Accuracy of ultrasound-guided fine-needle aspiration cytology in evaluation of thyroid nodules using different ultrasonographic and cytological features.

BACKGROUND: Fine-needle aspiration cytology (FNAC) is a reliable method for preoperative evaluation of thyroid nodules particularly if ultrasound-guided (USG-FNAC). The main purpose of this study is to evaluate the efficacy of USG-FNAC and its accuracy. METHODS: We retrospectively studied 212 thyroidectomy cases with preoperative ultrasonography and FNAC data during the period 2015-2022 using TI-RADS for final ultrasound diagnosis and Bethesda system for cytological diagnosis. RESULTS: The studied cases were 200 females and 12 males. Thyroid cancer was more prevalent under 20 years old (78.5%). Papillary thyroid carcinoma comprises 84% of all cancer cases. Significant ultrasound features (p-value <0.05) favour malignancy were hypoechogenicity (66%), mixed echogenicity (84%), irregular border (61%), microcalcification (68%) and rim halo (63.6%). Malignancy was found in 21% of TI-RADS-2, 65% of TI-RADS-4 and 100% of TI-RADS-5. There is a significant difference between different categories of Bethesda system. All cases in Cat-VI were malignant (100%). Malignancy was also found in 81% of Cat-V, 20% of Cat-IV, 33% of Cat-III, 16% of Cat-II and 43% of Cat-I. Cytological features consistent with malignancy were as follows: grooving (94%), nuclear irregularities (89%), nuclear pseudoinclusion (89%) and little colloid (82%). In our study, USG-FNAC sensitivity was 83%, specificity 85%, PPV 85%, NPV 83% and accuracy 84%. CONCLUSION: Ultrasound features in favour of malignancy in thyroid nodules are hypoechoic or complex echogenicity, irregular border, punctuate calcification and presence of rim halo. Cytological features in favour of malignancy are grooving, nuclear irregularities, nuclear pseudoinclusion and little or absent colloid.

Fish borne Edwardsiella tarda eha involved in the bacterial biofilm formation, hemolytic activity, adhesion capability and pathogenicity.

Edwardsiella tarda (E. tarda) is distributed widely in a variety of hosts including humans, other mammals and fish, and it is worthwhile to notice that E. tarda -caused fish infections lead to the most important bacterial disease in fish. Considering Eha acting as a transcriptional regulator in E. tarda strain ET13 have been reported previously, to better understand its pathogenesis due to this, a type of cell of epithelial cell line (Caco-2) infection model for the pathogen was established in the laboratory. We focused on studying various parameters such as lactate dehydrogenase release (to measure cytotoxicity) and cell adhesions, both of which are related to the bacterial pathogenesis. Furthermore biofilm formation, hemolytic activity, and adhesion to Caco-2 cells were decreased in an E.tarda mutant strain with deletion in-frame isogenic gene eha (∆eha) compared to the wild-type and the complementary strain eha+ (an engineered construct of ∆eha expressing eha); Meanwhile, we found that hemolytic activity and biofilm formation were significantly enhanced in the strain eha+. Moreover, the ∆eha strain had attenuated pathogenicity in the zebrafish infection model. The data also demonstrated that the series of genes fimA, esrB, gadB, mukF, katB, and katG are regulated by eha based on a quantitative reverse transcription polymerase chain reaction tests and analysis. Thus our research data indicated that eha has an impact on hemolytic activity, biofilm formation, adhesion, and pathogenicity of pathogenic strain ET13 and plays an essential role in manifesting the virulence factors.

The frequency, clinical course, and health related quality of life in adults with Gilbert's syndrome: a longitudinal study.

BACKGROUND: Gilbert syndrome (GS) is an autosomal recessive inherited disorder of bilirubin glucuronidation which has not been investigated in Egypt. This longitudinal study investigated the frequency, clinical course, genetic profile and health related quality of life in Egyptian adults. METHODS: An initial cross-sectional study was conducted to assess the frequency of Gilbert syndrome among Egyptian adults. Subjects fulfilling the criteria of GS were enrolled into the study and prospectively followed for the clinical features, risk factors for hyperbilirubinemia, health related quality of life [Short form-36 Health Survey version 2 (SF-36v2) and Chronic Liver Disease Questionnaire (CLDQ)], vitamins assessment and UGT1A1 polymorphisms. RESULTS: One hundred and one subjects fulfilled the criteria of GS with a prevalence of 8.016%. Recurrent jaundice was the only presentation in 47 (56.627%) GS subjects and jaundice was associated with abdominal pain, dyspepsia or loss of appetite in 54 (53.465%) subjects. A significant difference in 25-Hydroxyvitamin D3 levels was detected between GS patients and control subjects (P <  00001). Twelve subjects with GS developed significant unconjugated bilirubinemia during direct antiviral therapy (DAAs) therapy for HCV despite achieving sustained virologic response. Pregnancy was associated with significant exacerbation of unconjugated bilirubin which persisted through pregnancy. Risk factors for clinical jaundice included general anesthesia, pregnancy, fasting > 12 h, pregnancy, and low calorie weight losing plans, systemic infections, and intensive physical effort. During jaundice attacks, subjects with GS had significant differences in vitality, role emotional, social functioning, worry and general health domains of the SF-36v2 and CLDQ compared to controls. The homozygous polymorphism A(TA)7TAA was the most frequent polymorphism in Egyptians with GS. CONCLUSION: Gilbert syndrome is a frequent inherited disorder in Egypt. In a substantial percentage of subjects with GS, episodes of jaundice are associated with other symptoms and nutritional deficiencies which result in impairment of HRQOL. Screening, counseling, monitoring and individualized health care are recommended for subjects with GS in the setting of anesthesia, pregnancy, treatment with DAAs, deliveries, surgery and weight loss plans.

Free radicals and oxidative stress: Mechanisms and therapeutic targets.

BACKGROUND: Free radicals are small extremely reactive species that have unpaired electrons. Free radicals include subgroups of reactive species, which are all a product of regular cellular metabolism. Oxidative stress happens when the free radicals production exceeds the capacity of the antioxidant system in the body's cells. OBJECTIVE: The current review clarifies the prospective role of antioxidants in the inhibition and healing of diseases. METHODS: Information on oxidative stress, free radicals, reactive oxidant species, and natural and synthetic antioxidants was obtained by searching electronic databases like PubMed, Web of Science, and Science Direct, with articles published between 1987 and 2023 being included in this review. RESULTS: Free radicals exhibit a dual role in living systems. They are toxic byproducts of aerobic metabolism that lead to oxidative injury and tissue disorders and act as signals to activate appropriate stress responses. Endogenous and exogenous sources of reactive oxygen species are discussed in this review. Oxidative stress is a component of numerous diseases, including diabetes mellitus, atherosclerosis, cardiovascular disease, Alzheimer's disease, Parkinson's disease, and cancer. Although various small molecules assessed as antioxidants have shown therapeutic prospects in preclinical studies, clinical trial outcomes have been inadequate. Understanding the mechanisms through which antioxidants act, where, and when they are active may reveal a rational approach that leads to more tremendous pharmacological success. This review studies the associations between oxidative stress, redox signaling, and disease, the mechanisms through which oxidative stress can donate to pathology, the antioxidant defenses, the limits of their effectiveness, and antioxidant defenses that can be increased through physiological signaling, dietary constituents, and probable pharmaceutical interference. Prospective clinical applications of enzyme mimics and current progress in metal- and non-metal-based materials with enzyme-like activities and protection against chronic diseases have been discussed. CONCLUSION: This review discussed oxidative stress as one of the main causes of illnesses, as well as antioxidant systems and their defense mechanisms that can be useful in inhibiting these diseases. Thus, the positive and deleterious effects of antioxidant molecules used to lessen oxidative stress in numerous human diseases are discussed. The optimal level of vitamins and minerals is the amount that achieves the best feed benefit, best growth rate, and health, including immune efficiency, and provides sufficient amounts to the body.

Analysis of ethyl glucuronide in hair samples by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS).

Many different biomarkers can be used to evaluate ethanol intake. Ethyl glucuronide (EtG) is a direct phase II and minor metabolite of ethanol formed through the UDP-glucuronosyl transferase-catalyzed conjugation of ethanol with glucuronic acid. Its investigation is of interest in both clinical and forensic contexts because of the wide window of detection. A sensitive LC-MS/MS procedure has been developed and fully validated according to the guidelines of forensic toxicology for the analysis of EtG in hair. Sample preparation and chromatographic separation were thoroughly optimized. The analysis was performed in the multiple reaction monitoring mode using the transitions m/z 221 → 203 (for the quantification) and 221 → 85 or 75 (for the qualification) for EtG, and m/z 226 → 208 (for quantification) and 226 → 75 or 85 (for qualification) for EtG-D5, used as the internal standard. Analyses were carried out using an Inertsil ODS-3 column (100 × 3 mm i.d., 3 µm particle size) and a mobile phase composed of formic acid and acetonitrile. Various SPE cartridges and solvents were tested in order to obtain the highest recoveries and cleanest extracts. The assay linearity of EtG was confirmed over the range from 20 to 2500 pg mg(-1), with a coefficient of determination (R(2) ) above 0.99. The lower limit of quantitation (LLOQ) was 20 pg mg(-1) and the limit of detection was 10 pg mg(-1). Intra- and inter-day assays were less than 15% except at the LLOQ (20%). The analytical method was applied to 72 post-mortem hair samples. EtG concentration in the hair ranged from 0 to 653 pg mg(-1) hair.

Placental Dysfunction and Acute Toxoplasmosis: The Role of Melatonin in Relation to Inflammatory Cytokines Interleukin-10 and Interleukin-12.

Objective: The objective of this study was to elucidate the potential role of anti-inflammatory interleukin (IL)-10 and pro-inflammatory (IL-12) cytokines as well as melatonin (MEL) in the development of placental dysfunction in the pregnant women with acquired toxoplasmosis (TOX). Materials and Methods: This case-control study was carried out at the Department of Clinical Parasitology in teamwork with the Department of Gynecology and Obstetrics, Al-Yarmouk Teaching Hospital, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq, from September 2018 to February 2019. The recruited patients and healthy controls were allocated into two groups - Group A: pregnant women with acute TOX (n = 45) and Group B: healthy pregnant women (n = 25). Anti-Toxoplasma (Toxo) immunoglobulin M (IgM), serum and placental as well as serum-placental (SP) ratio of MEL, IL-10, and IL-12 were measured. SPSS version 20.00 was used for data analysis. Results: Anti-Toxo IgM serum level and IL-12 serum levels were higher compared with controls (P = 0.001). Both MEL and IL-10 serum levels were lower in the pregnant women with acute TOX compared with controls (P = 0.002 and P = 0.002), respectively. Besides, Both MEL and IL-10 placental levels were lower in the pregnant women with acute TOX compared with controls (P = 0.001). As well, placental IL-12 level was higher in the pregnant women with acute TOX compared with controls (P = 0.001). SP ratio of MEL was higher in the pregnant women with acute TOX compared with controls (P = 0.001). Conclusion: MEL and anti-inflammatory IL-10 are reduced in the pregnant women with acute TOX, while IL-12 is increased. SP ratio of MEL but not of IL-10 or IL-12 is elevated in the pregnant women with acute TOX reflecting the risk of PD.

An investigation of the relationship between cyberbullying, cybervictimization and depression symptoms: A cross sectional study among university students in Qatar.

BACKGROUND: Cyberbullying is a modern form of bullying that could be practiced electronically or on the internet. It is related to different mental health issues such as depression, which can affect both the cyberbully and the victim. Although a few studies have been conducted regarding the prevalence of cyberbullying and cyber-victimization among the younger generation in Qatar, no studies have been conducted among young adults despite studies showing that they are also prone to cyberbullying. METHODS: This is a cross-sectional study to investigate the prevalence and the relationship between cyberbullying, cyber-victimization, and depression symptoms among Qatar University students. A self-administered close-ended electronic questionnaire was used to assess student's cyberbullying/cyber-victimization behaviors and depression symptoms. The Revised Cyberbullying Inventory scale (RCBI-II) and Patient Health questionnaire-9 (PHQ-9) were utilized to measure involvement in cyberbullying and depression symptoms, respectively. A total of 836 students participated in the study. Pearson Chi-Square test and binary logistic regression were conducted to analyze the data. RESULTS: Results indicated the majority of students have been involved in cyberbullying as follows: 6.8% cyberbullies, 29.2% cybervictims, 35.8% cyberbully-victims, and 28.2% not involved in either. Approximately 50% of the students scored a ten or higher on the PHQ9 test indicating symptoms of depression. Moreover, significant associations were found between cyberbullying experiences and gender (p = 0.03), depression and gender (p = 0.046), and between cyberbullying experiences and depression (p<0.001). CONCLUSION: Our findings indicate that among Qatar University students, cyberbullying and cyber-victimization are prevalent behaviors that could be associated with the high reported rates of depression symptoms.

Influence of Nutrition on Disease Severity and Health-related Quality of Life in Adults with Sickle Cell Disease: A Prospective Study.

BACKGROUND & AIMS: Sickle cell disease (SCD), a genetic disorder resulting from the presence of a mutated hemoglobin S (HbS), has a worldwide distribution and causes significant morbidity and mortality in children and adults. Few studies addressed the determinants of SCD severity in adults; therefore, we investigated the impact of nutrition on the outcome of SCD and health-related quality of life (HRQoL) in adult patients. METHODS: In this longitudinal study, we recruited and prospectively followed 62 adults with SCD (aged ≥18 years) for a median of 93 months. At entry and follow-up, patients provided medical and dietary history, had a physical examination and anthropometric measurements, assessed protein-energy intake, measurement of micronutrient levels, estimation of SCD severity score, and determination of the HRQoL (SF-26v2). The study outcome was a composite of hospitalization due to SCD crises or death. RESULTS: At baseline, 42 (67.74%) patients had macro and, or micro-undernutrition (Group A), and 20 (32.26%) were well nourished. (Group B). The BMI and most anthropometric measurements were significantly lower in SCD patients compared to control subjects. Seventy percent of SCD patients had vitamin D, vitamin B12, and zinc deficiencies. Thirty-six under-nourished patients (86%) had gastrointestinal disorders. During follow-up, 46 patients (74.19%) developed one or more vaso-occlusive pain crises or other SCD related complications that required hospitalization. Significant differences in most SF-36v2 domains existed between well-nourished and undernourished SCD patients. Protein-energy and micronutrient deficiencies were independent predictors of severe SCD and mortality. Correction of undernutrition and hydroxyurea therapy improved SCD severity scores and HRQoL. CONCLUSIONS: Patients with sickle cell disease have various degrees of macro and micro deficiencies, which increase SCD severity and hospitalizations and reduce the health-related quality of life. Early diagnosis and prompt correction of macro and micronutrient deficiencies need to be incorporated in the standard of care of SCD patients to improve the disease outcomes.

Expression of androgen receptor in invasive ductal breast carcinomas: a clinicopathological study from Jordan.

BACKGROUND: The clinical relevance of androgen receptors (ARs) expressed in breast cancer cells and the suggested prognostic impact has been an area of active research. The prevalence rate of AR expression in breast cancer has never been reported among Jordanian patients. OBJECTIVE: Determine the expression rate of ARs among invasive ductal breast cancer cases of different stages and molecular subtypes. Also, analyze the relationship between AR expression and clinicopathologic and immunohistochemical criteria, and assess the impact of AR expression on survival. DESIGN: Retrospective medical record review. SETTING: Tertiary care hospital in Amman, Jordan. PATIENTS AND METHODS: Our study comprised only of cases of invasive ductal breast carcinoma of no special type among females from records during a 10-year period between 2006 and 2015. Immunohistochemical staining was considered positive if more than 10% of tumor nuclei showed positive staining. MAIN OUTCOME MEASURES: The expression rate of ARs and the association of the expression rate with the clinicopathologic features of invasive breast cancer. SAMPLE SIZE: 293. RESULTS: Immunohistochemical staining for AR revealed positive stain.ing in 180 (61.4%) cases, including approximately 50% of triple-negative breast cancer cases. AR positivity correlated with estrogen receptor (ER) status (P=.007) and smaller T size (P=.014). However, no significant association was found with any of the other variables. AR expression was positively associated with overall survival (P=.022) in general and in ER-positive cases (P=.012). However, in the multivariate Cox regression model, AR was not independently associated with survival. CONCLUSIONS: These results were consistent with international reports showing a significant relationship of AR expression with ER status. In addition, AR expression was significantly associated with smaller tumor size. Although AR status was not independently associated with survival, our data suggest AR is a good prognostic factor. LIMITATIONS: Some clinical data were missing. CONFLICT OF INTEREST: None.

Simultaneous LC-MS-MS determination of cyclosporine A, tacrolimus, and sirolimus in whole blood as well as mycophenolic acid in plasma using common pretreatment procedure.

The purpose of the study was to develop rapid and simple procedure for simultaneous determination of cyclosporine A (CsA), tacrolimus (TCR), and sirolimus (SIR) in whole blood and mycophenolic acid (MPA) in plasma. Ascomycin (ASCO), cyclosporine D (CsD), and desmethoxysirolimus (DMSIR) were used as internal standards (IS) for TCR, CsA and MPA, and SIR, respectively. In the method development, six-level blood calibrators were used for CsA (range 47-1725 ng/ml), TCR (range 2.1-38.8 ng/ml), and SIR (range 2.4-39.6 ng/ml). Four-level calibrators were used for MPA (range 0.15-5.48 microg/ml). Four levels of quality control (QC) standards were used for blood samples, together with two levels of QC standards in plasma. All QC standards and calibrators were obtained from commercial sources. Sample preparation based on precipitation of 50 microl of sample in zinc sulfate-methanol-acetonitrile mixture containing IS, followed by centrifugation. HPLC was performed on ChromSpher pi column, 30 mm x 3 mm, in ballistic gradient of ammonium formate buffer-methanol at 0.8 ml flow rate. Following gradient elution profile was applied: 0-1.2 min at 30% methanol (divert valve to waste), 1.21-3.1 min 97% methanol (divert valve to detector), 3.11-3.7 min 30% methanol (divert valve to waste). ESI-MS-MS (MRM) was done on TSQ Quantum instrument with ESI source in positive ion mode. Ammoniated adducts of protonated molecules were used as precursor ions for all analytes but MPA. For this compound sodium adduct was used. Following transitions were monitored: for CsA m/z 1220-1203; for CsD 1234-1217; for SIR 931.6-864.5 and 882.6; for DMSIR 902-834.5; for TCR 821.5-768.5 and 785.5; for ASCO 809.5-756; for MPA 343-211.6; for MPA-glucuronide 514-306 and 211.6. The limits of quantitation were: 1 ng/ml for TCR and SIR, 20 ng/ml for CsA, and 0.1 microg/ml for MPA. Post-column infusion experiments showed that no positive or negative peaks appeared after injection of matrix in the elution range of target compounds. General signal suppression caused by matrix ranged from 20-40%, and was caused mainly by zinc sulfate present in deproteinizing solution. Extracted samples were stable for 2 days at 4 degrees C and for at least 20 days at -20 degrees C. MPA was fully separated from its glucuronide, which was eluted at around 0.7-0.8 min and directed to the waste. Some mutual cross-contribution of CsD and CsA was observed (below 1%), other IS did not contribute to target compounds and vice versa. Observations of chromatograms from patients taken single therapy demonstrated that possible metabolites of CsA, TCR, or SIR did not interfere with target compounds or IS.

Reference intervals for common biochemistry laboratory tests in the Saudi population by a direct a priori method.

BACKGROUND: Reference intervals (RI) for biochemistry laboratory tests are now based on Caucasian rather than Saudi populations. Test parameters may vary because of race, lifestyle, population structure and geographic location. OBJECTIVES: To establish reference intervals for common clinical chemistry laboratory tests for the Saudi population. DESIGN: Direct a priori method. SETTING: Tertiary care hospital. MATERIALS AND METHODS: Blood samples were taken from 625 individuals aged from 2 to 87 years from different geographic areas for 93 biochemistry tests. RIs were established following the International Federation of Clinical Chemistry guideline. MAIN OUTCOME MEASURE(S): Reference values for common biochemistry lab tests. RESULTS: Ninety-three age- or gender-stratified reference intervals (RIs) based on the Saudi population were established. There were 72 non-partitioned tests. Most of the tests were similar to RIs from manufacturer's inserts. For some sex hormones (estrogen, luteinizing hormone, follicle-stimulating hormone, progesterone and 17 alpha-Hydroxyprogesterone) only male RIs were established as there were not enough samples to stratify for females based on physiologic status. CONCLUSION: The RIs are reliable and applicable to a general Saudi population. LIMITATIONS: Due to the sample size, RIs were not generated for some sex hormones for females.

Application of LC-ESI-MS-MS for detection of synthetic adulterants in herbal remedies.

Adulteration of allegedly "natural herbal medicines" with undeclared synthetic drugs is a common and dangerous phenomenon of alternative medicine. The purpose of the study was to develop a procedure for detection of most common synthetic adulterants in herbal remedies, using high-pressure liquid chromatography-electrospray tandem mass spectrometry (LC-ESI-MS-MS). Eighty drugs belonging to various pharmacological classes were included in the study. For most drugs two transitions were monitored, using protonated or deprotonated molecules as precursor ions. The drugs were isolated from herbal remedies using simple methanol extraction. Chromatographic separation was done in gradient of acetonitrile-10 mM ammonium formate buffer (pH 3.0). Drugs tested were grouped in suites, comprising analgesic drugs, antibiotics, antidiabetic drugs, antiepileptic drugs, aphrodisiacs, hormones and anabolic drugs, psychotropic drugs, and weight reducing compounds. These suites were used according to the declared benefits of examined preparations. Limits of detection ranged from 5 pg to 1 ng per injected sample. Drug-free herbal remedy spiked with eight various pharmaceuticals occurring in adulterated herbal preparations was used for internal proficiency testing. The recoveries of spiked drugs ranged from 63 to 100%. The procedure was applied in everyday casework. Several undeclared drugs were identified in "herbal" remedies, like e.g. sildenafil, tadalafil, testosterone, or glibenclamide. Pharmacological properties of detected drugs always corresponded with the claims of the "natural" remedies. The method presents a valuable extension of standard GC-MS screening used for this purpose.

The effect of aphasia upon personality traits, depression and anxiety among stroke patients.

BACKGROUND: Post-stroke patients with aphasia have higher levels of psychological distress. We aimed to find the relation between post-stroke aphasia and depression, anxiety and personality traits. METHODS: One month after stroke, 61 consecutive patients with stroke were included in this study. Thirty post-stroke patients with aphasia and 31 patients without aphasia. We used the following scales a clinical-friendly: Aphasic test, Eysenck Personality Questionnaire, Hamilton anxiety and Beck Depression Inventory. RESULTS: Depression and anxiety were more prominent among patients with aphasia than stroke without aphasia. Psychosis was more prominent among post-stroke patients with aphasia. LIMITATIONS: Our results may not exclusively exclude pre-morbid personality traits. CONCLUSIONS: Our study highlights the growing need to develop community rehabilitation services in the developing world, which address both physical and psychological morbidity.

Rapid determination of benzo(a)pyrene in olive oil samples with solid-phase extraction and low-pressure, wide-bore gas chromatography-mass spectrometry and fast liquid chromatography with fluorescence detection.

Benzo(a)pyrene (B(a)P) was extracted from olive oil using solid-phase extraction on columns filled with Florisil and Nucleoprep C18. The extracts were analyzed with GC-MS, using standard capillary column and low-pressure wide-bore column (LP-GC-MS), as well as with HPLC on standard column and short donor-acceptor complex chromatography (DACC) column. Quantitation was done with isotope dilution method (GC-MS and LP-GC-MS) or with internal standard benzo(k)fluoranthene (HPLC). Limits of detection were 1 ng/g for GC-MS on standard column, 1.6 ng/g on LP-column, 0.5 ng/g for HPLC on standard column, and 0.3 ng/g on DACC column, respectively. The applied extraction method allowed handling over 50 samples per day and assured recovery over 80%. Matrix solid-phase dispersion, tried as an alternative isolation method, appeared less advantageous. Fast chromatographic methods (LP-GC-MS and HPLC on DACC) made it possible to reduce analysis time to 8 and 5 min, respectively. The method was applied to routine analysis of B(a)P in olive oil samples.

Rapid determination of chloramphenicol and its glucuronide in food products by liquid chromatography-electrospray negative ionization tandem mass spectrometry.

Chloramphenicol (CAP) is subjected to monitoring in food products, with a minimum required performance level set at 0.3 ng/g. CAP was isolated from chicken meat and seafood by very simple solvent extraction procedure. For honey, a fast SPE procedure was applied. CAP-D5 was used as internal standard. HPLC separation was done on RP18 123 mm x 3 mm column in acetonitrile-ammonium formate 10 mM, pH 3.0 (40:60) at flow rate of 0.3 ml/min. A TSQ Quantum instrument with ESI source has been used in negative ionization mode. A MRM procedure has been applied and following transitions were monitored: m/z 321 > 152 (quantifier), 321 > 194, 321 > 257(qualifiers), 326 > 157 (IS). CAP peak was eluted at around 5 min; the total run time was 7 min. LOD was around 0.1 ng/g meat or 0.05 ng/g honey. Matrix effects were studied for all materials used, involving injection of blank extracts with post-column infusion of CAP, as well as checking the influence of the co-injected blank extracts on the signal intensity of CAP. No influence of matrix on the results of CAP determination were observed. The method allows analyzing up to 30 duplicate samples per day, including all calibration standards. Additionally, the method for determination of CAP glucuronide (CAP-G) was established, using urine from rats that were given this drug as a source of the metabolite. Full validation of the metabolite was not possible, due to the unavailability of reference standard.

In utero drug and alcohol exposure in infants born to mothers prescribed maintenance methadone.

AIMS: To describe the prevalence of in utero alcohol and illicit drug exposure in infants born to mothers prescribed methadone in pregnancy, and to compare the accuracy of maternal interview with infant toxicology. METHODS: Urine and meconium samples were collected from 56 infants born to mothers prescribed methadone during pregnancy and a confidential interview conducted soon after delivery. Samples were screened for drugs of misuse and meconium samples analysed for the presence of fatty acid ethyl esters (FAEEs) to detect prenatal alcohol exposure. RESULTS: 91% of infants had been exposed to illicit drugs in utero, including opiates (73%), benzodiazepines (70%) and cannabinoids (59%). 47% of infants had elevated FAEEs. Meconium was more sensitive at detecting in utero drug exposure than urine toxicology (p<0.01 for opiates, benzodiazepines, cannabinoids) or maternal interview (p=0.03 for opiates, p<0.01 for cannabinoids). CONCLUSIONS: The majority of infants born to mothers prescribed methadone during pregnancy are exposed to polysubstance misuse, and almost one-half additionally exposed to excess alcohol.

Determination of beta-hydroxybutyrate in blood and urine using gas chromatography- mass spectrometry.

Beta-hydroxybutyrate (BHB) is considered a potential biomarker for alcoholic ketoacidosis (AKA). A robust and sensitive method was developed and validated for the quantitative determination of BHB in postmortem blood and urine using deuterated gamma-hydroxybutyrate as an internal standard. Samples were analyzed by gas chromatography-mass spectrometry following liquid-liquid extraction and silyl derivatization. The limits of detection and lower limits of quantification in blood and urine were 2 and 7 mg/L and 2 and 6 mg/L, respectively. The interday and intraday precision was measured by coefficients of variation for blood and urine and ranged from 1.0 to 12.4% for quality control samples spiked at 50 and 300 mg/L. The linear range of 50-500 mg/L resulted in an average correlation of R(2) > 0.99, and the average extraction recoveries in blood and urine were >or= 82% and >or= 59%, respectively. BHB remains stable in blood spiked at a concentration of 300 mg/L for 15 days when stored within a refrigerator (2-5 degrees C). Postmortem blood and urine samples were analyzed using the validated method for cases where the deceased had a history of chronic alcohol abuse to establish the use of BHB as a potential marker of AKA.

How natural are 'natural herbal remedies'? A Saudi perspective.

OBJECTIVE: There is a rapidly growing trend in the consumption of herbal remedies in industrialised and developing countries. Users of herbal remedies are at risk of toxicity and adverse interactions of herbal preparations due to their frequent contamination with metals and adulteration with synthetic drugs. The purpose of this study was to assess the quality of herbal remedies present on the market in Saudi Arabia in recent years. METHODOLOGY: 247 herbal remedies and related preparations were examined from 2000-2001 at the Toxicology Laboratory, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Herbal powder samples were the most common sample type examined (n = 80), followed by complete, packed preparations (n = 59), single undescribed capsules or pills (n = 46), loose plant leaves or seeds (n = 28), creams (n = 18) and liquid or jelly samples (n = 16). All samples were subjected to toxicological screening for organic substances using gas chromatographic-mass spectrometric analysis, screening for heavy metals (arsenic, mercury, and lead) using inductive coupled plasma-mass spectrometry and microbiological examination. RESULTS: The preparations analysed were used to treat the following indications: leukaemia and other forms of cancer (n = 22); obesity (n = 18); diabetes mellitus (n = 14); rheumatic disorders (n = 14); skin pigmentation problems (n = 11); or to enhance male sexual activity (n = 9). In 123 cases, the indication of use was not known. 39 samples contained high concentrations of heavy metals. This was particularly striking in remedies used to treat leukaemia (arsenic content of 522-161,600 ppm) and in creams for whitening skin (mercury content of 5,700-126,000 ppm). Eight preparations contained synthetic drugs (e.g. benzodiazepines and tricyclic antidepressants in sedative preparations, cyproheptadine in a remedy to gain bodyweight, ibuprofen and dipyrone in herbal capsules used to treat rheumatism). 18 samples were contaminated with micro-organisms. 14 samples contained toxic substances of natural origin. Of the 247 examined preparations, 77 (i.e. over 30%) were disqualified due to high heavy metals content, bacterial contamination or presence of toxic organic substances. CONCLUSION: The study shows an urgent need to control the production, importing and selling of herbal preparations.