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Galor A, Britten-Jones AC, Feng Y, Ferrari G, Goldblum D, Gupta PK, Merayo-Lloves J, Na KS, Naroo SA, Nichols KK, Rocha EM, Tong L, Wang MTM, Craig JP. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf 2023; 28:262-303. [PMID: 37054911 DOI: 10.1016/j.jtos.2023.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Surgical Services, Miami Veterans Administration, Miami, FL, USA.
| | - Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Yun Feng
- Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, San Raffaele Scientific Institute, Milan, Italy
| | - David Goldblum
- Pallas-Kliniken, Olten, Bern, Zurich, Switzerland; University of Basel, Basel, Switzerland
| | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA; Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo, Principality of Asturias, Spain
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eduardo M Rocha
- Department of Ophthalmology, Othorynolaringology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Huang Y, Nguyen NV, Mammo DA, Albini TA, Hayek BR, Timperley BD, Krueger RR, Yeh S. Vision health perspectives on Breaking Bad: Ophthalmic sequelae of methamphetamine use disorder. FRONTIERS IN TOXICOLOGY 2023; 5:1135792. [PMID: 36969265 PMCID: PMC10031494 DOI: 10.3389/ftox.2023.1135792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023] Open
Abstract
Methamphetamine use has become a rampant public health issue that not only causes devastating consequences to the user but also poses a burden to surrounding communities. A spectrum of ophthalmic sequelae is associated with methamphetamine use and includes episcleritis, scleritis, corneal ulceration, panophthalmitis, endophthalmitis, retinal vasculitis, and retinopathy. In many instances, prompt recognition of the condition and associated infectious process and early initiation of antimicrobial therapy are crucial steps to preventing vision loss. In this review, we summarize the reported ocular complications that may result from methamphetamine use in addition to several postulated mechanisms regarding the ocular toxicity of methamphetamine. The increasing prevalence of methamphetamine use as a public health threat highlights the need for continued investigation of this ophthalmologic issue.
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Affiliation(s)
- Ye Huang
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Nam V. Nguyen
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Danny A. Mammo
- Cleveland Clinic, Cole Eye Institute, Cleveland, OH, United States
| | - Thomas A. Albini
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Brent R. Hayek
- North Georgia Eye Clinic, Gainesville, GA, United States
| | - Brent D. Timperley
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ronald R. Krueger
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- *Correspondence: Steven Yeh,
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Huang Y, Chundury RV, Timperley BD, Terp PA, Krueger RR, Yeh S. Ophthalmic complications associated with methamphetamine use disorder. Am J Ophthalmol Case Rep 2022; 26:101464. [PMID: 35282603 PMCID: PMC8907677 DOI: 10.1016/j.ajoc.2022.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose To describe the devastating ophthalmic sequelae of methamphetamine use disorder in two patients who developed vision loss from ocular complications, including keratitis and endophthalmitis. Observations Case 1 is a 26-year-old male with hepatitis C, poorly controlled type 1 diabetes, and chronic methamphetamine use who presented with a corneal ulcer in the left eye. Corneal culture grew Staphylococcus aureus and Streptococcus viridans, prompting antibiotic therapy. Follow-up exam showed peripheral corneal ulceration OD and diffusely vascularized and scarred cornea OS, although nonadherence was reported. Vision eventually worsened to hand motions OD and light perception OS. Case 2 is a 44-year-old woman with hepatitis C, acute myeloid leukemia, dry eye syndrome secondary to chronic graft-versus-host disease (GVHD), and chronic methamphetamine use who presented with a diffuse corneal infiltrate and hypopyon. She underwent emergent corneal transplantation, vitrectomy, and broad-spectrum intravitreal and intravenous antibiotics. Vitreous cultures were positive for Streptococcus pyogenes. However, progressive disease eventually required enucleation despite initial globe salvaging measures. Conclusions and importance These two patient cases highlight the risk of vision loss or blindness due to the detrimental effects of chronic methamphetamine use on the eye, including the potential for keratitis and endophthalmitis. Given the increasing prevalence of methamphetamine use disorder in the United States, further understanding of these toxicities and preventive strategies are needed.
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Gohil H, Miskovic M, Buxton JA, Holland SP, Strike C. Smoke Gets in the Eye: A systematic review of case reports of ocular complications of crack cocaine use. Drug Alcohol Rev 2022; 41:347-355. [PMID: 34337815 DOI: 10.1111/dar.13366] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/23/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
ISSUES Use of crack cocaine and associated medical complications persists globally. Some reports in medical literature describe a sight-threatening condition commonly referred to as 'crack eye' or 'crack eye syndrome'. The purpose of this review is to describe what is known about crack eye from case reports in peer-reviewed literature. APPROACH A structured search was completed in MEDLINE, TOXLINE, EMBASE, PsychInfo, Scopus and Biomed Central, to collect case reports and case series on corneal complications attributed to crack cocaine smoking. KEY FINDINGS Of 111 articles screened, 11 contained case reports or series. Thirty individual cases of 'crack eye' were reported. The majority (63%) of cases had bilateral involvement; 83% of all cases with microbial culture results had corneal infections. Aggressive treatment caused an improvement in 95% of all cases and 23% of all cases were lost to follow up. Of those who received treatment for corneal complications associated with crack cocaine, 22% remained with significant visual impairment (hand motions only) in the affected eye. IMPLICATIONS Clinicians should consider crack cocaine involvement in patients presenting with corneal disease without known predisposing factors, and elicit comprehensive drug histories to prevent a reduction in visual acuity. CONCLUSION Corneal complications of crack cocaine smoking are caused by a number of synergistic factors, including direct toxicity of crack cocaine vapours to surface cells, impairment of neurogenic support to corneal epithelial integrity, desiccation of the eye surface due to diminished blinking reflex, low level chemical burns and mechanical denudement of surface cells through eye rubbing.
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Affiliation(s)
- Hemant Gohil
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Miroslav Miskovic
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Simon P Holland
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Methamphetamine-Induced Keratitis Case Series. Cornea 2021; 41:367-369. [PMID: 34050072 DOI: 10.1097/ico.0000000000002764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Methamphetamine-induced keratitis is a recognized but not widely studied cause of corneal stromalysis and infections. These 2 cases describe the presentation and clinical course of keratitis in patients with preceding methamphetamine use.
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Abstract
Illicit drugs and substances of abuse are increasingly used by adults and teenagers, with novel substances constantly becoming available. Many substances can cause ocular effects or visually threatening conditions. Current literature informing eye-care practitioners on these effects is scant. The present scoping review reports the ocular effects of most commonly used drugs and substances of abuse in the teenage and adult populations of North America. Ovid MEDLINE and Ovid EMBASE databases were searched for publications from 1980 to 2019 regarding ocular effects of drug use. The selected papers regarded human subjects, in either teenage or adult population and included all types of studies, including case reports. Publications in English or in French were included. Exclusion criteria were publications about the use of prescriptions drugs, drug withdrawal, and publications about the use of alcohol, tobacco, or cannabis. Some 241 papers were retained and analysed. The use of various drugs and substances can lead to damage to structures throughout the eye, including but not limited to corneal conditions, glaucoma and other optic neuropathies, maculopathies and endophthalmitis. The data presented in this review may help guide clinicians in their diagnosis and treatment of certain ocular conditions, which could otherwise not be linked to drug use.
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Affiliation(s)
- Valérie Proulx
- School of Optometry, University of Montreal, Montréal, Canada
| | - Benoit Tousignant
- School of Optometry, University of Montreal, Montréal, Canada.,School of Public Health, University of Montreal, Montréal, Canada
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Lee M, Leskova W, Eshaq RS, Harris NR. Acute changes in the retina and central retinal artery with methamphetamine. Exp Eye Res 2020; 193:107964. [PMID: 32044305 DOI: 10.1016/j.exer.2020.107964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022]
Abstract
Methamphetamine (METH), an addictive stimulant of neurotransmitters, is associated with cardiovascular and neurological diseases. METH-induced ophthalmic complications are also present but have been insufficiently investigated. The purpose of this study is to investigate the retinal effects of METH. C57BL/6 mice were administrated progressively increasing doses of METH (0-6 mg/kg) by repetitive intraperitoneal injections for 5 days (4 times per day). Retinal degeneration was examined by morphological changes and terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) assay. Norepinephrine levels were measured by ELISA, protein expression levels were determined by immunoblot and immunostaining, and gelatinase activity was examined by zymography. The thickness of the retina and the number of nuclei in the inner and outer nuclear layers were decreased by METH. Retinal cell death and astrocyte activation by METH treatment were confirmed by TUNEL assay and glial fibrillary acidic protein expression, respectively. Increased tumor necrosis factor-α protein in the retina and elevated norepinephrine levels in plasma were found in METH-treated mice. Platelet endothelial cell adhesion molecule-1 (PECAM-1) protein expression level was decreased in the retina and central retinal artery (CRA) by METH treatment, along with the endothelial proteoglycans glypican-1 and syndecan-1. Moreover, a regulator of the extracellular matrix, matrix metalloproteinase-14 (MMP-14) in the retina, and MMP-2 and MMP-9 in plasma, were increased by METH treatment. In conclusion, METH administration is involved in retinal degeneration with a vascular loss of PECAM-1 and the glycocalyx in the CRA and retina, and an increase of MMPs.
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Affiliation(s)
- Minsup Lee
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA
| | - Wendy Leskova
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA
| | - Randa S Eshaq
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA
| | - Norman R Harris
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA.
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Zhang Y, Li Q, Guan S, Li H. Methamphetamine causes acute toxicity in the retina of Balb/c mice. Cutan Ocul Toxicol 2020; 39:83-88. [PMID: 31986912 DOI: 10.1080/15569527.2020.1722153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: As a powerful psychostimulant with high potential for abuse, methamphetamine (Meth) could cause neurological diseases. METH-induced ophthalmic complications are present, but its underlying mechanism has not been completely elucidated, specifically on the retina. This study was to investigate effects of Meth treatment on the retina. Methods: Balb/c mice were treated with Meth at progressively increasing doses (0-6 mg/kg) intraperitoneally four times per day for five days, mice treated with saline as negative control. Electroretinography (ERG) was used to test the function of retina after Meth treatment. Pathological changes were examined by haematoxylin and eosin staining and terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay. Enzyme-linked immunosorbent assay (ELISA) was used to measure the norepinephrine and tumour necrosis factor alpha (TNFα). Real-time PCR and western blot were used to measure expression changes of genes and proteins, respectively. Results: Our data showed that Meth treatment caused photoreceptor cell death and decreased the thickness of retina. Meth treatment also elevated norepinephrine levels in plasma and increased TNFα in the retina. Moreover, Meth treatment decreased platelet endothelial cell adhesion molecule-1 (PECAM-1) protein expression and increased protein expression of matrix metalloproteinases (MMPs) in the retina.Conclusions: Our study indicated that short-term intraperitoneal treatment of Meth induced retinal degeneration of Balb/c mice due to a vascular loss of PECAM-1 and an increase of MMPs.
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Affiliation(s)
- Yanlai Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People's Republic of China
| | - Qi Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People's Republic of China
| | - Siyuan Guan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Hao Li
- Department of Neurology, The First People's Hospital of Yibin, Yibin, People's Republic of China
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Heninger M, Collins KA. Acute Bacterial Meningitis with Coincident Methamphetamine Use: A Case Report and Review of the Literature. J Forensic Sci 2013; 58:1088-91. [DOI: 10.1111/1556-4029.12176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 07/07/2012] [Accepted: 07/14/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Heninger
- Fulton County Medical Examiner's Office; 430 Pryor Street SW; Atlanta, GA 30312
| | - Kim A. Collins
- Fulton County Medical Examiner's Office; 430 Pryor Street SW; Atlanta, GA 30312
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Luo M, Yu CW, Chen FF, Zhao L, Tian G, Liu X, Cui Y, Yang JY, Wu K. Histone deacetylase HDA6 is functionally associated with AS1 in repression of KNOX genes in arabidopsis. PLoS Genet 2012; 8:e1003114. [PMID: 23271976 PMCID: PMC3521718 DOI: 10.1371/journal.pgen.1003114] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 10/10/2012] [Indexed: 11/21/2022] Open
Abstract
ASYMMETRIC LEAVES 1 (AS1) is a MYB-type transcription repressor that controls leaf development by regulating KNOX gene expression, but the underlying molecular mechanism is still unclear. In this study, we demonstrated that AS1 can interact with the histone deacetylase HDA6 in vitro and in vivo. The KNOX genes were up-regulated and hyperacetylated in the hda6 mutant, axe1-5, indicating that HDA6 may regulate KNOX expression through histone deacetylation. Compared with the single mutants, the as1-1/axe1-5 and as2-1/axe1-5 double mutants displayed more severe serrated leaf and short petiole phenotypes. In addition, the frequencies of leaf lobes and leaflet-like structures were also increased in as1-1/axe1-5 and as2-1/axe1-5 double mutants, suggesting that HDA6 acts together with AS1 and AS2 in regulating leaf development. Chromatin immunoprecipitation assays revealed that HDA6 and AS1 bound directly to KNAT1, KNAT2, and KNATM chromatin. Taken together, these data indicate that HDA6 is a part of the AS1 repressor complex to regulate the KNOX expression in leaf development. AS1 is a MYB-type transcription repressor that controls leaf patterning by repressing class-1 KNOX gene expression. The molecular mechanism by which AS1 represses KNOX gene expression is still unclear. In this study, we found that AS1 interacted with the histone deacetylase HDA6. Furthermore, HDA6 repressed KNOX gene expression by histone deacetylation. hda6 mutants displayed serrated leaf and short petiole phenotypes. Additionally, hda6/as1-1 double-mutant plants showed a more severe phenotype compared to the single mutants, indicating that HDA6 may act together with AS1 in controlling leaf development. Taken together, our data indicated that HDA6 is an important component of the AS1 repressor complex in regulating the KNOX gene expression.
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Affiliation(s)
- Ming Luo
- Institute of Plant Biology, College of Life Science, National Taiwan University, Taipei, Taiwan
- Key Laboratory of Plant Resources, Conservation and Sustainable Utilization, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
| | - Chun-Wei Yu
- Institute of Plant Biology, College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Fang-Fang Chen
- Institute of Plant Biology, College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Linmao Zhao
- Key Laboratory of Plant Resources, Conservation and Sustainable Utilization, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- University of Chinese Academy of Sciences, Chinese Academy of Sciences, Beijing, China
| | - Gang Tian
- Southern Crop Protection and Food Research Centre, Agriculture and Agri-Food Canada, London, Ontario, Canada
| | - Xuncheng Liu
- Institute of Plant Biology, College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Yuhai Cui
- Southern Crop Protection and Food Research Centre, Agriculture and Agri-Food Canada, London, Ontario, Canada
| | - Jun-Yi Yang
- Institute of Biochemistry, National Chung Hsing University, Taichung, Taiwan
| | - Keqiang Wu
- Institute of Plant Biology, College of Life Science, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Sexton RL, Carlson RG, Leukefeld CG, Booth BM. Methamphetamine Use and Adverse Consequences in the Rural Southern United States: An Ethnographic Overview. J Psychoactive Drugs 2011; Suppl 3:393-404. [PMID: 17357531 DOI: 10.1080/02791072.2006.10400603] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Research on methamphetamine use and related issues often uses data from in-treatment and post-treatment populations in urban areas. Rural ethnographic studies are less common, particularly self-assessments by active methamphetamine users that explore use patterns and their adverse consequences. Such work is especially rare in the rural South, where illicit methamphetamine manufacture and use have recently been increasing. This article presents an ethnographic overview of methamphetamine use in rural Kentucky and Arkansas based on qualitative interviews conducted with 34 active, not-in-treatment, primary methamphetamine users. Methamphetamine supply, distribution, and prevalence of methamphetamine use are described. Pathways and motivations for methamphetamine use and use patterns are outlined as well. A discussion of the adverse consequences and potential risks of methamphetamine use follows. The findings indicate that informed drug treatment outreach and reduction of potential adverse consequences among methamphetamine users in rural areas are important issues for public health and for interventions.
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Affiliation(s)
- Rocky L Sexton
- Center for Interventions, Treatment & Addictions Research, Wright State University School of Medicine, 143 Biological Sciences, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA.
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Abstract
INTRODUCTION Metamfetamine is a highly addictive amfetamine analog that acts primarily as a central nervous system (CNS) stimulant. The escalating abuse of this drug in recent years has lead to an increasing burden upon health care providers. An understanding of the drug's toxic effects and their medical treatment is therefore essential for the successful management of patients suffering this form of intoxication. AIM The aim of this review is to summarize all main aspects of metamfetamine poisoning including epidemiology, mechanisms of toxicity, toxicokinetics, clinical features, diagnosis, and management. METHODS A summary of the literature on metamfetamine was compiled by systematically searching OVID MEDLINE and ISI Web of Science. Further information was obtained from book chapters, relevant news reports, and web material. Epidemiology. Following its use in the Second World War, metamfetamine gained popularity as an illicit drug in Japan and later the United States. Its manufacture and use has now spread to include East and South-East Asia, North America, Mexico, and Australasia, and its world-wide usage, when combined with amfetamine, exceeds that of all other drugs of abuse except cannabis. Mechanisms of toxicity. Metamfetamine acts principally by stimulating the enhanced release of catecholamines from sympathetic nerve terminals, particularly of dopamine in the mesolimbic, mesocortical, and nigrostriatal pathways. The consequent elevation of intra-synaptic monoamines results in an increased activation of central and peripheral α±- and β-adrenergic postsynaptic receptors. This can cause detrimental neuropsychological, cardiovascular, and other systemic effects, and, following long-term abuse, neuronal apoptosis and nerve terminal degeneration. Toxicokinetics. Metamfetamine is rapidly absorbed and well distributed throughout the body, with extensive distribution across high lipid content tissues such as the blood-brain barrier. In humans the major metabolic pathways are aromatic hydroxylation producing 4-hydroxymetamfetamine and N-demethylation to form amfetamine. Metamfetamine is excreted predominantly in the urine and to a lesser extent by sweating and fecal excretion, with reported terminal half-lives ranging from ∼5 to 30 h. Clinical features. The clinical effects of metamfetamine poisoning can vary widely, depending on dose, route, duration, and frequency of use. They are predominantly characteristic of an acute sympathomimetic toxidrome. Common features reported include tachycardia, hypertension, chest pain, various cardiac dysrhythmias, vasculitis, headache, cerebral hemorrhage, hyperthermia, tachypnea, and violent and aggressive behaviour. Management. Emergency stabilization of vital functions and supportive care is essential. Benzodiazepines alone may adequately relieve agitation, hypertension, tachycardia, psychosis, and seizure, though other specific therapies can also be required for sympathomimetic effects and their associated complications. CONCLUSION Metamfetamine may cause severe sympathomimetic effects in the intoxicated patient. However, with appropriate, symptom-directed supportive care, patients can be expected to make a full recovery.
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Affiliation(s)
- Leo J Schep
- National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
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Hazin R, Cadet JL, Kahook MY, Saed D. Ocular Manifestations of Crystal Methamphetamine Use. Neurotox Res 2009; 15:187-91. [DOI: 10.1007/s12640-009-9019-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 05/12/2008] [Accepted: 07/22/2008] [Indexed: 11/29/2022]
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14
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McLeod SD. Bacterial Keratitis. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ghosheh FR, Ehlers JP, Ayres BD, Hammersmith KM, Rapuano CJ, Cohen EJ. Corneal Ulcers Associated With Aerosolized Crack Cocaine Use. Cornea 2007; 26:966-9. [PMID: 17721298 DOI: 10.1097/ico.0b013e3180cfe716] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We report 4 cases of corneal ulcers associated with drug abuse. The pathogenesis of these ulcers and management of these patients are also reviewed. METHODS Review of all cases of corneal ulcers associated with drug abuse seen at our institution from July 2006 to December 2006. RESULTS Four patients with corneal ulcers associated with crack cocaine use were reviewed. All corneal ulcers were cultured, and the patients were admitted to the hospital for intensive topical antibiotic treatment. Each patient received comprehensive health care, including medical and substance abuse consultations. Streptococcal organisms were found in 3 cases and Capnocytophaga and Brevibacterium casei in 1 patient. The infections responded to antibiotic treatment. Two patients needed a lateral tarsorrhaphy for persistent epithelial defects. CONCLUSIONS Aerosolized crack cocaine use can be associated with the development of corneal ulcers. Drug abuse provides additional challenges for management. Not only treatment of their infections but also the overall poor health of the patients and increased risk of noncompliance need to be addressed. Comprehensive care may provide the patient the opportunity to discontinue their substance abuse, improve their overall health, and prevent future corneal complications.
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