely diagnosed. To our knowledge, currently there is no reliable method of determining IgE-mediated hypersensitivity to LAs and cocaine. To assess the clinical value of allergy tests (prick, IgE, challenges, and arrays) in people suffering hypersensitivity reactions (asthma and anaphylaxis) during local anesthesia with cocaine derivatives and drug abusers with allergic symptoms after cocaine inhalation. We selected cocaine-dependent patients and allergic patients who suffered severe reactions during local anesthesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity, and predictive value) of allergy tests using cocaine and coca leaf extracts in determining cocaine allergy was assessed, taking a positive challenge as the criterion standard. After prick tests, specific IgE, and challenge with cocaine extract, 41 of 211 patients (19.4%) were diagnosed as sensitized to cocaine. Prick tests and IgE to coca leaves (coca tea) had a good sensitivity (95.1% and 92.7%, respectively) and specificity (92.3 and 98.8%, respectively) for the diagnosis of cocaine allergy and LA-derived allergy. Cocaine may be an important allergen. Drug abusers and patients sensitized to local anesthesia and tobacco are at risk. Both prick tests and specific IgE against coca leaf extract detected sensitization to cocaine. The highest levels were related to severe clinical profiles.

Crack cocaine inhalation induces schizophrenia-like symptoms and molecular alterations in mice prefrontal cortex

Crack cocaine (crack) addiction represents a major social and health burden, especially seeing as users are more prone to engage in criminal and violent acts. Crack users show a higher prevalence of psychiatric comorbidities – particularly antisocial personality disorders – when compared to powder cocaine users. They also develop cognitive deficits related mainly to executive functions, including working memory. It is noteworthy that stimulant drugs can induce psychotic states, which appear to mimic some symptoms of schizophrenia among users. Social withdraw and executive function deficits are, respectively, negative and cognitive symptoms of schizophrenia mediated by reduced dopamine (DA) tone in the prefrontal cortex (PFC) of patients. That could be explained by an increased expression of D2R short isoform (D2S) in the PFC of such patients and/or by hypofunctioning NMDA receptors in this region. Reduced DA tone has already been described in the PFC of mice exposed to crack smoke. Therefore, it is possible that behavioral alterations presented by crack users result from molecular and biochemical neuronal alterations akin to schizophrenia. Accordingly, we found that upon crack inhalation mice have shown decreased social interaction and working memory deficits analogous to schizophrenia's symptoms, along with increased D2S/D2L expression ratio and decreased expression of NR1, NR2A and NR2B NMDA receptor subunits in the PFC. Herein we propose two possible mechanisms to explain the reduced DA tone in the PFC elicited by crack consumption in mice, bringing also the first direct evidence that crack use may result in schizophrenia-like neurochemical, molecular and behavioral alterations.

Subcutaneous emphysema and pneumomediastinum following cocaine inhalation: a case report

IntroductionSubcutaneous emphysema or pneumomediastinum can occur as a complication of illicit drug use although this is rare. When occurring without a pneumothorax and spontaneously, it is usually treated conservatively, but can have serious consequences.Case presentationHere, we present the case of an otherwise healthy 23-year-old Caucasian man who presented to the Emergency Department at our institution and was found to have both subcutaneous emphysema and pneumomediastinum as a result of cocaine use. His only presenting symptom was mild chest pain and he had palpable subcutaneous crepitations. He underwent a series of investigations including a chest radiograph and computed tomography as well as a barium fluoroscopy study to rule out secondary pneumomediastinum, which can be fatal. There were no other pulmonary features of illicit drug use, such as granulomas or fibrosis, seen on radiological imaging. He was subsequently managed with a period of observation and supportive care.ConclusionWe report a rare case of subcutaneous emphysema and pneumomediastinum likely due to the nasal insufflation of cocaine. We discuss the necessary investigations to rule out any serious underlying pathology. These should be considered in patients who present with chest pain after cocaine use.

Une cause de nécrose palatine à ne pas méconnaître

We report a case of pseudotumoral nasal septum and hard palate perforation in a 42-years-old man. The diagnosis retained after differential diagnosis exclusion was necrotic midfacial lesion due to chronic inhalation of cocaine. This condition can mimic vasculitis, primary tumors and granulomatous infections. Differential diagnosis and pathophysiology of this condition will be discussed in this anatomo-clinical case.