Background: Toxic desomorphine encephalopathy (TDE) is a pathological condition that develops as a result of the intravenous use of a drug called Krokodil containing desomorphine, made in the ...artisanal conditions using codeine-containing drugs, organic solvents (gasoline), iodine and red phosphorus. This disease is more often observed in the CIS countries. In addition to the acute and chronic pathological conditions with the damage to various organs, the use of Krokodil is characterized by pronounced extrapyramidal manifestations in the form of dystonia, parkinsonism, postural disorders, as well as the occurrence of cognitive and affective disorders.
Aims: To find the clinical and neuroimaging features of toxic desomorphine encephalopathy, as well as possible methods of its treatment.
Methods: A clinical analysis of the medical documentation of 21 TDE patients (11 women and 10 men) with a history of the use of Krokodil was carried out, the patients had been under observation from 2014 to 2021. All the patients underwent a clinical physical and neurological examination, 14 of them underwent neuroimaging (brain MRI and/or MSCT). The observation of these patients revealed a number of characteristic clinical and neuroimaging features inherent in the majority of drug addicts.
Results: The clinical picture of patients with TDE was dominated by movement disorders. All the patients had pronounced postural disorders and gait disturbance. Parkinsonism was observed in 20 of 21 patients. The hyperkinetic syndrome was presented in 17 patients (80.9%) and was manifested by dystonia of various localization with polymorphic manifestations. The brain MRI data taken from the Krokodil users for 3 years were characterized by symmetrical focal changes in the basal ganglia, brainstem, cerebellum and internal capsule of the thalamus in the form of an increase in the intensity of the MR signal in the T1 mode and attenuation in the T2-weighted images mode (7 of 11 cases), with the subsequent regression of these characteristics based on the results of the subsequent MRI studies.
Conclusion: The study results have revealed the clinical manifestations characteristic of TDE polymorphic extrapyramidal disorders, as well as neuroimaging changes reflecting these data.
Krokodil, the street name for desomorphine, has emerged as a deadly and alarming drug phenomenon in recent years. This report delves into the intricate relationship between krokodil abuse, its ...adverse effects on the skin and its profound impact on cardiovascular events. Our patient developed a non-healing cutaneous ulceration associated with an acute onset of cardiac arrhythmia, as well as bilateral upper extremity acute deep-vein thrombosis.
The use of Krokodil can lead to chronic non-healing ulcerations.It is important to be aware that new cardiac arrhythmias can arise in individuals using krokodil.Acute bilateral upper extremity thrombosis can occur as a complication in patients using krokodil.
The purpose of our study was to determine the species composition of microflora and to study its sensitivity to antibiotics for toxic osteonecrosis of the jaws, depending on the phase of the ...inflammatory process to develop the principles of rational antibacterial therapy of this pathology.
The Methods. A retrospective study of 38 patients aged from 21 to 45 years old, observed in the dental clinic of PSMU from 2012 to 2018, including 25 men and 13 women, was conducted. They were divided into 2 groups. The first group (19 people) were admitted for emergency treatment in the acute phase of the inflammatory process, accompanied by the development of pyo-inflammatory complications in the maxillofacial area. The second group (19 people) were hospitalized as planned for sequestrectomy. Bacteriological research from a pathological focus was carried out with all of the subjects, followed by determination of the sensitivity of the selected microflora to antibiotics.
The rezults. After analyzing the results, it turned out that differences in the composition of the predominant microflora were revealed in the different study groups: in the group of patients with osteonecrosis in the acute phase, the prevailing group of bacteria were staphylococci, in the group of patients with osteonecrosis in the chronic phase - streptococci. In addition, in the first group, the presence of such microorganisms as enterococci and acinetobacter was noted, and in the second group, bacilli and fungi. Also, the isolated microorganisms in the first group were more susceptible to antibiotics than in the second. At the same time, it is preferable to use levofloxacin and gentamicin in both study groups. In addition, penicillin preparations, cephalosporins and chloramphenicol can be used in the acute phase.
Summary. This study showed that the composition of microflora in toxic osteonecrosis is diverse and depends on the phase of the inflammatory process. It is the basis for the appointment of a rational antibacterial therapy, which contributes to more successful treatment of this disease, reducing the risk of developing severe purulent complications and generalizing the inflammatory process.
The aim of the paper is to present rehabilitation principles of atypical jaw osteomyelitis — osteonecrosis of lower jaw among addicts to synthetic drug desomorphine. Custom nikelid titanium plates ...and plexiform guides from superelastic nikelid titanium proved to be effective in reconstruction mandibular defects in drug addicts.
New drugs of abuse Rech, Megan A; Donahey, Elisabeth; Cappiello Dziedzic, Jacqueline M ...
Pharmacotherapy,
February 2015, Volume:
35, Issue:
2
Journal Article
Peer reviewed
Drug abuse is a common problem and growing concern in the United States, and over the past decade, novel or atypical drugs have emerged and have become increasingly popular. Recognition and treatment ...of new drugs of abuse pose many challenges for health care providers due to lack of quantitative reporting and routine surveillance, and the difficulty of detection in routine blood and urine analyses. Furthermore, street manufacturers are able to rapidly adapt and develop new synthetic isolates of older drugs as soon as law enforcement agencies render them illegal. In this article, we describe the clinical and adverse effects and purported pharmacology of several new classes of drugs of abuse including synthetic cannabinoids, synthetic cathinones, salvia, desomorphine, and kratom. Because many of these substances can have severe or life-threatening adverse effects, knowledge of general toxicology is key in recognizing acute intoxication and overdose; however, typical toxidromes (e.g., cholinergic, sympathomimetic, opioid, etc.) are not precipitated by many of these agents. Medical management of patients who abuse or overdose on these drugs largely consists of supportive care, although naloxone may be used as an antidote for desomorphine overdose. Symptoms of aggression and psychosis may be treated with sedation (benzodiazepines, propofol) and antipsychotics (haloperidol or atypical agents such as quetiapine or ziprasidone). Other facets of management to consider include treatment for withdrawal or addiction, nutrition support, and potential for transmission of infectious diseases.
Desomorphine, a semi-synthetic opioid, is a component of the street drug Krokodil. Despite continued reports of Krokodil use, confirmation via toxicological testing remains scarce. The lack of ...confirmed desomorphine reports may be in part due to the limited published analytical methodology capable of detecting desomorphine at forensically relevant concentrations. In an effort to assist with identification efforts, a robust analytical method was developed and validated. Solid phase extraction (SPE) and gas chromatography–mass spectrometry (GC–MS) were used to determine desomorphine in blood and urine using a deuterated analog as the internal standard. Data was acquired using selected ion monitoring (SIM) mode. Extraction efficiencies in blood and urine were 69% and 90%, respectively. The limits of quantitation in blood and urine were 5 ng/mL and 8 ng/mL, ten-fold lower than previously published methods. Intra- and inter-assay CVs were 2–4% (n = 3) and 3–7% (n = 15), respectively. The method was fully validated in accordance with published guidelines for forensic use. Furthermore, it provides a means by which desomorphine can be identified in toxicology specimens at forensically relevant concentrations, without the need for derivatization.
•GC–MS was used to quantify desomorphine in blood and urine.•First GC–MS method to use SPE to extract desomorphine from sample matrix•LOD/LOQ in blood and urine was 5 and 8 ng/mL respectively.•Ten-fold more sensitive than previously published methods•Derivatization was found unnecessary for analysis.•Method was validated in accordance with standards required for forensic toxicology.
Krokodil is the street name for a homemade mixture that has been used as a cheap substitute for heroin. The main active substance in krokodil is desomorphine, an opioid that is 10 times more potent ...than morphine. Krokodil use began in Russia and Ukraine but has spread throughout several countries in Europe and North America. Krokodil is produced from codeine tablets in a bootleg reaction performed under clandestine and unsanitary conditions. The toxicity of krokodil is characterized by devastating symptoms that start as black ulcers at the injection site and evolve to gangrene and limb amputation. The dangerous effects of krokodil are associated with its homemade nature and lack of purification prior to use. In this review, we discuss the chemical and pharmacological properties and the metabolism of desomorphine, the preparation of krokodil, and how its homemade nature contributes to its toxicity. The synthesis of krokodil produces several other morphinans in addition to desomorphine that warrant further study as possible analgesic alternatives to morphine.
Opioids are arguably one of the most important pharmacologic classes, mainly due to their rich history, their useful and potent analgesic effects, and also, just as importantly, their “Dark Side”, ...constituted by their reinforcing properties that have led countless of users to a spiral of addiction, biological dependence, tolerance, withdrawal syndromes, and death. Among the most significant abused and addictive known opioids are heroin and desomorphine, both synthetic derivatives of morphine that belong to the 4,5-epoxymorphinan structural chemical group of the opioid family drugs. These agents share not only structural, pharmacological, and epidemiological features but also a common geographical distribution. A drop in Afghan heroin production and its “exports” to Russia gave rise to widespread consumption of desomorphine in ex-Soviet republics during the first decade of the 21st century, representing an economical and accessible alternative for misusers to this sort of derivative. Herein we review the state of the art of history, chemistry and synthesis, pharmacology, and impact on society of these “cursed cousins”.
Desomorphine is an opioid misused as “crocodile”, a cheaper alternative to heroin. It is a crude synthesis product homemade from codeine with toxic byproducts. The aim of the present work was to ...investigate the metabolic fate of desomorphine in vivo using rat urine and in vitro using pooled human liver microsomes and cytosol as well as human liver cell lines (HepG2 and HepaRG) by Orbitrap-based liquid chromatography-high resolution-tandem mass spectrometry or hydrophilic interaction liquid chromatography. According to the identified metabolites, the following metabolic steps could be proposed:
N
-demethylation, hydroxylation at various positions,
N
-oxidation, glucuronidation, and sulfation. The cytochrome P450 (CYP) initial activity screening revealed CYP3A4 to be the only CYP involved in all phase I steps. UDP-glucuronyltransferase (UGT) initial activity screening showed that UGT1A1, UGT1A8, UGT1A9, UGT1A10, UGT2B4, UGT2B7, UGT2B15, and UGT2B17 formed desomorphine glucuronide. Among the tested in vitro models, HepaRG cells were identified to be the most suitable tool for prediction of human hepatic phase I and II metabolism of drugs of abuse. Finally, desomorphine (crocodile) consumption should be detectable by all standard urine screening approaches mainly via the parent compound and/or its glucuronide assuming similar kinetics in rats and humans.
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