Search Results (228)

Background and Objectives: Acute poisoning is a frequent cause of pediatric emergency department visits and represents a significant public health issue, with children particularly vulnerable due to developmental and behavioral factors. This study aimed to characterize the clinical and demographic profiles of pediatric patients presenting with acute intoxication over a ten-year period (2014–2023) and to assess the impact of the SARS-CoV-2 pandemic on patterns of pediatric poisoning. Materials and Methods: A retrospective cohort study was conducted at the Fondazione Policlinico A. Gemelli in Rome, including all patients under 18 years presenting with acute intoxication between September 2014 and June 2023. Data were extracted from electronic medical records and categorized by age group (0–5, 6–11, and 12–18 years) and by three pandemic-related periods: Pre-COVID-19 (to March 2020), COVID-19 (March 2020–June 2021), and Post-COVID-19 (June 2021 onwards). Statistical analyses included chi-squared tests and Cramér’s V for effect size. Results: Of 794 PED admissions for acute intoxication, 64.5% involved children aged 0–5 years, and 24.9% involved adolescents. Most events occurred at home (63.2%) and were accidental (76.4%), with voluntary intoxications exclusively among adolescents. Drug ingestion was the leading cause (39.3%), followed by solvents (17.8%) and alcohol (7.8%), with alcohol-related cases rising markedly post-pandemic. Statistically significant associations were found between the pandemic period and both age group and intentionality of poisoning (p < 0.00001), but not gender. Voluntary and recreational intoxications increased during and after the pandemic, particularly among adolescents. Conclusions: Pediatric acute poisoning displays a bimodal age distribution, with accidental exposures predominant in young children, and intentional cases predominant in adolescents. The COVID-19 pandemic was associated with an increase in adolescent voluntary and recreational intoxications. These findings underscore the need for targeted prevention strategies addressing both household safety for young children and mental health and substance use interventions for adolescents. Full article

Background: The dual nature of cannabis, as both a promising therapeutic tool and a widely used recreational substance with potential risks, raises important societal controversies, including its unclear impacts regarding mental health. This narrative review provides a comprehensive overview of cannabis, addressing (i) its historical context; (ii) its chemical composition and pharmacokinetics; (iii) its pharmacological effects; (iv) its negative impacts on physiological and mental health; (v) its potential use as a drug for the treatment of neurological and psychiatric disorders; (vi) its relationship with the gut microbiome and how this interaction might influence mental functioning; (vii) the pathophysiology, prevalence, comorbidities, and treatment strategies of cannabis use disorder; and (viii) social perspectives on its legalization. Results: Cannabis presents a complex chemical profile and pharmacokinetics that show promise in treating numerous neurological, psychiatric, and psychological conditions. However, its use carries risks, which depend on factors such as compound concentration, dosage, consumption method, frequency of use, and individual vulnerability. Cannabis use disorder seems to be less severe than other substance use disorders, but it still constitutes a significant concern, as its manifestation is not uniform across all users. Conclusions: Cannabis demands a thorough understanding that goes beyond simplistic explanations and prejudices, standing as a plant of substantial clinical significance and highlighting the importance of personalized approaches to its use and increased awareness of how individuals respond to its effects. Full article

Beach Sand Mycobiome is currently among the most important health challenges for viticulture in the world. Remarkably, the study of fungal communities in coastal beach sand and recreational waters remains underexplored despite their potential implications for human health. This research aimed to assess the prevalence of fungal species and the antifungal susceptibility profiles of fungi recovered from the beaches of the Persian Gulf and the Sea of Oman. Sand and seawater samples from 39 stations distributed within 13 beaches along the coastline were collected between May and July 2023. The grown isolates were identified at the species level based on morphological characteristics and DNA sequencing. Antifungal susceptibility testing was performed according to the Clinical Laboratory Standards Institute guidelines. Of 222 recovered isolates, 206 (92.8%) filamentous fungi and 16 (7.2%) yeast strains were identified. Sand-recovered fungi comprised 82.9%, while water-originated fungi accounted for 17.1%. The DNA sequencing technique categorized 191 isolates into 13 genera and 26 species. The most recovered genus was Aspergillus (68.9%), and Aspergillus terreus sensu stricto was the commonly identified species (26.14%). Voriconazole was the most effective antifungal drug against Aspergillus species. Research on fungal contamination levels at these locations could provide a foundation for establishing regulatory frameworks to diminish fungal risks, thereby enhancing public health protection. The ecological significance of fungal communities in sandy beaches to human infections remains to be explored, and earlier reports in the literature may motivate researchers to focus on detecting this mycobiome in natural environments where further investigation is warranted. Ultimately, our discovery serves as a reminder that much remains to be learned about pathogenic fungi and underscores the need for vigilance in areas where emerging pathogens have not yet been identified. Full article

Background: Human induced pluripotent stem cell cardiomyocytes (hiPSC-CMs) allow for high-throughput evaluation of cardiomyocyte (CM) physiology in health and disease. While multimodality testing provides a large breadth of information related to electrophysiology, contractility, and intracellular signaling in small populations of iPSC-CMs, current technologies for analyzing these parameters are expensive and resource-intensive. Methods: We have designed a novel 2D/3D hybrid organoid system that can harness optical imaging techniques to assess electromechanical properties and calcium dynamics across CMs in a high-throughput manner. We validated our methods using a doxorubicin-based system, as the drug has well-characterized cardiotoxic, pro-arrhythmic effects. Results: This novel hybrid system provides the functional benefit of 3D organoids while minimizing optical interference from multilayered cellular systems through our cell-culture techniques that propagate organoids outwards into 2D iPSC-CM sheets. The organoids recapitulate contractile forces that are more robust in 3D structures and connectivity, while 2D CMs facilitate analysis at an individual cellular level, which recreated numerous doxorubicin-induced electrophysiologic and propagation abnormalities. Conclusions: Thus, we have developed a novel 2D/3D hybrid organoid model that employs an integrated optical analysis platform to provide a reliable high-throughput method for studying cardiotoxicity, providing valuable data on calcium, contractility, and signal propagation. Full article

Previously, we reported that microplastic volatile organic compounds are present within the Chrysaora chesapeakei of Chesapeake Bay, MD. In this study, we report the presence of contaminants of emerging concern (CECs) on the hydrophobic surface of microplastic (MP) particles extracted from the C. chesapeakei, detected by Raman spectroscopy and identified by Wiley’s KnowItAll Software with IR & Raman Spectral Libraries. C. chesapeakei encounters various microplastics and emerging contaminants as it floats through the depths of the Patuxent River water column. This study identifies subsuming CECs found directly on microplastics from within C. chesapeakei in the wild using Raman spectroscopy. Among the extracted microplastics, some of the emerging contaminants found on the different microplastics were pesticides, pharmaceuticals, minerals, food derivatives, wastewater treatment chemicals, hormones, and recreational drugs. Our results represent the first of such findings in C. chesapeakei, obtained directly from the field, and indicate C. chesapeakei’s relationship with microplastics, with this species serving as a vector of emerging contaminants through the marine food web. This paper further illustrates a relationship between different types of plastics that attract dissimilar types of emerging pollutants in the same surrounding environmental conditions, underscoring the urgent need for further research to fully understand and mitigate the risks that MPs coexist with contaminants. Full article

Aims: Cue exposure therapy (CET) is a promising treatment approach for cocaine substance use disorder (SUD). CET specifically targets the psychological and physiological responses elicited by drug-related cues, aiming to reduce their motivational impact. To advance understanding of CET for cocaine treatment, this systematic review aims to categorise the range of cocaine cues used in research. Methods: A systematic review of the existing literature with searches conducted on PubMed and Web of Science bibliographic databases with no time constraints in August 2024 (PROSPERO: CRD42024554361). Three reviewers were independently involved in the screening, review and data extraction process, in line with PRISMA guidelines. Data extracted included participant demographics, study design, data on the cocaine cue task, and examples (if provided). Each study was appraised and received a quality score. The secondary outcome was to summarise examples for each category type identified. The data are presented as a narrative synthesis. Results: 3600 articles were identified and screened. 235 articles were included in the analysis. Cues identified included images, paraphernalia, drug-related words, cocaine smell, auditory stimuli presented via audiotapes, video recordings, scripts, and virtual reality environments, often combining multiple modalities. Included studies recruited cocaine-dependent individuals, recreational users, polydrug users, and non-cocaine-using controls. The sample sizes of the studies ranged from a single case study to a study including 1974 participants. Conclusions: This review found that studies employed a wide range of cue categories, but detailed examples were often lacking, limiting replication. The number and combination of cues varied: some studies used only cocaine-related images, while others included images, videos, physical items, and audiotapes. The level of immersion and personalisation also differed considerably. All studies used cocaine-specific cues, most commonly images or representations of cocaine substance, cocaine use or drug paraphernalia, drug preparation items, or conversations of cocaine use and its effects. The overall quality of the included studies was deemed good, with all adhering to standard research norms. While this review highlights the breath of cue types used in the literature, further research should focus on enhancing cue exposure techniques by incorporating more immersive and personalised stimuli, and by providing clearer documentation of cue characteristics to support replication and clinical translation. Full article

Cannabis sativa L. is divided into three main groups: drug-type, intermediate-type, and fiber-type. The presence of tetrahydrocannabinol (THC) exceeding 0.2–0.3% in drug-type and intermediate Cannabis that utilized for recreational and medicinal purposes renders them illegal due to potential mental health implications. Fiber-type contains high cannabidiol (CBD) and low THC, making it suitable for household use such as textiles and animal feed. Accurate classification is essential to prevent misuse of the plant. High-performance thin-layer chromatography (HPTLC) and ultra-performance liquid chromatography (UPLC), used respectively for the qualitative and quantitative analyses of THC and CBD particularly in female inflorescences, categorized 85 samples of 46 cultivars used in this study into three distinct chemotypes. While chemotype analysis of a very specific organ of the plants accurately identifies Cannabis groups, it requires time-consuming plant development to maturity. Genotype analysis targeting tetrahydrocannabinolic acid synthase (THCAS) and cannabidiolic acid synthase (CBDAS) genes offers a faster alternative for classifying Cannabis types, allowing for sample determination from any part at any developmental stage of the plant. DNA sequencing allowed a phylogenetic analysis based on these genes, classifying all 85 samples of 46 cultivars into the same three groups identified by chemotype analysis. This study is the first to successfully examine the relationship between chemotype and genotype in 85 samples of 46 cultivars. Rapid identification of Cannabis types through genotype analysis lays the groundwork for future development of detection kits. Full article

Background: Recent drug enforcement activities have possibly suggested the presence of some calcium channel blocker antihypertensives in association with cocaine. The seizure revealed the possibility that the two drugs might have been used together for some unknown reasons. Methods: Hence, this study aimed at investigating the nature and frequency of adverse drug reactions (ADRs) reported in association with the concomitant use of calcium channel blockers (CCBs) and cocaine, using data from the FDA Adverse Event Reporting System (FAERS). Results: After removing duplicate reports, a total of 67 cases involving concomitant use of cocaine and CCBs were analyzed and were stratified into three groups based on the CCB involved: verapamil (n = 19), diltiazem (n = 30), and amlodipine (n = 18). Logistic regression analysis identified “product use for unknown indication” (β = 0.33) as the strongest predictor of fatal outcomes. Age revealed a modest negative association with fatal outcome (β = −0.93, intercept = 4.07). Concomitant substance use was reported in over 84% of cases. Frequently co-used substances included opioids, benzodiazepines, antidepressants, antihistamines, and alcohol. Poly-drug use was most pronounced in the diltiazem group, which exhibited the highest burden of opioid and alcohol co-exposure. Conclusions: It is here suggested that clinicians should exercise caution when managing individuals who use cocaine, due to the potential for increased toxicity and lethality when CCBs are co-used, either as part of a prescribed treatment or if CCBs are present as adulterants in cocaine. Full article

Background: Synthetic cathinones (SCs) are the second most representative class of New Psychoactive Substances, with more than 100 analogues identified in the illicit drug market up to 2024. According to the United Nations Office on Drugs and Crimes, N-ethylhexedrone (NEH) and N-ethyl-nor-pentedrone (NEP) were identified among the most frequently seized SCs worldwide. However, still, little is known with regard to their pharmacological effects in humans. Methods: For the first time, we conducted a naturalistic, prospective observational study in 16 participants (7 women and 9 men) with a previous history of psychostimulant recreational use. They intranasally self-administered a single dose of NEP (n = 8, 20–40 mg) or NEH (n = 8, 20–40 mg). The physiological effects (systolic and diastolic blood pressure, heart rate, and temperature) and subjective effects (visual analogue scales, Addiction Research Center Inventory questionnaire and Evaluation of Subjective Effects of Substances with Abuse Potential questionnaire) were assessed up to 4 h after the self-administration at different time points (0, 20 and 40 min and 1, 1.5, 2, 3 and 4 h). Results: Despite several differences, both NEP and NEH produced significant effects within 20 min, with a return to baseline 3–4 h after self-administration. In general, NEP showed a faster onset and a more rapid disappearance of subjective effects than NEH. Moreover, intranasal self-administration of NEH and NEP in experienced recreational drug users, within a non-controlled setting, induces a constellation of psychostimulant-like effects. Conclusion: NEH and NEP showed similar pharmacological properties after insufflation, with typical effects of SCs Full article

Background: Medical cannabis continues to generate interest as a potential therapeutic option, yet its acceptance in clinical practice faces challenges, including regulatory barriers, social stigma, and gaps in scientific evidence. Methods: This study explores the perspectives of Greek medical doctors and pharmacists on medical cannabis—key stakeholders in its clinical application—through semi-structured interviews with 12 participants from each profession. Results: Medical doctors and pharmacists expressed a range of views on medical cannabis, with many acknowledging its potential while emphasizing the need for rigorous, disease-specific research. Medical doctors highlighted the lack of consistent clinical trials, concerns about drug interactions, and the fine line between medical use and misuse. Pharmacists echoed these concerns, citing regulatory inconsistencies and the need for standardized dosing. Both groups agreed that social stigma and misinformation hinder cannabis adoption, advocating for targeted education and transparent research communication. Participants indicated that regulatory barriers also pose challenges, with calls for harmonized policies and phased market entry approaches. Effective communication strategies, including digital outreach and clear messaging, were suggested to differentiate medical cannabis from recreational use and improve trust among healthcare providers and patients. Participants also highlighted the urgent need for collaboration between policymakers, researchers, and healthcare professionals to establish medical cannabis as a credible therapeutic option. Conclusion: The insights gained provide actionable recommendations to bridge existing gaps and emphasize the need for a responsible, evidence-based approach to the acceptance of medical cannabis as a therapeutic option. Full article

Cancer is the second leading cause of death worldwide, after cardiovascular disease, claiming not only a staggering number of lives but also causing considerable health and economic devastation, particularly in less-developed countries. Therapeutic interventions are impeded by differences in patient-to-patient responses to anti-cancer drugs. A personalized medicine approach is crucial for treating specific patient groups and includes using molecular and genetic screens to find appropriate stratifications of patients who will respond (and those who will not) to treatment regimens. However, information on which risk stratification method can be used to hone in on cancer types and patients who will be likely responders to a specific anti-cancer agent remains elusive for most cancers. Novel developments in 3D bioprinting technology have been widely applied to recreate relevant bioengineered tumor organotypic structures capable of mimicking the human tissue and microenvironment or adequate drug responses in high-throughput screening settings. Parts are autogenously printed in the form of 3D bioengineered tissues using a computer-aided design concept where multiple layers include different cell types and compatible biomaterials to build specific configurations. Patient-derived cancer and stromal cells, together with genetic material, extracellular matrix proteins, and growth factors, are used to create bioprinted cancer models that provide a possible platform for the screening of new personalized therapies in advance. Both natural and synthetic biopolymers have been used to encourage the growth of cells and biological materials in personalized tumor models/implants. These models may facilitate physiologically relevant cell–cell and cell–matrix interactions with 3D heterogeneity resembling real tumors. Full article

Background: Hiking is a physical activity recommended for people of all ages. In an era of increased incidence of cardiovascular and psychiatric diseases, directing individuals to hiking can be very important from both public health and socioeconomic perspectives. Since the health status of recreational hikers and the general population in the Republic of Serbia has not been compared yet, our objectives are to compare the health-related characteristics of those two groups, including the prevalence of comorbidities, pharmacotherapy, and drug consumption. Methods: A descriptive epidemiological study was conducted. Research questions were asked via two specially prepared questionnaires distributed through the Google Forms platform. The means of the two groups were tested by a two-sample Student t-test for independent variables. Results: The sample consisted of 259 hikers and 292 people from the general population. A total of 199 hikers (76.8%) and 218 people from the general population group (74.7%) were declared as healthy. The statistically significant differences between the groups included age, sex, education level, and body mass index. In both groups, the majority of those with pre-existing medical conditions had at least one cardiovascular disease (23.5% of the hikers and 19.5% of the individuals in the general group). Pre-existing psychiatric diseases were noted in 6% of the hikers and in 12% of those in the general group. The average durations of the disease in the hiker and general population were 11.9 and 8.4 years, respectively (p < 0.05), whereas, there were no differences in drug consumption. Conclusions: This pilot study represents the comparison of the cardiovascular and mental health among hikers and the general population in the Republic of Serbia. Although psychiatric diseases were clearly less prevalent among hikers, the prevalence and burden of cardiovascular diseases must be interpreted with caution, due to big age difference between the respondents from both groups. However, our future studies will employ objective measurements and clinical parameters rather than self-reported surveys, so that the health benefits of hiking appear more clearly. Full article

Background: Cocaine is a recreational drug known for its negative impact on health and social and economic life. One of the complications for cocaine abusers is cocaine-induced midline destructive lesion (CIMDL) syndrome, which includes the extensive destruction of the osteocartilaginous structures of the nose, the sinus, and the palate. Methods: Here, we describe three cases of the surgical management of CIMDL using a temporalis muscle flap combined with a Le Fort I osteotomy, which allows sufficient space for the muscle to settle. Results: The addition of the osteotomy allowed better handling of the pedicled flap, with no signs of relapse in the reported cases and high patient satisfaction. Conclusions: CIMDL syndrome is an impairing disease that negatively affects the functionality of the nasal and oral cavities, as well as the aesthetic. Surgical repair using a pedicled flap is a valid option in rehabilitated and sober patients with endothelial damage. Full article

Introduction: Novel psychoactive substances (NPSs) are substances not controlled by the United Nations’ 1961 Narcotic Drugs and 1971 Psychotropic Substances convention, which pose a threat to public health. The use of NPSs is growing among recreational drug users. NPSs mimic the effects of the existing illegal drugs; they are used as substitutes for the traditional drugs of use. NPSs are commonly marketed as safe substances. NPS abuse is especially risky among vulnerable individuals, such as children and adolescents. The Aim: This study aims to analyze the knowledge and attitudes of primary and high school students regarding NPSs, determining the frequency and patterns of NPS use, and examine motivational factors for their consumption. Methodology: The questionnaire was employed to primary and secondary school students of the city of Novi Sad in November 2024. The data were analyzed using the methods of descriptive and inferential statistics in the statistical software package JASP 0.18.1.0. Results: A total of 1095 participants took part in the survey (53.6% males and 46.4% females). The age range of participants was 11–18 years (mean age 14.637 years). The majority of pupils lived in the city (70.5%). The most numerous students were students with the highest overall grade. The proportion of students who were familiar with NPSs was 38.3%, while 61.7% of them were not aware of their existence. Living in cities correlated positively with the NPS knowledge. The NPS risk awareness was notably low. The proportion of students who tried one or more novel drugs was 1.918%. Conclusions: The abuse of novel psychoactive substances is a growing concern, particularly among young individuals, requiring increased awareness and education on their risks. Educational systems should provide accurate information to prevent false beliefs, while policymakers must legally regulate new drugs. A coordinated approach is crucial for effective prevention, involving education, media, and support from different organizations. Future studies should focus on the impact of education on attitudes towards NPSs. Full article

Nitrous oxide has a wide range of medical applications, such as being used as an analgesic in general anesthesia, dental procedures, childbirth and sedation. Lately, it has also been employed as an inhalant recreational drug to induce brief euphoria. Recent studies indicate a worldwide rise in the incidence of skin frostbites associated with nitrous oxide use. A scoping review was conducted to synthesize and summarize the existing literature published in English regarding frostbite injuries associated with the recreational use of nitrous oxide. The literature search was carried out in July 2024 using databases such as Embase, Web of Science and PubMed^®. From an initial pool of 83 publications, 8 studies were ultimately selected for full-text review as they met our inclusion criteria for analysis. Additionally, we provide a representative clinical case involving a 21-year-old male who experienced frostbite following skin exposure to nitrous oxide. Most publications on nitrous oxide induced frostbites are from recent years, primarily between 2022 and 2024, with the first case documented in 1996. These injuries are mostly observed in young adults, with a female dominance, and are typically localized to the inner thighs. According to the existing literature, the predominant treatment approach is conservative management, with excision and split-thickness skin grafting (STSG) in the second place. This study represents the first literature review summarizing frostbite injuries to the skin from nitrous oxide misuse. There is a need for enhanced preventive measures to raise public awareness and reduce the incidence of frostbite injuries associated with the recreational use of nitrous oxide. Full article