The risk and prevalence of pressure injuries in older people in the home care service: a cross-sectional study.

OBJECTIVE: This study aimed to understand the risk of developing pressure injuries (PIs) and their prevalence rate in older adults in Italy who received public funded home care services and who were often living alone. METHOD: In May 2019, a cross-sectional study was performed according to the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines. The data collection included demographic variables, a PI risk assessment using the Braden Scale score, the type of mobility devices available, the wound description detailing the PI category, body location and ongoing treatment. Data analysis was conducted using non-parametric descriptive statistics. RESULTS: Of the 2223 patients who participated in the study, the risk of developing a PI as measured with the Braden Scale sore was: 'absent' for 37.7%; 'mild' for 25.8%; 'moderate' for 13.8%; 'high' for 15.5%; and 'severe' for 7.1% of patients. The PI prevalence in the sample of home care service patients was 26%, of which 46% were inpatients with a Braden Scale score of <14. Of the PIs that developed during the study, 65% of these developed in patients in home care and of these, 81% had a Braden Scale score of ≤9. CONCLUSION: PIs developed not only during hospitalisation but at home. Assessing the commitment of patients and caregivers to PI prevention and treatment strategies in home care services could be key to reducing PI prevalence, hospital admissions for PIs, related complications for older people living at home, and the severity of the PI category.

Oral fluid analysis to monitor recent exposure to synthetic cannabinoids in a high-risk subpopulation.

Among novel psychoactive substances, synthetic cannabinoid receptor agonists (SCRA) seem to have the widest diffusion in the population with no limitation to any particular demographic group. Information on drug consumption relies mostly on anonymized surveys and less on clinical or analytical data; notwithstanding, the huge efforts constantly made to enroll subjects to gather epidemiological data. In the present study, we collected 66 oral fluid samples from volunteers in a drug rehabilitation center in 2019 and early 2020. A liquid chromatography-mass spectrometry method previously developed and validated by our Unit was applied to detect SCRA (n = 10) in oral fluid. Results proved the presence of synthetic cannabinoids at a positivity rate of almost 20%, with detection frequency HU211(5/13) > UR144/JWH122 (3/13) > JWH019/JWH081/AM2201 (1/13). Concentrations were in the range < LOQ -0.36 ng/ml. Synthetic cannabinoids consumption had not been declared by any volunteer. This study enabled for the unprecedent detection of synthetic cannabinoids use in the territory of Parma (Italy) in a high-risk subpopulation. The identified SCRA proved the persistence into the market of the "first-generation" JWH family into the Italian territory and the marketing of relatively new ones (AM-2201). Public health consequences represented by NPS consumption are still scarce; therefore, further studies are needed to understand the real diffusion in the population.

Validation of a Bioanalytical Method for the Determination of Synthetic and Natural Cannabinoids (New Psychoactive Substances) in Oral Fluid Samples by Means of HPLC-MS/MS.

New psychoactive substances (NPS) represent an important focus nowadays and are continually produced with minimal structural modifications in order to circumvent the law and increase the difficulty of identifying them. Moreover, since there are a high number of different compounds, it is arduous to develop analytical screening and/or confirmation methods that allow the identification and quantification of these compounds. The aim of this work is to develop and validate a bioanalytical method for detecting new synthetic drugs in biological samples, specifically oral fluid, using high-performance liquid chromatography coupled with mass spectrometry (HPLC-MS/MS) with minimal sample pretreatment. Oral fluid samples were simply centrifuged and denaturized with different rapid procedures before injection into the LC-MS/MS system. Calibration curves covered a linear concentration range from LOQ to 100 ng/mL. Validation parameters such as linearity, precision, accuracy, selectivity, matrix effect and thermal stability were evaluated and showed satisfactory results, in accordance with US Food & Drug Administration guidelines. The inter-day analytical bias and imprecision at two levels of quality control (QC) were within ±15% for most compounds. This method was able to identify and calculate the concentration of 10 NPS validated in this biological sample, even in the presence of matrix effect.

A case report positive for synthetic cannabinoids: are cardiovascular effects related to their protracted use?

The use of synthetic cannabinoids is being increasingly recognised worldwide, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. New substances are constantly being added to the content of synthetic cannabinoids and they are rarely identified on toxicological screening tests. Due to their structures synthetic cannabinoids and their effects have been compared to the psychoactive compound, Δ-9-tetrahydrocannabinol (THC), found in marijuana. On the molecular level, they are potent cannabinoid receptor agonists that also may have affinity for other types of receptors such as those on platelets. Reported symptoms of toxicity include anxiety, agitation, paranoia, hallucinations, tachycardia, hypertension, excessive sweating, nausea, and vomiting. They can also be linked to serious adverse cardiovascular events and can affect the cardiovascular system causing hypotension and bradycardia, myocardial infarction, atrial fibrillation, prolonged QTc, and Mobitz type II atrioventricular block, as well as interfere with the aggregation of platelets. We present a case report of a cardiac tamponade with toxicological findings positive for synthetic cannabinoids. This case highlights the importance of testing routinely for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions.

Determination of synthetic and natural cannabinoids in oral fluid by solid-phase microextraction coupled to gas chromatography/mass spectrometry: A pilot study.

In 2008, several synthetic cannabinoids were detected in herbal smoking blends sold on websites and in the so-called "smart shops". These compounds, as well as new psychoactive substances, flooded the market of illicit drugs and are sold at street level. Development and validation of rapid analytical methods for the detection and quantification of synthetic cannabinoids in biological matrices are essential for the investigation of pharmacokinetic, pharmacodynamic and toxicological properties. In this pilot study, the potential of direct immersion solid-phase microextraction coupled to GC/MS for the determination of synthetic and natural cannabinoids in oral fluid was proved. Validation proved the suitability of the developed method for the determination of the analytes at trace levels in oral fluid: linearity was assessed in the LOQ - 1000 ng/mL range, whereas a good precision was observed with CV below 20%. The method was then applied to more than 100 real oral fluid samples collected from a population of young students, showing a positivity rate of 3.8%.

Toxicological findings: A retrospective overview of medico-legal investigations in Parma (Italy).

The aim of this study was to collect all available data from 2009 to 2016 focusing on the epidemiological, clinical and pharmacological issues only related to acute intoxication fatalities in the Unit of Legal Medicine of the Department of Medicine and Surgery at the University of Parma. All death certificates and autopsy reports were retrieved from the archives and evaluated to identify cases in which only acute intoxication from xenobiotics could be defined as the cause of death, however statistical and descriptive analyses were applied to all the data. A more comprehensive analysis on all causes of death showed that out of 1005 total cases the most common is haemorrhagic shock/traumatic shock (36.5%), followed by cardiogenic shock with 27.4%; asphyxia ranks as the third cause of death (11.8%); concerning encephalic injuries, our data show 10.9% of cases, while acute intoxication by xenobiotics accounts for 5.7%. Data show that the majority of subjects are poly-abuser (75.4%); people not enrolled within a preventive treatment (59.4%) were more likely to commit suicide (28.1%), whereas only 6.2% in the sub-population in treatment (40.6%) committed suicide: therefore, data strongly suggest the evidence that joining a preventive programme can decrease the probability of extreme action. Access to a full case history may indeed save considerable time and expense in carrying out tests, but also valuable targeted samplings. The investigating officer should, therefore, submit as much information as possible about the case, as this may influence the type and extent of analysis undertaken, as well as the interpretation of analytical results.