Morphometrics and Phylogenomics of Coca (Erythroxylum spp.) Illuminate Its Reticulate Evolution, With Implications for Taxonomy.

South American coca (Erythroxylum coca and E. novogranatense) has been a keystone crop for many Andean and Amazonian communities for at least 8,000 years. However, over the last half-century, global demand for its alkaloid cocaine has driven intensive agriculture of this plant and placed it in the center of armed conflict and deforestation. To monitor the changing landscape of coca plantations, the United Nations Office on Drugs and Crime collects annual data on their areas of cultivation. However, attempts to delineate areas in which different varieties are grown have failed due to limitations around identification. In the absence of flowers, identification relies on leaf morphology, yet the extent to which this is reflected in taxonomy is uncertain. Here, we analyze the consistency of the current naming system of coca and its four closest wild relatives (the "coca clade"), using morphometrics, phylogenomics, molecular clocks, and population genomics. We include name-bearing type specimens of coca's closest wild relatives E. gracilipes and E. cataractarum. Morphometrics of 342 digitized herbarium specimens show that leaf shape and size fail to reliably discriminate between species and varieties. However, the statistical analyses illuminate that rounder and more obovate leaves of certain varieties could be associated with the subtle domestication syndrome of coca. Our phylogenomic data indicate extensive gene flow involving E. gracilipes which, combined with morphometrics, supports E. gracilipes being retained as a single species. Establishing a robust evolutionary-taxonomic framework for the coca clade will facilitate the development of cost-effective genotyping methods to support reliable identification.

Association between coca (Erythroxylum coca) chewing habit and oral squamous cell carcinoma: a case-control study from Argentina.

OBJECTIVE: Previous isolated reports have hypothesized that chewing coca leaves, a pre-Columbian tradition found in certain regions of South America, may be associated with the development of oral squamous cell carcinoma (OSCC). Coca chewing (CC) is a habit that shares many characteristics with the well-known practice of betel chewing observed in Asia. The aim of this study is to analyze the association between CC and OSCC among patients who attended the Señor del Milagro Hospital in Salta, Argentina. STUDY DESIGN: A case-control study was conducted from 2013 to 2018. For each case of OSCC, three healthy control patients were included. Odds ratios were calculated to compare demographics, concurrent oral conditions, and other classical risk factors for OSCC. RESULTS: A total of 62 cases and 180 controls were included, adjusted for sex and age. OSCC was significantly associated with tobacco use (27.4% vs 9.4%, P = .001), CC (62.9% vs 32.2%, P < .001), and poor oral condition (81.1% vs 67.7%, P = .02). In the multivariate analysis, smoking (OR = 2.77, 95% CI 1.23-6.25, P = .0139), CC (OR = 2.98, 95% CI 1.58-5.63, P = .0007), and poor oral condition (OR = 3.1, 95% CI 1.62-5.85, P = .0006) remained independently associated with OSCC development. CONCLUSIONS: Chewing coca leaves could be considered a risk factor for oral cancer in a subset of Argentinean patients. Further studies are necessary to validate our findings and to elucidate the underlying pathways linking this habit to oral carcinogenesis.

Evaluation of an Oral Fluid Collection Device and a Solid-Phase Extraction Method for the Determination of Coca Leaf Alkaloids by Gas Chromatography-Mass Spectrometry.

Some South American countries have ancient traditions that may pose legal problems, such as the consumption of coca leaves, as this can provide positive results for cocaine use after the analysis of biological samples. For this reason, it is necessary to find specific markers that help differentiate legal from illegal consumption, such as tropacocaine, cinnamoylcocaine, and especially hygrine and cuscohygrine. In this work, two techniques for collecting biological samples are compared: the Quantisal® Oral Fluid collection device and passive drooling. Once the samples were collected, they were subjected to solid-phase extraction for subsequent injection into GC-MS. Different validation parameters included in international guides have been studied to evaluate whether the proposed method is valid for the defined purpose, placing special emphasis on the study of the matrix effect and little value on GC-MS analyses. With respect to this parameter, an increase in the signal was found for CUS and t-CIN, but it was not significant for the rest of the substances studied. The recoveries have varied significantly depending on the way of working, being higher when working with standardized areas. After carrying out work with the oral fluid samples collected from laboratory volunteers, the method was applied to two real samples. The results obtained support the need for further research to overcome certain limitations presented by the device.

Isotropic liquid state of cocoa butter.

The complex crystal structure of coca butter (CB) is responsible for the unique melting behavior, surface gloss, and mechanical properties of chocolate. While most studies concentrated on the crystalline state of CB, few studied the isotropic liquid state, which has a major impact on the crystallization process and the characteristics of the resulting crystals. In this study, the molecular organizations of the main CB triacylglycerols (TAGs; 1,3-dipalmitoyl-2-oleoylglycerol, palmitoyl-oleoyl-stearoylglycerol, POS, and 1,3-distearoyl-2-oleoylglycerol) were studied. The findings revealed the tunning-fork (Tf) conformation, commonly found in the crystalline state, is the least abundant in the isotropic liquid state of CB and pure TAGs. Notably, POS was found to interact with itself in CB, while its molecules with Tf conformation, although in small amounts in the mixture, tend to pair with each other at lower temperatures. These results highlight the significance of POS in CB crystallization and provide insights for developing CB alternatives.

Window of detection of cocaine-related alkaloids in oral fluid collected with the FloqSwab™ after coca tea consumption.

Coca tea is a popular drink in some countries of South America, where it is presented as a safe energy preparation, based on a limited total content of cocaine of ∼3-5 mg. Tea bags can be bought with no legal considerations in these countries both by locals and tourists, but its consumption can have consequences when consumed overseas. Driving under the influence of cocaine is banned in most of the places in the world and can be documented by oral fluid testing. A study was implemented with coca tea bags (Coca & Muna) purchased in Peru, after a French attorney-at-law contacted the laboratory to assess the involvement of coca tea in the positive oral fluid results of a driver. Ten healthy volunteers consumed 250 mL of coca tea containing 4.5 mg of cocaine. No volunteer reported any change in behavioral effects after consumption of the coca tea. Oral fluid was collected with a swab (FloqSwab™, Copan) over 8 h to follow the elimination of cocaine and its major metabolites (benzoylecgonine and ecgonine methylester). This is the procedure used by the French police. All samples were analyzed by UHPLC-MS-MS after Quantisal™ buffer desorption. As the device does not allow measurement of the amount of collected fluid, the results are qualitative. This is in accordance with the French law that requires a yes or no response about the presence of cocaine, with a minimum required performance level of 10 ng/mL of cocaine or benzoylecgonine. Parent cocaine was identified for 30-120 min. Benzoylecgonine and ecgonine methylester were identified between 1 and 8 h, with a large inter-individual variation. Although it is generally accepted that a 4-5 mg cocaine dose has no significant pharmacological effect, the consumption of coca tea can lead to the suspension of a person's driving license due to a positive oral fluid test.

[Cocaine, in The Affair at the Victory Ball].

The Affair at the Victory Ball is a short story that depicts a murder case involving cocaine use and also portrays the symptoms of cocaine addiction. Cocaine was once used as an anesthetic for surgeries involving the eyes and nose and was even an ingredient in Coca-Cola in the late 19th century in the United States. As concerns about drug contamination increase in Japan, it is important to examine the content of the work and address the current scenario and risks associated with cocaine addiction. Furthermore, it is crucial to discuss the necessity of collaboration between medical institutions and government authorities in addressing this issue.

Detection of coca alkaloids in oral fluid from coca leaf (tea) consumers: using solid phase extraction to improve validation parameters and widen the detection window.

Hygrine and cuscohygrine, two coca leaf alkaloids, have been previously proposed as markers to differentiate legal and illegal cocaine consumption. This is a very common problem in some countries of South America, where the consumption of coca leaves has a long tradition. Analytical methods focusing on the assessment of coca leaf alkaloids, such as cuscohygrine, hygrine, tropacocaine and t-cinnamoylcocaine, in oral fluid are virtually non-existent in forensic toxicology laboratories worldwide due to their lack of application. However, the problem of differentiating legal and illegal cocaine use in criminal justice, DUID (drug-impaired driving) and WDT (workplace drug testing) programs is growing. Therefore, researchers are obliged to develop methods to measure coca leaf alkaloids (cuscohygrine, hygrine and t-cinnamoylcocaine) in biological matrices for further validation for routine analyses in forensic toxicology laboratories. This work aims to optimize a previously published separation method by protein precipitation in oral fluid by using solid-phase extraction (SPE) coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) operating in multiple reaction monitoring (MRM) mode. The use of SPE allowed the matrix effect and the background to be reduced in the chromatograms due to the obtained cleaner extracts. Consequently, improved detection and quantification limits were reached. Findings showed that the detection windows for coca leaf alkaloids were longer than three hours in real oral fluid samples from volunteers who drank a cup of coca tea. These detection windows are quite higher than those previously obtained when using the method based on separation by protein precipitation.

Navigating Chemical Toxicity in Coca Production in the Colombian Borderlands of Putumayo.

In Putumayo, a jungle borderland in southern Colombia, thousands of farmers derive their livelihood from the cultivation and processing of coca leaf, exposing themselves to fertilizers, pesticides, and other toxic chemicals on a daily basis. In this article, we show how the coca growers' relationship with chemicals and the health risks to which they are exposed, are politically and institutionally structured. We discuss the specific impact of anti-narcotics policy in a broader context of deep inequalities and document the emergent and adaptive day-to-day attempts of the farmers to navigate the structural risk environment.

Endoscopic administration of Coca-Cola for medical management of a wedged intestinal trichobezoar in a cat.

A 16-year-old, neutered male domestic longhair feline with gastroduodenal and jejunal trichobezoars was treated with administration of Coca-Cola through endoscopic injection catheter. Examination with a Karl Storz endoscope identified a trichobezoar causing suspected partial or early complete obstruction of the jejunum; however, the length of the scope was inadequate to retrieve the trichobezoar. Consequently, 55 mL of Coca-Cola and 5 mL of iohexol were instilled into an injection catheter to disrupt the trichobezoar. No peri- or postoperative complications were reported, and the cat recovered uneventfully. Key clinical message: This case report demonstrates a minimally invasive approach to treatment of a small intestinal trichobezoar in a cat with no intra- or postoperative complications. Coca-Cola infusion through an endoscopic injection catheter may be a viable treatment in cats when a surgical approach is not an option, although further cases are needed to determine whether these results can be generalized to the larger patient population.

Administration endoscopique de Coca-Cola pour la prise en charge médicale d'un trichobézoard intestinal coincé chez un chat. Un félin domestique à poil long mâle castré de 16 ans atteint de trichobézoards gastroduodénaux et jéjunaux a été traité par l'administration de Coca-Cola via un cathéter d'injection endoscopique. L'examen avec un endoscope Karl Storz a identifié un trichobézoard suspecté d'obstruction partielle ou complète précoce du jéjunum; cependant, la longueur de l'endoscope était insuffisante pour récupérer le trichobézoard. Par conséquent, 55 ml de Coca-Cola et 5 ml d'iohexol ont été instillés dans un cathéter d'injection pour défaire le trichobézoard. Aucune complication péri- ou postopératoire n'a été signalée et le chat s'est rétabli sans incident.Message clinique clé :Ce rapport de cas démontre une approche peu invasive du traitement d'un trichobézoard de l'intestin grêle chez un chat sans complications per- ou postopératoires. L'infusion de Coca-Cola via un cathéter d'injection endoscopique peut être un traitement viable chez les chats lorsqu'une approche chirurgicale n'est pas une option, bien que d'autres cas soient nécessaires pour déterminer si ces résultats peuvent être généralisés à une population de patients plus large.(Traduit par Dr Serge Messier).

The political economy of a failed drug reform: Insights from Peru's main legal coca valley.

As the world's second largest coca producer, Peru has a flourishing market for coca for non-narcotic uses. With more than 20,000 hectares and approximately 35,000 officially registered farmers in the Peruvian legal scheme for coca cultivation and commercialization, this market is formally under the monopoly of the National Enterprise of Coca (ENACO). Nonetheless, ENACO only captures 2% of all coca produced nationally and has experienced a sustained reduction of farmers' participation and coca purchases within the legal trade. At different times, these problems have opened the way to demands from left-wing political parties, subnational governments, coca growers' organizations and even Peru's central drug control institutions to reform the legal coca market in Peru. However, none of these attempts have succeeded. Based on a policy analysis of the legal coca trade and analysis of official data, together with a case study of Peru's main legal coca valley (La Convención) this article seeks to understand the current crisis of the legal coca trade as well as the repeated failures of reform. Peru's political centralism and the historical marginalization of Andean culture help to explain the successful blocking of reform attempts to the legal coca trade.

Comparison of the Degree of Staining of Computer-Aided Design-Computer-Aided Manufacture (CAD-CAM) Ceramic Veneers by Green Tea, Coffee, and Coca-Cola Using a Digital Spectrophotometer.

BACKGROUND The majority of dental professionals currently recognize lithium disilicate E-max ceramic veneers as a the most widely used, conservative, and effective cosmetic materials in dentistry. This study aimed to compare the degree of surface changes - roughness (Ra), depth (Rz), and mean color changes (ΔE00) - of computer-aided design-computer-aided manufactured (CAD/CAM) ceramic veneers materials of varying thicknesses caused by staining by green tea, coffee, and Coca-Cola using digital spectrophotometer. MATERIAL AND METHODS This study was conducted at King Khalid University, College of Dentistry. Lithium disilicate glass ceramic (LDGC) material was used to create 60 rectangular slices using the CAD/CAM system. The material thickness and the type of beverage were measured. The specimens were immersed in beverages according to the manufacturer's instructions. Specimen description and tomography were completed with a 3D noncontact surface metrology using interferometry. The "VITA Easy-Shade" spectrophotometer was used to measure ΔE00. It was recorded after 2 weeks for different material thicknesses after immersing samples in green tea, coffee, and Coca-Cola staining materials.f RESULTS Significant changes in ceramic thickness were found in Ra and Rz of 0.07 and 1.00 mm after 14 days of staining. Coca-Cola showed a significant difference in Ra and Rz with 1.00 mm thickness measurement compared to the 0.07 mm group with ≤ of 0.05, which was considered statistically significant. Highest ΔE00 were recorded among samples stained by Coca-Cola, followed by coffee, for both thicknesses. CONCLUSIONS Those findings support previous studies using spectrophotometric analysis of staining of CAD-CAM ceramic veneers that Coca-Cola followed by coffee resulted in the greatest color ΔE00 change.

The post-conflict expansion of coca farming and illicit cattle ranching in Colombia.

Illicit cattle ranching and coca farming have serious negative consequences on the Colombian Amazon's land systems. The underlying causes of these land activities include historical processes of colonization, armed conflict, and narco-trafficking. We aim to examine how illicit cattle ranching and coca farming are driving forest cover change over the last 34 years (1985-2019). To achieve this aim, we combine two pixel-based approaches to differentiate between coca farming and cattle ranching using hypothetical observed patterns of illicit activities and a deep learning algorithm. We found evidence that cattle ranching, not coca, is the main driver of forest loss outside the legal agricultural frontier. There is evidence of a recent, explosive conversion of forests to cattle ranching outside the agricultural frontier and within protected areas since the negotiation phase of the peace agreement. In contrast, coca is remarkably persistent, suggesting that crop substitution programs have been ineffective at stopping the expansion of coca farming deeper into protected areas. Countering common narratives, we found very little evidence that coca farming precedes cattle ranching. The spatiotemporal dynamics of the expansion of illicit land uses reflect the cumulative outcome of agrarian policies, Colombia's War on Drugs, and the 2016 peace accord. Our study enables the differentiation of illicit land activities, which can be transferred to other regions where these activities have been documented but poorly distinguished spatiotemporally. We provide an applied framework that could be used elsewhere to disentangle other illicit land uses, track their causes, and develop management options for forested land systems and people who depend on them.

Multivariate Base Rates of Low Score on Neuropsychological Tests of Individuals with Coca Paste Use Disorder.

OBJECTIVE: The aim of this study was to determine the prevalence of low scores on eight commonly used neuropsychological tests to evaluate learning and memory, language, and executive functions in individuals with coca paste use disorders (CPUD) and to identify the differences with respect to a group of healthy nonconsuming subjects (HCs). METHODS: 162 Colombian adults with CPUD and a group of 162 Colombian adult HCs participated in this comparative study. Eight tests (eighteen test scores) were grouped into three categories: learning and memory, language, and executive functions. Each participant was categorized based on the number of low scoring tests in specific percentile cut-off groups (25th, 16th, 10th, 5th, and 2nd). RESULTS: In the learning and memory domain, 89.5% of individuals with CPUD and 55.6% of HCs scored below the 25th percentile on at least one of the five test scores, in the language domain, 80.7% of individuals with CPUD and 58% of HCs and in the executive function domain, 92% of individuals with CPUD and 67.3% of HCs. Having two or more scores below the 10th percentile or 10 or more at the 5th percentile shows an optimal cut-off for determining the sensitivity and specificity for discriminating between the two groups. CONCLUSIONS: The individuals with CPUD had a higher percentage of low scores than the HCs in the domains of learning and memory, language, and executive function. It is important for clinicians to be aware of low scores in individuals with CPUD to avoid false-positive diagnoses of cognitive impairment.

Effect of calcium in patients with pulseless electrical activity and electrocardiographic characteristics potentially associated with hyperkalemia and ischemia-sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial.

OBJECTIVE: The Calcium for Out-of-hospital Cardiac Arrest (COCA) trial was recently conducted and published. This pre-planned sub-study evaluated the effect of calcium in patients with pulseless electrical activity (PEA) including subgroup analyses based on electrocardiographic characteristics potentially associated with hyperkalemia and ischemia. METHODS: Patients aged ≥ 18 years were included if they had a non-traumatic out-of-hospital cardiac arrest and received adrenaline. The trial drug consisted of calcium chloride (5 mmol) or saline placebo given after the first, and again after the second, dose of adrenaline for a maximum of two doses. This sub-study analyzed patients with PEA as their last known rhythm prior to receiving the trial drug. Outcomes were return of spontaneous circulation and survival at 30 days. RESULTS: 104 patients were analyzed. In the calcium group, 9 patients (20 %) achieved return of spontaneous circulation vs 23 patients (39 %) in the placebo group (risk ratio 0.51; 95 %CI 0.26, 1.00). Subgroup analyses based on electrocardiographic characteristics potentially associated with hyperkalemia and ischemia showed similar results. At 30 days, 1 patient (2.2 %) was alive in the calcium group while 8 patients (13.6 %) were alive in the placebo group (risk ratio 0.16; 95 %CI 0.02, 1.26). CONCLUSION: In adults with out-of-hospital cardiac arrest presenting with PEA, effect estimates suggested harm of calcium administration as compared to placebo but with wide confidence intervals. Results were consistent for patients with electrocardiographic characteristics potentially associated with hyperkalemia and ischemia. The results do not support calcium administration based strictly on electrocardiographic findings seen during out-of-hospital cardiac arrest.

Elucidation of tropane alkaloid biosynthesis in Erythroxylum coca using a microbial pathway discovery platform.

Tropane alkaloids (TAs) are heterocyclic nitrogenous metabolites found across seven orders of angiosperms, including Malpighiales (Erythroxylaceae) and Solanales (Solanaceae). Despite the well-established euphorigenic properties of Erythroxylaceae TAs like cocaine, their biosynthetic pathway remains incomplete. Using yeast as a screening platform, we identified and characterized the missing steps of TA biosynthesis in Erythroxylum coca. We first characterize putative E. coca polyamine synthase- and amine oxidase-like enzymes in vitro, in yeast, and in planta to show that the first tropane ring closure in Erythroxylaceae occurs via bifunctional spermidine synthase/N-methyltransferases and both flavin- and copper-dependent amine oxidases. We next identify a SABATH family methyltransferase responsible for the 2-carbomethoxy moiety characteristic of Erythroxylaceae TAs and demonstrate that its coexpression with methylecgonone reductase in yeast engineered to express the Solanaceae TA pathway enables the production of a hybrid TA with structural features of both lineages. Finally, we use clustering analysis of Erythroxylum transcriptome datasets to discover a cytochrome P450 of the CYP81A family responsible for the second tropane ring closure in Erythroxylaceae, and demonstrate the function of the core coca TA pathway in vivo via reconstruction and de novo biosynthesis of methylecgonine in yeast. Collectively, our results provide strong evidence that TA biosynthesis in Erythroxylaceae and Solanaceae is polyphyletic and that independent recruitment of unique biosynthetic mechanisms and enzyme classes occurred at nearly every step in the evolution of this pathway.

From strong leadership to active community engagement: Effective resistance to illegal coca crops in Afro-Colombian collective territories.

In this paper, we study whether leadership and community organisation can explain differences in the presence and expansion of coca crops in rural Afro-Colombian collective territories. Following a mixed-method approach that combines the analysis of satellite imagery, semi-structured interviews and household surveys, our results suggest that leadership and community organisation help explain differences in the presence of illegal coca crops by activating pre-existing 'stocks' of social capital that enable rural Afro-Colombian communities in the country's southern Pacific region to resist the penetration and/or expansion of illegal coca crops. Results also show that resistance is more effective when the interests and strategies of leadership and communities are aligned. We argue that the effectiveness and sustainability of resistance depend on: (a) the stock of social capital that determines organisational capabilities, (b) the specific normative content with which this capital is infused, (c) the legitimacy and influence of leadership on the community, and (d) synergies among different levels of grass-root community organisation. We conclude that investing in social capital and community capabilities is thus one way to reorient policy interventions, a goal to which the Colombian state can only partially contribute given its policy priorities and structural limitations.

Analysis of Cocaine and Its Metabolites in Urine after Consumption of Coca Tea by Five Subjects and Subsequent Hair Testing.

Coca tea is a popular drink in some countries of South America where it is reputed to have medicinal properties. This preparation is composed of natural cocaine (COC) alkaloids and therefore can be banned in some countries. During an anti-doping control in Peru the urine of an athlete tested positive for benzoylecgonine (BZE) ecgonine methyl ester (EME) and COC (400 180 and 0.5 ng/mL respectively). The athlete indicated that she had consumed coca tea in the morning before the competition. As her lawyer contacted us to assess the scientific aspects of the possible involvement of coca tea to explain the adverse analytical finding a study was implemented with similar tea bags urine specimens were collected for each subject for 3 days to follow the elimination of COC and metabolites (BZE and EME). All samples were analyzed byultra high performance liquid chromatography tandem mass spectrometry after alkaline extraction. Maximum detection times for COC was 20 h with concentrations ranging from 6 to 91 ng/mL. Maximum detection times for BZE and EME were 70 h and 60 h respectively with concentrations ranging from 6 to 3,730 ng/mL and from 6 to 1,738 ng/mL. The concentration profiles were identical for the five volunteers. This study supports the athlete's claims. In addition, the sample of hair strands of the five subjects was collected a month later and all the hair tests showed a negative result for COC with a limit of decision of 10 pg/mg. Although it is accepted that a 4 mg dose of COC has no significant pharmacological effect the consumption of coca tea can lead to significant legal consequences since the measured urine concentrations sometimes cannot be considered incidental. Therefore, discrimination between coca tea consumption and recreational COC abuse relies primarily on hair analysis.

Tannin-phytobezoars with Gastric Outlet Obstruction Treated by Dissolution with Administration and Endoscopic Injection of Coca-Cola®, Endoscopic Crushing, and Removal (with Video).

A 77-year-old man complained of postmeal vomiting and sustained general fatigue. An abdominal computed tomography scan showed massive gastric expansion and fluid storage. Gastroscopy revealed four gastric bezoars that were considered to have caused pyloric ring obstruction. The patient was asked to drink 500 mL per day of Coca-Cola® for 4 days. On the fourth day, we performed endoscopic crushing and removal by injecting Coca-Cola®, cutting the softened bezoar with endoscopic snares, and collecting the pieces with endoscopic nets. We herein report (with a video presentation) a rare case of tannin-phytobezoars endoscopically removed with the administration and injection of Coca-Cola®.

Risk factors for acute mountain sickness in travellers to Cusco, Peru: coca leaves, obesity and sex.

BACKGROUND: Acute mountain sickness (AMS) may occur after rapid ascents to altitudes >2500 m. Cusco (3350 m) in Peru is a popular destination for altitude inexperienced travellers. This study aimed at evaluating the incidence and risk factors for AMS among a cohort of foreign Spanish language students in Cusco. METHODS: We performed a cohort study among young healthy foreign Spanish language students arriving to Cusco between 2012 and 2016. Consenting students answered an enrollment questionnaire on demographics, travel history and intended AMS preventive behaviour within 48 h of arrival. At 4-5 days after enrollment participants answered a second questionnaire about actual preventive behaviour before symptoms and the development of symptoms compatible with AMS during their first 48 h in Cusco. We used the 2018 Lake Louise Scoring System for AMS diagnosis. Participants with headache and a score ≥ 3 were considered to have AMS. RESULTS: We enrolled 142 language students, the median age was 21 years (interquartile range 20-25) and 57% were female. Participants decreased physical activity (38%), increased fluid intake (34%), drank coca leaf tea (34%), took acetazolamide (16%) and acclimatized at a lower altitude (6%) to prevent AMS. Thirty-nine percent had AMS. In the multivariate analysis, obesity [odds ratio (OR) 14.45 (2.33-89.6)] and female sex [OR 4.32 (1.81-10.28)] were associated with increased risk of AMS. Taking acetazolamide [OR 0.13 (0.03-0.56)] was associated with decreased AMS risk. Consumption of coca leaf tea was not associated with decreased risk of AMS. CONCLUSIONS: In our cohort, AMS affected two out of five travellers. Obesity and female sex were associated with increased risk. Drinking coca leaf tea for prevention did not decrease the risk of AMS. Acetazolamide prophylaxis was associated with decreased risk of AMS.

Advances in cocaine signature methodology: Alkaloid and isotope profiles of coca grown in Puno, Peru.

Drug Enforcement Administration's (DEA) Cocaine Signature Program previously identified 19 coca-growing regions within South America and developed methodology to geo-source cocaine using a combination of trace cocaine alkaloids, stable isotopes, and multivariate statistics. Twenty-nine coca leaf samples collected in 2016 and 2019 from a previously unanalyzed coca-growing region located in Puno, Peru, were analyzed with this methodology. Trace cocaine alkaloids and stable isotopes were compared with other Peruvian regions. Minor differences were observed in the extracted cocaine alkaloid profiles when compared with samples collected from the Ucayali-Huallaga Valley and Cusco-Apurimac regions while the stable isotopes of δ2 H (-177.1‰) and δ18 O (23.8‰) were enriched. Puno's alkaloid and stable isotope results are presented in this publication to assist forensic laboratories and enhance their cocaine geo-sourcing capabilities.