An overview of non-cardiac cocaine toxicity

Cocaine use in the United States continues to be a significant problem. Cocaine use is responsible for approximately 143,000 Emergency Department visits annually. The cardiac effects of cocaine are well known and much is written on this topic; this is beyond the scope of this article. Cocaine use is also responsible for a variety of non-cardiac, systemic complications, which it is our purpose to review. Multiple systemic effects of cocaine are seen with both acute and chronic use. These systems include: psychological and psychiatric, neurological, renal, pulmonary, gastrointestinal, obstetrical, and otolaryngological.     

Ocular injuries,attention deficit and hyperactivity disorder,and maternal anxiety/depression levels:Is there a link?

Purpose:Given the increased risk of accidents in patients with attention deficit and hyperactivity dis-order(ADHD)or maternal anxiety/depression,we aimed to investigate the frequency of the two diseases in children with penetrating eye injury(PEI).Methods:Altogether 79 children,39 with PEIs and 40 healthy individuals(control group),aged 5-15 years,underwent a complete ophthalmologic examination.Afterwards,schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children.Turgay diagnostic and statistical manual of mental disorders(DSM-Ⅳ)-based child and adolescent behavior disorders screening and rating scale(T-DSM-Ⅳ-S)was flled by parents to evaluate the severity of ADHD symptoms.The depression and anxiety levels of mothers of each group were evaluated by two self-report measures:the Beck depression scale and the state-trait anxiety inventory(STAI),respectively.Data were analyzed by IBM SPSS version 22.0.The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables.Results:The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs(48.7%in PEI vs.17.5%in control group,χ^2=7.359,p=0.007).The total scores of the T-DSM-Ⅳ-S(attention subscale U=418.000,p=0.006;hyperactivity subscale U=472.000,p=0.022)and maternal state-trait anxiety inventory(maternal STAI-state U=243.00,p=0.003;maternal STAl-trait U=298.000,p=0.021)were significantly higher in the PEI group than in control group.In logistic regression,children with PEI had a tendency to have a 3.5-fold increased risk for ADHD(OR=3.538,CI=0.960-13.039,p=0.058).Conclusion:ADHD was detected almost 1 in 2 children with PEls.Besides,the maternal anxiety level was significantly higher in the PEI group than in the control group.This association should be further explored via a future prospective longitudinal study.Since a proper treatment of ADHD in children and anxiety treatment in mothers may prevent vision loss following PEIs in children.     

Persistent verbal and behavioral deficits after resection of the left supplementary motor area in epilepsy surgery

An 8-year-old boy underwent a resection for focal cortical dysplasia at the left supplementary motor area (SMA) for the treatment of intractable epilepsy. The manifestations of SMA syndrome, such as transient mutism and right hemiparesis, resolved within a few weeks. Verbal disfluency and impaired executive function, accompanied by impulsivity and distractibility, persisted for more than 12 months. The verbal and behavioral problems caused serious difficulties in the school life of the patient, until they became less evident at 18 months after surgery. Tractography performed 18 months after surgery revealed a defect in the subportion of fronto-parietal association fibers within the left superior longitudinal fascicles. Verbal influency can persist with unusually long duration after resection of SMA during childhood. Although not discernible on the routine neuroimaging, white matter damage beneath the SMA region could result in serious disabilities in executive function. These complications should be recognized for the prediction and assessment of deficits in children after surgical intervention involving this region.