Stimulant Drugs of Abuse and Cardiac Arrhythmias

Nonmedical use of prescription and nonprescription drugs is a worldwide epidemic, rapidly growing in magnitude with deaths because of overdose and chronic use. A vast majority of these drugs are stimulants that have various effects on the cardiovascular system including the cardiac rhythm. Drugs, like cocaine and methamphetamine, have measured effects on the conduction system and through several direct and indirect pathways, utilizing multiple second messenger systems, change the structural and electrical substrate of the heart, thereby promoting cardiac dysrhythmias. Substituted amphetamines and cocaine affect the expression and activation kinetics of multiple ion channels and calcium signaling proteins resulting in EKG changes, and atrial and ventricular brady and tachyarrhythmias. Preexisting conditions cause substrate changes in the heart, which decrease the threshold for such drug-induced cardiac arrhythmias. The treatment of cardiac arrhythmias in patients who take drugs of abuse may be specialized and will require an understanding of the unique underlying mechanisms and necessitates a multidisciplinary approach. The use of primary or secondary prevention defibrillators in drug abusers with chronic systolic heart failure is both sensitive and controversial. This review provides a broad overview of cardiac arrhythmias associated with stimulant substance abuse and their management.

Impact of Environmental and Pharmacologic Changes on the Upper Gastrointestinal Microbiome

Diseases of the upper gastrointestinal tract have become more prevalent over time. Mechanisms of disease formation are still only partially understood. Recent literature has shown that the surrounding microbiome affects the propensity for disease formation in various parts of the upper gastrointestinal tract. A review was performed of any literature to our best knowledge concerning the effects of pharmacologic agents, environmental changes, and surgical intervention on the microbiome of the upper gastrointestinal tract. Searches of the literature were performed using specific keywords related to drugs, surgical procedures, and environmental factors. Many prescription and nonprescription drugs that are commonly used have varying effects on the upper gastrointestinal tract. Proton pump inhibitors may affect the relative prevalence of some organisms in the lower esophagus and have less effect in the proximal esophagus. Changes in the esophageal microbiome correlate with some esophageal diseases. Drugs that induce weight loss have also been shown to affect the microbiomes of the esophagus and stomach. Common surgical procedures are associated with shifts in the microbial community in the gastrointestinal tract. Environmental factors have been shown to affect the microbiome in the upper gastrointestinal tract, as geographic differences correlate with alterations in the microbiome of the gastrointestinal tract. Understanding the association of environmental and pharmacologic changes on the microbiome of the upper gastrointestinal tract will facilitate treatment plans to reduce morbidity from disease.

Antimicrobial effect of bothropstoxin-i in broilers

Bacterial resistance is a sanitary issue explained by indiscriminate use of nonprescription drugs, and antimicrobial use in food production for growth promotion. Bothropstoxin-I (BthTx-I) is a phospholipase A2 (PLA2) from Bothrops jararacussu venom, which has a known antimicrobial effect. The goal of this study was the unprecedented evaluation of in vivo antimicrobial activity of BthTx-I in broilers. Microbiological, biochemical, and histological parameters were determined using 84 21-day old broilers that were kept in cages with four birds each at a density of 625 cm2/broiler. The experiment was randomized by three treatments with seven repetitions of four broilers each that lasted seven days. The treatments were: 1) bacitracin zinc diet; 2) PLA2-BthTx-I; 3) without additives. The data obtained from the studied variables was subjected to analysis of variance and an F-test at the 5% significance level. Averages of each variable in each treatment were compared by Tukey’s test. Broiler bacterial cloacal counts showed that BthTx-I decreased the microbial population without reducing body weight, intestinal morphology, or liver or kidney histopathological damage. The toxin showed in vivo activity, being an alternative for better performance in the production of broiler chickens, because it acted by decreasing the microbial load of potentially pathogenic bacteria in the intestinal microbiota of the birds and did not cause muscle, liver or kidney damage at the assessed dosage.

Acute insomnia: experience of treatment with doxylamine

Insomnia is a common clinical condition characterized by difficulty initiating and/or maintaining sleep. According to most epidemiological studies, about a third of adults (30–36%) report at least one symptom of insomnia, such as having difficulty falling asleep or maintaining sleep. Insomnia interferes with the full-fledged social and professional functioning of patients, forcing them to visit doctors more often, take sick leave. While therapeutic approaches are actively developed and discussed in chronic insomnia, acute insomnia due to the transient state and the tendency (in some cases) to spontaneous resolution often remains the subject of underdiagnosis and undrtreatment. Antihistamines that are non-addictive and have a narrower side-effect profile and are nonprescription drugs are an alternative in the pharmacological treatment of insomnia, especially secondary and transient insomnia, which is widespread in the population. Donormil (doxylamine succinate) is a blocker of H1-histamine receptors from the ethanolamine group. Donormil (doxylamine succinate) is a blocker of H1-histamine receptors from the ethanolamine group. Doxylamine is successfully used in both psychiatric and general medical practice, including dermatology, allergology, and gynecology.This article presents the clinical observation of a patient with acute insomnia arising in adjustment disorder and was accompanied by anxiety and mild conversion symptoms.. Donormil therapy during two weeks allowed to reduce acute insomnia: the time to fall asleep and the number of night awakenings decreased, cognitive impairment, distraction, and asthenia associated with insomnia reduced. No significant side effects were observed.

Pediatric self-medication use in Rwanda – a cross sectional study

Background: Self-medication, a worldwide practice, has both benefits and risks. Many countries have regulated non-pre- scription medications available for use in self-medication. However, in countries such as Rwanda, where prescriptions are not required to purchase medications, prescription, non-prescription and traditional medications have been used for self-medi- cation. Objectives: To determine the reported self-medication use in Rwanda and to determine attitudes and reasons associated with parental decisions to self-medicate their children. Methods: A cross-sectional multi-center questionnaire based quantitative study of 154 parents/caregivers of children under ten years undertaken in private and public health facilities. Results: The use of self-medication was reported to be 77.9%. Among these parents/caregivers, 50.8% used modern self-medication only, 15.8% used traditional self-medication only and 33.3% used both types of self-medication. Paraceta- mol was the most commonly used drug in modern self-medication; the traditional drugs used were Rwandan local herbs. Parents/caregivers who used modern medicines had slightly more confidence in self-medication than self-medication users of traditional medicines (p=0.005). Parents/caregivers who used modern self-medication reported barriers to consultation as a reason to self-medicate more frequently than those who used traditional drugs. Having more than one child below 10 years of-age was the only socio-demographic factor associated with having used self-medication (AOR=4.74, CI: 1.94- 11.58, p=0.001). Being above 30 years (AOR= 5.78, CI: 1.25-26.68, p=0.025) and living in Kigali (AOR=8.2, CI: 1.58-43.12, p=.0.012) were factors associated with preference of modern self- medication compared to traditional self-medication. Conclusion: Self-medication is common in Rwanda. Parents/caregivers are involved in this practice regardless of their socio-demographic background. Keywords: Self-medication; medicines; parents; caregivers; children; Nonprescription Drugs; Rwanda.

Injuries Caused by Freshwater Stingrays in the Western Amazon: Folk Medicine and Beliefs

The envenomation caused by freshwater stingrays is one of the most frequent injuries related to aquatic animals in South America. Such injury is severe with skin necrosis as a probable result of the sting and subsequent intense pain. Here, we characterized the accidents caused by freshwater stingrays in Juruá Valley, Acre, Brazil, with reports of people who had suffered injuries. Data collection was performed in nearby communities in the Juruá River and its tributaries through a semi-structured questionnaire. Bathers and fishermen were the main group affected, and injuries were mainly in the lower limbs. The results were similar to those previously reported for other regions of Brazil, except for the treatment applied. Severe pain, edema, erythema, necrosis, and ulceration of the wound are some of the symptoms reported by the injured population. Most of the treatment is based on folk remedies, such as human urine, hot boiled egg, medicinal plants, and nonprescription drugs. In most cases, injuries usually occur in remote areas which favor the use of folk remedies, but the accidents are still neglected by the population itself because of the low lethality. Therefore, educational activities and prophylactic measures should be carried out with a standardization of first aid and late measures. In addition, the correct use of medicinal plants and folk remedies could be a strong ally to ensure a safe and affordable care for the population.