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Background: Ecstasy, mainly composed of 3,4-methylenedioxymethamphetamine MDMA , is one of the most popular addictive synthetic drugs. This study was aimed to investigate the amount of MDMA in the ecstasy tablets seized in West Azerbaijan province, northwest Iran and also to assess the relationship between the physicochemical and morphological characteristics of the tablets. Methods: MDMA content of ecstasy tablets was analyzed using high-performance liquid chromatography method. The fluorescence spectrophotometer detector set at an excitation and emission wavelength of and nm, respectively. The retention time of ecstasy on this system was 2. The limit of detection and the limit of quantitation were found to be 0. Results: In this study, 85 ecstasy tablets were analyzed. Mean weight of the tablets was Mean MDMA content of the tablets was The tablets were classified into 8 groups based on their morphological features color and logo. Conclusion: There is variability in the physicochemical properties of ecstasy tablets available in the black market for illicit drugs in northwest Iran. This variability may potentially put abusers at increased risk of overdose due to inadvertent excess ingestion of the tablets to achieve desired effects and also experiencing more harm due to tablets adulterants. Asia Pac J Med Toxicol ; Nowadays, drug abuse is considered as a social, health, economic and cultural problem and has caused a great deal of global concern as a destructive phenomenon 1. Addictive synthetic substances are of great importance because young population of the society is more inclined to abuse them. The prevalence of synthetic drugs abuse in Iran is lower compared with other countries; however, it is getting increasingly popular especially among youth 1,2. It is an amphetamine-derived compound and due to its effects is categorized as a psychoactive drug by World Health Organization 3. American psychologists used this drug to facilitate psychotherapy in Since then and due the psychoactive properties of MDMA, many people have been encouraged using it for recreational purposes. Thus, the concern on the potential risks of non-medical use of these drugs urged the health authorities of the United States as well as other countries to restrict the use of MDMA and other amphetamine-derived medications 4,5. Nevertheless, these drugs are still illegally traded and abused across the world. In black market for illicit drugs, ecstasy is distributed in various forms, mostly capsules and oral tablets. Ecstasy tablets might be colorful and almost always some signs are imprinted on them 6. Ecstasy is easily absorbed by the gastrointestinal system and its peak plasma concentration can be reached after 2 hours 7. This compound is mainly metabolized by CYP2D6 enzyme in the liver 7. MDMA can enhance release of monoamine and acetylcholine neurotransmitters from nerve endings 8. Therefore, it leads to a considerable increase in wakefulness, energy, sexual arousal and delay in fatigue 6, Moreover, increase in the muscles activity due to the direct effect of the drug on the thermoregulatory system can induce hyperthermia 9. In addition, headache, stiffness and pain at the lower-back and limb muscles, nausea, loss of appetite, blurred vision, mouth dryness, hypertension, tachycardia and insomnia has been reported during the first days after consumption of ecstasy In long term and in the most extreme cases, the use of these drugs can entail to hyperactivity, uncontrolled thoughts, illusions, loss of emotional intelligence, depersonalization and anxiety 6,9,10,12, It has been found that no association may exist between the severity of ecstasy overdose and the number of tablets ingested, suggesting variation in the amount of MDMA in ecstasy tablets available in the black market Although this issue has been investigated in other parts of the world , only limited number of studies worked out the variation of MDMA content in ecstasy tablets available in the black market of Iran 18, Measurement of MDMA in these compounds helps determining their toxicity risk. The present study was aimed to investigate the amount of MDMA in the ecstasy tablets seized in West Azerbaijan province, northwest of Iran, using high-performance liquid chromatography HPLC techniques, and also to assess the relationship between the physicochemical and morphological characteristics of the tablets. Materials and devices. The compounds utilized in this study had the appropriate purity for chromatography. All solvents were of HPLC grade and reagents were analytical grade. For weighing the tablets, digital analytical balance with 0. Process of measurement of standard solutions concentration. The samples concentrations were measured using HPLC technique with fluorescence spectrophotometer detector. In addition, fluorescence spectrophotometer detector was set at an excitation and emission wavelength of and nm, respectively. Investigation of the standard curve. In addition, the limit of detection of 0. Figure 1. Calibration curve of the MDMA standard samples concentration range: 0. Investigation of accuracy and precision of the method. In order to determine the accuracy and precision of the analytical method, inter-day and intra-day changes were evaluated by calculation of standard deviation SD and coefficient of variation of the results obtained from investigation of the 3 selected concentrations. In order to monitor inter-day and intra-day changes, 3 different concentrations of MDMA standard solution were taken into account. The results of 5 replicates of each sample within one day inter-day are presented in table 1. Table 1. Inter-day changes of 3 concentrations of MDMA standard solution. The results of 5 replicates of each sample within 3 consecutive days intra-day are presented in table 2. Table 2. Intra-day changes of 3 concentrations of MDMA standard solution. Collection of tablet samples and ethics. The ecstasy tablets analyzed in this study were collected by the anti-narcotics police in West Azerbaijan province, Iran, and were handed over to our research laboratory after obtaining license from the higher authorities. Approval of the local medical ethics committee was obtained for performing this study. Stages of samples content analysis. Firstly, the ecstasy tablets were weighed using a digital scale. Then, the tablets were powdered using a porcelain mortar. Considering the difference in the tablets weights, 40 g of each tablet was put into appropriate falcon tubes. In order to effectively mix the materials and extract the MDMA, the mixture was put in ultrasonic device for 30 minutes. Then, the falcon tubes were centrifuged at g for five minutes. Ultimately, the samples were filtered using syringe filters and were injected into the HPLC column. Each sample was analyzed in triplicate Figure 2. Statistical analysis. The correlation between two variables was analyzed by using Spearman's rank correlation coefficient. P values less than 0. In this study, 85 ecstasy tablets were analyzed. As mentioned previously, the tablets were classified into 8 groups based on their color and logo Table 3. The highest and lowest weights were related to the tablets with pink camel The highest and lowest amounts of MDMA were related to the tablets with cross Table 3. Comparison of the 8 groups of tablets according to weight and MDMA content. Color and logo of tablets. Dark blue camel. Light blue camel. Pink camel. Brown captanor. White captanor. Yellow cross. Green Mitsubishi. Blue crocodile. Results showed that only 2 out of the 8 groups could be categorized into one group dark blue camel and light blue camel as they had similar weights and MDMA content. Furthermore, in spite of the fact that tablets with one logo may have different colors, their MDMA contents may not be significantly different. In this respect, tablets with camel imprinting had almost similar amount of MDMA, while the tablets with captanor logo were considerably different. Given the MDMA to weight ratio, the tablets could be divided into 4 groups: group 1: dark blue, light blue and pink camel; group 2: brown and white captonor and green Mitsubishi; group 3: yellow cross, group 4: blue crocodile. The present study was aimed to find reasonable relationship between morphological color and logo and physicochemical weight and MDMA content features of ecstasy tablets seized in northwestern Iran. We found some links between the tablets morphology and MDMA content as well as their weight. However, it should be noted that the weight and MDMA content of ecstasy tablets may not be precisely predicted if only their logo is taken into account because their weights and MDMA content even differs based on their colors despite having same logos. Nevertheless, as we found a significant correlation between MDMA content and tablet weight, it can be stated that the tablets weighing more contain greater amounts of MDMA. Khajeamiri et al similarly found partial relationship between MDMA content and weight of ecstasy tablets seized in different parts of Iran Correspondingly, in a study by Cole et al on ecstasy tablets seized in the north-west of England during to significant positive association between the weight of the tablets and the MDMA content was established However, in a study by Shetab Boushehri et al on the tablets captured in Tehran such correlation was not observed Ecstasy has been regarded as an illicit drug and its production and use has been prohibited in all countries. Hence, the production, distribution, and selling of this drug has been shifted to the black market for illicit drugs. Meanwhile, the production of ecstasy tablets has been expanded in illegal laboratories. Thus, these drugs are not controlled qualitatively and quantitatively, and so they are different regarding content, shape, color, and logo. Various studies have been performed on ecstasy tablets seized in different parts of the world and the findings of the most recent ones are summarized in table 4 14, As can be seen, illegal ecstasy tablets have a wide range of MDMA content throughout the world and in each country. Moreover, it seems that despite having relatively similar weight of tablets, there has been a year-wise decline in the MDMA content of tablets in a single country. Table 4. Physicochemical features of ecstasy tablets seized across the world. Study, ref n. Analysis technique. Physicochemical features of tablets. Weight mg. MDMA content mg. Cole et al, United Kingdom. Mean: Range: Palhol et al , Teng et al, GC-MS 3. Wood et al, Khajeamiri et al, LC-MS 4. ShetabBoushehri et al, TLC 5. Present study. Range: 0. In this respect, the MDMA content of ecstasy tablets in Iran decreased from mg in as assessed by Khajeamiri et al 18 to This annual decrease in the MDMA purity of ecstasy tablets has also been shown independently in the study by Cole et al as they found mean MDMA content of ecstasy tablets seized in northwest England decreased from mg in to 73 mg in This can be due the fact that illegal producers in the recent years have adulterated the tablets with different impurities to gain more benefits In the majority of cases, ecstasy tablets have been adulterated with caffeine, ephedrine and ketamine 23, Investigation of MDMA content in ecstasy tablets in Netherlands showed that reduction of MDMA purity led individuals to consume more tablets or high-dose preparations in order to achieve previous effects Thus, having information about the amount of MDMA in the tablets distributed in the illegal markets can help health authorities assess the change in the pattern of consumption among abusers. On the other hand, identification of morphological and physicochemical features of ecstasy tablets can be beneficial in the emergency departments to assess the severity of poisoning especially when an unconscious patient is admitted to the hospital. Hence, preparing an information bank of the common ecstasy tablets seized in each geographical region including the tablets logo, shape, color, weight and MDMA content is recommended. Nevertheless, it should be noted that the morphological characteristics of tablets cannot definitely determine the MDMA content. Furthermore, given the fact that ecstasy tablets are produced illegally, information about their impurities and adulterants are necessary to be obtained to help clinicians predict the consequences of consumption. In fact, having knowledge about the ecstasy tablets adulterants can provide the physicians with valuable information about unwanted complications of poisoning with these drugs and facilitate decision making in the treatment process. This can be investigated in future studies. We could not evaluate and analyze impurities of the tablets in this study. The sample of ecstasy samples analyzed in this study was related to illicit drug market in northwest of Iran and thus is not nationally representative of the population of Iran ecstasy tablets. In addition, this sample is limited to Iran and therefore our findings may not be extrapolated to ecstasy tablets in other countries. Long term effects of ecstasy tablets are indeed depended upon their MDMA content. There is variability in the physicochemical properties of ecstasy tablets available in the black market for illicit drugs in West Azerbaijan province, Iran. Authors would like to thank regional department of anti-narcotics police in West Azerbaijan province, Iran for their kind cooperation. Conflict of interest : None to be declared. Funding and support : Authors would like to thank the Vice Chancellor for Research, Urmia University of Medical Sciences, Urmia, Iran, for the financial support of this research project. Ghafari, R. Asia Pacific Journal of Medical Toxicology , 3 4 , Asia Pacific Journal of Medical Toxicology , ; 3 4 : Guide for Authors. Submit Manuscript. Contact Us. Full Text. Introduction Nowadays, drug abuse is considered as a social, health, economic and cultural problem and has caused a great deal of global concern as a destructive phenomenon 1. Methods Materials and devices The compounds utilized in this study had the appropriate purity for chromatography. Physicochemical features of ecstasy tablets seized across the world Study, ref n. Year Country N. Kulsudjarit K. Drug problem in southeast and southwest Asia. Ann N Y Acad Sci ; Prevalence and risk factors of ecstasy use among college students in Astara, Islamic Republic of Iran. East Mediterr Health J ; The prevalence of methamphetamine and amphetamine abuse in North America: a review of the indicators, Drug Alcohol Rev ; Afshari R. Afshari R, Monzavi SM. Poisoning with illegal substances and opioids. Mechanism-based inactivation of CYP2D6 by methylenedioxymethamphetamine. Drug Metab Dispos ; Actions of 3,4-methylenedioxymethamphetamine MDMA on cerebral dopaminergic, serotonergic and cholinergic neurons. Pharmacol Biochem Behav ; Kalant H. The pharmacology and toxicology of 'ecstasy' MDMA and related drugs. CMAJ ; The harmful health effects of recreational ecstasy: a systematic review of observational evidence. Health Technol Assess ; Depression, impulsiveness, sleep, and memory in past and present polydrug users of 3,4-methylenedioxymethamphetamine MDMA, ecstasy. Psychopharmacology Berl ; The agony of ecstasy: MDMA 3,4-methylenedioxymethamphetamine and the kidney. Clin J Am Soc Nephrol ; Variability in the 3,4-methylenedioxymethamphetamine content of 'ecstasy' tablets in the UK. Emerg Med J ; Analysis of illicit ecstasy tablets: implications for clinical management in the accident and emergency department. J Accid Emerg Med ; Composition profiling of seized ecstasy tablets by Raman spectroscopy. Analyst ; The content of ecstasy tablets: implications for the study of their long-term effects. Addiction ; Profiling of ecstasy tablets seized in Iran. Iran J Pharm Res ; Quantitative determination of 3,4-methylenedioxymethamphetamine by thin-layer chromatography in ecstasy illicit pills in Tehran. Toxicol Mech Methods ; Anal Chim Acta ; Characteristics and trends of 3,4-methylenedioxymethamphetamine MDMA tablets found in Taiwan from to February Forensic Sci Int ; Parrott AC. Is ecstasy MDMA? A review of the proportion of ecstasy tablets containing MDMA, their dosage levels, and the changing perceptions of purity. Tanner-Smith EE. Pharmacological content of tablets sold as 'ecstasy': results from an online testing service. Drug Alcohol Depend ; Adulterants in illicit drugs: a review of empirical evidence. Drug Test Anal ; Content of ecstasy in the Netherlands: Mean: Range:

Asia Pacific Journal of Medical Toxicology

Mashhad buy MDMA pills

Official websites use. Share sensitive information only on official, secure websites. Corresponding author: Feyza Bora. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Ecstasy MDMA; 3,4-methylenedioxymethylamphetamine is an illicit drug that has been increasingly abused by young people. Its effects include euphoria, enhanced sociability and heightened mental awareness. These come about via the increase of serotonin in both the central nervous system and the sympathetic nervous system. Due to personal pharmacokinetics, effects from the same dosage vary according to the individual. However, it is seldom the case that hyponatremia and hyperthermia co-exist. Hyponatremia is caused by the inappropriate secretion of arginine vasopressin AVP and the excessive intake of hypotonic liquid accompanied by increased hyperthermia. Symptomatic, even deadly hyponatremia is seen more frequently in females, with the effects of oestrogen on arginine vasopressin believed to be the cause. Reasons for acute kidney injury may include rhabdomyolysis, malign hypertension, and necrotizing vasculitis. Synthetic tablet abuse has seen a dramatic worldwide increase. We also suggest treatment methods for these kidney injuries. Ecstasy MDMA; 3,4-methylenedioxymethyl-amphetamine is an illicit drug that has been increa-singly abused by young people. The most well-known of the illicit synthetic tablets, it was introduced to Turkey in the early s — a country which, due to its geographical location and youthful population, has been subject to the negative effects of the international drug trafficking. However, it is still third on the list of most-seized drugs 1. The amounts of ecstasy captured in Turkey between are shown in the Table 1. Although the active component of ecstasy is 3,4-methylenedioxy-methylamphetamine MDMA , users of the drug give the same name to all similar synthetic tables. These tablets, which are illegally manufactured and sold on the streets, contain amphetamine-type stimulants. They may also contain sugar, inorganic chemicals and inorganic salts that do not have any stimulant, sedative or sleeping effects on the human body. Amphetamine-type stimulant substances are illegally produced. As a result, they contain additional chemicals that are created during the production process and which present an added danger to drug users. Ecstasy tablets are made and sold in various colours, with different geometric shapes and logos intended to make them more attractive to young people. The increased attractiveness of synthetic tablets leads to greater curiosity, which in turn leads to higher levels of addiction. Examples of recently captured ecstasy tablets are shown in Figure 1. In , the number of the deaths directly related to illicit drugs in Turkey was , rising to in — a MDMA causes feelings of vibrancy and well-being, loss of anxiety, emotional fluctuations and indecisi-veness 1 , 5 , 8 , 9. Initially, the body experiences hyperthermia and hyperactivity 1 , 5 , There may also be adverse effects such as exhaustion, sleeping disorders, nausea, vomiting, shudders, sweats, chin-lock, gnashing of teeth, blurry sight, dilating pupils, discomfort caused by light, and arrhythmia 1 , 5 , MDMA has a stimulant, hallucinogenic effect, and is also known to enhance mental factors such as energy, empathy and euphoria Generally considered a recreational drug, MDMA produces these effects by preventing the re-uptake of neuroactive hormones such as serotonin, dopamine and noradrenalin in both the central nervous system and the sympathetic nervous system Tablets that include amphetamine-type stimu-lants have a mass of between mg and mg 1. On average, they contain mg of MDMA. The drug begins to take effect after min, peaking at 90 min 14 , In general, its effect may last between hr, occasionally longer. The effects of illicit tablets on humans may depend on the contents and amounts of the tablet consumed. Effects may also differ from case to case depending on the varieties and amounts of the active ingredients in different synthetic tablets 5. MDMA metabolizes in two pathways. In the first, it conjugates with N-dealkylation, deamination, oxidation and glycine, becoming HMA 4-hydroxymethoxyamphetamine. Medicines that are inhibitors of cytochrome P 2D6 isoenzyme ritonavir and antifungal can prevent ecstasy from being metabolized 16 - It has been established that the effect of cytochrome P 2D6 isoenzyme, in addition to inhibiting other medicines, varies from person to person. As the drug stays longer in the body of people who metabolize it slowly, there is a higher risk of acute toxicity Due to the lower enzyme activity in people of Korean, Chinese and Japanese origin, there is an inclination towards hyperthermia, rhabdomyolysis, serotonin syndrome and multi-organ failure 19 , Also, it has been shown that MDMA metabolites might create an inhibitor complex with the cytochrome P 2D6 enzyme, leading to toxicity in repetitive doses. MDMA and metabolites 21 are removed by the kidneys, and variations in the removal process might explain why people taking the same dose of MDMA do not experience the same adverse effects. Although ecstasy usage is relatively common, instances of fatal adverse effects are rare. MDMA has a negative effect on the immune system. IL is an anti-inflammatory or immunosuppressive cytokine that inhibits the production of pro-inflammatory cytokine TNF-alpha, IL, and IFN-gamma, as well as decreasing many macrophage functions. MDMA also has a suppressive effect on catechol aminergic beta-adrenoceptor and nicotinic acetyl-choline receptor-mediated immune function 23 , The drug increases levels of glucocorticoid cortisol, plasma corticosterone, and also the inactive steroid dehydrocorticosterone. MDMA use may negatively affect cancer progression by inhibiting immune regulatory systems and reducing the resistance of host cells to viral infections The effects of ecstasy on the kidneys can be placed into the following sub-groups: effects on fluid and electrolyte metabolism; hyperthermia; and acute kidney injury. These categories are discussed in further detail below. Acute symptomatic hyponatremia heads the list of serious ecstasy-related complications. In terms of physiopathology, inappropriate secretion of AVP is believed to be the cause of hyponatremia. Psychogenic polydipsia resulting from the belief that large amounts of generally hypotonic liquid should be taken to avoid hyperthermia during parties could be of benefit to the physiopathology. In one study, there was a statistically significant increase from 1. Case studies in which AVP levels were not measured have also shown that urine osmolality increases incompatibility in the case of serum hypoosmolality, which is compatible with the inappropriate secretion of AVP MDMA and metabolites have been shown to increase serotonin levels in the central nervous system, and this high level of serotonin causes AVP release due to neurohypophysis It is believed that AVP release could increase with stress, physical activity and the use of nicotine—additional factors that are generally present in situations where ecstasy is used As seen in the case of fluoxetin—a serotonin-specific reuptake inhibitor SSRI —another factor might be increased water absorption in the internal medullar collector channel linked to an increase in the expression of aquaporin 2 channels Hyperthermia, which could be caused by a reduction in MDMA levels and an increase in HMMA, is not frequently seen in cases that are accompanied by hyponatremia Hyponatremia symptoms generally commence between two to twelve hours after ecstasy intake. In patients with Ayus—Arieff syndrome, there may be neurogenic pulmonary oedema. Hyponatremia in patients with this syndrome will cause the development of pulmonary oedema after cytotoxic cerebral oedema. Pulmonary oedema would result in hypoxia, which inhibits the volume regulation of the brain cells, which in turn causes further deterioration to the cerebral and pulmonary oedema The same Na values are more symptomatic in women than in men Some studies affirm that there is a higher risk of symptomatic hyponatremia in women and that the condition may even be fatal 38 , It is more likely for women to experience hyponatremia for the following reasons:. A study involving eight men and eight women found that the levels of copeptin, which is easier to quantify than MDMA, is higher in men. Hyperthermia is a fatal complication of MDMA. However, the condition might lead to non-traumatic rhabdomyolysis, hypotension, disseminated intravas-cular coagulation DIC , acute kidney failure, hepatic failure, cardiovascular collapse, intracranial bleeding and death 48 , Some studies state that hyperthermia originates from sustained heat resulting from the activation of 5-OH tryptamine and dopamine receptor systems 54 - It has been observed that hyperthermia does not originate from a change in heat adjustment in the hypothalamus, and antipyretics are hence not included in the treatment options. It has also been observed that increased muscular activity could contribute to hyperthermia Long-lasting hyperthermia may result in DIC and multi-organ failure 11 , The most significant reason for acute kidney injury is acute tubular necrosis caused by pigment due to non-traumatic rhabdomyolysis necrosis of myocytes caused by a rapid rise in cellular calcium. Acute kidney injury might be caused by hyperthermia, extreme activity, seizures, or by the direct toxic effects of MDMA on muscle cells Volume depletion increases the nephrotoxic effect of rhabdomyolysis. There may also be myoglobinuria, hyperuricemia, hyperkala-emia and hyperphosphatemia. Obvious and long-lasting hyperuricemia in particular may cause renal vasoconstriction, endothelial dysfunction, infla-mmatory response, oxidative stress and failures in autoregulation Reasons for acute kidney injury may include urinary bladder neck obstruction 60 and malign hypertension In a patient who has isole proximal tubule dysfunction, temporary glycosuria, phosphaturia and solute diuresis have all been observed In the literature, there are histopathologic diagnoses of necrotising vasculitis 63 and vascular thrombosis The presence of vascular thrombosis and fibrinoid necrosis 65 have also been seen in the results of renal biopsy performed due to the loss of graft function in two renal kidney transplant patients. A greater number of biopsy results would leave us better placed to establish the relationship between acute kidney injury and MDMA. The underlying cause of tissue damage due to MDMA may be increased oxidative stress or mitochondrial dysfunction The over-expression of antioxidant enzymes such as N-acetylcysteine, ascorbic acid or superoxide dismutase may neutralize the potential toxic effects of MDMA 70 , As there is increased urine osmolality due to the inappropriate secretion of AVP, hypotonic fluids and 0. In cases of acute medium symptomatic hyponat-remia, the transition from hyponatremia to normo-natremia may be achieved by restricting the intake of liquids. The patient should be clinically monitored for urine output, serum Na, urine osmolality and urine Na. AVP antagonists have recently been introduced for clinical use in cases where AVP secretion is inappropriate e. Paralysis and intubation could be performed to reduce muscular thermogenesis, while benzodiazepines can be used for reducing agitation and seizures. Although there are conflicting data on the use of Dantrolene a muscle relaxant in the treatment of hyperthermia caused by MDMA, there are cases in which Dantrolene has been employed successfully 74 , In a study by Hysek et al involving 16 healthy volunteers, Carvedilol helped reduce the low-level hyperthermia and cardiostimulant effects that occurred after a single dose of MDMA. Hyperthermia resulting from MDMA is caused by alpha 1 and beta adrenoceptor, and Carvedilol inhibits alpha 1 and beta 1. The authors therefore support the use of Carvedilol in treating hyperthermia Non-traumatic rhabdomyolysis is caused by long periods of dancing, seizures or hyperthermia. Hyperkalaemia originating from rhabdomyolysis can cause arrhythmias. Treatment requires hydration-force diuresis, monitoring of the fluid and electrolyte situation, including intake and removal, and kidney function tests. For hyperkalaemia, hemodialysis can be used. For hyperuricemia, rasburicase might be used A study by Karami et al has shown that an extract made from the leaves of plant called Feijoa sellowiana acca sellowiana histopathologically showed a protective effect in mice from MDMA-related injury by increasing kidney glutathione CKD presence, kidney function and albuminuria were not found to be related to the use of cocaine, methamphetamine and heroin 80 , despite a study by Vupputturi et al claiming this to be the case However, these studies are not sufficiently large to state with confidence that the use of illicit drugs is not linked to the development of CKD. An increase in the number of young people, coupled with the ease of cross-border transportation, mean that the use and accompanying health effects of MDMA will become more frequent in the future. The adverse effects of ecstasy use include mortality, particularly in young patients with hyperthermia or serious hyponatremia. Fatal hyperthermia is caused by increases in serotonin affecting muscular activity, the treatment for which requires peripheral cooling. Severe hyponatremia is caused by the inappropriate secretion of the antidiuretic hormone psychogenic polydipsia. In order to prevent hyperthermia, a high fluid intake is required. Besides fatal hyperthermia and hyponatre-mia, rhabdomyolysis generally non-traumatic causes acute renal failure. Rhabdomyolysis treatment in this instance is unconventional. Urine alkalization is not recommended, as it would reduce the ability of the kidneys to remove the MDMA We clinicians have an obligation to recognize these deadly side effects of MDMA. Most importantly, young people should be kept away from drugs in order to avoid complications that may result in their deaths. As a library, NLM provides access to scientific literature. Iran J Basic Med Sci. Find articles by Feyza Bora. Find articles by Taner Bora. Received Sep 10; Accepted Apr Open in a new tab. 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