Silent severe myocardial ischemia in a past illicit drug user imaged with myocardial perfusion scintigraphy

Patients with illicit drug use may have deleterious acute and chronic cardiac effects. We present a case of a 42-year-old man, former alcohol and various illicit drugs user, who was admitted to the psychiatric unit for management of psychosis. Because of his previous drug and alcohol history, a cardiological evaluation was performed which revealed silent severe myocardial ischemia detected by myocardial perfusion imaging (MPI). The myocardial ischemia was attributed to coronary microvascular dysfunction, occurring several years after quitting the illicit drugs. This study highlights the potential myocardial ischemia that may occur in patients with previous alcohol and illicit drug use, and the role of MPI, a non-invasive test that can provide important information regarding the myocardial status of such patients, even without obvious cardiac symptoms or findings.

Abstract P692: This is Your Brain on Drugs: The Burden and Severity of Stroke Related to Substance Use and Infective Endocarditis

Background: Substance abuse is a major health crisis in the US, with approximately 20 million people suffering from substance use disorders (SUD). The rate of opioid-related overdose deaths in Kentucky has climbrf from 1.3 per 100,000 persons in 1999 to a staggering 23.6 in 2016. SUD is a risk factor for infectious endocarditis (IE), an important cause of stroke in young patients. We previously reported that SUD in stroke is associated with poorer admission NIH stroke scales and longer lengths of stay (LOS) compared to patients without SUD. Objective: To describe the burden of stroke due to endocarditis in a regional population within Kentucky, and to compare outcomes of stroke in patients with SUD with or without evidence of IE. Methods: This is a single center, retrospective chart review of patients with SUD and stroke. Subjects included adults age > 18 years, who received the diagnosis of acute stroke, and were identified as an illicit drug user based on either urine drug testing or provided history in the medical record, admitted between October 2015 and May 2019. Data elements collected included length of stay (LOS), admission/discharge NIH stroke scale scores, drug use history, laboratory data, discharge modified Rankin Scores, intracerebral hemorrhage (ICH) scores, and discharge status. Results: We identified 197 (M=157, 74.6%) SUD/IE-, and 116 (M=81, 69.8%) SUD/IE+ stroke cases. SUD+/IE+ cases were younger with a mean age of 36.53 +/- 8.94, as compared to SUD+/IE-, mean age of 54.94 +/-12.01 (p<0.0001). Ischemic stroke was more common than ICH in both groups. While admission NIHSS scores were similar in the two groups, SUD+/IE+ patients had longer lengths of stay (29.60 +/-25.73 days vs. 11.65 +/-16.95, p<0.0001), and experienced greater mortality, with 38 deaths (32.8% SUD+/IE+) as compared to 20 (10.2%) in the SUD+/IE- group, p<0.0001. An additional 16 (13.8%) patients IE+ were discharged to hospice, compared to 8 (4.1%) in the IE- group, p=0.003. Conclusion: Within our regional population, there is a high burden of SUD-related infective endocarditis and stroke, which is associated with poorer outcomes and increased mortality. Further study is warranted to examine the socioeconomic factors influencing SUD in our population to reduce overall disease burden.

Scurvy in a patient with AIDS: case report

We report the case of a 35-year-old homeless alcoholic and illicit drug user, with AIDS, who was admitted to the emergency unit complaining of asthenia and a weight loss of 30kg over the preceding three months. Clinical and laboratory data confirmed a diagnosis of marasmus, bacterial pneumonia, chorioretinitis caused by Toxoplasma gondii and oral Candida infection. The patient also presented loss of tongue papillae, gingival hypertrophy, perifollicular hyperkeratosis and hemorrhage, coiled, corkscrew-like hair, anemia, hypoalbuminemia, increased C-reactive protein levels and low serum vitamin C levels. The patient developed severe gastric hemorrhage, with hemodynamic instability and terminal disseminated intravascular coagulopathy.

The Canadian Recreational Drug Use Survey: Aims, Methods and First Results

In late 2006, pilot research was initiated in two western Canadian sites (Vancouver and Victoria) to systematically monitor patterns and trends in three specific illicit drug user populations: club and rave party attendees, adolescent street involved injection and non-injection drug users, and adult injection drug users. These sentinel groups were selected because of elevated rates of alcohol and other drug use within these populations and contexts, and the high levels of associated risks and harms. Drawing from international monitoring and surveillance systems, novel research instruments were developed for each population and were administered in face-to-face interviews at each study site. This paper presents an overview of the broad research methodology for the “high risk” monitoring research as well as select findings for the “club drug” sample. The piloted research design yielded high quality data, particularly in relation to recent patterns of drug use behaviour (items on drug use “yesterday” and “last weekend”). The success of these novel items highlights the value of the present study and its relevance for similar studies across the country.