Episode Details

Episode 66: Meth Abuse. 

By Ikenna Nwosu, MD, and Hector Arreaza, MD.  

Discussion about screening, epidemiology, clinical presentation, diagnosis, and treatment of meth abuse. Association between intranasal corticosteroids and lower risk of COVID-19 complications is mentioned.

Introduction: Intranasal corticosteroids associated with better outcomes in COVID-19
By Bahar Hamidi, MS3, American University of the Caribbean 

When I first heard of the news of a pandemic occurring, I never thought it would last more than a couple weeks. Of course, as a medical student the first thing I wanted to know was what bug is causing all this commotion in the news. When I discovered “Coronavirus” my first reaction was a chuckle and blurting out “no way.” Why did I respond this way you may ask? As a student when we studied that coronavirus would cause nothing more than a regular cold, thus a mere pesky virus causing a whole pandemic seemed odd to me at the time. Little did I know almost two years later we are still talking about it! 

“Don’t touch your face before washing your hands.” These are the words that run through my mind anywhere I am nowadays. Why? Well, SARS-CoV-2 spike (S) protein is why. This protein engages ACE2 (angiotensin-converting enzyme 2) as the entry receptor. This virus’s receptor is found to be highly expressed in our nasal mucosa. How much of this ACE2 we have interestingly can correlate with your age; lower in children compared with adults. Other things that can affect a person’s susceptibility is the level of eosinophils in your body. High absolute eosinophil count showed to have a lower hospitalization risk in a group of individuals with asthma and COVID, but we must keep in mind that the study can be confounded by the use of inhaled corticosteroids (iCS). This was taken into account during a study.

The study was done by Ronald Strauss and collaborators, it’s titled, Intranasal Corticosteroids Are Associated with Better Outcomes in Coronavirus Disease 2019, and it was published on The Journal of Allergy and Clinical Immunology: In Practice, September 2021.

So how may inhaled corticosteroids prevent significant illness from COVID? The answer is lower expression of ACE2 and its cellular serine protease TMPRSS2. Theoretically, it makes sense because the less entry gates the virus has the less sick someone may possibly get. Therefore, the study hypothesizes that by suppressing receptor expression, intranasal corticosteroid use is protective against complicated outcomes like hospitalizations, admission to ICU and mortality.

Interestingly in addition, two types of corticosteroids [ciclesonide (Alvesco®) and mometasone (Asmanex® for asthma and Nasonex for allergic rhinitis)] were discovered to suppress replication of coronavirus. This overall study has pertinent findings for the treatment of this everlasting pandemic and proves there is yet much left to discover and continue to research.

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. 

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Meth Abuse. 
By Ikenna Nwosu, MD, and Hector Arreaza, MD

Introduction

Drug use is a growing problem with serious consequences to individuals, families, and whole nations. Today we will discuss one of the most common drugs abused by our patients: Methamphetamine.

Definition   

Methamphetamine (street name chalk, crank, crystal, glass, ice, meth) is a stimulant commonly abused in many parts of the United States. It is a psychostimulant that causes the release and blocks the reuptake of monoamine neurotransmitters, including dopamine, norepinephrine, and serotonin. Metha