Multivariate analysis applied in dataset of Poison Control Center of São Paulo, Brazil.

Multivariate analysis techniques could be used to identify possible intercorrelations in intoxications cases. The statistical analyses used were a multiple logistic regression, multiple correspondence analysis, principal component and hierarchical cluster analysis. Of the 320 samples analysed, 192 samples were positive for some of the investigated toxic agents, of which 100 were positive for ethanol and 131 were positive for other substances. It was possible to group the patients into 3 clusters, which appears 66.5% of this information in the three first factorial axes. On the first axis, the male patients were separated from the female patients. Patients exposed to drugs, between 30 and 39 years old were grouped in the same cluster. On the second factorial axis, patients who were intoxicated with ethanol and who became intoxicated with diazepam were grouped. This work contributed to the mapping of intoxication cases at the Poison Control Centre of the São Paulo city, Brazil (CCI-SP) and serves as an initial study for the creation of a database that could be updated constantly and thus could provide a toxicovigilance system for educational policies.

Relação entre concentração sanguínea de cocaí­na e cocaetileno com a gravidade das manifestações clí­nicas apresentadas por pacientes com diagnóstico de intoxicação por cocaína / Relationship between blood concentration of cocaine and cocaethylene with the severity of clinical manifestations presented by patients diagnosed with cocaine intoxication

As intoxicações decorrentes do uso de drogas de abuso representam atualmente um grave problema para a saúde pública. Dentre os principais agentes envolvidos, destaca-se a cocaína. Ela se tornou uma das drogas mais consumidas ao redor do mundo, sendo um dos principais motivos de atendimentos em pronto-socorro (PS) devido ao uso de substâncias ilícitas. Seu uso ocorre principalmente em associação com bebida alcóolica. Existem poucos estudos realizados que relacionem a concentração sanguínea de cocaína e a gravidade das manifestações clínicas em populações que a utilizam como droga de abuso, e que envolvam pacientes atendidos em PS. O objetivo do presente estudo foi verificar a possível relação entre concentração sanguínea de cocaína e cocaetileno (produto da interação de cocaína com etanol) com a gravidade das manifestações clínicas apresentadas por pacientes com hipótese diagnóstica de intoxicação por cocaína. As concentrações sanguíneas foram determinadas por cromatografia líquida de alta eficiência (HPLC) e a gravidade das manifestações clínicas foi avaliada através do Stimulant Intoxication Score (SIS). Dos 81 pacientes incluídos no estudo 77,8% são homens com idade média de 32,5 anos ± 8,5 e SIS médio de 3,4 ± 2,5. Do total de pacientes incluídos no estudo 20 (24,7%) tiveram resultados positivos em sangue para os analitos de interesse, sendo a concentração sanguínea média de cocaína igual a 0,34 µg/mL ± 0,45 e de cocaetileno igual a 0,38 µg/mL ± 0,34. A concentração sanguínea de cocaína e cocaetileno não se mostrou informação útil para tratamento e prognóstico dos pacientes, porém a detecção no sangue destas substâncias no momento do atendimento, independentemente de sua concentração, pode ser um indicador de gravidade, mostrando que quaisquer concentrações destas substâncias devem ser consideradas potencialmente tóxicas. A aplicação do score SIS revelou-se como importante alternativa capaz de predizer a gravidade dos pacientes atendidos devido a intoxicação por cocaína de maneira rápida e simplificada

Currently, poisoning resulting from the abuse of drug represents a serious problem for public health. Among the main agents involved, cocaine stands out. It became one of the most abused drugs around the world, being one of the main reasons for visits to the emergency room due to the use of illicit substances. The use of cocaine is primarily in combination with alcoholic beverages. There are few studies that relate cocaine blood concentration and the severity of its clinical manifestations in patients attended in the Emergency Room. The aim of the present study was to verify the possible relationship between the blood concentration of cocaine and cocaethylene (product of the interaction of cocaine with ethanol) with the severity of the clinical manifestations presented by patients with cocaine intoxication. Blood levels were measured by high-performance liquid chromatography (HPLC) and the severity of clinical manifestations was assessed using the Stimulant Intoxication Score (SIS). Of the 81 patients included in the study, 77.8% were men with a mean age of 32.5 years ± 8.5 and mean of SIS 3.4 ± 2.5. From the total of patients included in the study 20 (24.7%) had positive blood results for the analytes of interest, being the mean blood concentration of cocaine equal to 0,34 µg/mL ± 0,45 and of cocaethylene equal to 0,38 µg/mL ± 0,34. The blood concentration of cocaine and cocaethylene has not been shown to be useful information for the treatment and prognosis of patients, but blood levels of these substances at the time of treatment, regardless of their concentration, may be an indicator of severity, showing that any concentrations of these substances should be considered as potentially toxic. The application of the SIS score proved to be an important alternative capable of predicting the severity of the patients attended due to cocaine intoxication in a fast and simplified way

Development of a method for the determination of cocaine, cocaethylene and norcocaine in human breast milk using liquid phase microextraction and gas chromatography-mass spectrometry.

Most licit and illicit substances consumed by the nursing mother might be excreted in breast milk, which may cause potential short and long term harmful effects for the breastfed infant. The extraction of substances from this matrix represents an analytical challenge due to its high protein and fat content as well as the fact that its composition changes during postpartum period. The aim of the present study was to develop a liquid phase microextraction (LPME) method for detection of the active substances: cocaine (COC), cocaethylene (CE) and norcocaine (NCOC) in human breast milk using gas chromatography-mass spectrometry (GC-MS). Validation was performed working on spiked human breast milk samples. The limits of detection (LOD) and quantification (LOQ) were of 6 and 12ng/mL, respectively, for all analytes. Calibration curves were linear over a concentration range of 12.0ng/mL-1000ng/mL (r(2)=0.99). No interferences were noticed at the retention times of interest. Within-run and between-run precision was always less or equal to 15 as % relative standard deviation, and bias ranged from 3 to 18%. Forty six milk samples were analyzed. Only one sample was confirmed to be COC positive (138ng/mL) and another one presented COC concentration near the LOD (6ng/mL). This method has shown to be a reliable alternative for the determination of cocaine, cocaethylene and norcocaine in human breast milk in the fields of clinical and forensic toxicology. LPME extraction procedure demonstrated to be a rather promising, low cost and environmental-friendly technique for the purpose of this study.