Pre-analytical factors related to the stability of ethanol concentration during storage of ante-mortem blood alcohol specimens.

Sterile ante-mortem blood specimens were spiked with ethanol at the South African blood alcohol legal concentration limits of 0.20 g/L and 0.50 g/L and were stored in tubes containing sodium fluoride over a period of twenty-nine weeks under refrigeration (4 °C) and at room temperature (22 °C) to study the stability of the ethanol concentrations over time. Those stored under refrigeration were found to be stable, while a significant decrease in ethanol concentration at 99% confidence was observed in those stored at room temperature. Additional blood specimens, also spiked with ethanol, were inoculated with the dimorphic fungus Candida albicans at five different levels (1 × 106 cells/mL, 5 × 105 cells/mL, 1 × 104 cells/mL, 5 × 103 cells/mL and 5 × 101 cells/mL) and stored with and without sodium fluoride at 4 °C and 22 °C. The ethanol concentrations were monitored for nine weeks unless no fungal colonies were detected. Regardless of the presence or absence of NaF in samples - sterile or otherwise - storing specimens at 4 °C was sufficient to maintain the integrity of blood alcohol concentrations. The ethanol analyses were performed with an in-house validated isotope dilution gas chromatography-mass spectrometry analytical method on newly opened specimens once a week after which significance testing was performed to draw conclusions regarding changes in ethanol concentrations with measurement uncertainty in mind.

Efavirenz interference in urine screening immunoassays for tetrahydrocannabinol.

BACKGROUND: It has been known for some time that the antiretroviral drug, efavirenz (EFV), cross-reacts in urine immunoassays for tetrahydrocannabinol (THC). Because published studies investigating this phenomenon are limited, cross-reactivity information for several immunoassays is lacking. Reports of possible false-positive THC results from clinicians conducting workplace testing prompted us to investigate cross-reactivity for assays frequently employed in our own setting. In light of the potentially deleterious consequences of misclassification, information about EFV cross-reactivity should be included in product information to facilitate interpretation of results and assay selection. METHODS: Random urine samples from 30 patients on EFV therapy were analysed for THC metabolites by two near-testing devices (THC One Step Marijuana and Rapid Response(®) Drugs of Abuse Test Strips) and two automated immunoassays (Roche Diagnostics Cannabinoids II and Beckman Coulter SYNCHRON(®) Systems THC2). THC confirmatory testing was performed by gas chromatography-mass spectrometry (GC-MS). RESULTS: GC-MS failed to detect THC metabolites in any of the samples, as did three of the four immunoassays. However, the Rapid Response(®) test strips yielded positive results in 28 out of 30 samples, which could be reversed on re-testing after sample pretreatment with glucuronidase. CONCLUSIONS: Our study supports previous findings that interference is attributable to a glucuronidated EFV metabolite. We postulate that cross-reactivity is influenced by the composition of immunogens used to elicit anti-THC antibodies. Since access to such information is restricted, contributions from scientists in the antibody industry may be enlightening.

Rapid GC-MS confirmation of amphetamines in urine by extractive acylation.

Amphetamine and related derivatives are widely abused central- and psychostimulants. Detection of certain derivatives, such as methcathinone, by commonly available immunoassay screening techniques is insufficient. Multi-analyte confirmations for amphetamine type stimulants are therefore required, but traditional gas chromatography-mass spectrometry methods necessitate lengthy analytical procedures with prolonged sample turn-around times. A validated rapid GC-MS assay for urinary confirmation of amphetamine, methamphetamine, methcathinone, ephedrine, norephedrine, methylenedioxyamphetamine, methylenedioxymethamphetamine, methylenedioxyethylamphetamine and N-methyl-1-(3,4 methylenedioxyphenyl)-2-butanamine is reported. The method entailed in situ derivatization of urine specimens by extractive acylation with pentafluoropropionic anhydride, followed by rapid chromatography on a microbore capillary column. Analytes were separated in less than 3 min and quantified simultaneously by selected-ion monitoring using stable isotope substituted internal standards. The total instrument cycle-time was 6 min per sample. The limits of detection were between 1.5 ng/mL and 6.25 ng/mL for the various analytes. Intermediate precision and accuracy were in the range of 6.3-13.8% and 90.5-107.3% for the respective analytes at the lower limit of quantitation, and between 5.8-12.6% and 95.4-103.1% for the high control. Long-term storage of methcathinone positive specimens at -20 degrees C proved insufficient stability of this analyte. The proposed assay is precise and accurate for confirmation of amphetamine and derivatives in urine. The complementary approach of extractive-derivatization and fast GC-MS analysis is especially applicable in routine clinical settings where reduced sample turn-around times are required. Further investigation of cathinone as a possible metabolite of methcathinone is warranted, based on results from analyzed authentic urine samples.

Diagnosis of Helicobacter pylori infection with the (13)C-urea breath test by means of GC-MS analysis.

The diagnosis of Helicobacter pylori (H. pylori) infection by GC-MS detection of the (13)CO(2) enrichment in (13)C-urea breath test ((13)C-UBT) samples is reported. This study aimed to optimize the (13)C-UBT with regards to the diagnostic cut-off value, sampling time, and frequency. The H. pylori status of 103 dyspeptic patients was obtained by histological examination, the rapid urease test as well as with the GC-MS (13)C-UBT. Analytical and diagnostic accuracies were determined by comparison of the GC-MS (13)C-UBT results with that of the analytical and diagnostic gold standards, namely GC-isotope ratio MS (IRMS) and histology. The (13)CO(2) enrichment values obtained with GC-MS analysis, correlated favorably (r(2) = 0.993) with those obtained by GC-IRMS analysis. When compared to histology, the GC-MS (13)C-UBT had a diagnostic sensitivity of 92% and a specificity of 93%. The positive predictive value (PPV), negative predictive value (NPV), and accuracy were 95, 89, and 92%, respectively. It was concluded that SIM GC-MS is capable of analyzing nonradioactive (13)C-UBT samples, with a precision and accuracy sufficient to distinguish between H. pylori positive and negative patients.

The analysis of illicit methaqualone containing preparations by gas chromatography-mass spectrometry for forensic purposes.

A validated gas chromatographic-mass spectrometric method for quantitative analysis of methaqualone (MTQ) in illicit preparations is reported. The method proved to have a coefficient of variation of below 5%. Four batches of seized tablets, two pairs with similar imprints, were analyzed. It was found that the average MTQ concentration in all four batches of tablets differed significantly (p = 0.01) rendering it impossible to conclude that, on the basis of MTQ concentration alone, the batches with a similar logo originated from the same manufacturer or manufacturing batch. Conversely, it can be said that in this case, the four batches originated from either different clandestine laboratories or manufacturing batches.

Analysis of urinary biomarkers for exposure to alkyl benzenes by isotope dilution gas chromatography-mass spectrometry.

A validated GC-MS method for the analysis of urinary metabolites of alkyl benzenes is reported. Metabolites for exposure to toluene, xylene and ethylbenzene were analyzed simultaneously using stable isotope substituted internal standards. The method entailed acidic deconjugation of urine samples followed by extractive alkylation with pentafluorobenzyl bromide as alkylating agent. The resulting pentafluorobenzyl derivatives of ortho-, meta-, para-cresol, mandelic acid (MA), hippuric acid (HA) and ortho-, meta-, para-methylhippuric acid (MHA) were then quantified by SIM. Optimized reaction conditions for the extractive alkylation step are reported. The derivatives were found to be sufficiently stable for overnight batch analysis. The LODs were below 0.1 micromol/L for the cresols and below 1 micromol/L for MA and the HAs. Within-batch precision for o-MHA was 7%, for m-MHA 5%, for p-MHA 5.2% and below 5% for the rest of the analytes.