How can I buy cocaine online in Las Palmas de Gran Canaria

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How can I buy cocaine online in Las Palmas de Gran Canaria

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How can I buy cocaine online in Las Palmas de Gran Canaria

Official websites use. Share sensitive information only on official, secure websites. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Anabolic-androgenic steroids AAS , a synthetic derivate of testosterone, have become a popular drug among athletes and bodybuilders to enhance muscle mass and improve the athletic performance. Many pathological effects such as hepatic and endocrine dysfunction, behavioural changes and cardiovascular complications have been reported. Within these ast ones, we find an increase in left ventricular muscle mass, concentric myocardial hypertrophy, left ventricular diastolic dysfunction, arterial hypertension, prothrombotic effects, changes in the concentration of cholesterol levels, particularly a reduction in HDL cholesterol concentration, myocardial infarctions in relation to endothelial dysfunction, vasospasms or thrombosis and sudden cardiac death. We report the case of a year-old patient with a history of arterial hypertension, depressive syndrome and consumption of cocaine, amphetamines and AAS who developed severe left ventricular systolic dysfunction and myocardial hypertrophy with signs of heart failure and peripheral arterial embolism. Anabolic-androgenic steroids AAS are synthetic derivates of testosterone used primarily for hormone replacement in male hypogonadism. However, in many countries, this medication is sold over-the-counter to enhance muscle mass and improve the athletic performance. Physiologically, elevations in testosterone concentrations stimulate protein synthesis resulting in improvements in muscle size, body mass and strength. AAS is by far the most detected doping substance banned by all major sporting bodies. AAS can cause many adverse effects such hepatic failure, endocrine dysfunction, behavioural changes or cardiovascular complications depending on the length and dose-dependent of drug abuse. The patient had an athletic constitution, with a weight of kg and a body mass index of Three days after requesting voluntary hospital discharge, the patient returned to the emergency department with intense weakness, deep sweating and severe arterial hypotension after beta blocker intake, requiring fluid and catecholamines perfusion for a few hours. Analytically, there was leukocytosis Basic coagulation study was normal and urine test showed positivity for methamphetamines and barbiturates. Cardiac markers were within normal limits. Abdominal ultrasonography showed increased heterogeneous echogenicity of the liver without associated focal lesions. Metanephrines and catecholamines in urine were checked to rule out pheochromocytoma, as well as thyroid-stimulating hormone TSH and antinuclear antibodies, which were all in normal range. The patient was discharged under angiotensin-converting-enzyme inhibitors, beta blockers and anti-aldosterone treatment emphasizing the need for a radical change in the lifestyle, type of physical exercise and eating habits. Meanwhile, analytical data shows normal serum sex-hormone-binding globulin SHBG concentrations, normal serum metanephrines and normetanefrines levels and normal catecholamines, metanephrines and normetanefrinas hour urine concentrations. However, testosterone levels were low 0. However 2 weeks later the patient was readmitted to the hospital due to critical ischemia of the lower limbs. Systemic heparinization associated with intravenous prostaglandin was started, presenting the patient an improvement of his symptoms with recovery of the mobility and the sensitivity. Control echocardiography showed severe global left ventricular dysfunction with a pedunculated mobile thrombus adhered to the ventricular septum Figure 1A. Arteriography of the lower limbs showed right popliteal artery and left superficial femoral artery occlusion with a poor collateral circulation Figure 1B. Given the improvement and little chance of surgical treatment due to the severe distal obliterations, conservative treatment and outpatient control was decided under oral anticoagulation treatment. A: Apical four chamber echocardiographic view showing a thrombus, 23 mm long, attached to the ventricular septum in the left ventricular cavity arrowhead. B: Lower limbs arteriography showing right popliteal artery arrowhead and left superficial femoral artery double arrowhead occlusion with a poor collateral circulation. Anabolic steroids have become a popular drug among athletes and are known to have a multitude of pathological effects when administered in suprapharmacological doses. Serious adverse effects include hepatic and endocrine dysfunction, behavioral changes and cardiovascular complications such as arterial hypertension, especially in those with pre-existing hypertension 1 , myocardial infarction 2 , myocardial hypertrophy with diastolic dysfunction 3 , congestive heart failure, ventricular arrhythmias, sudden death, arterial and ventricular thrombosis 4 , stroke and dyslipidemia 5. In fact, changes in the concentration of blood lipoproteins, particularly an increase in LDL and a reduction in HDL cholesterol, can lead to early atherosclerosis. However, and because of their youth, myocardial infarction in AAS consumers usually occur due to endothelial dysfunction, vasospasms or hypercoagulability 6. Meanwhile, left ventricular hypertrophy LVH differential diagnosis may be considered in arterial hypertension, hypertrophic cardiomyopathy, accumulation myocardial diseases, non-compact myocardium, valvular and combined cardiac pathology, compensatory LVH in athletes and the consumption of anabolic steroids. In this context, Nieminen et al. However, after cessation of the use of anabolic steroids left ventricular and wall thickness reduced quickly and left ventricular ejection fraction increased. Endomyocardial biopsy revealed increased fibrosis in the myocardium in two of the three cases. On the contrary, Urhausen et al. Similarly, D'Andrea et al. In fact, anabolic steroids consumers administer them in alternating cycles, and at doses much higher than usual, to maximize end-organ effects, to prevent gradual loss of benefits with chronic usage and to avoid detection on drug testing. In this context, the pituitary—testicular axis frequently becomes suppressed resulting in testicular atrophy, azoospermia, gynecomastia, hot flushes and fluid retention. Also, unfavorable cardiovascular events have been linked to both cocaine and anabolic-androgenic steroid abuse in healthy, physically active individuals 9. Cocaine can cause myocardial infarction in the context of coronary arteries spasms, enhanced myocardial oxygen demand and a procoagulant effect. Meanwhile, global ventricular dysfunction has been related to the cardiotoxic effects of the catecholamines on the heart. Similarly, the main cardiovascular manifestations of methamphetamine abuse encompass tachycardia, atrioventricular arrhythmias, myocardial ischemia and hypertension It is also important to draw attention to the fact that drug abuse addictions and psychiatric disorders often occur at the same time having certain mental conditions such as depression, bipolar disorders, psychosis, aggression and violence, mania, suicide and symptoms of dependence and withdrawal on discontinuation associated with AAS consumption 11 , Because the over-the-counter availability and unrestrained self-medication with products containing AAS create a heightened potential for serious side effects, we should be aware of those bodybuilder patients, especially if they have a psychiatric disorder background with the consumption of other types of drugs. As a library, NLM provides access to scientific literature. Int J Endocrinol Metab. Find articles by Efren Martinez-Quintana. Find articles by Beatriz Saiz-Udaeta. Find articles by Natalia Marrero-Negrin. Find articles by Fayna Rodriguez-Gonzalez. Find articles by Vicente Nieto-Lago. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

How can I buy cocaine online in Las Palmas de Gran Canaria