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      Manifestaciones de cabeza y cuello secundarias al uso de cocaína. Revisión bibliográfica Translated title: Head and neck manifestations of cocaine abuse. Review

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          Abstract

          RESUMEN: Introducción y objetivo: El consumo de cocaína se ha asociado a patología a múltiples niveles, pero ésta es especialmente relevante a nivel de cabeza y cuello, por ser la vía intranasal una de sus más frecuentes vías de consumo. Este trabajo describe las principales manifestaciones clínicas del consumo de cocaína en el área otorrinolaringológica, y se analizan algunos de los diagnósticos diferenciales que se han de descartar. Método: Se realizó una revisión bibliográfica vía, PubMed, Cochrane y Google Schoolar con artículos publicados entre 1999 y 2019 con la palabra cocaine junto con diferentes términos de búsqueda, siguiendo los criterios PRISMA para la selección de artículos. Resultados: La búsqueda inicial redujo los artículos a 641, finalizando la selección en 63 artículos, a los cuales se añadieron otros 66 desde otras fuentes. Finalmente, 129 artículos fueron incluidos en la presente revisión sistemática. Conclusiones: La necrosis de la línea media y la perforación septal son las manifestaciones más frecuentemente descritas asociadas al abuso de cocaína. Sin embargo, esta sustancia puede originar otras muchas lesiones en cabeza y cuello, generalmente de difícil diagnóstico, sobre todo cuando el paciente niega el abuso de sustancias.

          Translated abstract

          SUMMARY: Introduction and objective: Cocaine abuse has been linked to pathology in multiple levels, but especially relevant are the ones located in the head and neck area, since one of the most used routes of administration is precisely through the nose (snorted). This paper describes the main clinical manifestations of cocaine use in the otolaryngologic area, and analyses some of the differential diagnoses that must be ruled out. Method: A systematic review was conducted via PubMed, Cochrane and Google Schoolar with articles published between 1999 and 2019 using the word «cocaine» together with some other search terms, following the PRISMA criteria for the selection of articles. Results: The initial search reduced the articles to 641, from which 63 articles were selected based on their content. In addition to those, another 66 were added from different sources. Finally, 129 articles were included in this systematic review. Conclusions: Midline necrosis and septal perforation are the most common manifestations described as due to cocaine abuse. However, this substance can cause many other head and neck lesions, usually difficult to diagnose, especially when the patient denies substance abuse.

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          Most cited references139

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          Side effects of cocaine abuse: multiorgan toxicity and pathological consequences.

          Cocaine is a powerful stimulant of the sympathetic nervous system by inhibiting catecholamine reuptake, stimulating central sympathetic outflow, and increasing the sensitivity of adrenergic nerve endings to norepinephrine (NE). It is known, from numerous studies, that cocaine causes irreversible structural changes on the brain, heart, lung and other organs such as liver and kidney and there are many mechanisms involved in the genesis of these damages. Some effects are determined by the overstimulation of the adrenergic system. Most of the direct toxic effects are mediated by oxidative stress and by mitochondrial dysfunction produced during the metabolism of noradrenaline or during the metabolism of norcocaina, as in cocaine-induced hepathotoxicity. Cocaine is responsible for the coronary arteries vasoconstriction, atherosclerotic phenomena and thrombus formation. In this way, cocaine favors the myocardial infarction. While the arrhythmogenic effect of cocaine is mediated by the action on potassium channel (blocking), calcium channels (enhances the function) and inhibiting the flow of sodium during depolarization. Moreover chronic cocaine use is associated with myocarditis, ventricular hypertrophy, dilated cardiomyopathy and heart failure. A variety of respiratory problems temporally associated with crack inhalation have been reported. Cocaine may cause changes in the respiratory tract as a result of its pharmacologic effects exerted either locally or systemically, its method of administration (smoking, sniffing, injecting), or its alteration of central nervous system neuroregulation of pulmonary function. Renal failure resulting from cocaine abuse has been also well documented. A lot of studies demonstrated a high incidence of congenital cardiovascular and brain malformations in offspring born to mothers with a history of cocaine abuse.
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            Understanding polydrug use: review of heroin and cocaine co-use

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              Complications associated with use of levamisole-contaminated cocaine: an emerging public health challenge.

              Levamisole is an immunomodulatory agent that was used to treat various cancers before being withdrawn from the United States market in 2000 because of adverse effects. Levamisole is currently approved as an antihelminthic agent in veterinary medicine, but is also being used illicitly as a cocaine adulterant. Potential complications associated with use of levamisole-laced cocaine include neutropenia, agranulocytosis, arthralgias, retiform purpura, and skin necrosis. Treatment is primarily supportive, and skin lesions typically resolve with cessation of cocaine use. The incidence of hospitalizations related to use of levamisole-contaminated cocaine continues to increase and clinicians should be aware of the more common clinical manifestations.
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                March 2022
                : 13
                : 1
                : 55-70
                Affiliations
                [2] orgnameHospital De Pretlei Bélgica
                [3] Santander orgnameHospital Universitario Marqués de Valdecilla orgdiv1Servicio de Otorrinolaringología España
                [1] Cantabria orgnameUniversidad de Cantabria orgdiv1Facultad de Medicina Spain
                Article
                S2444-79862022000100006 S2444-7986(22)01300100006
                10.14201/orl.26581
                1c9369e5-ab77-4067-b0f3-320eb6cb3bc8

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 03 June 2021
                : 03 August 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 141, Pages: 16
                Product

                SciELO Spain

                Categories
                Artículo de revisión

                evamisol,CIMDL,otorrinolaringología,cocaína,head and neck,levamisole,otolaryngology,cocaine,cabeza y cuello

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