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Lifetime prevalence of drugs use in adolescents from Cartagena, Colombia. Prevalencia de vida de consumo de sustancias sicoactivas en adolescentes de Cartagena, Colombia. Receipt date: June 27 th Approval date: March 23 rd Invest Educ Enferm. To estimate the prevalence of lifetime use of psychoactive drugs in adolescents from Cartagena, Colombia. Cross-sectional study carried out with a representative sample of adolescents between 13 and 17 years of age from the general population. The study inquired on use of psychoactive drugs at any time of their lives cocaine, ecstasy, inhalants, marihuana, or any drug that can be injected. The explanatory variables were adjusted through logistic regression. Participants were from low and middle socio-economic levels. Use of any illegal drug some time in their lives by adolescents is high, constituting a healthcare problem, which should be addressed by government organizations. This use was related to male gender, not being religious, cigarette smoking, and having risky alcohol use. Key words: substance-related disorders; adolescent; students; cross-sectional studies. Estimar la prevalencia de vida de consumo de sustancias sicoactivas en adolescentes de Cartagena, Colombia. Palabras clave: trastornos relacionados con sustancias; adolescente; estudiantes; estudios transversales. Experimentation or drug use some time during their lives keep an important relation with the prevalence of habitual use during adolescence and adult life. Within this process, nursing personnel play a relevant role in different healthcare contexts. Most studies available in Colombia reported on the lifetime prevalence of drug use based on samples of school-attending adolescents. Regarding the risk factors associated to use of illegal drugs some time in their lives, these vary in the different investigations. This information will permit knowing the dimension of experimentation outside the school context and will permit designing prevention strategies that take into account the associated factors. The aim of this research was to estimate the lifetime prevalence of psychoactive drug use in adolescents from low and middle socio-economic levels in Cartagena, Colombia. The parents or legal guardians of students under the age of consent signed the informed consent. Additionally, the students assented to participate, according to the norms for health research in Colombia. In the classroom, students filled out a questionnaire inquiring on the demographic characteristics and on the lifetime use of cocaine, ecstasy, inhalants glue , marihuana, or some injected psychoactive drug. The WHO-5 is a 5-item instrument with four response options scored from zero to three. The total score below six suggests clinically important depressive symptoms. The total score of seven or less indicates low self-esteem. This instrument includes five questions with an equal number of response options, scored from zero to four. Scores of 18 or less classify the person as non-religious. The five-point questionnaire was used with three response options scored from zero to two. Scores of seven or less indicate family dysfunction. An affirmative response to two or more points indicates risky alcohol use. A descriptive analysis was performed of the information collected. The internal consistency of the scales was estimated with Cronbach's alpha coefficient. A total of adolescents between 13 and 17 years of age participated. The general characteristics of those surveyed were as follows: mean age The internal consistency of the instruments used in this study was 0. Regarding frequencies of exposure to risk factors for use of psychoactive drugs in the group investigated, A total of Table 1 shows the associations between the risk factors studied and having used illegal psychoactive drugs during their lives. Except for the variables for age and clinically important depressive symptoms, significant differences were found in the rest of the risk factors considered by this study. Family dysfunction was shown as a moderate risk factor 2. Table 2 shows that in the multivariate model, importance was verified of four of the seven risk factors related in the bivariate analysis with the risk of having used illegal drugs during some point of their lives. This revealed that, although the strength of association diminishes, the following risk factors continue being high: cigarette use, not being religious, male gender, and risky alcohol use. The investigations consistently indicated that adolescents that not attending schools have a higher risk of drug use and other behaviors that can deteriorate the health status. It is important to highlight the association between daily cigarette use, risky alcohol use, and use of illegal drugs some time in their lives, consistent with other previous studies. Regarding the association and the attitude toward religion, this study 23 found that less religious youth had higher probability of using illegal drugs. These data agree with those reported in another study, 24 which holds that the factors related to religiosity are significantly associated to legal and illegal drug use. Youth with religious participation tended to associate with peers who had low levels of use, which is also related to lower individual propensity to said behaviors. Each of the risk factors analyzed herein must be considered upon designing interventions to prevent and control use of legal and illegal drugs; prevention can be facilitated by the presence of protective factors in the lives of individuals, which seem to influence on the use of different drugs, the family structure, religiosity, among others. Nursing professionals play an important role in preventing, identifying, and monitoring adolescents who use legal and illegal drugs, by actively leading and participating in prevention, and educational interventions and in promoting healthy behaviors. This study provides preliminary data upon exploring illegal drug use in adolescents from the general community. However, it presents the limitations of a cross-sectional study with a relatively small sample for analysis. The conclusion from this study is that for adolescents the use of any illegal drug at some time during their lives is high, constituting a healthcare problem that needs to be addressed by government organizations. This use was related to male gender, non-religiosity, current smokers, and engaging in risky alcohol use. Risky alcohol use and heavy episodic drinking among Spanish university students: a two-year follow-up. Gac Sanit. An Psicol. Enduring effects of prenatal and infancy home visiting by nurses on children: follow-up of a randomized trial among children at age 12 years. Arch Pediatr Adolesc Med. Consumo de sustancias psicoactivas en adolescentes, Bucaramanga, Colombia, Rev Colomb Psiquiatr. Comportamientos de riesgo para la salud en adolescentes estudiantes: prevalencia y factores asociados. Salud Uninorte. Paulone I, Candioti CA. Consumo de sustancias adictivas en adolescentes escolarizados. Arch Argent Pediatr. Salud Publica Mex. Developmental epidemiology of drug use and abuse in adolescence and young adulthood: Evidence of generalized risk. Drug Alcohol Depend. World Health Organization. Regional Office for Europe. Well-being measures in primary health care: The DepCare Project. Consensus meeting. Stockholm: World Health Organization; Rosenberg M. Society and the adolescent self-image. Internal consistency of a five-item form of the Francis scale of attitude toward Christianity among adolescent students. J Soc Psychol. Smilkstein G. J Fam Pract. Berks J, McCormick R. Screening for alcohol misuse in elderly primary care patients: a systematic literature review. Int Psychogeriatr. Factores predictores relacionados con bienestar general en adolescentes de Cartagena, Colombia. Rev Salud Publica;;12 1 Psychol Report. Consistencia interna del cuestionario CAGE para consumo abusivo de alcohol en adolescentes estudiantes. Arch Salud. Esc Anna Nery Rev Enferm. Puerta de entrada al consumo de sustancias ilegales en Colombia: Infracciones a la norma de inicio. Rev Salud Publica. Is religiosity a protective factor against substance use in young adulthood? Only if you're straight!. J Adolesc Health. The Psychology of Religion. Annu Rev Psychol. Evaluating the Lions -Quest ''Skills for Adolescence'' drug education program. Second-year behavior outcomes. Addict Behav. Developmentally inspired drug prevention: middle school outcomes in a school-based randomized prevention trial. Standards of practice for culturally component nursing care: a request for comments. Int Transcult Nurs. Morris J. In-between, cross, and within difference: an examination of ''cultural competence''. Int J Child Youth Fam. Leddy Susan, Pepper J. Filadelfia: Lippincott Company; All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. Conflicts of interest: none. How to cite this article.

Toxic Dilated Cardiomyopathy: Recognizing a Potentially Reversible Disease

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Official websites use. Share sensitive information only on official, secure websites. Postal Code , Porto - Portugal. E-mail: inesrang gmail. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The use of illicit drugs has increased in recent years 1. Related to this increase, there is a growing need to recognise and properly treat the adverse effects associated with the consumption of these drugs. These substances can induce several cardiovascular CV complications, being this acute or chronic 1. Some of them are the ischemic and arrhythmic events, the development of dilated cardiomyopathy DCM and the left ventricular systolic dysfunction LVSD. There are several types of drugs with different pharmacological and pathophysiological properties, and synergism is described between them 1. Among these, cocaine and heroin stand out. The key to a successful intervention towards one of these adverse effects is the high index of suspicion and early intervention. We describe the case of a year-old Portuguese woman, a heroin and cocaine addicted intra-venous consumption, as well smoking since the age of 23, a chronic bearer of hepatitis B and C virus, with a previous history of pulmonary tuberculosis treated and moderate drinking habits. The patient was admitted to the Emergency Department ED with exertional dyspnea of four months' evolution and progressive worsening in the last month dyspnea on mild exertion. She denied chest pain, fever, chills or other associated symptoms. She denied recent travelling outside Portugal. She also showed signs of pulmonary congestion, hepatomegaly and mild peripheral edemas. The chest x-ray showed an increased cardiothoracic index, signs of vascular cephalization, with hypotransparency at the level of the lower thirds of both lung fields, compatible with pulmonary congestion. The electrocardiogram revealed sinus tachycardia and left bundle branch block LBBB. Analytically, she had normochromic and normocytic anemia hemoglobin of She presented no significant elevation of myocardial necrosis or inflammatory biomarkers. Computed tomography angiography excluded signs of pulmonary thromboembolism and showed the presence of bilateral pleural effusion and alveolar consolidation. Mild right ventricular dysfunction was also evident. Transthoracic echocardiogram at admission showing the presence of dilated cardiomyopathy, with mitral regurgitation due to poor coaptation of the valve leaflets A and thrombus adhering to the apex arrow B. Given these findings, we conducted the diagnosis of decompensated heart failure HF in a patient with dilated cardiomyopathy and ventricular dysfunction, with probable toxic etiology. She was discharged by the 5 th day of hospitalization, and she was oriented to the outpatient Consultation in the hospital and to the Support Centre for Addicts. The oral hypocoagulant was suspended, keeping up the therapy with BB carvedilol and the ACE inhibitor lisinopril. All the types of recreational drugs may induce important CV complications and they are responsible for high morbidity and mortality. Following the cannabinoids, the psychostimulant drugs are the most widely consumed illicit substances. Acute intoxication by these drugs is a frequent cause of resort to the ED, particularly for chest pain, as well as an important cause of drug related death 2. Psychostimulants and opioids have been related with LVSD. However, few clinical reports have illustrated the role of drug abstinence in the recovery of heart failure and myocardial dysfunction, which can be achieved in a short period of time 3 , 4. The major cardiovascular manifestations, secondary to cocaine and heroin drug abuse, will be reviewed here. The CV toxicity associated with psychostimulants is well described and it is an phenomenon independent from the consumption standard, dosage or administration route. CV effects of cocaine abuse derive essentially from the activation of the sympathetic nervous system, contributing to the occurrence of arrhythmias and ischemic events 3 , 5. The ischemic events are undoubtedly the more frequent CV complications in consumers of stimulants such as cocaine 2. There is even a temporal relation between the consumption and the event. It was found that two thirds of acute myocardial infarctions AMI related to the effect of cocaine occur within the first three hours after its consumption 6. In addition, cocaine promotes thrombogenesis, by atherosclerotic plaque formation and platelet activation and aggregation 3 , 7. More rarely, the chronic use of cocaine is associated with the development of DCM and LVSD, the latter being potentially reversible with a consumption discontinuation 7. The mechanisms which cause the systolic dysfunction include direct toxic effects of cocaine, the presence of sustained ischemia, the persistent hyperadrenergic state and inflammatory mechanisms including the alteration of cytokine production and induction of myocyte apoptosis 5. Opioids are another type of recreational drugs. Heroin is the most widely consumed illicit opiate. They act by increasing parasympathetic activity and decreasing sympathetic activity, which can cause bradycardia and hypotension 1. Like psychostimulants, this kind of drugs has also been associated with the occurrence of several types of arrhythmias, ischemic events and potentially reversible LVSD 1 , 3. It is believed that the most likely mechanism of myocardial ischemia is also vasospasm. Moreover, acute heroin intoxication can cause noncardiogenic pulmonary edema due to the disruption of alveolarcapillary membrane integrity. The indicated treatment for the vast majority of patients admitted under recreational drug use is the conventional treatment, considering its complications and supportive measures. Although there are not enough studies about the best therapeutic strategy in this clinical context, current recommendations suggest that nitrates and calcium channel blockers are the preferred drugs for the initial control of arterial hypertension, coronary vasoconstriction and tachycardia verapamil. The consumption of recreational drugs can induce an extensive range of cardiovascular manifestations, causing many serious medical conditions which include arrhythmias, ischemic events and LVSD. The case described significantly illustrates the importance of recognizing the toxic etiology, particularly for recreational drug abuse, associated with dilated cardiomyopathy, which when treated properly and with proof, is potentially reversible and may have a favourable prognosis. As a library, NLM provides access to scientific literature. Arq Bras Cardiol. Marta Amorim 1 Centro Hospitalar S. Find articles by Marta Amorim. Carla Sousa 1 Centro Hospitalar S. Find articles by Carla Sousa. Paulo Bettencourt 1 Centro Hospitalar S. Find articles by Paulo Bettencourt. Keywords: Cardiomyopathy, Dilated; Cocaine; Heroin. PMC Copyright notice. Open in a new tab. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any post-graduation program. Similar articles. Add to Collections. Create a new collection. 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