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Lee SJ, Liu S, Blackwill H, Stradling D, Shafie M, Yu W. Cardiomyopathy in Patients With Acute Ischemic Stroke and Methamphetamine Use: Relevance for Cardioembolic Stroke and Outcome. J Am Heart Assoc 2024; 13:e033667. [PMID: 38533970 PMCID: PMC11179773 DOI: 10.1161/jaha.123.033667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Methamphetamine use has emerged as a major risk factor for cardiovascular and cerebrovascular disease in young adults. The aim of this study was to investigate a possible association of methamphetamine use with cardioembolic stroke. METHODS AND RESULTS We performed a retrospective study of patients with acute ischemic stroke admitted at our medical center between 2019 and 2022. All patients were screened for methamphetamine use and cardiomyopathy, defined as left ventricular ejection fraction ≤45%. Among 938 consecutive patients, 46 (4.9%) were identified as using methamphetamine. Compared with the nonmethamphetamine group (n=892), the methamphetamine group was significantly younger (52.8±9.6 versus 69.7±15.2 years; P<0.001), included more men (78.3% versus 52.8%; P<0.001), and had a significantly higher rate of cardiomyopathy (30.4% versus 14.0%; P<0.01). They were also less likely to have a history of atrial fibrillation (8.7% versus 33.4%; P<0.01) or hyperlipidemia (28.3% versus 51.7%; P<0.01). Compared with patients with cardiomyopathy without methamphetamine use, the patients with cardiomyopathy with methamphetamine use had significantly lower left ventricular ejection fraction (26.0±9.59% versus 32.47±9.52%; P<0.01) but better functional outcome at 3 months, likely attributable to significantly younger age and fewer comorbidities. In the logistic regression model of clinical variables, methamphetamine-associated cardiomyopathy was found to be significantly associated with cardioembolic stroke (odds ratio, 1.79 [95% CI, 1.04-3.06]; P<0.05). CONCLUSIONS We demonstrate that methamphetamine use is significantly associated with cardiomyopathy and cardioembolic stroke in young adults.
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Affiliation(s)
- Sook Joung Lee
- Department of NeurologyUniversity of CaliforniaIrvineCA
- Department of Physical Medicine and Rehabilitation, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Shimeng Liu
- Department of NeurologyUniversity of CaliforniaIrvineCA
- Department Neurology, Tiantan HospitalCapital Medical UniversityBeijingChina
| | | | | | | | - Wengui Yu
- Department of NeurologyUniversity of CaliforniaIrvineCA
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2
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Evans K, Wu P, Mamas MA, Irwin C, Kang P, Perlow JH, Foley M, Gulati M. Substance Use in Pregnancy and its Association With Cardiovascular Events. JACC. ADVANCES 2023; 2:100619. [PMID: 38938361 PMCID: PMC11198094 DOI: 10.1016/j.jacadv.2023.100619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 06/29/2024]
Abstract
Background Substance use and cardiovascular (CV) events are increasing among pregnant women in the United States, but association between substance use in pregnancy and CV events remains unknown. Objectives The purpose of this study was to examine the association between substance use and acute CV events in pregnancy. Methods We identified all women with a delivery hospitalization between 2004 and 2018 in the Nationwide Inpatient Sample, stratified on the presence or absence of substance use. The primary outcome was any acute CV event, defined as the presence of: acute myocardial infarction, stroke, arrhythmia, endocarditis, acute cardiomyopathy or heart failure, or cardiac arrest. Secondary outcomes were individual acute CV events, major adverse cardiac events, and maternal mortality. The association between substance use and outcomes were examined using multivariable logistical regression. Results A total of 60,014,368 delivery hospitalizations occurred from 2004 to 2018, with substance use complicating 955,531 (1.6%) deliveries. Substance use was independently associated with CV events (adjusted odds ratio [aOR]: 1.61; 95% CI: 1.53-1.70; P < 0.001), major adverse cardiac events (aOR: 1.53; 95% CI: 1.46-1.61; P < 0.001), and maternal mortality (aOR: 2.65; 95% CI: 2.15-3.25; P < 0.001) during delivery hospitalization. All individual substances had an increased association with CV events; however, amphetamine/methamphetamine had the strongest association (aOR: 2.71; 95% CI: 2.35-3.12; P < 0.001). All substances other than cocaine and cannabis had a significant association with maternal death. Conclusions Substance use has a strong association with acute CV events and maternal mortality during hospitalization for delivery and women with substance use warrant increased surveillance for CV events during this time.
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Affiliation(s)
- Kari Evans
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Pensée Wu
- Department of Cardiology, Keele University, Keele, United Kingdom
| | - Mamas A. Mamas
- Department of Cardiology, Keele University, Keele, United Kingdom
| | - Chase Irwin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Paul Kang
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Jordan H. Perlow
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Michael Foley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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3
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Zhao X, Lu J, Zhang C, Chen C, Zhang M, Zhang J, Du Q, Wang H. Methamphetamine induces cardiomyopathy through GATA4/NF-κB/SASP axis-mediated cellular senescence. Toxicol Appl Pharmacol 2023; 466:116457. [PMID: 36914120 DOI: 10.1016/j.taap.2023.116457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
With the world pandemic of methamphetamine (METH), METH-associated cardiomyopathy (MAC) has become a widespread epidemic and is also recognized as a cause of heart failure in young people. The mechanism of occurrence and development of MAC is not clear. In this study, firstly, the animal model was evaluated by echocardiography and myocardial pathological staining. The results revealed that the animal model exhibited cardiac injury consistent with clinical alterations of MAC, and the mice developed cardiac hypertrophy and fibrosis remodeling, which led to systolic dysfunction and left ventricular ejection fraction (%LVEF) < 40%. The expression of cellular senescence marker proteins (p16 and p21) and senescence-associated secretory phenotype (SASP) was significantly increased in mouse myocardial tissue. Secondly, mRNA sequencing analysis of cardiac tissues revealed the key molecule GATA4, and Western blot, qPCR and immunofluorescence results showed that the expression level of GATA4 was significantly increased after METH exposure. Finally, knockdown of GATA4 expression in H9C2 cells in vitro significantly attenuated METH-induced cardiomyocyte senescence. Consequently, METH causes cardiomyopathy through cellular senescence mediated by the GATA4/NF-κB/SASP axis, which is a feasible target for the treatment of MAC.
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Affiliation(s)
- Xu Zhao
- Centre of General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan 528200, China
| | - Jiancong Lu
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China; Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China
| | - Cui Zhang
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Neher Neural Plasticity Laboratory, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen 518055, China
| | - Chuanxiang Chen
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China; Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China
| | - Manting Zhang
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China; Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China
| | - Jingyi Zhang
- Centre of General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan 528200, China
| | - Qingfeng Du
- Centre of General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan 528200, China; School of Traditional Chinese medicine, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial Key Laboratory of Chinese Medicine Pharmaceutics, Guangzhou 510515, China.
| | - Huijun Wang
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China; Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China.
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Cénat JM, Kogan CS, Kebedom P, Ukwu G, Moshirian Farahi SMM, Darius WP, Mulopo Bakombo S, Dalexis RD, Ndengeyingoma A, Noorishad PG, Labelle PR. Prevalence and risk factors associated with psychostimulant use among Black individuals: A meta-analysis and systematic review. Addict Behav 2023; 138:107567. [PMID: 36521424 DOI: 10.1016/j.addbeh.2022.107567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Psychostimulants (e.g., cocaine, amphetamine) are among the most widely used drugs globally with detrimental short and long-term physical, psychological and social consequences. There is limited data on psychostimulant use for various racial and ethnic groups, including Black people, and the challenges they face living as minorities overcoming historical challenges including increased incarceration associated with drug possession. METHODS Peer-reviewed articles were identified in five databases (APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, MEDLINE). Eligible studies were published in French or English, provided empiral data on psychostimulant use in Black individuals living in a minority context. The PRISMA guideline was used for structuring the review. Random-effects meta-analyses were generated to estimate the pooled prevalence of lifetime and periodic psychostimulant use among Black individuals using STATA 16. RESULTS Sixty-three studies published from 1991 to 2022 with a sample size of 139,683 Black individuals were included in the current meta-analysis. Results indicate a pooled prevalence estimate of 11.4% for any form of psychostimulant use among Black individuals. The pooled prevalence estimates were 12.4% (95% CI, 8.4% - 16.4%) for cocaine, 8.3% (95% CI, 0% - 19.1%) for amphetamines, and 11.4% (95% CI, 4.6% - 18.1%) for other stimulants. Prediction intervals for all psychostimulant types were highly heterogenous ranging from 0% to as high as 51.2% for amphetamine suggesting prevalence of use in some studies of Black people could be found to be as low as zero. Subgroup analyses were conducted to examine differences between age groups, gender, reference period, and type of assessment. CONCLUSIONS High prevalence rates of psychostimulant use among Black people argues for greater access to evidence-based treatments. However, current psychosocial interventions are suboptimal, warranting further study. Consideration needs to be given to the challenges of the large range of prediction intervals, living in urban areas, racial discrimination experiences, race-based stress, and sociodemographic characteristics, including poverty, education level, age, gender.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Philmona Kebedom
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gloria Ukwu
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
| | - Assumpta Ndengeyingoma
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Nursing, Université du Québec en Outaouais, Quebec, Canada
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Manja V, Nrusimha A, Gao Y, Sheikh A, McGovern M, Heidenreich PA, Sandhu ATS, Asch S. Methamphetamine-associated heart failure: a systematic review of observational studies. Heart 2023; 109:168-177. [PMID: 36456204 DOI: 10.1136/heartjnl-2022-321610] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To conduct a systematic review of observational studies on methamphetamine-associated heart failure (MethHF) . METHODS Six databases were searched for original publications on the topic. Title/abstract and included full-text publications were reviewed in duplicate. Data extraction and critical appraisal for risk of bias were performed in duplicate. RESULTS Twenty-one studies are included in the final analysis. Results could not be combined because of heterogeneity in study design, population, comparator, and outcome assessment. Overall risk of bias is moderate due to the presence of confounders, selection bias and poor matching; overall certainty in the evidence is very low. MethHF is increasing in prevalence, affects diverse racial/ethnic/sociodemographic groups with a male predominance; up to 44% have preserved left-ventricular ejection fraction. MethHF is associated with significant morbidity including worse heart failure symptoms compared with non-methamphetamine related heart failure. Female sex, methamphetamine abstinence and guideline-directed heart failure therapy are associated with improved outcomes. Chamber dimensions on echocardiography and fibrosis on biopsy predict the extent of recovery after abstinence. CONCLUSIONS The increasing prevalence of MethHF with associated morbidity underscores the urgent need for well designed prospective studies of people who use methamphetamine to accurately assess the epidemiology, clinical features, disease trajectory and outcomes of MethHF. Methamphetamine abstinence is an integral part of MethHF treatment; increased availability of effective non-pharmacological interventions for treatment of methamphetamine addiction is an essential first step. Availability of effective pharmacological treatment for methamphetamine addiction will further support MethHF treatment. Using harm reduction principles in an integrated addiction/HF treatment programme will bolster efforts to stem the increasing tide of MethHF.
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Affiliation(s)
- Veena Manja
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Department of Health Policy, Stanford University, Stanford, California, USA
| | | | - Ya Gao
- McMaster University, Hamilton, Ontario, Canada
| | | | - Mark McGovern
- Stanford University School of Medicine, Stanford, California, USA
| | - Paul A Heidenreich
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Steven Asch
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Stanford University School of Medicine, Stanford, California, USA
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Abdullah CS, Remex NS, Aishwarya R, Nitu S, Kolluru GK, Traylor J, Hartman B, King J, Bhuiyan MAN, Hall N, Murnane KS, Goeders NE, Kevil CG, Orr AW, Bhuiyan MS. Mitochondrial dysfunction and autophagy activation are associated with cardiomyopathy developed by extended methamphetamine self-administration in rats. Redox Biol 2022; 58:102523. [PMID: 36335762 PMCID: PMC9641018 DOI: 10.1016/j.redox.2022.102523] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
The recent rise in illicit use of methamphetamine (METH), a highly addictive psychostimulant, is a huge health care burden due to its central and peripheral toxic effects. Mounting clinical studies have noted that METH use in humans is associated with the development of cardiomyopathy; however, preclinical studies and animal models to dissect detailed molecular mechanisms of METH-associated cardiomyopathy development are scarce. The present study utilized a unique very long-access binge and crash procedure of METH self-administration to characterize the sequelae of pathological alterations that occur with METH-associated cardiomyopathy. Rats were allowed to intravenously self-administer METH for 96 h continuous weekly sessions over 8 weeks. Cardiac function, histochemistry, ultrastructure, and biochemical experiments were performed 24 h after the cessation of drug administration. Voluntary METH self-administration induced pathological cardiac remodeling as indicated by cardiomyocyte hypertrophy, myocyte disarray, interstitial and perivascular fibrosis accompanied by compromised cardiac systolic function. Ultrastructural examination and native gel electrophoresis revealed altered mitochondrial morphology and reduced mitochondrial oxidative phosphorylation (OXPHOS) supercomplexes (SCs) stability and assembly in METH exposed hearts. Redox-sensitive assays revealed significantly attenuated mitochondrial respiratory complex activities with a compensatory increase in pyruvate dehydrogenase (PDH) activity reminiscent of metabolic remodeling. Increased autophagy flux and increased mitochondrial antioxidant protein level was observed in METH exposed heart. Treatment with mitoTEMPO reduced the autophagy level indicating the involvement of mitochondrial dysfunction in the adaptive activation of autophagy in METH exposed hearts. Altogether, we have reported a novel METH-associated cardiomyopathy model using voluntary drug seeking behavior. Our studies indicated that METH self-administration profoundly affects mitochondrial ultrastructure, OXPHOS SCs assembly and redox activity accompanied by increased PDH activity that may underlie observed cardiac dysfunction.
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Affiliation(s)
- Chowdhury S Abdullah
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Naznin Sultana Remex
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Richa Aishwarya
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Sadia Nitu
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Gopi K Kolluru
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - James Traylor
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Brandon Hartman
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Judy King
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Mohammad Alfrad Nobel Bhuiyan
- Department of Medicine, Division of Clinical Informatics, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Nicole Hall
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Kevin Sean Murnane
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA; Department of Psychiatry, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Nicholas E Goeders
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Christopher G Kevil
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA; Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - A Wayne Orr
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA; Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA
| | - Md Shenuarin Bhuiyan
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA; Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, 71103, USA.
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Fontana S, Panahi L, Udeani G, Surani S, Desai D. Case Report Highlighting Cardiovascular Effects of Concomitant Use of Methamphetamine and Marijuana. Cureus 2022; 14:e27866. [PMID: 36110480 PMCID: PMC9462887 DOI: 10.7759/cureus.27866] [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] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
We present the case of a 51-year-old male admitted for cardiovascular complications in the face of concomitant chronic methamphetamine and cannabis use. Upon further assessment, the patient exhibited cardiotoxicity, including acute to chronic congestive heart failure (CHF) exacerbation, hypercoagulable state, and electrolyte abnormalities. Cardiotoxicity secondary to chronic methamphetamine use has been established. However, marijuana's cardiovascular effects have not been well established. Even less information exists about the simultaneous use of methamphetamine and cannabis. With increasing interest in the use of marijuana for medical purposes, it is imperative to study any corresponding toxicity and adverse effect profile. The worldwide pattern of drug co-administration also brings the importance of this topic to light. This case report serves to provide insight into this information gap.
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Batra V, Murnane KS, Knox B, Edinoff AN, Ghaffar Y, Nussdorf L, Petersen M, Kaufman SE, Jiwani S, Casey CA, Terhoeve S, Alfrad Nobel Bhuiyan M, Dominic P, McNeil S, Patterson J. Early onset cardiovascular disease related to methamphetamine use is most striking in individuals under 30: A retrospective chart review. Addict Behav Rep 2022; 15:100435. [PMID: 35620216 PMCID: PMC9127267 DOI: 10.1016/j.abrep.2022.100435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/24/2022] Open
Abstract
Prior MA is associated with an earlier onset of cardiovascular onset which is striking in young adults. Both the races displayed the prior MA use associated earlier age of CVD onset with marked differences in the latency to cardiovascular onset between the Blacks and Whites. Hypertension emerged as the most frequently observed CVD in the MA group.
Introduction The illicit use of methamphetamine (MA), a dangerous psychostimulant has become a global epidemic. Studies have demonstrated a link between illicit substance use and cardiovascular consequences. The objective of this study was to assess whether MA use is associated with an early onset of cardiovascular diseases (CVD). Methods Retrospective analysis was conducted using data collected from 1376 individuals at Louisiana State University Health Sciences Center - Shreveport between 2011 and 2020. Cardiovascular patients with and without a history of MA use were divided into the MA and Control groups. The age of CVD onset was assessed. Descriptive statistics for patient characteristics, Two Samples T-Test for continuous and Pearson's χ^2- tests for categorical variables were calculated. Hazard ratios (HR) and time ratios (TR) were calculated. Results The age of CVD onset in patients with prior MA use occurred on average 8 year earlier than the age of CVD onset (mean age ± SD = 44 ± 12.04) in controls (mean age ± SD = 52 ± 10.70) (unpaired t-test, p < 0.0001). The findings were noted in both the races (Time Ratio = 0.93, 95% CI = 0.89 to 0.97, p-value < 0.001), with a striking difference in the latency to CVD onset between Black and White subjects. A 12-fold increase in subjects who showed a premature onset of CVD (<30 years of age) in the MA group was observed. Our data analysis revealed that hypertension was the most frequently observed CVD. Conclusions MA use likely accelerates early onset of CVD and contributes to CVD complications in young adults.
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Affiliation(s)
- Vinita Batra
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Louisiana Addiction Research Center, From Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Corresponding author at: Louisiana State University Health Sciences, Department of Psychiatry and Behavioral Medicine, 1501 Kings Highway, Shreveport, Louisiana 71103, USA.
| | - Kevin S. Murnane
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Louisiana Addiction Research Center, From Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Department of Pharmacology, Toxicology & Neuroscience, School of Graduate Studies, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Brianne Knox
- Department of Neurology, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Amber N. Edinoff
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Yahya Ghaffar
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Laura Nussdorf
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Murray Petersen
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Sarah E. Kaufman
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Sania Jiwani
- Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Christopher A. Casey
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Stephanie Terhoeve
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Mohammad Alfrad Nobel Bhuiyan
- Section of Clinical Informatics, Department of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Paari Dominic
- Louisiana Addiction Research Center, From Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - Shawn McNeil
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
| | - James Patterson
- Department of Psychiatry & Behavioral Medicine, School of Medicine, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Louisiana Addiction Research Center, From Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Department of Pharmacology, Toxicology & Neuroscience, School of Graduate Studies, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
- Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences – Shreveport, Shreveport, LA, USA
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9
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Daiwile AP, Jayanthi S, Cadet JL. Sex differences in methamphetamine use disorder perused from pre-clinical and clinical studies: Potential therapeutic impacts. Neurosci Biobehav Rev 2022; 137:104674. [PMID: 35452744 PMCID: PMC9119944 DOI: 10.1016/j.neubiorev.2022.104674] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 01/31/2023]
Abstract
Methamphetamine (METH) use, and misuse are associated with severe socioeconomic consequences. METH users develop tolerance, lose control over drug taking behaviors, and suffer frequent relapses even during treatment. The clinical course of METH use disorder is influenced by multifactorial METH-induced effects on the central and peripheral nervous systems. Although these METH-induced consequences are observed in humans of all ages, races, and sexes, sexual dimorphism in these outcomes have been observed in both pre-clinical and clinical settings. In this review, we have provided a detailed presentation of the sex differences reported in human and animal studies. We have therefore presented data that identified the influences of sex on METH pharmacokinetics, METH-induced changes in behaviors, cognitive processes, structural changes in the brain, and the effects of the drug on neurotransmitter systems and molecular mechanisms. Finally, we highlighted the potential significance of sex as a critical variable that should be considered when planning the development of new pharmacotherapeutic approaches against MEH use disorder in humans.
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Affiliation(s)
- Atul P Daiwile
- Molecular Neuropsychiatry Research Branch, NIDA Intramural Research Program, Baltimore, MD 21224, USA.
| | - Subramaniam Jayanthi
- Molecular Neuropsychiatry Research Branch, NIDA Intramural Research Program, Baltimore, MD 21224, USA.
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, NIDA Intramural Research Program, Baltimore, MD 21224, USA.
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10
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Thoi F, Scherer DJ, Kaye DM, Sanders P, Stokes MB. Methamphetamine-Associated Cardiomyopathy: Addressing the Clinical Challenges. Heart Lung Circ 2022; 31:616-622. [PMID: 35153149 DOI: 10.1016/j.hlc.2021.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/02/2021] [Accepted: 12/17/2021] [Indexed: 01/05/2023]
Abstract
The growth in methamphetamine usage worldwide continues to present increasing societal and health care challenges. With the escalation of its usage in a variety of social demographics, the entity of methamphetamine-associated cardiomyopathy (MA-CMP) has emerged. This entity is increasingly responsible for an important proportion of heart failure burden in both admissions to hospital and in those individuals requiring chronic heart failure care. MA-CMP poses some unique challenges including its recognition, particularly in younger patients presenting with new-onset heart failure, its severity at presentation and complications as well as management options. The challenging nature of methamphetamine addiction and the necessity to achieve abstinence is a fundamental aspect of management of this condition. As methamphetamine use continues at high levels in Australia, the burden of MA-CMP will inevitably increase and, therefore, all clinicians responsible for heart failure management require an awareness of this disease entity and the specific clinical challenges of its care.
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Affiliation(s)
- Fiona Thoi
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Daniel J Scherer
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia; Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - David M Kaye
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Clinical Research, The Baker Heart and Diabetes Institute; Department of Cardiology, The Alfred Hospital; Department of Medicine, Monash University, Melbourne, Vic, Australia
| | - Prashanthan Sanders
- School of Medicine, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia; Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia. https://twitter.com/PrashSanders
| | - Michael B Stokes
- School of Medicine, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia; Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia.
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11
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Ding J, Wang Y, Wang Z, Hu S, Li Z, Le C, Huang J, Xu X, Huang J, Qiu P. Luteolin Ameliorates Methamphetamine-Induced Podocyte Pathology by Inhibiting Tau Phosphorylation in Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5909926. [PMID: 35368760 PMCID: PMC8970803 DOI: 10.1155/2022/5909926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Abstract
Methamphetamine (METH) can cause kidney dysfunction. Luteolin is a flavonoid compound that can alleviate kidney dysfunction. We aimed to observe the renal-protective effect of luteolin on METH-induced nephropathies and to clarify the potential mechanism of action. The mice were treated with METH (1.0-20.0 mg/kg/d bodyweight) for 14 consecutive days. Morphological studies, renal function, and podocyte specific proteins were analyzed in the chronic METH model in vivo. Cultured podocytes were used to support the protective effects of luteolin on METH-induced podocyte injury. We observed increased levels of p-Tau and p-GSK3β and elevated glomerular pathology, renal dysfunction, renal fibrosis, foot process effacement, macrophage infiltration, and podocyte specific protein loss. Inhibition of GSK3β activation protected METH-induced kidney injury. Furthermore, luteolin could obliterate glomerular pathologies, inhibit podocyte protein loss, and stop p-Tau level increase. Luteolin could also abolish the METH-induced podocyte injury by inactivating GSK3β-p-Tau in cultured podocytes. These results indicate that luteolin might ameliorate methamphetamine-induced podocyte pathology through GSK3β-p-Tau axis.
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Affiliation(s)
- Jiuyang Ding
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, Guizhou, China
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Yuanhe Wang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Zhuo Wang
- Department of Infertility and Sexual Medicine, The Third Affiliated hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Shanshan Hu
- Good Clinical Practice Center, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - Zhu Li
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Cuiyun Le
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Jian Huang
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Xiang Xu
- School of Forensic Medicine, Wannan Medical College, Wuhu 241000, Anhui, China
| | - Jiang Huang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Pingming Qiu
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China
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12
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Hemodynamic Effects of Methamphetamine and General Anesthesia. Anesthesiol Res Pract 2022; 2022:7542311. [PMID: 35222639 PMCID: PMC8872671 DOI: 10.1155/2022/7542311] [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: 06/01/2021] [Revised: 12/08/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Design A retrospective analysis of all anesthetic records at our institution over a two-year period was performed. Setting. Operating room cases under balanced anesthesia. Patients. All patients with ASA class I or II, who did not have trauma or were initially admitted to ICU, aged 18–65, without preexisting cardiac, renal, or pulmonary disease. Patients were divided into three groups: those acutely positive for methamphetamine within 48 hours of surgery (n = 137), those positive for methamphetamine between 48 hours and 7 days of surgery (n = 69), and randomly selected controls who were negative for methamphetamine within 7 days of surgery (n = 159). Measurements. Intraoperative hemodynamic instability was defined as either a drop of more than 40% in MAP for greater than 5 minutes or requirement for significant amount of vasopressors. Main Results. Among the patients who were acutely positive for methamphetamine within 24 hours, 31.4% met the criteria for hemodynamic instability within the first hour of general anesthesia, compared to 26.1% of the subacutely positive patients and 6.3% of controls (p < 0.0001). This was despite lower doses of anesthetic medications in the acutely and subacutely positive groups. Conclusion Patients who present to the operating room with a positive urine drug screen for amphetamines within 2 days of surgery are at increased risk of hemodynamic instability. Postponing surgery up to 7 days somewhat decreases this risk, but not to the levels of patients who do not use methamphetamines.
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13
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Abstract
Extending from the triple wave epidemic of opioid-related overdose deaths, a fourth wave of high mortality involving methamphetamine and cocaine use has been gathering force. This article provides a review of the published literature on stimulants including epidemiology, pharmacology, neurobiology, medical and psychiatric consequences, withdrawal management, and medical and behavioral treatments.
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Affiliation(s)
- Daniel Ciccarone
- Justine Miner Professor of Addiction Medicine, Department of Family and Community Medicine, University of California, San Francisco, MU3-E, Box 900, 500 Parnassus Avenue, San Francisco, CA 94143-0900, USA.
| | - Steve Shoptaw
- Professor and Vice Chair for Research, Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024, USA
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14
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Bhatia HS, Nishimura M, Martinez A, Vanam S, Kahn AM, DeMaria A, Thomas IC. Systolic dysfunction in patients with methamphetamine use and heart failure with preserved ejection fraction. Int J Cardiol 2021; 348:90-94. [PMID: 34921901 PMCID: PMC10174667 DOI: 10.1016/j.ijcard.2021.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to evaluate for occult systolic dysfunction and the effect of methamphetamine cessation among patients with methamphetamine use (MU) and heart failure with preserved ejection fraction (HFpEF). METHODS A retrospective cohort of patients with HFpEF with serial echocardiograms was stratified by MU and evaluated using myocardial strain analysis on echocardiograms at baseline and 1 year to measure global longitudinal strain (GLS). Contemporaneous controls with an ICD diagnosis of HF within 3 days of an MU case were chosen. RESULTS Patients with MU (n = 31) were younger (49 ± 10 vs 59 ± 16 years, p < 0.01) and more frequently male (55% vs 26%, p = 0.04) than controls (n = 23). There was no baseline difference in ejection fraction (EF) (median 66% [IQR 58,71%] vs 62% [56,69%], p = 0.33) or GLS (-13.0% [-16.3,-10.9%] vs -14.8% [-16.0,-11.3%], p = 0.40). At one-year follow-up, MU cessation (n = 15) was associated with improvement in GLS (absolute change -4.4% [-6.5,-1.7%], p < 0.01), while no absolute change was observed with continued MU (n = 16) (0.74% [-1.2,-2.8%], p = 0.22) or controls without MU (-0.6% [-2.1,2.8%], p = 0.78). Of those with abnormal baseline GLS, normalization was observed in 46% with MU cessation, none with continued MU, and 5% of controls (p < 0.001). Among MU patients, improvement in GLS was associated with decreased HF admissions per year [HR 0.74 per 1% change in GLS, 95% CI 0.55,0.98, p = 0.04]. CONCLUSIONS Patients with MU and HFpEF may have occult systolic dysfunction as demonstrated by abnormal GLS, and MU cessation at 1 year is associated with improvement in GLS and a reduction in risk of HF admissions.
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Affiliation(s)
- Harpreet S Bhatia
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Marin Nishimura
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Armando Martinez
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92903, USA
| | - Sai Vanam
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92903, USA
| | - Andrew M Kahn
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Anthony DeMaria
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Isac C Thomas
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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15
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Clinical and demographic factors associated with stimulant use disorder in a rural heart failure population. Drug Alcohol Depend 2021; 229:109060. [PMID: 34628093 PMCID: PMC9511175 DOI: 10.1016/j.drugalcdep.2021.109060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Heart failure is becoming increasingly common among patients under 50 years of age, particularly in African Americans and patients with stimulant use disorder. Yet the sources of these disparities remain poorly understood. This study identified key demographic and clinical factors associated with stimulant use disorder in a largely rural heart failure patient registry. METHODS Patient records reporting a diagnosis of heart failure between January 2008 and March 2020 were requested from West Virginia University Hospital Systems (n=37,872). Odds of stimulant use disorder were estimated by demographic group (age, race, sex), insurance carrier, and clinical comorbidities using logistic regression. RESULTS Multivariable regression analysis identified higher odds of stimulant use disorder among Black/African Americans (1.95 [1.32, 2.77]) and patients who report drinking one or more alcoholic drinks per week (2.23 [1.72, 2.88]). Lower odds of stimulant use disorder were identified among patients with hypertension (0.59 [0.47, 0.73]), or diabetes (0.65 [0.52, 0.81]).. Likewise, lower odds of stimulant use disorder were noted among females, patients older than 30 years of age and those not enrolled in Medicaid. CONCLUSION These results highlight the alarming extent to which Medicaid enrollees, Black/African Americans, people aged 18-24 and 25-44, or persons with a past alcohol use disorder diagnosis are associated with stimulant use disorder among heart failure populations living in largely rural areas. Additionally, they emphasize the need to develop policies and refine clinical care that affects this vulnerable population's prognoses.
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16
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Reddy PKV, Chau E, Patel SV, Yang K, Ng TMH, Elkayam U. Characteristics of Methamphetamine-associated Cardiomyopathy and the Impact of Methamphetamine Use on Cardiac Dysfunction. Am J Cardiol 2021; 154:86-91. [PMID: 34233837 DOI: 10.1016/j.amjcard.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
Methamphetamine-associated cardiomyopathy (MACM) in an increasingly prevalent disease yet presenting clinical characteristics have not been well studied. We studied consecutive patients with MACM presenting between June 2018 and March 2020 who were interviewed for drug use and medical history. We retrospectively identified an age- and gender-matched cohort of Non-MACM (NMACM) patients and compared clinical characteristics. 140 patients (70 MACM and 70 NMACM) were studied. MACM patients were young (49.6 ± 10 years) and predominantly male (94%). Compared to NMACM, MACM patients were more likely to be Caucasian (21% vs 6%, p = 0.007) and homeless (47% vs 7%, p = 0.001). MACM was characterized by lower left ventricular ejection fraction (EF) (p <0.001) and greater LV end diastolic volume (LVEDV) (p = 0.024). Right ventricular (RV) dilation was present more often (p = s0.001) and was more often severe (p = 0.03). Among MACM cases, half of the cohort developed MACM within 5 years of starting MA (18% within 1 year). There was no apparent relationship between frequency or amount of MA used weekly with time until heart failure onset. Drug use patterns were not clearly related to the degree of LV structural change however there were more consistent, significant associations with RV and right atrial (RA) size parameters. In conclusion, patients with MACM have more severe myocardial impairment with lower EF, greater LVEDV and RV dilation. Drug use patterns do not clearly impact degree of LV structural changes by echocardiography however may be related to RV and RA size.
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17
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Cornwell DQ, Thompson AR, Ivie RM, Working ZM, Friess DM, Meeker JE. Methamphetamine in Orthopaedics: Considerations of an At-Risk Population. JBJS Rev 2021; 9:01874474-202106000-00012. [PMID: 34550663 DOI: 10.2106/jbjs.rvw.20.00229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Methamphetamine use by orthopaedic trauma patients has risen to epidemic proportions. » Perioperative methamphetamine use by orthopaedic trauma patients requires physicians to consider both medical and psychosocial factors during treatment. » Behavioral and psychosocial effects of methamphetamine use present barriers to care. » Patients who use methamphetamine face elevated rates of complications.
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Affiliation(s)
- David Q Cornwell
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
| | - Austin R Thompson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
| | - Ryan M Ivie
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Zachary M Working
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
| | - Darin M Friess
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
| | - James E Meeker
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
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18
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Freedland KE, Skala JA, Carney RM, Steinmeyer BC, Rich MW. Psychosocial Syndemics and Multimorbidity in Patients with Heart Failure †. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6:e210006. [PMID: 33954261 PMCID: PMC8096199 DOI: 10.20900/jpbs.20210006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heart failure (HF) is a common cause of hospitalization and mortality in older adults. HF is almost always embedded within a larger pattern of multimorbidity, yet many studies exclude patients with complex psychiatric and medical comorbidities or cognitive impairment. This has left significant gaps in research on the problems and treatment of patients with HF. In addition, HF is only one of multiple challenges facing patients with multimorbidity, stressful socioeconomic circumstances, and psychosocial problems. The purpose of this study is to identify combinations of comorbidities and health disparities that may affect HF outcomes and require different mixtures of medical, psychological, and social services to address. The syndemics framework has yielded important insights into other disorders such as HIV/AIDS, but it has not been applied to the complex psychosocial problems of patients with HF. The multimorbidity framework is an alternative approach for investigating the effects of multiple comorbidities on health outcomes. The specific aims are: (1) to determine the coprevalence of psychiatric and medical comorbidities in patients with HF (n = 535); (2) to determine whether coprevalent comorbidities have synergistic effects on readmissions, mortality, self-care, and global health; (3) to identify vulnerable subpopulations of patients with HF who have high coprevalences of syndemic comorbidities; (4) to determine the extent to which syndemic comorbidities explain adverse HF outcomes in vulnerable subgroups of patients with HF; and (5) to determine the effects of multimorbidity on readmissions, mortality, self-care, and global health.
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Affiliation(s)
- Kenneth E. Freedland
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Judith A. Skala
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Robert M. Carney
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Brian C. Steinmeyer
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA
| | - Michael W. Rich
- Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
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Chavva H, Brazeau DA, Denvir J, Primerano DA, Fan J, Seeley SL, Rorabaugh BR. Methamphetamine-induced changes in myocardial gene transcription are sex-dependent. BMC Genomics 2021; 22:259. [PMID: 33845768 PMCID: PMC8042975 DOI: 10.1186/s12864-021-07561-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Prior work demonstrated that female rats (but not their male littermates) exposed to methamphetamine become hypersensitive to myocardial ischemic injury. Importantly, this sex-dependent effect persists following 30 days of subsequent abstinence from the drug, suggesting that it may be mediated by long term changes in gene expression that are not rapidly reversed following discontinuation of methamphetamine use. The goal of the present study was to determine whether methamphetamine induces sex-dependent changes in myocardial gene expression and whether these changes persist following subsequent abstinence from methamphetamine. RESULTS Methamphetamine induced changes in the myocardial transcriptome were significantly greater in female hearts than male hearts both in terms of the number of genes affected and the magnitude of the changes. The largest changes in female hearts involved genes that regulate the circadian clock (Dbp, Per3, Per2, BMal1, and Npas2) which are known to impact myocardial ischemic injury. These genes were unaffected by methamphetamine in male hearts. All changes in gene expression identified at day 11 returned to baseline by day 30. CONCLUSIONS These data demonstrate that female rats are more sensitive than males to methamphetamine-induced changes in the myocardial transcriptome and that methamphetamine does not induce changes in myocardial transcription that persist long term after exposure to the drug has been discontinued.
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Affiliation(s)
- Hasitha Chavva
- Department of Pharmaceutical Science, Marshall University School of Pharmacy, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Daniel A Brazeau
- Department of Pharmacy Practice, Administration, and Research, Marshall University School of Pharmacy, 1 John Marshall Drive, Huntington, WV, 25755, USA
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - James Denvir
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Donald A Primerano
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Jun Fan
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Sarah L Seeley
- Department of Pharmaceutical and Biomedical Sciences, Ohio Northern University College of Pharmacy, 525 South Main Street, Ada, OH, 45810, USA
| | - Boyd R Rorabaugh
- Department of Pharmaceutical Science, Marshall University School of Pharmacy, 1 John Marshall Drive, Huntington, WV, 25755, USA.
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA.
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20
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Bhatia HS, Nishimura M, Dickson S, Adler E, Greenberg B, Thomas IC. Clinical and echocardiographic outcomes in heart failure associated with methamphetamine use and cessation. Heart 2020; 107:741-747. [PMID: 33020227 DOI: 10.1136/heartjnl-2020-317635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Methamphetamine use is associated with systolic dysfunction, pulmonary arterial hypertension and may also be associated with diastolic dysfunction. The impact of methamphetamine cessation on methamphetamine-associated heart failure (MethHF) remains poorly characterised. We aimed to longitudinally characterise methamphetamine-associated heart failure patients with reduced (METHrEF) and preserved (METHpEF) left ventricular ejection fraction (EF), and evaluate the relationship between methamphetamine cessation and clinical outcomes. METHODS We performed a retrospective cohort study, and reviewed medical records of patients with METHrEF, METHpEF and heart failure controls without methamphetamine use. Echocardiographic variables were recorded for up to 12 months, with clinical follow-up extending to 24 months. RESULTS Among METHrEF patients (n=28, mean age 51±9 years, 82.1% male), cessation was associated with improvement in EF (+10.6±13.1%, p=0.009) and fewer heart failure admissions per year compared with continued use (median 0.0, IQR 0.0-1.0 vs median 2.0, IQR 1.0-3.0, p=0.039). METHpEF patients (n=28, mean age 50±8 years, 60.7% male) had higher baseline right ventricular systolic pressure (median 53.44, IQR 43.70-84.00 vs median 36.64, IQR 29.44-45.95, p=0.011), and lower lateral E/E' ratio (8.1±3.6 vs 11.2±4., p<0.01) compared with controls (n=32). Significant improvements in echocardiographic parameters and clinical outcomes were not observed following cessation in this group. CONCLUSIONS METHrEF patients who cease methamphetamine use have significant improvement in left ventricular systolic function and fewer heart failure admissions, suggesting that METHrEF may be reversible. Echocardiographic parameters suggest that some patients with METHpEF may have pulmonary hypertension in the absence of overt signs of left ventricular diastolic dysfunction, but additional study is needed to characterise this patient cohort.
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Affiliation(s)
- Harpreet Singh Bhatia
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Marin Nishimura
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Stephen Dickson
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Eric Adler
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Barry Greenberg
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Isac C Thomas
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
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21
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Paulus MP, Stewart JL. Neurobiology, Clinical Presentation, and Treatment of Methamphetamine Use Disorder: A Review. JAMA Psychiatry 2020; 77:959-966. [PMID: 32267484 PMCID: PMC8098650 DOI: 10.1001/jamapsychiatry.2020.0246] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The prevalence of and mortality associated with methamphetamine use has doubled during the past 10 years. There is evidence suggesting that methamphetamine use disorder could be the next substance use crisis in the United States and possibly worldwide. OBSERVATION The neurobiology of methamphetamine use disorder extends beyond the acute effect of the drug as a monoaminergic modulator and includes intracellular pathways focused on oxidative stress, neurotoxic and excitotoxic effects, and neuroinflammation. Similarly, the clinical picture extends beyond the acute psychostimulatory symptoms to include complex cardiovascular and cerebrovascular signs and symptoms that need to be identified by the clinician. Although there are no pharmacologic treatments for methamphetamine use disorder, cognitive behavioral therapy, behavioral activation, and contingency management show modest effectiveness. CONCLUSIONS AND RELEVANCE There is a need to better understand the complex neurobiology of methamphetamine use disorder and to develop interventions aimed at novel biological targets. Parsing the disorder into different processes (eg, craving or mood-associated alterations) and targeting the neural systems and biological pathways underlying these processes may lead to greater success in identifying disease-modifying interventions. Finally, mental health professionals need to be trained in recognizing early cardiovascular and cerebrovascular warning signs to mitigate the mortality associated with methamphetamine use disorder.
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Affiliation(s)
- Martin P. Paulus
- Scientific Director and President Laureate Institute for Brain Research 6655 S Yale Ave, Tulsa, OK 74136-3326,Department of Community Medicine, University of Tulsa, Tulsa OK 74104
| | - Jennifer L. Stewart
- Scientific Director and President Laureate Institute for Brain Research 6655 S Yale Ave, Tulsa, OK 74136-3326,Department of Community Medicine, University of Tulsa, Tulsa OK 74104
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22
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Heart Failure in Vulnerable Populations: The Emerging Evidence of Methamphetamine-Associated Cardiomyopathy. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00653-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Baker S, Castle D. The Cardiac Conduction and Contractility Complications of Methamphetamine Use and the Relationship to Psychiatric Comorbidity: A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216666200226102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Methamphetamine has the potential to produce more severe short and long
term effects than typical amphetamines due to the drug’s increased purity. The cardiovascular consequences
compromise a large proportion of the drug’s mortality. Previous reviews have not examined
these complications in relation to psychiatric patients who have high rates of substance use and
physical comorbidity.
Methods:
Ovid Medline, Embase, Emcare, PsycINFO, CINAHL, and Cochrane were systematically
searched in English until November 2017. Data were coded according to study design, sample size,
demographics, medical and psychiatric comorbidity, electrocardiograph abnormalities, echocardiograph
parameters, illness severity, treatment, and outcome on follow up.
Results:
The 11 included studies were predominantly case series conducted in the USA. Males were
more likely to use methamphetamine and be associated with global systolic dysfunction. The mean
age was lower for those with methamphetamine-related cardiovascular complications. QTc interval
prolongation was the most frequent electrocardiograph abnormality. Continued methamphetamine
use was associated with persistently impaired ventricular function, whilst discontinuation led to
remodeling and improved ejection fraction. Only one study referenced psychiatric comorbidity or
dual diagnosis.
Conclusion:
This review describes the range of variables related to methamphetamine associated
arrhythmias and cardiomyopathies. Early detection of methamphetamine use and the subsequent
cardiac complications is important, especially in a psychiatric cohort where physical illness is more
commonly neglected. The monitoring of electrocardiographs in methamphetamine users is also
crucial. Future research is needed to allow for appropriate recommendations in managing the harmful
impacts of methamphetamine use in this population.
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Affiliation(s)
- Sarah Baker
- Psychiatry Registrar, St. Vincent’s Health, 46 Nicholson Street, Fitzroy, 3065, Australia
| | - David Castle
- Chair of Psychiatry, St. Vincent’s Health, 46 Nicholson Street, Fitzroy, 3065, Australia
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24
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Freeling JL, McFadden LM. The emergence of cardiac changes following the self-administration of methamphetamine. Drug Alcohol Depend 2020; 212:108029. [PMID: 32408136 PMCID: PMC7293916 DOI: 10.1016/j.drugalcdep.2020.108029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Clinical observations suggest an association between methamphetamine (METH) use and cardiovascular disease, but preclinical studies are lacking. The purpose of the current study was to explore changes in left ventricular function as a potential precursor to cardiovascular disease in a rodent model of METH use. METHODS Male rats were allowed to self-administer either METH or saline for 9 d. On the day following the 4th and 9th self-administration sessions, an echocardiogram was performed to assess left-ventricular parameters under basal conditions and following a low-dose of METH (1 mg/kg). RESULTS A low challenge dose of METH resulted in subtle but statistically significant changes in cardiac function during the echocardiogram in both the METH and saline self-administering groups. Further, differences in left-ventricular parameters such as stroke volume and heart rate were observed between METH and saline groups following the 9th self-administration session. Finally, supervised machine learning correctly predicted the self-administration group assignment (saline or METH) using cardiac parameters following the 9th self-administration session. CONCLUSIONS The findings of the current study suggest the heart, specifically the left ventricle, is sensitive to METH. Overall, these findings and emerging clinical observations highlight the need for research to investigate the effects of METH use on the heart.
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Affiliation(s)
- Jessica L. Freeling
- Physiology Core, Division of Basic Biomedical Sciences, University of South Dakota, Vermillion SD 57069
| | - Lisa M. McFadden
- Center for Brain and Behavioral Research, Division of Basic Biomedical Sciences, University of South Dakota, Vermillion SD 57069
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25
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Reddy PKV, Ng TMH, Oh EE, Moady G, Elkayam U. Clinical Characteristics and Management of Methamphetamine-Associated Cardiomyopathy: State-of-the-Art Review. J Am Heart Assoc 2020; 9:e016704. [PMID: 32468897 PMCID: PMC7428977 DOI: 10.1161/jaha.120.016704] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Methamphetamine‐associated cardiomyopathy (MACM) is an increasingly recognized disease entity in the context of a rapidly spreading methamphetamine epidemic. MACM may afflict individuals with a wide range of ages and socioeconomic backgrounds. Presentations can vary greatly and may involve several complications unique to the disease. Given the public health significance of this disease, there is a relative dearth of consensus material to guide clinicians in understanding, diagnosing, and managing MACM. This review therefore aims to: (1) describe pathologic mechanisms of methamphetamine as they pertain to the development, progression, and prognosis of MACM, and the potential to recover cardiac function; (2) summarize existing data from epidemiologic studies and case series in an effort to improve recognition and diagnosis of the disease; (3) guide short‐ and long‐term management of MACM with special attention to expected or potential sequelae of the disease; and (4) highlight pivotal unanswered questions in need of urgent investigation from a public health perspective.
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Affiliation(s)
- Pavan K V Reddy
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
| | - Tien M H Ng
- School of Pharmacy University of Southern California Los Angeles CA
| | - Esther E Oh
- School of Pharmacy University of Southern California Los Angeles CA
| | - Gassan Moady
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
| | - Uri Elkayam
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
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26
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Thomas IC, Nishimura M, Ma J, Dickson SD, Alshawabkeh L, Adler E, Maisel A, Criqui MH, Greenberg B. Clinical Characteristics and Outcomes of Patients With Heart Failure and Methamphetamine Abuse. J Card Fail 2020; 26:202-209. [DOI: 10.1016/j.cardfail.2019.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/26/2019] [Accepted: 10/07/2019] [Indexed: 11/15/2022]
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27
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The Other Substance Abuse Epidemic: Methamphetamines and Heart Failure. J Card Fail 2020; 26:210-211. [PMID: 31958515 DOI: 10.1016/j.cardfail.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 11/20/2022]
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28
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Zhu D, Jiang M, Xu D, Schöllhorn WI. Long-Term Effects of Mind-Body Exercises on the Physical Fitness and Quality of Life of Individuals With Substance Use Disorder-A Randomized Trial. Front Psychiatry 2020; 11:528373. [PMID: 33391039 PMCID: PMC7775308 DOI: 10.3389/fpsyt.2020.528373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 11/30/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Mind-body exercises (MBE) are sequences of low to medium-intensity activities that benefit healthy performers physically and mentally. In contrast to the unmodified application of traditional tai chi, qi gong, or yoga in the healthy population, MBEs are typically tailored for individuals with substance abuse disorder (SUD). Despite numerous applications in practice, the detailed effects of tailor-made MBEs for SUD are unclear. Objectives: This study aimed to analyze and compare changes in the physical fitness and quality of life of individuals with SUD that underwent conventional or tailor-made MBEs. Methods: A total of 100 subjects obtained from the Shanghai Mandatory Detoxification and Rehabilitation Center with SUD were randomly assigned into two groups. The subjects in the experimental group (n = 50) practiced tailored MBE for 60 min a day, five times a week, for 3 months. The subjects (n = 50) in the control group were treated with conventional rehabilitation exercises with the same intervention protocol. The outcomes of fitness and quality of life for drug addiction were measured at the beginning and after 3 and 6 months by a questionnaire (QOL-DA). A two-way repeated measure analysis of variance was applied to compare the difference of treatments in the two groups. Results: Statistically significant differences for the experimental group were found in systolic (p < 0.01, η2 = 0.124) and diastolic blood pressure (p < 0.01, η2 = 0.097), pulse (p < 0.01, η2 = 0.086), vital capacity (p < 0.05, η2 = 0.036), flexibility (p < 0.01, η2 = 0.143), and aerobic endurance (p < 0.01, η2 = 0.165). Results of the QOL-DA showed statistically significant differences between the experimental and control groups in total score (p < 0.01, η2 = 0.158) with greater effects on the former. Conclusions: This study provided evidence that tailored MBE could lead to remarkable effects with regard to blood pressure, vital capacity, flexibility, and aerobic endurance in comparison with conventional rehabilitation methods. Clinical Trial Registration: ChiCTR-IPR-14005343.
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Affiliation(s)
- Dong Zhu
- School of International Education, Shanghai University of Sport, Shanghai, China
| | - Mei Jiang
- School of International Education, Shanghai University of Sport, Shanghai, China
| | - Ding Xu
- Shanghai Drug Administration, Shanghai, China
| | - Wolfgang I Schöllhorn
- School of International Education, Shanghai University of Sport, Shanghai, China.,Institute for Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
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29
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Duflou J. Psychostimulant use disorder and the heart. Addiction 2020; 115:175-183. [PMID: 31321853 DOI: 10.1111/add.14713] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/08/2019] [Accepted: 06/10/2019] [Indexed: 01/07/2023]
Abstract
Psychostimulants are a diverse range of substances that encompass cocaine and the phenylethylamines, the latter including the amphetamines, cathinones and some 'novel psychoactive substances'. This paper examines the range of pathophysiological processes, clinical presentations and treatment options involving the heart and cardiovascular system both in the acute setting and where long-term effects of psychostimulant use have affected the cardiovascular system. A common feature of these drugs is their effect on the cardiovascular system, where their major action is that of sympathomimetic amines with short- and long-term stimulation of the adrenergic system and consequent effects on blood pressure, cardiac modelling, atherogenesis and cellular calcium signalling. Cocaine additionally exhibits a variety of prothrombotic effects, effects on inflammatory mediators and alterations in myocardial gene expression. Persistent psychostimulant use results in progressive cardiovascular pathology, largely in the form of accelerated atherosclerosis, hypertension and myocardial ischaemia. Abstinence results in at least partial reversal of pathology. To a large extent, an assumption is made that treatment protocols used for cocaine-associated cardiovascular pathology apply to the amphetamines and other phenylethylamines, but there appears to be little research in this area, despite acknowledgement that cocaine and the better-known amphetamines have different modes of action.
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Affiliation(s)
- Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
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30
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Carrier M, Giraldeau, G, Parent MC, Ducharme A. Association of recreational drug consumption, cardiac toxicity and heart transplantation. Can J Surg 2019; 62:356-357. [PMID: 31550103 DOI: 10.1503/cjs.011018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Summary Cardiac toxicity from recreational drug use remains difficult to establish. We report the cases of 3 young patients who were hospitalized for cardiogenic shock. All were bridged to transplantation with implantation of a left ventricular assist device (LVAD). They underwent uneventful heart transplantation. The patients did not have any significant personal or family medical history, but all admitted consuming large quantities of recreational drugs daily. Histological examination of the native heart did not show any inflammation or infiltrative myocardial disease. In this series of young patients presenting in cardiogenic shock with minimal histologic findings on examination of the native hearts, the association between cardiac toxicity and active use of recreational drugs remains a strong possibility. The transplant community should be made aware of this possible association in the current era of legalization and social trivialization of drug consumption.
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Affiliation(s)
- Michel Carrier
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Giraldeau, Parent, Ducharme)
| | - Geneviève Giraldeau,
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Giraldeau, Parent, Ducharme)
| | - Marie-Claude Parent
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Giraldeau, Parent, Ducharme)
| | - Anique Ducharme
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Giraldeau, Parent, Ducharme)
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31
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Nishimura M, Ma J, Fox S, Toomu A, Mojaver S, Juang DK, Maisel AS, Thomas IC. Characteristics and Outcomes of Methamphetamine Abuse Among Veterans With Heart Failure. Am J Cardiol 2019; 124:907-911. [PMID: 31311659 DOI: 10.1016/j.amjcard.2019.05.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
Methamphetamine is one of the most commonly abused illicit substances worldwide. Chronic methamphetamine abuse (MA) is associated with the development of a dilated cardiomyopathy. MA in patients with heart failure (MethHF) is increasingly reported yet poorly characterized. This was a retrospective cohort study of veterans treated at the VA Medical Center in San Diego between 2005 and 2015 with a diagnosis of HF and a history of MA. The incidence of MA each year was calculated, and clinical characteristics and outcomes of veterans with HF with and without MA were compared. Among 9,491 veterans with HF, 429 were identified as having a history of MA. Between 2006 and 2015, the incidence of MA in veterans with HF doubled from 3.44% to 6.70%. Of the 429 identified, 106 veterans had a hospitalization for HF and they were compared with veterans with HF without evidence of MA (HF). Compared with veterans with HF, veterans with MethHF were significantly younger (60.7 ± 7.3 vs 71.6 ± 11.6 years, p <0.001), with more frequent co-morbid post-traumatic stress disorder (16.8% vs 4.4%, p = 0.006), depression (28.7% vs 11.0%, p = 0.002), homelessness (27.9% vs 8.9%, p = 0.001), and unemployment (55.8% vs 30.0%, p <0.001). Despite their younger age, veterans with MethHF had high rates of HF readmission or emergency room visit (49% vs 38% in MethHF vs HF, p = 0.34) and mortality at 6 months (27% vs 38% in MethHF vs HF, p = 0.10) compared with HF. In conclusion, MA in veterans with HF is on the rise. Certain demographic and clinical characteristics of veterans with MethHF may contribute to their poor outcomes.
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32
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Snow SC, Fonarow GC, Ladapo JA, Washington DL, Hoggatt KJ, Ziaeian B. National Rate of Tobacco and Substance Use Disorders Among Hospitalized Heart Failure Patients. Am J Med 2019; 132:478-488.e4. [PMID: 30562497 PMCID: PMC6615901 DOI: 10.1016/j.amjmed.2018.11.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several cardiotoxic substances impact heart failure incidence. The burden of comorbid tobacco or substance use disorders among heart failure patients is under-characterized. We describe the burden of tobacco and substance use disorders among hospitalized heart failure patients in the United States. METHODS We calculated the proportion of primary heart failure hospitalizations in the 2014 National Inpatient Sample with tobacco or substance use disorders accounting for demographic factors. RESULTS Of 989,080 heart failure hospitalizations, 15.5% (n = 152,965) had documented tobacco (n = 119,285, 12.1%) or substance (n = 61,510, 6.2%) use disorder. Female sex was associated with lower rates of tobacco (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.70-0.74) and substance (OR 0.37; 95% CI, 0.36-0.39) use disorder. Tobacco and substance use disorder rates were highest for hospitalizations <55years of age. Native American race was associated with increased risk of alcohol use disorder (OR 1.67; 95% CI, 1.27-2.20) and black race with alcohol (OR 1.09; 95% CI, 1.02-1.16) or drug (OR 1.63; 95% CI, 1.53-1.74) use disorder. Medicaid insurance or income in the lowest quartile were associated with increased risk of tobacco and substance use disorders. CONCLUSIONS Tobacco and substance use disorders affect vulnerable heart failure populations, including those of male sex, younger age, lower socioeconomic status, and racial/ethnic minorities. Enhanced screening for tobacco and substance use disorders in hospitalized heart failure patients may reveal opportunities for treatment and secondary prevention.
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Affiliation(s)
- Sarah C Snow
- Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles; Ahmanson-UCLA Cardiomyopathy Center, University of California,Los Angeles Medical Center
| | - Joseph A Ladapo
- Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Donna L Washington
- Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles; Division of Health Services Research & Development, Veterans Affairs Greater Los Angeles Healthcare System, Calif
| | - Katherine J Hoggatt
- Division of Health Services Research & Development, Veterans Affairs Greater Los Angeles Healthcare System, Calif; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles; Division of Health Services Research & Development, Veterans Affairs Greater Los Angeles Healthcare System, Calif; Divisionof Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Calif.
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33
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Sun X, Wang Y, Xia B, Li Z, Dai J, Qiu P, Ma A, Lin Z, Huang J, Wang J, Xie WB, Wang J. Methamphetamine produces cardiac damage and apoptosis by decreasing melusin. Toxicol Appl Pharmacol 2019; 378:114543. [PMID: 30904475 DOI: 10.1016/j.taap.2019.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/17/2022]
Abstract
Methamphetamine (METH) is an amphetamine-type drug that is highly addictive and widely abused. Many studies have shown that METH exposure causes severe damage not only to the nervous system but also to the cardiovascular system. Melusin protein is a mechanotransducer that plays an important role in maintaining normal heart function. However, the role of melusin in METH-induced cardiotoxicity has not yet been reported. We hypothesized that methamphetamine can produce cardiac damage and apoptosis by decreasing the quantity of melusin. To test this hypothesis, we determined the protein expression of melusin and apoptosis markers in METH-treated rats and primary rat cardiomyocytes. We also established a melusin-overexpressing cell model to assess the importance of melusin in maintaining antiapoptotic pathways. To confirm our findings from the in vitro and animal models, we also evaluated the apoptotic index of cardiomyocytes and the protein expression of apoptotic markers in postmortem heart tissues from deceased METH abusers and age-matched control subjects. The results showed that the apoptosis of cardiomyocytes was increased significantly and that the protein expression of melusin was decreased after exposure to METH in primary rat cardiomyocytes, in rats and in humans. METH treatment also decreased the expression of the downstream proteins FAK, IQGAP1, p-AKT, p-GSK3β, and p-ERK in primary rat cardiomyocytes and in vivo. After overexpression of melusin, the above effects were partially reversed in primary rat cardiomyocytes. We conclude that METH can produce cardiac damage and apoptosis by decreasing melusin, while melusin-activated signaling by phosphorylated AKT, phosphorylated GSK3β, and ERK may be resistant to methamphetamine-induced myocardial apoptosis.
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Affiliation(s)
- Xiaoyu Sun
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, China
| | - Yu Wang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, China
| | - Bing Xia
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, China
| | - Zhu Li
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, China
| | - Jialin Dai
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, China
| | - Pingming Qiu
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China
| | - Ande Ma
- Department of Hygiene Inspection & Quarantine Science, Guangdong Province Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Zhoumeng Lin
- Institute of Computational Comparative Medicine and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA
| | - Jiang Huang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, China
| | - Jiawen Wang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, China
| | - Wei-Bing Xie
- School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China.
| | - Jie Wang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang 550004, China.
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34
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Richards JR, Harms BN, Kelly A, Turnipseed SD. Methamphetamine use and heart failure: Prevalence, risk factors, and predictors. Am J Emerg Med 2018; 36:1423-1428. [DOI: 10.1016/j.ajem.2018.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/12/2017] [Accepted: 01/01/2018] [Indexed: 01/30/2023] Open
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35
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Neeki MM, Dong F, Liang L, Toy J, Carrico B, Jabourian N, Sin A, Hussain F, Brown S, Safdari K, Borger R, Wong D. Evaluation of the effect of methamphetamine on traumatic injury complications and outcomes. Addict Sci Clin Pract 2018; 13:11. [PMID: 29592800 PMCID: PMC5874991 DOI: 10.1186/s13722-018-0112-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates the impact of methamphetamine use on trauma patient outcomes. Methods This retrospective study analyzed patients between 18 and 55 years old presenting to a single trauma center in San Bernardino County, CA who sustained traumatic injury during the 10-year study period (January 1st, 2005 to December 31st, 2015). Routine serum ethanol levels and urine drug screens (UDS) were completed on all trauma patients. Exclusion criteria included patients with an elevated serum ethanol level (> 0 mg/dL). Those who screened positive on UDS for only methamphetamine and negative for cocaine and cannabis (MA(+)) were compared to those with a triple negative UDS for methamphetamine, cocaine, and cannabis (MA(−)). The primary outcome studied was the impact of a methamphetamine positive drug screen on hospital mortality. Secondary outcomes included length of stay (LOS), heart rate, systolic and diastolic blood pressure (SBP and DBP, respectively), and total amount of blood products utilized during hospitalization. To analyze the effect of methamphetamine, age, gender, injury severity score, and mechanism of injury (blunt vs. penetrating) were matched between MA(−) and MA(+) through a propensity matching algorithm. Results After exclusion, 2538 patients were included in the final analysis; 449 were patients in the MA(+) group and 2089 patients in the MA(−) group. A selection of 449 MA(−) patients were matched with the MA(+) group based on age, gender, injury severity score, and mechanism of injury. This led to a final sample size of 898 patients with 449 patients in each group. No statistically significant change was observed in hospital mortality. Notably, a methamphetamine positive drug screen was associated with a longer LOS (median of 4 vs. 3 days in MA(+) and MA(−), respectively, p < 0.0001), an increased heart rate at the scene (103 vs. 94 bpm for MA(+) and MA(−), respectively, p = 0.0016), and an increased heart rate upon arrival to the trauma center (100 vs. 94 bpm for MA(+) and MA(−), respectively, p < 0.0001). Moreover, the MA(+) group had decreased SBP at the scene compared to the MA(−) group (127 vs. 132 bpm for MA(+) and MA(−), respectively, p = 0.0149), but SBP was no longer statistically different when patients arrived at the trauma center (p = 0.3823). There was no significant difference in DBP or in blood products used. Conclusion Methamphetamine positive drug screens in trauma patients were not associated with an increase in hospital mortality; however, a methamphetamine positive drug screen was associated with a longer LOS and an increased heart rate.
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Affiliation(s)
- Michael M Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA. .,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA.
| | - Fanglong Dong
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E 2nd St., Pomona, CA, 91766, USA
| | - Lidia Liang
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E 2nd St., Pomona, CA, 91766, USA
| | - Jake Toy
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E 2nd St., Pomona, CA, 91766, USA
| | - Braeden Carrico
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA
| | - Nina Jabourian
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA
| | - Arnold Sin
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
| | - Farabi Hussain
- Department of General Surgery, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
| | - Sharon Brown
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA
| | - Keyvan Safdari
- Department of Anesthesiology, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
| | - Rodney Borger
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Medical Office Building, Suite 7, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
| | - David Wong
- Department of General Surgery, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA, 92324, USA.,California University of Sciences and Medicine, 1405 W Valley Boulevard, Suite 101, Colton, CA, 92321, USA
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Darke S, Kaye S, Duflou J. Rates, characteristics and circumstances of methamphetamine-related death in Australia: a national 7-year study. Addiction 2017; 112:2191-2201. [PMID: 28603836 DOI: 10.1111/add.13897] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/10/2017] [Accepted: 06/06/2017] [Indexed: 11/28/2022]
Abstract
AIMS To (1) assess trends in the number and mortality rates of methamphetamine-related death in Australia, 2009-15; (2) assess the characteristics and the cause, manner and circumstances of death; and (3) assess the blood methamphetamine concentrations and the presence of other drugs in methamphetamine-related death. DESIGN Analysis of cases of methamphetamine-related death retrieved from the National Coronial Information System (NCIS). SETTING Australia. CASES All cases in which methamphetamine was coded in the NCIS database as a mechanism contributing to death (n = 1649). MEASUREMENTS Information was collected on cause and manner of death, demographics, location, circumstances of death and toxicology. FINDINGS The mean age of cases was 36.9 years, and 78.4% were male. The crude mortality rate was 1.03 per 100 000. The rate increased significantly over time (P < 0.001), and at 2015 the mortality rate was 1.8 [confidence interval (CI) = 1.2-2.4] times that of 2009. Deaths were due to accidental drug toxicity (43.2%), natural disease (22.3%), suicide (18.2%), other accident (14.9%) and homicide (1.5%). In 40.8% of cases, death occurred outside the major capital cities. The median blood methamphetamine concentration was 0.17 mg/l, and cases in which only methamphetamine was detected had higher concentrations than other cases (0.30 versus 0.15 mg/l, P < 0.001). The median blood methamphetamine concentration varied within a narrow range (0.15-0.20 mg/l) across manner of death. In the majority (82.8%) of cases, substances other than methamphetamine were detected, most frequently opioids (43.1%) and hypnosedatives (38.0%). CONCLUSIONS Methamphetamine death rates doubled in Australia from 2009 to 2015. While toxicity was the most frequent cause, natural disease, suicide and accident comprised more than half of deaths.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Justice Health and Forensic Mental Health Network, NSW Health, NSW, Australia
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
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Lappin JM, Darke S, Farrell M. Stroke and methamphetamine use in young adults: a review. J Neurol Neurosurg Psychiatry 2017; 88:1079-1091. [PMID: 28835475 DOI: 10.1136/jnnp-2017-316071] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/04/2017] [Accepted: 06/13/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Methamphetamine use and stroke are significant public health problems. Strokes among people aged below 45 years are much less common than in older age groups but have significant mortality and morbidity. Methamphetamine is a putative cause of strokes among younger people. METHODS A review of methamphetamine-related strokes was conducted. Bibliographic databases were searched until February 2017 for articles related to methamphetamine and stroke. Both haemorrhagic and ischaemic strokes were considered. RESULTS Of 370 articles screened, 77 were selected for inclusion. There were 81 haemorrhagic and 17 ischaemic strokes reported in case reports and series. Both types were approximately twice as common in males. Route of administration associated with haemorrhagic stroke was typically oral or injecting, but for ischaemic stroke inhalation was most common. Haemorrhagic stroke was associated with vascular abnormalities in a third of cases. One quarter of individuals completely recovered, and a third died following haemorrhagic stroke. One-fifth completely recovered, and one-fifth died following ischaemic stroke. CONCLUSIONS There is a preponderance of haemorrhagic strokes associated with methamphetamine use in young people, and methamphetamine-related stroke is associated with poor clinical outcomes. Mechanisms of methamphetamine-associated stroke include hypertension, vasculitis, direct vascular toxicity and vasospasm. In a period of rising worldwide methamphetamine use, the incidence of methamphetamine-related stroke will increase, with a consequent increase in the burden of disease contributed by such events.
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Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
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Darke S, Duflou J, Lappin J, Kaye S. Clinical and Autopsy Characteristics of Fatal Methamphetamine Toxicity in Australia. J Forensic Sci 2017; 63:1466-1471. [PMID: 29193063 DOI: 10.1111/1556-4029.13710] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/22/2022]
Abstract
Characteristics of death attributed solely to methamphetamine toxicity (MT, n = 93) by forensic pathologists were examined and compared to cases of multiple drug toxicity (MDT, n = 634). The mean age of MT cases was 36.7 years, and 86.0% were male. Strenuous activity was reported in 12.9%. The most common witness observations were: collapse (60.3%), difficulty in breathing (36.2%), and hyperthermia (27.6%). MT cases had higher blood methamphetamine (0.54 vs. 0.11 mg/L) and amphetamine (0.04 vs. 0.02 mg/L) concentrations and lower likelihoods for opioids (12.5% vs. 80.9%), hypnosedatives (27.3 vs. 60.7%), antidepressants (14.8 vs. 29.8%), and antipsychotics (9.1 vs. 19.7%). MT cases had significantly heavier hearts than MDT cases (423.4 vs. 385.8 g) and were more likely to have cardiomegaly (37.1 vs. 20.4%) and replacement fibrosis (25.7 vs. 14.5%). The clinical picture was of a sudden cardiac event in a middle-aged man with a high methamphetamine concentration. Cardiovascular signs of heavy methamphetamine use are frequently seen.
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Affiliation(s)
- Shane Darke
- National Drug& Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Johan Duflou
- National Drug& Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Julia Lappin
- National Drug& Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Sharlene Kaye
- National Drug& Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,Justice Health and Forensic Mental Health Network, NSW Health, Sydney, NSW, Australia
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Choi YJ, Kim NJ, Zhao RJ, Kim DH, Yang CH, Kim HY, Gwak YS, Jang EY, Kim JS, Lee YK, Lee HJ, Lee SN, Lim SC, Lee BH. Acupuncture suppresses intravenous methamphetamine self-administration through GABA receptor's mediation. Neurosci Lett 2017; 662:65-70. [PMID: 29030218 DOI: 10.1016/j.neulet.2017.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/07/2017] [Accepted: 10/09/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Methamphetamine is one of the widely abused drugs. In spite of a number of studies, there is still little successful therapy to suppress the methamphetamine abuse. Acupuncture has shown to attenuate the reinforcing effects of psychostimulant. Based on, the present study investigated if acupuncture could suppress intravenous methamphetamine self-administration behavior. In addition, a possible neuronal mechanism was investigated. MATERIALS & METHODS Male Sprague-Dawley rats weighing 270-300g were trained to intake food pellet. After catheter implantation, animal was trained to self-administer methamphetamine (0.05mg/kg) intravenously using fixed ratio 1 schedule in daily 2h session during 3 weeks. After training, rats who established baseline (infusion variation less than 20% of the mean for 3 consecutive days) received acupuncture treatment on the next day. Acupuncture was performed at each acupoint manually. In the second experiment, the selective antagonists of GABAA or GABAB receptor were given before acupuncture to investigate the possible neuronal involvement of GABA receptor pathway in the acupuncture effects. C-Fos expression was examined in the nucleus accumbens to support behavioral data. RESULTS Acupuncture at HT7, but not at control acupoint LI5, reduced the self-administration behavior significantly. Also, the effects of acupuncture were blocked by the GABA receptor antagonists. C-Fos expression was shown to be parallel with the behavioral data. CONCLUSIONS Results of this study have shown that acupuncture at HT7 suppressed methamphetamine self-administration through GABA receptor system, suggesting that acupuncture at HT7 can be a useful therapy for the treatment of methamphetamine abuse.
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Affiliation(s)
- Yi Jeong Choi
- Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Nam Jun Kim
- Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Rong Jie Zhao
- School of Mental Health, Qiqihar Medical University, Qiqihar, Heilongjiang Province, 161006, China
| | - Da Hye Kim
- Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Chae Ha Yang
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Hee Young Kim
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Young S Gwak
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Eun Young Jang
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Jae Su Kim
- Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Yun Kyu Lee
- Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Hyun Jong Lee
- Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Sang Nam Lee
- Department of Qigong, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea
| | - Sung Chul Lim
- Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea.
| | - Bong Hyo Lee
- Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu 42158, Republic of Korea.
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Darke S, Duflou J, Kaye S. Prevalence and nature of cardiovascular disease in methamphetamine-related death: A national study. Drug Alcohol Depend 2017; 179:174-179. [PMID: 28787694 DOI: 10.1016/j.drugalcdep.2017.07.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Methamphetamine dependence is a major public health problem. This study examined the nature, and extent, of cardiovascular disease amongst cases of methamphetamine-related death in Australia, 2009-2015. METHODS Analysis of 894 cases of methamphetamine-related death with full autopsy reports retrieved from the National Coronial Information System. RESULTS The mean age was 37.9yrs (range 15-69yrs) and 78.5% were male. A quarter (26.3%) of cases had enlarged hearts and left ventricular hypertrophy was diagnosed in 18.9%. Severe coronary artery disease was present in 19.0%, the left coronary artery being the vessel most frequently stenosed (16.6%). Replacement fibrosis (evidence of earlier ischaemic events) in the heart muscle was observed in 19.8% of cases, and cardiomyopathy was diagnosed in 5.5%. Histological evidence of hypertension was observed in 32.7% of cases. With the exception of cardiomyopathy, equally common amongst both sexes, cardiovascular disease was more common amongst males, and those aged >35yrs. Clinically significant levels of cardiovascular disease were also observed amongst cases where the cause of death was not attributed to cardiovascular disease: cardiomegaly (19.3%), left ventricular hypertrophy (14.6%), severe coronary artery disease (9.4%), replacement fibrosis (14.4%), cardiomyopathy (3.3%). CONCLUSIONS Cardiovascular disease was highly prevalent, despite the relatively young age of cases. With methamphetamine use increasing rapidly in major regions, cardiovascular disease and cardiovascular-related death will likely increase amongst methamphetamine users.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia.
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia; Justice Health and Forensic Mental Health Network, NSW Justice Health, NSW Australia
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Chafetz L, Collins-Bride G. Primary Care for Mentally Ill Adults in Acute Residential Treatment Facilities. Issues Ment Health Nurs 2017; 38:791-797. [PMID: 28933627 DOI: 10.1080/01612840.2017.1364809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Psychiatric bed capacity has decreased nationally with an impact on the number and the types of patients admitted to acute in-patient units. Acute residential programs provide alternatives to hospitals for patients with problems that do not meet criteria for admission. However, these settings may not have resources to respond to the medical co-morbidities associated with severe mental illness. To understand the medical needs of patients in these settings, this research examined data from a nurse-managed primary care outreach service. Prevalent problems included acute issues and chronic disorders associated with severe mental illness. In multivariate analyses, demographic and substance related factors contributed to all chronic illness. However, age was the over-riding predictor of cardio-metabolic disorders. Drug abuse consistently predicted HIV/AIDS and HCV risk. Findings demonstrate that patients diverted to alternative forms of acute psychiatric care are no less in need of medical services than those admitted to hospitals. This underscores the importance of primary care that is provided at the site of acute residential treatment and integrated with overall care.
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Affiliation(s)
- Linda Chafetz
- a University of California at San Francisco School of Nursing , Dept. of Community Health Systems , San Francisco , California , USA
| | - Gerri Collins-Bride
- b University of California at San Francisco School of Nursing , Dept. of Community Health Systems , 2 Koret Way, San Francisco , California , USA
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Methamphetamine Use and Emergency Department Utilization: 20 Years Later. JOURNAL OF ADDICTION 2017; 2017:4050932. [PMID: 28913001 PMCID: PMC5585625 DOI: 10.1155/2017/4050932] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/19/2017] [Indexed: 11/20/2022]
Abstract
Background Methamphetamine (MAP) users present to the emergency department (ED) for myriad reasons, including trauma, chest pain, and psychosis. The purpose of this study is to determine how their prevalence, demographics, and resource utilization have changed. Methods Retrospective review of MAP patients over 3 months in 2016. Demographics, mode of arrival, presenting complaints, disposition, and concomitant cocaine/ethanol use were compared to a 1996 study at the same ED. Results 638 MAP-positive patients, 3,013 toxicology screens, and 20,203 ED visits represented an increase in prevalence compared to 1996: 461 MAP-positive patients, 3,102 screens, and 32,156 visits. MAP patients were older compared to the past. Mode of arrival was most frequently by ambulance but at a lower proportion than 1996, as was the proportion of MAP patients with positive cocaine toxicology screens and ethanol coingestion. Admission rate was lower compared to the past, as was discharge to jail. The proportion of MAP patients presenting with blunt trauma was lower compared to the past and higher for chest pain. Conclusion A significant increase in the prevalence of MAP-positive patients was found. Differences in presenting complaints and resource utilization may reflect the shifting demographics of MAP users, as highlighted by an older patient population relative to the past.
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Rorabaugh BR, Seeley SL, Stoops TS, D’Souza MS. Repeated exposure to methamphetamine induces sex-dependent hypersensitivity to ischemic injury in the adult rat heart. PLoS One 2017; 12:e0179129. [PMID: 28575091 PMCID: PMC5456396 DOI: 10.1371/journal.pone.0179129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/24/2017] [Indexed: 12/23/2022] Open
Abstract
Background We previously reported that adult female, but not male rats that were prenatally exposed to methamphetamine exhibit myocardial hypersensitivity to ischemic injury. However, it is unknown whether hypersensitivity to ischemic injury develops when rats are exposed to methamphetamine during adulthood. The goal of this study was to determine whether methamphetamine exposure during adulthood sensitizes the heart to ischemic injury. Methods Adult male and female rats received daily injections of methamphetamine (5 mg/kg) or saline for 10 days. Their hearts were isolated on day 11 and subjected to a 20 min ischemic insult on a Langendorff isolated heart apparatus. Cardiac contractile function was measured by an intraventricular balloon, and infarct size was measured by triphenyltetrazolium chloride staining. Results Hearts from methamphetamine-treated females exhibited significantly larger infarcts and suppressed postischemic recovery of contractile function compared to hearts from saline-treated females. In contrast, methamphetamine had no effect on infarct size or contractile recovery in male hearts. Subsequent experiments demonstrated that hypersensitivity to ischemic injury persisted in female hearts following a 1 month period of abstinence from methamphetamine. Myocardial protein kinase C-ε expression, Akt phosphorylation, and ERK phosphorylation were unaffected by adult exposure to methamphetamine. Conclusions Exposure of adult rats to methamphetamine sex-dependently increases the extent of myocardial injury following an ischemic insult. These data suggest that women who have a heart attack might be at risk of more extensive myocardial injury if they have a recent history of methamphetamine abuse.
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Affiliation(s)
- Boyd R. Rorabaugh
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, Ohio Northern University, Ada, Ohio, United States of America
- * E-mail:
| | - Sarah L. Seeley
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, Ohio Northern University, Ada, Ohio, United States of America
| | - Thorne S. Stoops
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, Ohio Northern University, Ada, Ohio, United States of America
| | - Manoranjan S. D’Souza
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, Ohio Northern University, Ada, Ohio, United States of America
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