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1.
J Forensic Leg Med ; 69: 101890, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32056808

RESUMO

This retrospective study sought to identify a regular pattern of limb bruising which occurs in association with suicidal or accidental hanging. Following exclusion of cases suspicious for homicide, 82 consecutive cases of hanging from a 10-year period were retrospectively reviewed to identify the pattern of traumatic limb injury in each case. Relevant information such as location, toxicology, and type of suspension was also noted. 72% of the reviewed cases had traumatic limb lesions, the majority of which occurred on the posterior upper limb and the anterior lower limb. Although the distribution of limb injury in our study mirrored that found in the literature, the incidence is much higher than in previous studies (7.4-20%). This could either be due to differences in confounding factors such as intoxication and location of hanging or differences in the practice of recording of limb trauma in hanging between centres. Neither type of suspension nor location of hanging were significantly associated with an increased incidence of traumatic limb injury. Positive toxicology was found to increase the likelihood of sustaining limb injury (p = .044084). In conclusion, the presence of this well documented pattern of traumatic limb lesions in cases of hanging should not always raise suspicion of foul play.


Assuntos
Asfixia/patologia , Extremidade Inferior/lesões , Lesões do Pescoço/patologia , Extremidade Superior/lesões , Adulto , Distribuição por Idade , Asfixia/mortalidade , Depressores do Sistema Nervoso Central/sangue , Depressores do Sistema Nervoso Central/urina , Etanol/sangue , Etanol/urina , Feminino , Ciências Forenses , Humanos , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Preparações Farmacêuticas/sangue , Estudos Retrospectivos , Distribuição por Sexo , Detecção do Abuso de Substâncias , Extremidade Superior/patologia , Adulto Jovem
2.
Sports Health ; 12(2): 189-199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023171

RESUMO

CONTEXT: Cannabis use has increased, in large part due to decriminalization. Despite this increase in usage, it remains unclear what proportion of athletes use cannabis and what effect it has on athletic performance and recovery. OBJECTIVE: To systematically review cannabis use among athletes, including epidemiology, effect on performance and recovery, and regulations for use in sport. DATA SOURCES: PubMed, MEDLINE, and EMBASE databases were queried from database inception through November 15, 2018. A hand search of policies, official documents, and media reports was performed for relevant information. STUDY SELECTION: All studies related to cannabis use in athletes, including impact on athletic performance or recovery, were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Demographic and descriptive data of included studies relating to epidemiology of cannabis use in athletes were extracted and presented in weighted means or percentages where applicable. RESULTS: Overall, 37 studies were included, of which the majority were cross-sectional studies of elite and university athletes. Among 11 studies reporting use among athletes (n = 46,202), approximately 23.4% of respondents reported using cannabis in the past 12 months. Two studies found a negative impact on performance, while another 2 studies found no impact. There was no literature on the influence of cannabis on athletic recovery. Across athletic organizations and leagues, there is considerable variability in acceptable thresholds for urine tetrahydrocannabinol levels (>15 to 150 ng/mL) and penalties for athletes found to be above these accepted thresholds. CONCLUSION: Overall, these results suggest that approximately 1 in 4 athletes report using cannabis within the past year. Based on the available evidence, cannabis does not appear to positively affect performance, but the literature surrounding this is generally poor. Given the variability in regulation across different sport types and competition levels, as well as the growing number of states legalizing recreational cannabis use, there is a need to improve our understanding of the effects of cannabis use on the athlete and perhaps adopt a clearer and overarching policy for the use of cannabis by athletes in all sports and at all levels.


Assuntos
Abuso de Maconha/epidemiologia , Fumar Maconha/epidemiologia , Esportes/estatística & dados numéricos , Desempenho Atlético/fisiologia , Dronabinol/urina , Humanos , Política Organizacional , Esportes/legislação & jurisprudência , Detecção do Abuso de Substâncias
3.
Forensic Sci Int ; 307: 110137, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31927248

RESUMO

Seizures of synthetic opioids have increased since 2012, with a 45 % increase in synthetic opioid related deaths between 2016 and 2017 in US. Recently, concerns have arisen around these substances and their illicit use also in several European countries. Our aim was to develop and validate an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for the analysis of 16 synthetic opioids in segmented hair, including fentanyl, norfentanyl, acetylfentanyl, U-47700, AH-7921, acrylfentanyl, crotonylfentanyl, butyrylfentanyl, methoxacetylfentanyl, U-49900, valeryfentanyl, 4-fluoro-iso-butyrylfentanyl, ocfentanyl, furanylfentanyl, tetrahydrofuranylfentanyl, and alfetanyl. Sample preparation involved washing the hair in dichloromethane, water and methanol, and extraction in methanol, followed by solid phase extraction clean-up. This method was validated for linearity, limit of quantification (LLOQ), precision and bias, selectivity, stability, matrix effects, extraction efficiency of the clean up procedure, and carryover. LLOQs ranged from 0.15-1pg/mg, and the calibration ranged from the LLOQ up to 500pg/mg. Intra and inter-day precision were evaluated at low and high concentrations, with spiked QCs, during 8 days and the results were satisfactory with RSD<15 % for all the compounds except for norfentanyl (22 %) and alfentanyl (19 %). Two external certified QCs containing fentanyl at 11 and 105pg/mg were also analysed within each batch and the RSD and bias were lower than 16 % and 10 %, respectively. Matrix effects compensated by internal standard fentanyl-d5 (MEIS), were between 77-115 % (RSD<10 %) and extraction efficiency of the clean-up procedure was between 66-93 % (RSD<21 %). Processed sample stability and carryover were acceptable for all of the compounds. The method was applied to 17 authentic hair samples (body or head hair) from US fentanyl analogue users. When head hair was available, the hair strands were analysed in 1cm/segment. Concentrations ranges were as follows: fentanyl (n=16) 2->ULOQ (500) pg/mg, norfentanyl (n=14) 1-38pg/mg, acetylfentanyl (n=7) 0.6->ULOQ (250) pg/mg, furanylfentanyl (n=5) 2-123pg/mg, tetrahydrofuranylfentanyl (n=1) 0.5-63pg/mg and valerylfentanyl (n=1) 2.1->ULOQ (50) pg/mg, along the hair strands. To our knowledge, this is the first time where concentrations of tetrahydrofuranylfentanyl, and valerylfentanyl in hair are reported. The same samples were also analysed for the determination of other drugs of abuse using our routine method (also in 1cm/segment for head hair when available). The results demonstrated poly-drug use in these fentanyl-analogue users population (mean drugs: n=5): amphetamine and/or methamphetamine (n=10), buprenorphine (n=5), cocaine (n=8), methadone (n=8), 6-MAM (n=17), meperidine (n=1), oxycodone (n=11), tramadol (n=3). Evaluation of the concentrations of these drugs, together with the fentanyl analogues is discussed in the present paper. Two authentic samples from two Belgian post-mortem cases, were also analysed showing fentanyl use and in one case polydrug use. The results demonstrated multi-analyte quantitative methods, including fentanyl analogues, are becoming useful in forensic laboratories involved in hair analysis, and in particular when polydrug use is suspected.


Assuntos
Analgésicos Opioides/análise , Fentanila/análogos & derivados , Fentanila/análise , Cabelo/química , Detecção do Abuso de Substâncias/métodos , Cromatografia Líquida de Alta Pressão/métodos , Toxicologia Forense/métodos , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Medicamentos Sintéticos/análise , Espectrometria de Massas em Tandem/métodos
6.
Clin Biochem ; 75: 70-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707014

RESUMO

BACKGROUND: Dried specimens have been proposed in multiple environments to minimize costs associated with specimen storage and shipping in clinical studies. This report describes the development and validation of an automated method for qualitative toxicology screening of dried urine samples using LC-MS/MS. METHODS: Urine standards containing 41 compounds were prepared and applied to filter paper cards. Dried urine was eluted from the cards using a Dried Blood Spot (DBS) autosampler from Spark Holland, which was plumbed inline with a Thermo Scientific Turboflow chromatography system for subsequent MS/MS detection with selected reaction monitoring. Limits of detection, precision of peak areas, repeatability, and carryover studies were conducted. Concordance with a reference LC-MS/MS method using liquid samples was evaluated using remnant discarded specimens. RESULTS: The limit of detection ranged from 5 to 75 ng/mL for most compounds. At the LOD for each analyte, the peak area precision ranged from 8 to 29%. For 20 repeat injections of samples spiked at ±25% of the LOD, there was a 4% false positive rate for the 75% × LOD samples, and a 0.4% false negative rate for the +125% × LOD samples. In comparing 40 known positive specimens analyzed with the DUS method and a liquid urine reference method, there was 88% agreement. Analysis of 10 known negative specimens yielded negative results. There was no significant carryover detected up to 2000 ng/mL for any of the analytes in the assay. CONCLUSION: Using a robotic DUS sampling an inline HTLC-MS/MS system, we have developed and validated a fully-automated and robust method for multi-analyte detection of drugs of abuse in dried urine specimens.


Assuntos
Cromatografia Líquida/métodos , Ensaios de Triagem em Larga Escala , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/urina , Espectrometria de Massas em Tandem/métodos , Urinálise/métodos , Ensaios de Triagem em Larga Escala/instrumentação , Ensaios de Triagem em Larga Escala/métodos , Humanos , Limite de Detecção , Robótica/métodos
7.
Toxicol Lett ; 320: 109-112, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31778775

RESUMO

BACKGROUND: Since 2016 an increase has been observed in the availability of new synthetic opioids (NSO) in Europe. Cyclopropylfentanyl is a very potent and selective µ-opioid agonist, which was reported for the first time in August 2017 in Europe. METHODS: The case was included in a prospective observational study of patients treated in emergency departments after the intake of novel psychoactive substances (NPS). Clinical features were acquired using a structured questionnaire for physicians. Serum and/or urine samples of ED patients were analyzed using liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) screening methods for NPS. CASE REPORT: Within 10 min after intranasal intake of fentanyl, a 25-year-old male developed nausea, profuse sweating and dyspnoe. Because soon afterwards coma and respiratory insufficiency was noticed, the patient was admitted to hospital. After administration of naloxone (0.8 mg) breathing stabilized. However, the patient displayed recurrent decreases of oxygen saturation for 12 h. The intake of cyclopropylfentanyl was analytically confirmed. CONCLUSION: The constantly growing diversity of NSO still poses a high risk for drug users and can be a challenging task for clinicians and forensic toxicologists. Clinicians treating opioid overdoses should be aware of the potentially long lasting respiratory depression induced by fentanyl analogs.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/diagnóstico , Fentanila/análogos & derivados , Transtornos Relacionados ao Uso de Opioides , Detecção do Abuso de Substâncias/métodos , Administração Intranasal , Adulto , Aerossóis , Analgésicos Opioides/administração & dosagem , Cromatografia Líquida de Alta Pressão , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/fisiopatologia , Fentanila/administração & dosagem , Fentanila/envenenamento , Humanos , Masculino , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Espectrometria de Massas por Ionização por Electrospray , Espectrometria de Massas em Tandem , Resultado do Tratamento
8.
Int J Sports Med ; 41(1): 44-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31747700

RESUMO

The indirect identification of doping in sports can be performed by assessing athletes' hematological perturbations from the analysis of blood collected on different occasions. Because prosecution for doping based on this information requires expensive and time-consuming interpretation of blood analysis results by various expert hematologists, mathematical data screening is performed to decide which cases should be forwarded to hematologists. The current Bayesian and univariate screening of data does not process the multivariate trends of blood parameters or take the time interval between samplings into account. This work presents a computational tool that overcomes these limitations by calculating a single score, the hematological perturbation index (HPIx), for which a threshold is defined above which hematologists should be asked to assess the athlete's biological passport. The doping detection from this index, normalized for days difference between samplings based on 3, 4 or 5 consecutive samplings, is associated with true positive result rates (TP) not below 98% and false positive result rates (FP) less than 0.9%. Therefore, this tool can be useful as an early warning system of hematological perturbations to decide which athletes should be more closely monitored and which biological passports should be forwarded to hematologists for medical interpretation of data.


Assuntos
Doping nos Esportes , Testes Hematológicos , Detecção do Abuso de Substâncias/métodos , Reações Falso-Positivas , Humanos , Método de Monte Carlo , Análise Multivariada , Incerteza
9.
Forensic Sci Int ; 306: 110071, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31785510

RESUMO

The presence of Ethyl glucuronide (EtG) in hair provides a strong indication of ethanol consumption and its investigation is of interest in both clinical and forensic contexts because of the wide window of detection. However, due to the possibility of false negative results in cases of small ethanol intake or excessive hair washing, the combined measurement of ethyl palmitate (EtP) with EtG could be useful. In this study, a sensitive UHPLC-MS/MS procedure for the measurement of EtG in hair was developed and validated, using optimized sample preparation and chromatographic separation. Milled hair was extracted with water for 24 h at room temperature, followed by clean-up of the extract by ion-exchange solid phase extraction (SPE). Extraction was highly efficient, with yield of 96.93-101.06%. Chromatographic separation was performed with a Fluoro-Phenyl stationary phase. The assay was linear from 4 to 500pgmg-1, with accuracy in the range of 100.30-106.16%. Matrix effects (-0.87 to 5.89%) were adequately compensated by the use of deuterated EtG as internal standard. EtG was measured in hair samples of 46 volunteers, and results were compared with hair concentrations of ethyl palmitate (EtP) and the score in the AUDITC questionnaire. EtG hair concentrations were significantly correlated to the AUDIT-C classification (rs=0.365, p<0.05), but not to EtP hair levels. The diagnostic performance of EtG hair concentrations to identify excessive or moderate ethanol use was similar to the capability of AUDIT-C to identify severe and high health risk (Kappa, p=0.013). The developed assay is suitable for clinical use, providing a useful tool to evaluate chronic ethanol consumption.


Assuntos
Consumo de Bebidas Alcoólicas , Alcoolismo/diagnóstico , Glucuronatos/análise , Cabelo/química , Detecção do Abuso de Substâncias/métodos , Adulto , Biomarcadores/análise , Cromatografia Líquida , Feminino , Toxicologia Forense/métodos , Humanos , Masculino , Ácidos Palmíticos/análise , Extração em Fase Sólida , Espectrometria de Massas em Tandem
10.
Forensic Sci Int ; 306: 110058, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786516

RESUMO

Hair is one of the key samples for judging drug abuse in the field of forensic science. However, few studies have examined synthetic cannabinoids and their metabolites in human hair. Synthetic cannabinoids are a class of chemicals that bind to cannabinoid receptors, but they differ structurally from the cannabinoids found in cannabis. They have been sold sprayed on dried, shredded plant material under brand names such as "Spice" since the 2000s. In South Korea, synthetic cannabinoids have been widely distributed since 2009 and many types detected up to now. Unlike traditional drugs such as methamphetamine and cannabis, the abuse trends of synthetic cannabinoids were variable by regions and changed according to the times. If new types of synthetic cannabinoids become popular which has been altered in some structures, it becomes difficult to identify using exist analytical method. Therefore, it is important to develop a new analytical method for synthetic cannabinoids currently being abused in society. In this study, we developed simultaneous analytical methods for the detection of 18 synthetic cannabinoids and 41 of their metabolites in authentic human hair samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Selectivity, linearity, limits of detection (LODs), limits of quantification (LOQs), precision, accuracy, matrix effect, recovery, and process efficiency were evaluated, and all results were acceptable. Additionally, the distribution of synthetic cannabinoids in the head hair of Korean drug abusers from 2016 to 2018 was investigated. Hair samples from 43 individuals suspected of synthetic cannabinoid use were provided by law enforcement agencies. The drugs detected most prevalently in the head hair of Korean drug abusers were AB-CHMINACA and JWH-210.


Assuntos
Canabinoides/análise , Cabelo/química , Detecção do Abuso de Substâncias/métodos , Medicamentos Sintéticos/análise , Adulto , Cromatografia Líquida , Feminino , Toxicologia Forense , Humanos , Limite de Detecção , Masculino , República da Coreia , Espectrometria de Massas em Tandem , Adulto Jovem
11.
Forensic Sci Int ; 306: 110070, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786517

RESUMO

Propofol abuse has been reported worldwide, suggesting the need to establish analytical methods for human biological samples to investigate the abuse of propofol. This study aimed to investigate the relationship between dose and hair concentration using a simple and rapid analytical method developed and validated in this study. In the sample preparation, hair samples were washed with distilled water and methanol and extracted in methanol during 16h at room temperature. After centrifugation and evaporation, the residue was reconstituted and filtered through a 0.22µm membrane filter before LC-MS/MS analysis. The precursor-to-product ion transitions were 353 → 175, 113 for propofol glucuronide and m/z 370 → 175, 113 for internal standard(propofol glucuronide-d17). The calibration curves were satisfactory (R2=0.9997) and the limits of detection and quantification were 2 and 5pg/mg, respectively. In addition, this study collected the history of propofol use from subjects using a questionnaire and analyzed subjects' hair samples using a validated analytical method. As a result, the concentrations of propofol glucuronide ranged from 7 to 122pg/mg (mean : 51pg/mg). There were cases of positive relationships, but generally there was no correlation between dose and hair concentration.


Assuntos
Glucuronídeos/análise , Cabelo/química , Hipnóticos e Sedativos/análise , Propofol/análise , Detecção do Abuso de Substâncias/métodos , Adulto , Cromatografia Líquida , Feminino , Toxicologia Forense , Glucuronídeos/administração & dosagem , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Espectrometria de Massas em Tandem , Adulto Jovem
12.
Toxicol Lett ; 320: 87-94, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31812604

RESUMO

Human exposures to fentanyl analogs, which significantly contribute to the ongoing U.S. opioid overdose epidemic, can be confirmed through the analysis of clinical samples. Our laboratory has developed and evaluated a qualitative approach coupling liquid chromatography and quadrupole time-of-flight mass spectrometry (LC-QTOF) to address novel fentanyl analogs and related compounds using untargeted, data-dependent acquisition. Compound identification was accomplished by searching against a locally-established mass spectral library of 174 fentanyl analogs and metabolites. Currently, our library can identify 150 fentanyl-related compounds from the Fentanyl Analog Screening (FAS) Kit), plus an additional 25 fentanyl-related compounds from individual purchases. Plasma and urine samples fortified with fentanyl-related compounds were assessed to confirm the capabilities and intended use of this LC-QTOF method. For fentanyl, 8 fentanyl-related compounds and naloxone, lower reportable limits (LRL100), defined as the lowest concentration with 100 % true positive rate (n = 12) within clinical samples, were evaluated and range from 0.5 ng/mL to 5.0 ng/mL for urine and 0.25 ng/mL to 2.5 ng/mL in plasma. The application of this high resolution mass spectrometry (HRMS) method enables the real-time detection of known and emerging synthetic opioids present in clinical samples.


Assuntos
Analgésicos Opioides/sangue , Analgésicos Opioides/urina , Cromatografia Líquida de Alta Pressão , Fentanila/sangue , Fentanila/urina , Espectrometria de Massas por Ionização por Electrospray , Detecção do Abuso de Substâncias/métodos , Espectrometria de Massas em Tandem , Analgésicos Opioides/síntese química , Cromatografia Líquida de Alta Pressão/normas , Fentanila/análogos & derivados , Fentanila/síntese química , Humanos , Limite de Detecção , Padrões de Referência , Reprodutibilidade dos Testes , Espectrometria de Massas por Ionização por Electrospray/normas , Detecção do Abuso de Substâncias/normas , Espectrometria de Massas em Tandem/normas
13.
Forensic Sci Int ; 306: 110073, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31812818

RESUMO

Suicides involving more than one suicide method are termed "complex suicides" and need to be differentiated from murders. Self-immolation is the action of setting fire to oneself and is an infrequent method of suicide method in Western countries. However, burned corpses must be carefully examined because setting fire to a body after death can be a way of covering up a crime. Complex suicides involving self-immolation are rare, but careful analysis is necessary if we are to identify the manner of death. A systematic search of the literature concerning self-incineration in cases of complex suicides was carried out. This covered the age, gender and psychiatric condition of the victims, any history of previous suicide attempts, the existence of suicide notes, evidence of fire accelerants, signs of vital exposure to the fire, toxicology, the other suicide methods used in combination with burning and the characteristics of the burns. 46 cases were found in 22 papers published since 1985, but few of these studies provide any detailed analysis and in several cases many important data were missing. There is, therefore, a need to study this topic and to use an approach based on careful examination of the corpse, detailed investigation of the scene, toxicological examination and an evaluation of the victim's physical and psychiatric state.


Assuntos
Fogo , Patologia Legal , Distribuição por Idade , Queimaduras/patologia , Carboxihemoglobina/análise , Humanos , Transtornos Mentais/psicologia , Publicações Periódicas como Assunto/estatística & dados numéricos , Mucosa Respiratória/patologia , Distribuição por Sexo , Fuligem , Detecção do Abuso de Substâncias
14.
J Forensic Sci ; 65(1): 189-192, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31310667

RESUMO

Through the measurement of ethyl glucuronide in hair (hETG), it is possible to assess chronic alcohol abuse over time. In this paper, we present a study on hETG in Italian prison inmates. Analyses were performed by LC-MS according to a previously published method. Results were evaluated using the cut-offs established by the Society of Hair Testing. Positives samples (ETG > 30 pg/mg) accounted for 6% of all subjects, with concentrations ranging from 42 pg/mg up to 270 pg/mg, abstinent subjects (ETG < 7 pg/mg) accounted for 88%, and moderate alcohol consumption (7 < ETG < 30 pg/mg) for 6% of the subjects. No females displayed ETG values above 30 pg/mg. Among positive samples, only two subjects did not declare heavy alcohol consumption and were found strongly positive at 210 and 270 pg/mg. To the best of our knowledge, this represents the first study on ETG hair concentration on prison inmates.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/diagnóstico , Glucuronatos/análise , Cabelo/química , Prisioneiros/estatística & dados numéricos , Adulto , Biomarcadores/análise , Cromatografia Líquida , Feminino , Humanos , Itália/epidemiologia , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Detecção do Abuso de Substâncias/métodos , Adulto Jovem
15.
Br J Sports Med ; 54(1): 8-12, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31326919

RESUMO

The use of systemic glucocorticoids (GCs), as well as local injections, continues to be a controversial issue in the sport/anti-doping community. There is widespread and legitimate use of GCs for numerous health conditions, yet there are concerns about side effects and the possibility of enhanced athletic performance in limited settings. This is compounded by the uncertainty regarding the prevalence of GC use, mechanisms underlying physiological effects and complex pharmacokinetics of different formulations. While WADA continues to promote research in this complex area, some international sporting federations, major event organisers and professional sports leagues have introduced innovative rules such as needle policies, mandatory rest periods and precompetition guidelines to promote judicious use of GCs, focusing on athlete health and supervision of medical personnel. These complementary sport-specific rules are helping to ensure the appropriate use of GCs in athletes where overuse is a particular concern. Where systemic GCs are medically necessary, Therapeutic Use Exemptions (TUEs) may be granted after careful evaluation by TUE Committees based on specific and strict criteria. Continued vigilance and cooperation between physicians, scientists and anti-doping organisations is essential to ensure that GC use in sport respects not only principles of fairness and adherence to the rules but also promotes athlete health and well-being. The purpose of this narrative review is to summarise the use and management of GCs in sport illustrating several innovative programmes by sport leagues and federations.


Assuntos
Doping nos Esportes , Glucocorticoides , Desempenho Atlético/fisiologia , Comportamento Competitivo/efeitos dos fármacos , Doping nos Esportes/legislação & jurisprudência , Glucocorticoides/efeitos adversos , Glucocorticoides/farmacocinética , Glucocorticoides/farmacologia , Glucocorticoides/uso terapêutico , Política de Saúde , Humanos , Substâncias para Melhoria do Desempenho/efeitos adversos , Substâncias para Melhoria do Desempenho/farmacocinética , Substâncias para Melhoria do Desempenho/farmacologia , Detecção do Abuso de Substâncias
16.
Forensic Sci Int ; 306: 110094, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31864115

RESUMO

Methamphetamine (MAMP) is one of the most commonly abused illicit drugs in Asian countries, which belongs to the amphetamine-type stimulant class of substances. To detect the chronic drug misuse, human hairs have often been used as analytical specimens due to their long detection windows and easy accessibility. However, there is no investigation regarding the cut-off value of MAMP detection used in black-hair Chinese populations. Based on the analytical data obtained from 563 MAMP users, the cut-off value was found to be 0.97 ng/mg for the simultaneous detection of MAMP and amphetamine (AMP) ≥0.004 ng/mg (LOD). Through the established HPLC-MS/MS analytical method, the limits of detection and quantification of MAMP were 0.004 and 0.01 ng/mg, respectively. The cut-off value was optimized by AMP detection rate and receiver operating characteristic analysis, and the results were consistent with the previously reported MAMP/AMP ratio.


Assuntos
Estimulantes do Sistema Nervoso Central/análise , Cabelo/química , Metanfetamina/análise , Detecção do Abuso de Substâncias/métodos , Grupo com Ancestrais do Continente Asiático , China , Cromatografia Líquida de Alta Pressão , Toxicologia Forense , Humanos , Limite de Detecção , Espectrometria de Massas , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
17.
Accid Anal Prev ; 134: 105329, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704642

RESUMO

Though U.S. motor vehicle crashes as a whole have decreased over the past few years, fatalities among vulnerable road users have increased. Pedestrian deaths rose nationally by 27% between 2007 and 2016 accounting for 16% of all motor vehicle fatalities. This increase continues to burden transportation specialists, public health professionals, and community stakeholders. Potential risk factors include characteristics of the built environment, distractions, and pedestrians' use of alcohol and drugs. Pedestrian deaths in Georgia, United States, increased 40% between 2014 and 2016 while drug overdose deaths have increased by 18% during the same period. Concurrent increases in mortality due to pedestrian fatalities and drug overdoses make Georgia a natural environment in which to describe the proximity of drugs among pedestrian fatalities, a topic largely overlooked by the literature. This study explores the epidemiology of pedestrian fatalities in Georgia over a 10-year period with an emphasis on reported substance use among cases. The study employed 10-year data from the Fatality Analysis Reporting System (FARS) administered by the National Highway Traffic Safety Administration. Descriptive methods were used to explore drug screens by person, place, and time. We also examined trends in total drug screens over the examination period. Between 2007 and 2016, 1781 pedestrian crashes were reported to FARS; the fatality rate for this period was 94.5%. Of these, most were male with Blacks and Whites equally represented. Ages 15-64 accounted for 81.1% of cases with most occurring in the Atlanta Metropolitan area. When adjusted for population, one finds higher rates in more rural areas of the state. Data revealed that testing for the presence of drugs occurred among half of reported cases. Of those testing positive, five drug categories emerged; stimulants (45.8%), cannabinoids (21.5%), narcotics (including opioids) (14.1%), depressants (12.1%), and "Other Drugs" (6.3%). Positive drug screens across all drug classifications increased by 178.1% between 2007 and 2016. These findings suggest the need for state-wide policies designed to promote more consistent screening among pedestrians involved in motor vehicle crashes as well as diligence in understanding the role played by drugs among this population. Additional investigation should be conducted to tease out the presence of category-specific drugs among pedestrians. Understanding the epidemiology of pedestrian fatalities in the state, especially in relation to substance use, serves as a first step toward implementing localized preventive efforts.


Assuntos
Acidentes de Trânsito/mortalidade , Pedestres/estatística & dados numéricos , Detecção do Abuso de Substâncias/métodos , Acidentes de Trânsito/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Georgia/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise Espacial , Detecção do Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
18.
Sci Total Environ ; 698: 134207, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31499350

RESUMO

This study used wastewater-based epidemiology (WBE) to investigate the lifestyle of the inhabitants of Malé, the capital of the Republic of Maldives. Raw wastewater 12-h composite samples were collected from nine pumping stations serving the city area - thus representative of the whole Malé population. Samples were analysed by liquid chromatography coupled to mass spectrometry for estimating the profile of use of a large number of substances including illicit drugs, alcohol, caffeine, tobacco and pharmaceuticals. The illicit drugs most used were cannabis (THC) and heroin (700 and 18 g/day), with lower consumption of cocaine and amphetamines (0.1-1.2 g/day). It is important to note that the consumption of cannabis in Malé was comparable to that measured in other countries, while the consumption of heroin was higher. Among cathinones, mephedrone was detected at the highest levels similar to other countries. Consumption of alcohol, which is not allowed in Maldives, was found (1.3 L/day/1000 inhabitants), but at a low level compared with other countries (6-44 L/day/1000 inhabitants), while the consumption of caffeine and tobacco was generally in line with reports from other countries. Unique information on pharmaceuticals use was also provided, since no official data were available. Human lifestyle was evaluated by applying for the first time the full set of WBE methodologies available in our laboratory. Results provided valuable epidemiological information, which may be useful for national and international agencies to understand population lifestyles better, including illicit drug issues, and for planning and evaluation of drug prevention programs in Malé.


Assuntos
/análise , Águas Residuárias/química , Poluentes Químicos da Água/análise , Anfetaminas/análise , Cafeína/análise , Cocaína/análise , Humanos , Ilhas do Oceano Índico , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
19.
J Law Med ; 26(4): 800-814, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682358

RESUMO

In 2017 and 2018 Australia almost implemented laws to require unemployed people to undertake mandatory drug testing and treatment. Debate about linking welfare with mandatory drug treatment suffers from the complexity and paucity of research specifically about the efficacy of mandatory welfare drug treatment. This allows the possibility for mandatory welfare drug treatment to remain on the political horizon. This article situates the Australian proposal to introduce mandatory drug treatment for the unemployed within the relevant research literature. It concludes that the literature shows there is little chance of efficacy if welfare is linked with mandatory drug treatment. Instead, cost ineffectiveness and perverse outcomes are more probable than treatment efficacy.


Assuntos
Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/terapia , Austrália , Seguridade Social/legislação & jurisprudência
20.
Forensic Sci Int ; 305: 110004, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31707239

RESUMO

This study aims to investigate the prevalence of alcohol and drugs of abuse in Italian drivers involved in road traffic crashes between 2011 and 2018. Toxicological analyses were performed on the whole blood of 7593 injured drivers. Alcohol and illicit drugs, namely tetrahydrocannabinol (THC; cut-off 2ng/ml), cocaine (cut-off 10ng/ml), illicit opiates (cut-off 10ng/ml) and amphetamines (amphetamine, methamphetamine, MDMA, MDA; cut-off 20ng/ml) were investigated. The age and gender of the driver, the time of the crash (weekend/weekday and day/night), the road crash year and Blood Alcohol Concentration (BAC) were also considered. The 16.2% of samples tested positive for alcohol, 2.5% for cocaine, followed by opiates (2.0%), cannabinoids (1.5%), and amphetamines (0.5%). The overall prevalence of alcohol and drugs was lower than those reported in previous epidemiological studies of the DRUID project. The year 2011 showed the highest prevalence of drug-positive cases (24.1%), while the lowest prevalence was found in 2016 (16.8%), after the update of the Road Traffic Law (RTL) that increased punishments for driving under the influence. A progressive increase in the number of alcohol-positive female drivers was observed from 2011 to 2018, and the highest prevalence was found in the 26-35-year-old age range. Illicit drugs showed the highest overall prevalence in drivers <26 years of age but, if considering single drugs, cocaine and opiates were mostly found in subjects older than 36 years of age. A higher percentage of drug-positive drivers was found on weekend nights for alcohol and on both weekend and weekday nights for drugs. The types of drugs used by drivers did not change during the studied period.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Concentração Alcoólica no Sangue , Dirigir sob a Influência/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Distribuição por Idade , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/sangue
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