Sexual Dysfunction as a Side Effect of Hyperprolactinemia in Methadone Maintenance Therapy

Although endocrine abnormalities are recognized in opiate users, very little is known about the range of hormones affected, their pathophysiology and their clinical relevance. Various endocrine abnormalities have been reported in these patients including, increased prolactin levels and abnormalities in sexual hormone. Path physiological mechanism postulated does explain these findings including direct action of heroin or methadone at the hypothalamic pituitary level. The aim of this study was to explore the effects of heroin and methadone maintenance treatment on the plasma prolactin levels and sexual function. Material and methods: We evaluated 20 male narcotic addicts maintained of methadone more than 3 years on oral high dose methadone 60-120 mgr/day. Patients taking neuroleptic therapy were excluded from the study because neuroleptic-included hyperprolactinemia. We also evaluated group of twenty male heroin addicts on the street heroin .The prolactin plasma levels were assayed using the chemiluminescent immunometric essay (CLIA) - high sensitive methods, The normal range of prolactin levels was 1,5-17 ng/ml(53-360 nmol/l) for men and 1,90-25,0 ng/ml for women. The sexual function was assessed using a Questionnaire: International Index of Erectile Function (IIEF) with 15 items in four levels of sexual function. The differences between two examination groups were determined by a student’s t test. The results show that street heroin addicts (55% of them have high level of prolactin) have significantly higher plasma prolactin levels (p=0,006) then the group of methadone maintenance patients (only 15% of them have high prolactin level). In our study, when we compared sexual dysfunction in examination groups in some domains, we did not find statistical significant results (sexual desire p=0,52 and overall satisfaction p=0,087). But in domains of erectile function p=0,011 and orgasm function p=0,033 we got statistical significant results. Key words: heroin addiction, methadone maintenance therapy, sexual dysfunction, prolactin plasma level

Respiratory Complications from Acute Corrosive Poisonings in Adults

Introduction: Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are most commonly used as household agents. Intoxications with these kind of agents produce numerous and severe post-corrosive complications of the upper gastrointestinal tract. On the other hand, our experience showed that corrosive agents may also cause injuries of the respiratory system, which makes the treatment very hard and additionally complicates the severe clinical condition of the patient. Objective: The aim of the study is to show the incidence of respiratory complications in acute corrosive poisonings, the need of various clinical investigations and also the treatment and final outcome of these kind of poisoning. Methods: We retrospectively analyzed clinical records of 415 patients hospitalized and treated at the University clinic for toxicology and urgent internal medicine, in Skopje, Republic of Macedonia, in the period between 2007 and 2011. The protocol consisted of methods for analyzing the systemic complications, with an accent on the post-corrosive respiratory complications. Results: From the total number of patients even 98 (23.61%) exhibited systemic complications, from which 51 (52.04%) are respiratory complications. The majority of patients are female (n=40, 78.43%) and the most common complication is pneumonia (n=47). The youngest patient in this study was 14 and the oldest was 87 years old. Conclusion: Besides the gastrointestinal complications in the acute corrosive poisonings respiratory complications are also very often. They complicate the clinical state of patient and very often lead to fatal endings

Nutritional therapy in the treatment of acute corrosive intoxication in adults

Introduction: Acute intoxications with corrosive substances can cause severe chemical injuries of the upper gastrointestinal tract, most often located in the mouth, pharynx, esophagus, stomach and duodenum. If a patient survives the acute phase of intoxication, regenerative response may result in esophageal and/or gastric stenosis, and increased risk of esophageal and gastric cancer. Such intoxication may be fatal due to perforation or tracheal necrosis. Enteral nutrition is a nutritional method when nutritional substances are administered through specially designed tubing placed through the nose or percutaneously, directly into the GIT. Aim: The aim of this study is to describe the methods of artificial nutrition in patients with acute corrosive intoxications and the importance of nutritional support in the treatment of these intoxications. Discussion: Nutrition in the treatment of acute corrosive intoxications is one of the most important therapeutic processes that largely contribute to faster recovery of the post-corrosive injuries of upper GIT, stabilization of biologic, immunologic and metabolic parameters, and reduction of length of stay in hospital Aim of the treatment of acute corrosive intoxications is to prevent perforation and progressive fibrosis, and esophageal and gastric stenosis. There are different and often conflicting positions, on the conservative treatment of acute corrosive intoxications in adults. Such treatment mainly consists of anti-secretory treatment, antibiotics and intensive hyper-alimentation, aiming to prevent late post-corrosive intoxications. Conclusion: It is considered that nutritional support plays a major role in maintenance of metabolic processes and prevention of severe metabolic complications that could additionally aggravate the condition and impair the treatment. Key words: corrosive poisonings, deglutition, deglutition disorders, nutritional therapy, enteral nutrition, parenteral nutritio

Multi–System Complications after Intravenous Cocaine Abuse

BACKGROUND: Use and abuse of cocaine are associated with numerous adverse effects, independent of the route of administration. More severe conditions of poisoning, however, are observed after cocaine intravenous administration.AIM: We present a case of severe poisoning after violent intravenous injection of cocaine, but with a good outcome.CASE PRESENTATION: Cocaine was intravenously (i.v.) administered in 16-years old female patient as a homicide attempt. Shortly after that, patient experienced series of generalised tonic-clonic seizures, was highly febrile (400C), somnolent, agitated, presenting with tachycardia, tachypnea and with increased blood pressure 150/90 mmHg. Neurologic status, lumbar puncture and computerised tomography (CT) of the brain were without remarks. Electroencephalogram (EEG) was characterised with signs of diffuse encephalopathy, and acid-base analyses resulted in metabolic acidosis. Urine screening revealed the presence of cocaine and benzodiazepines. The patient presented with signs of the hepatic lesion, acute renal insufficiency (ARI), and increased D-dimers resulting from activated fibrinolysis. The patient was discharged in stable general condition after being hospitalised for 23 days.CONCLUSION: Intravenous abuse of cocaine results in overdose and serous multi-system complications requiring multidisciplinary diagnostic and intensive therapeutic approach

Teško oštećenje bubrežne funkcije u odraslih bolesnika s akutnim trovanjem octenom kiselinom

Acetic acid is a widely used organic acid with corrosive properties that depend on its concentration. If acetic acid is ingested in concentrations above 30 % it may severely damage the upper gastrointestinal tract and cause intravascular haemolysis, which can result in severe kidney and liver disorders and disseminated intravascular coagulation. In this retrospective study, we analysed acetic acid ingestion data collected at the University Clinic for Toxicology of Skopje, Macedonia from 1 January 2002 to 31 December 2011. The analysis included systemic complications, kidney damage, and the outcomes in particular. Over the ten years, 84 patients were reported at the Clinic to have ingested highly concentrated acetic acid. Twenty-eight developed kidney disorders, while the remaining 56 had no complications. Fatal outcome was reported for 11 patients, seven of whom had systemic complications and four severe gastrointestinal complications.Octena kiselina organska je kiselina s korozivnim svojstvima koja ovise o njezinoj koncentraciji. Ako se unese u koncentracijama iznad 30 %, može teško oštetiti gornji dio gastrointestinalnog sustava i izazvati intravaskularnu hemolizu, što može dovesti do teških oštećenja bubrega i jetara te do diseminirane intravaskularne koagulacije. U ovome retrospektivnom ispitivanju analizirani su slučajevi gutanja octene kiseline prikupljeni u Sveučilišnoj klinici za toksikologiju u Skopju od 1. siječnja 2002. do 31. prosinca 2011. Analize su obuhvatile sistemske komplikacije, oštećenja bubrega i ishode. Tijekom deset godina, u Kliniku su se javila 84 bolesnika zbog gutanja visokokoncentrirane octene kiseline. Njih 28 dobilo je bolest bubrega, a preostalih 56 nije imalo komplikacije. Smrtni je ishod bio zabilježen u 11 bolesnika, od kojih je sedam imalo sustavne komplikacije, a četiri teške gastrointestinalne komplikacije

The role of urgent esophagogastoduodenoscopy in prognosis of acute caustic poisonings

Acute corrosive poisonings cause severe chemical injuries of the upper gastrointestinal tract, the most common location being the esophagus and the stomach. There are different opinions concerning the ques- tion of taking food and liquids by mouth immediately after caustic ingestion. This prospective study comprised 146 patients aged between 14 and 75 years divided in two groups. In the examined group prevailed those with esopha- gitis gr.IIb ( n=36; 54,54 %), esophagitis gr.III ( n=30; 45,45 %), gastritis gr. IIb (n=42, 63,63 %) and gastritis III (n=24;36,36%). In the controlled group prevailed those with esophagitis gr III ( n= 52; 65 %) and esophagitis gr IIb (n= 28; 35 %), gastritis gr. IIb( n= 55; 68,75 %)and gastritis gr III (n= 25; 31,25 %). Analysis of the results has shown a high percentage of esophageal stenosis in both groups 25 days after poisoning (31.82% v.s 43.75%), three and six months after poisoning (36.36% v.s. 52.50%) and also gastric injuries 25 days after the poisoning ( 37,88 % v.s. 46,25 %), three and six months after the poisoning (40,91% v.s 53,75%) In spite of the not significant difference, the results of our investigation have shown that the group with “esophageal rest” (NPO) had a smaller percentage of post-corrosive complications than the patients who were given food or liquids immediately after poisoning

Nutritional Therapy in Adult Patients with Post-corrosive Injuries of GastrointestinalTract

Acute poisonings with corrosive substances may cause serious chemical injuries of the upper gastrointestinal tract, from the mouth to the intestines. They appear as a result of accidental or intentional ingestion of caustic substances and may be found in patients of different ages. The aim of this paper was to present our experience with nutritional support in patients with acute caustic poisonings that hinder normal nutrition. Material and Methods. This retrospective study included 33 patients with a history of corrosive substances abuse (acids, alkali and chlo- rine bleach), of both sexes, aged above 14 years. Results. Follow-up assessment of our patients has shown a considerable weight loss on day 7 (p<0.001), day 14 (p<0.001), day 21 (p<0.001) and day 28 (p<0.001) after admission to hospital, which is explained with the severe post-corrosive condition of the patients and hypercatabolic state. Conclusion. Caustic poisonings are the most severe poisonings in the clinical practice and they are mostly encountered in younger adults. By application of artificial nutritional support we managed to maintain body weight, level of proteins and albumins, nutritional status and nitrogen balance in our patients. Key words: corrosive poisonings, nutritional therapy, proteins, nitr

Clinical evaluation and management of acute corrosive poisoning in adult patients - A ten year experience

Acute poisonings with corrosive substances cause various chemical injuries along the entire upper gastrointestinal tract and they can be either superficial or destructive, often leading to serious and fatal complications, such as perforation. The outcome of these intoxications depends on the severity of the injuries, clinical state of the patient and obtainability of adequate medical treatment [1-3]. Unfortunately, acute corrosive poisonings in adults have high mortality rates and still remain serious medical and social proble

Acute corrosive poisonings - Frequent cause for fatal outcome

We are presenting you with a follow-up of our previously published study pertaining to acute corrosive intoxications, based on data collected over a ten-year period. Despite the efforts to decrease the incidence of acute corrosive intoxications through educational activities, media platforms and information brochures about the health risks from the ingestion and abuse of corrosive agents, these poisonings are still a serious medical and social issue with high morbidity and mortality rates. Our study showed that the occurrence of these poisonings was higher in populations of lower socioeconomic and health status, among which there were higher rates of suicide attempts, greater risk for long-term invalidity and even death.