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1.
Forensic Sci Int ; 306: 110055, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31785512

RESUMO

Body fluid analysis has played a crucial role in ascertaining various characteristics and has greatly aided in reconstructing events during crime scene investigation. It is often presumed that crimes that involve violence and mental disturbances such as murder or sexual assault provide good sources of body fluids such as blood, saliva, semen, vaginal secretions, urine and tears. Tears are secreted in response to any emotional or stressful situations and may be found deposited on surfaces such as bedding, tissue paper or cloth. In the absence of the commonly noted body fluids such as blood or saliva, tears can play an important role that can lead to personal identification by examining the biochemistry and molecular aspects to obtain a full DNA profile. Additionally, identification of an individual may be done by carefully observing certain unique eye characteristics such as heterochromia which is highly individualistic. Characteristics of eyewear such as spectacles and contact lenses have unique properties and prescription criteria for correcting an individual's eyesight that can provide vital clues in understanding the visual ability of an individual. In crime scene investigation, the presence or absence of eyewear provides immense evidentiary value that has greatly aided in solving cases such as Janet Abaroa's Murder. This paper provides a systematic review of the possibility of using tears and eyewear for the purpose of forensic investigation and to statistically support the inferences with prescription databases which may be initiated across different populations. Forensic Optometry is yet to get streamlined along with the routinely followed investigative techniques and scientifically explored although no standard protocols exist to analyse eyewear. The use of behavioural optometry is gaining attention in the context of driving laws of different countries and is a simple but powerful indicator of abnormal behaviour. It is speculated that the last seen image referred to as an 'Optogram' of an individual may be captured in the retina since our eyes functions like a camera. Although this claim is considerably unexplored, it is quite possible that the last seen image of a criminal, objects or a place may be noted that can positively help in linking individuals at the scene of crime or identify the primary crime location. In this review, the potential for new insights into the analysis of tears, eye and eyewear characteristics have been explored.


Assuntos
Lentes de Contato , Impressões Digitais de DNA , DNA/isolamento & purificação , Óculos , Ciências Forenses/métodos , Lágrimas/química , Bases de Dados Factuais , Epitélio Anterior/química , Olho/patologia , Movimentos Oculares , Humanos , Mudanças Depois da Morte , Prescrições , Manejo de Espécimes , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Corpo Vítreo/química
2.
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
3.
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
4.
Medicine (Baltimore) ; 98(52): e18295, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876705

RESUMO

RATIONALE: 3-Methoxyphencyclidine (3-MeO-PCP) is a new psychoactive substance derived from phencyclidine. Although it can lead to severe intoxications, the main manifestations and optimal management have not been well characterized. Here, we report 2 cases of 3-MeO-PCP intoxication in the same patient, and summarize the manifestations of this intoxication reported in literature. PATIENT CONCERNS: A 17-year-old male purchased a bag of 3-MeO-PCP on the Internet but took an oral dose (200 mg) that corresponds to the less active isomer 4-MeO-PCP. He developed high blood pressure (158/131 mm Hg), tachycardia (100 bpm), and neurological manifestations (confusion, hypertonia, nystagmus, and then agitation). A maculopapular rash appeared, although this may have been related to the administration of midazolam. Hyperlactatemia (2.6 mmol/L) was the main laboratory finding. Seven days later, he returned to the emergency department after sniffing 50 mg of 3-MeO-PCP. High blood pressure, tachycardia, and neurological manifestations (psychomotor impairment and dysarthria) were present but less severe than after the first intoxication. DIAGNOSIS: In the first intoxication, the blood and urine 3-MeO-PCP concentrations were, respectively, 71.1 ng/mL and 706.9 ng/mL. Conventional toxicity tests were all negative. In the second intoxication, biological samples were not available. INTERVENTIONS: In the first intoxication, treatment consisted of intravenous hydration and midazolam. The patient was transferred to an intensive care unit for monitoring. After the second intoxication, he was monitored for 12 hours. OUTCOMES: The patient's condition improved quickly in both cases. LESSONS: These cases provide additional information on the manifestations of 3-MeO-PCP intoxication. These manifestations are mainly cardiovascular (high blood pressure, tachycardia) and neurological. The fact that second (50 mg) intoxication was less severe than the first (200 mg) is suggestive of a dose-effect relationship for 3-MeO-PCP. The first case also emphasizes the risk of dosing errors caused by the similarity between the names "3-MeO-PCP" and "4-MeO-PCP."


Assuntos
Drogas Desenhadas/envenenamento , Fenciclidina/análogos & derivados , Adolescente , Humanos , Hipertensão/induzido quimicamente , Masculino , Fenciclidina/sangue , Fenciclidina/envenenamento , Fenciclidina/urina , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Taquicardia/induzido quimicamente
5.
Lancet Psychiatry ; 6(12): 1054-1067, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31630982

RESUMO

Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.


Assuntos
Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/terapia , Programas de Rastreamento , Saúde Pública , Encaminhamento e Consulta , Comorbidade , Saúde Global , Humanos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários
6.
Forensic Sci Int ; 304: 109972, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31604205

RESUMO

5-Methoxy-N,N-diisopropyltryptamine (5-MeO-DiPT) is a designer hallucinogen that is a synthetic tryptamine derivative. It is highly abused and is involved in criminal activities because of its psychotropic properties. Herein, we presented an UHPLC-MS/MS method allowing for the qualitative and quantitative determination of 5-MeO-DiPT in human hair. The hair was first decontaminated and then cut into pieces. Thirty milligrams of hair samples was pulverized below 4°C in the presence of 0.5mL deionized water containing 0.1% formic acid. After centrifuging twice, 5µL of supernatant was injected into the LC-MS/MS system. A T3 column (100mm×2.1mm, 1.8µm) was used, and mobile phases consisted of 20mmol/L ammonium acetate, 5% acetonitrile and 0.1% formic acid in water (solvent A) and acetonitrile (solvent B). The gradient elution was used at a flow rate of 0.3mL/min. The resulting calibration curve for 5-MeO-DiPT was y=281.50213x+0.00231 (R2=0.992), the limit of detection (LOD) was 0.05pg/mg, and the lower limit of quantification (LLOQ) was 0.1pg/mg. The accuracy was between 92.1% and 105.6%, and the intra- and interday precision, recovery and matrix effect were acceptable. The validated method was successfully used in 106 real cases, and the concentration of 5-MeO-DiPT in hair samples of these suspected users was 0.2-7532.5pg/mg. These cases present data to document illegal 5-MeO-DiPT use.


Assuntos
5-Metoxitriptamina/análogos & derivados , Drogas Desenhadas/análise , Cabelo/química , Alucinógenos/análise , Detecção do Abuso de Substâncias/métodos , 5-Metoxitriptamina/análise , 5-Metoxitriptamina/química , Adulto , Cromatografia Líquida de Alta Pressão , Drogas Desenhadas/química , Feminino , Toxicologia Forense , Alucinógenos/química , Humanos , Limite de Detecção , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Estrutura Molecular , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-31547477

RESUMO

Advances in experimental psychology have provided evidence for the presence of attentional and approach biases in individuals with substance use disorders. Traditionally, reaction time tasks, such as the Stroop or the Visual Probe Task, are commonly used in the assessment of attention biases. The Visual Probe Task has been criticized for its poor reliability, and other research has highlighted that variations remain in the paradigms adopted. However, a gap remains in the published literature, as there have not been any prior studies that have reviewed stimulus timings for different substance use disorders. Such a review is pertinent, as the nature of the task might affect its effectiveness. The aim of this paper was in comparing the different methods used in the Visual Probe Task, by focusing on tasks that have been used for the most highly prevalent substance disorders-that of opiate use, cannabis use and stimulant use disorders. A total of eight published articles were identified for opioid use disorders, three for cannabis use disorders and four for stimulant use disorders. As evident from the synthesis, there is great variability in the paradigm adopted, with most articles including only information about the nature of the stimulus, the number of trials, the timings for the fixation cross and the timings for the stimulus set. Future research examining attentional biases among individuals with substance use disorders should take into consideration the paradigms that are commonly used and evaluate the optimal stimulus and stimulus-onset asynchrony timings.


Assuntos
Viés de Atenção , Tempo de Reação , Transtornos Relacionados ao Uso de Substâncias/patologia , Humanos , Reprodutibilidade dos Testes , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Percepção Visual
8.
Praxis (Bern 1994) ; 108(12): 793-798, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31530127

RESUMO

Fatigue - a Common Symptom in General Practice Abstract. When patients suffering from fatigue consult a GP surgery, GPs should understand what patients mean by fatigue, how strongly they are affected in everyday life and how they themselves explain the symptom. In a next step, dangerous diseases such as depression, addiction or sleep apnea syndrome must be excluded. The main somatic and psychiatric causes of fatigue should be explored simultaneously with a more in-depth history. A simple physical exam and a few lab examinations are sufficient to capture the major disorders that present with the isolated symptom of fatigue. For further care, a primary biopsychosocial approach with a viable physician-patient relationship is crucial. Rough conclusions based on laboratory findings should be avoided; comorbidities must be considered.


Assuntos
Fadiga , Medicina Geral , Comorbidade , Depressão/complicações , Depressão/diagnóstico , Medicina de Família e Comunidade , Fadiga/diagnóstico , Fadiga/etiologia , Humanos , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
9.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401569

RESUMO

Granulomatous interstitial nephritis (GIN) is a rare entity identified in <1% of native kidney biopsies. The most frequent aetiology is drug-related, followed by systemic granulomatous conditions. Among drugs implicated in GIN, antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent. We report the case of a 45-year-old white man referred to a nephrology consult due to chronic kidney disease. He had a history of arterial hypertension with 10 years of evolution, hyperuricaemia, medicated with allopurinol and NSAID abuse for at least 20 years. Urine sediment was blunt, without proteinuria. Renal ultrasound was normal. A kidney biopsy revealed well-defined epithelioid granulomas with glomerular wrinkling and collapse. Infectious and systemic conditions were excluded, favouring the hypothesis of drug-induced GIN, probably related to NSAIDs. Kidney biopsy remains the gold standard for the diagnosis of GIN. Facing a patient with renal failure without significant proteinuria or active sediment, one should look for causes of tubulointerstitial injury.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Granuloma/induzido quimicamente , Nefrite Intersticial/induzido quimicamente , Biópsia , Nitrogênio da Ureia Sanguínea , Creatina/sangue , Taxa de Filtração Glomerular , Granuloma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/patologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
10.
Tijdschr Psychiatr ; 61(7): 477-487, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31372969

RESUMO

BACKGROUND: Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur in adults. Together, they complicate diagnosis and can negatively influence treatment outcome.
AIM: To develop a practical guide to assist professionals with the screening, diagnosis and treatment of adult patients with SUD and ADHD.
METHOD: A literature search and a consensus procedure between several international scientific and clinical experts. This manuscript is an adapted and summarized Dutch version of the International consensus statement on screening, diagnosis and treatment of patients with SUD and comorbid ADHD.
RESULTS: The routine use of adequate screening tools enables ADHD to be detected earlier in adults with SUD. The diagnostic process for ADHD should be initiated as soon as possible in patients with SUD. Integrated treatment, involving a combination of pharmacotherapy and psychotherapy, is preferred. Long-acting stimulants with up-titration to higher dosages may be considered.
CONCLUSION: Early detection of ADHD in patients with SUD is essential for adequate diagnosis and more effective treatment and follow-up for these patients.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Comorbidade , Consenso , Humanos , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
11.
Nord J Psychiatry ; 73(8): 482-489, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31419392

RESUMO

Purpose: To examine gender-specific associations between multiple lifestyle-related risk factors, appearance satisfaction and depressive symptoms in a sample of Norwegian adolescents (13-16 years of age), and to study the role of appearance satisfaction as a possible confounder in the associations between lifestyle and depressive symptoms. Materials and methods: Data were obtained from Ungdata, a cross-sectional national survey of adolescents in Norway. In total 4379 subjects were included in the study. We constructed a lifestyle risk index and used multiple logistic regressions to examine the associations between lifestyle-related risk factors, appearance satisfaction, and depressive symptoms. Results: High screen time and use of alcohol were significantly associated with depressive symptoms among girls, while high screen time, tobacco and cannabis use were significantly associated with depressive symptoms among boys. An additive relationship was observed between the lifestyle risk index scores and the likelihood of depressive symptoms for both genders, the relationship being strongest among boys. Low appearance satisfaction was strongly associated with depressive symptoms, especially among boys, and identified as an important confounder in the associations between lifestyle and depressive symptoms, particularly among girls. Conclusions: High screen time was the most prevalent lifestyle risk behavior independently associated with depressive symptoms. Multiple lifestyle changes and improvement of appearance satisfaction should be included in measures targeting adolescents for the prevention and treatment of depressive symptoms. Future studies should elaborate on the gender differences in other adolescent age groups. Appearance satisfaction should be acknowledged as an important confounder in future studies of lifestyle and depressive symptoms.


Assuntos
Depressão/epidemiologia , Depressão/psicologia , Estilo de Vida , Satisfação Pessoal , Aparência Física , Tempo de Tela , Adolescente , Estudos Transversais , Depressão/diagnóstico , Feminino , Humanos , Masculino , Noruega/epidemiologia , Aparência Física/fisiologia , Fatores de Risco , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
13.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31296568

RESUMO

BACKGROUND AND OBJECTIVES: The primary care (PC) setting provides an opportunity to address adolescent alcohol and marijuana use. We examined moderators of effectiveness for a PC brief motivational intervention on adolescents' alcohol and marijuana use and consequences 1 year later. METHODS: We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 and followed adolescents using Web-based surveys. We examined whether demographic factors and severity of use moderated 12-month outcomes. Adolescents aged 12 through 18 were screened by using the National Institute on Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomly assigned to the intervention (CHAT) or to usual care (UC). RESULTS: The sample (n = 294) was 58% female, 66% Hispanic, 17% African American, 12% white, and 5% multiethnic or of other race with an average age of 16 years. After controlling for baseline values of outcomes, teens in CHAT who reported more negative consequences from drinking or had an alcohol use disorder at baseline reported less alcohol use, heavy drinking, and consequences 1 year later compared with teens in UC. Similarly, teens in CHAT with more negative consequences from marijuana use at baseline reported less marijuana use 1 year later compared with teens in UC; however, teens in CHAT who reported fewer marijuana consequences at baseline reported greater marijuana use 1 year later compared with teens in UC. CONCLUSIONS: A brief intervention can be efficacious over the long-term for adolescents who report problems from alcohol and marijuana use. Findings emphasize the importance of both screening and intervention in at-risk adolescents in PC.


Assuntos
Comportamento do Adolescente/psicologia , Compreensão , Intervenção Médica Precoce/métodos , Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Feminino , Humanos , Masculino , Entrevista Motivacional/métodos , Autorrelato , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
14.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31341007

RESUMO

BACKGROUND: The utility of CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) in identifying current and future problematic substance use and substance use disorders (SUDs) in pediatric emergency department (PED) patients is unknown. We conducted a secondary analysis of a study in 16 PEDs to determine the concurrent and predictive validity of CRAFFT with respect to SUD. METHODS: At baseline, 4753 participants aged 12 to 17 years completed an assessment battery (CRAFFT and other measures of alcohol, drug use, and risk behaviors). A subsample was readministered the battery at 1-, 2-, and 3-year follow-up to investigate future SUDs. RESULTS: Of 2175 participants assigned to follow-up, 1493 (68.6%) completed 1-year, 1451 (66.7%) completed 2-year, and 1265 (58.1%) completed the 3-year follow-up. A baseline CRAFFT value of ≥2 was significantly associated with problematic substance use or mild or moderate to severe SUD diagnosis on the Diagnostic Interview Schedule for Children at baseline (P < .001). The results persisted after 1, 2, and 3 years (P < .001). The best combined sensitivity and specificity was achieved with a baseline CRAFFT value of ≥1 as a cutoff for predicting problematic substance use and a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of mild SUD at 1, 2, and 3 years. The baseline CRAFFT score that best predicted a moderate to severe SUD at 1 year was ≥2; but at 2 and 3 years, the cutoff score was ≥1. CONCLUSIONS: CRAFFT has good concurrent validity for problematic substance use and SUD in PED patients and is useful in predicting SUDs at up to 3 years follow-up but with limited sensitivity.


Assuntos
Detecção do Abuso de Substâncias/normas , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários/normas , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
15.
BMC Res Notes ; 12(1): 451, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331383

RESUMO

OBJECTIVE: Mitragynine is the main active compound of Mitragyna speciose (Kratom in Thai). The understanding of mitragynine derivative metabolism in human body is required to develop effective detection techniques in case of drug abuse or establish an appropriate dosage in case of medicinal uses. This in silico study is based upon in vivo results in rat and human by Philipp et al. (J Mass Spectrom 44:1249-1261, 2009). RESULTS: Gas-phase structures of mitragynine, 7-hydroxymitragynine and their metabolites were obtained by quantum chemical method at B3LYP/6-311++G(d,p) level. Results in terms of standard Gibbs energies of reaction for all metabolic pathways are reported with solvation energy from SMD model. We found that 7-hydroxy substitution leads to changes in reactivity in comparison to mitragynine: position 17 is more reactive towards demethylation and conjugation with glucuronic acid and position 9 is less reactive towards conjugation with glucuronic acid. Despite the changes, position 9 is the most reactive for demethylation and position 17 is the most reactive for conjugation with glucuronic acid for both mitragynine and 7-hydroxymitragynine. Our results suggest that 7-hydroxy substitution could lead to different metabolic pathways and raise an important question for further experimental studies of this more potent derivative.


Assuntos
Mitragyna/química , Alcaloides de Triptamina e Secologanina/metabolismo , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Animais , Simulação por Computador , Desmetilação , Ácido Glucurônico/química , Ácido Glucurônico/metabolismo , Humanos , Redes e Vias Metabólicas , Modelos Químicos , Estrutura Molecular , Ratos , Alcaloides de Triptamina e Secologanina/análise , Alcaloides de Triptamina e Secologanina/química , Transtornos Relacionados ao Uso de Substâncias/metabolismo , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
16.
Med Care ; 57(9): 673-679, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31295165

RESUMO

BACKGROUND: Authorities recommend universal substance use screening, brief intervention, and referral to treatment (SBIRT) for all (ie, universal) adult primary care patients. OBJECTIVE: The objective of this study was to examine long-term (24-mo) changes in health care utilization and costs associated with receipt of universal substance use SBIRT implemented by paraprofessionals in primary care settings. RESEARCH DESIGN: This study used a difference-in-differences design and Medicaid administrative data to assess changes in health care use among Medicaid beneficiaries receiving SBIRT. The difference-in-differences estimates were used in a Monte Carlo simulation to estimate potential cost-offsets associated with SBIRT. SUBJECTS: The treatment patients were Medicaid beneficiaries who completed a 4-question substance use screen as part of an SBIRT demonstration program between 2006 and 2011. Comparison Medicaid patients were randomly selected from matched clinics in Wisconsin. MEASURES: The study includes 4 health care utilization measures: outpatient days; inpatient length of stay; inpatient admissions; and emergency department admissions. Each outcome was assigned a unit cost based on mean Wisconsin Medicaid fee-for-service reimbursement amounts. RESULTS: We found an annual increase of 1.68 outpatient days (P=0.027) and a nonsignificant annual decrease in inpatient days of 0.67 days (P=0.087) associated with SBIRT. The estimates indicate that the cost of a universal SBIRT program could be offset by reductions in inpatient utilization with an annual net cost savings of $782 per patient. CONCLUSIONS: Paraprofessional-delivered universal SBIRT is likely to yield health care cost savings and is a cost-effective mechanism for integrating behavioral health services in primary care settings.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/economia , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Análise Custo-Benefício , Custos e Análise de Custo , Feminino , Implementação de Plano de Saúde , Humanos , Modelos Lineares , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Análise Multinível , Atenção Primária à Saúde/métodos , Psicoterapia Breve/economia , Encaminhamento e Consulta/economia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
17.
Artigo em Inglês | MEDLINE | ID: mdl-31279971

RESUMO

New psychoactive substances have been introduced into the market in the last years due to their unregulated status. Synthetic cathinones are one of their main representatives, and they have shown to produce neonatal complications. It is important to have objective tools to identify in utero exposure to drugs that have shown to produce neonatal complications. An analytical method was developed and fully validated for the determination of common synthetic cathinones, including methylone, methedrone, mephedrone, 3,4-methylenedioxypyrovalerone (MDPV), (±)-4-fluoromethamphetamine and 4-fluoromethcathinone in meconium. Meconium (0.25 ±â€¯0.02 g) was homogenized with methanol by sonication for 30 min. After centrifugation, the sample was extracted with Oasis MCX columns. The analysis was performed by LC-MS/MS using an Atlantis T3 column (3 µm, 2.1 × 50 mm) and a gradient with acetonitrile and 0.1% formic acid in water. Method validation included the following parameters: selectivity (no endogenous or exogenous interferences), limits of detection (n = 3, 0.5-1 ng/g) and quantification (n = 3, 1-2 ng/g), linearity (n = 5, LOQ-200 ng/g), imprecision (n = 15, 0% to 10%), accuracy (n = 15, 87.3% to 97.8%), matrix effect (n = 10, -76% to -28.1%), extraction efficiency (n = 6, 63.7% to 91.3%), total process efficiency (n = 6, 16% to 60.2%) and stability for 72 h in the autosampler (n = 3, %loss = -6.7% to 5.1%). The method was applied to 28 meconium specimens.


Assuntos
Alcaloides/análise , Cromatografia Líquida de Alta Pressão/métodos , Mecônio/química , Espectrometria de Massas em Tandem/métodos , Adulto , Alcaloides/síntese química , Feminino , Humanos , Gravidez , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
18.
J Forensic Sci ; 64(6): 1943-1949, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31305953

RESUMO

Kava is an Oceanic plant in which the root is consumed as a beverage and is becoming increasingly popular. The effects of kava consumption may include sedation, euphoria, and impairment of motor coordination. This article demonstrates kava impairment through four cases of self-reported kava use supported with Drug Recognition Expert (DRE) evaluations of each subject. Subject's urines screened negative for common drugs of abuse by immunoassay analysis. Urine from cases 3 and 4 were analyzed by liquid chromatography-tandem mass spectrometry, and gas chromatography-mass spectrometry, which yielded the presence of kavalactones. Subjects exhibited poor driving behavior and signs of intoxication. Indicators of impairment from multiple drug categories, central nervous system (CNS) depressants, CNS stimulants, and cannabis were observed, which may be consistent with the presence of multiple kavalactones and their diverse array of mechanisms of action. The consumption of kava can hinder one's ability to operate a vehicle safely.


Assuntos
Dirigir sob a Influência , Kava/efeitos adversos , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto , Cromatografia Líquida , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Kava/química , Masculino , Raízes de Plantas/efeitos adversos , Piranos/urina , Pironas/urina , Espectrometria de Massas em Tandem , Adulto Jovem
19.
Forensic Sci Int ; 302: 109866, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31302415

RESUMO

5F-ADB (methyl 2-{[1-(5-fluoropentyl)-1H-indazole-3-carbonyl]amino}-3,3-dimethylbutanoate) is a frequently abused new synthetic cannabinoid that has been sold since at least the end of 2014 on the drug market. It has been classified as an illicit drug in most European countries, and also in Turkey, Japan, and the United States. In this study, 5F-ADB and its methyl ester metabolite were determined in the blood and urine samples taken from fatal cases using liquid chromatography-highresolution mass spectrometry (LC-HRMS). The extraction of samples was performed using a solid-phase extraction method, followed by LC-HRMS analysis. The method was fully validated for linearities, limits of detection (LODs), limits of quantification (LOQs), recoveries, matrix effects, process efficiencies, accuracies, precisions, and stabilities and was applied to 70 blood and 36 urine samples from fatal cases where 5F-ADB was the only drug detected. The LODs were between 0.08 and 0.10ng/mL, and LOQs were between 0.10 and 0.12ng/mL for both blood and urine samples. 5F-ADB and its methyl ester hydrolysis metabolite were found at the blood concentrations ranging from 0.10 to 1.55ng/mL (mean=0.40ng/mL) and 0.15 to 23.4ng/mL (mean=2.69ng/mL), respectively. 5F-ADB was not detected in any urine samples. 5F-ADBmethyl ester hydrolysis metabolite was detected in 35 urine samples with a detection range of 0.28-72.2ng/mL and a mean of 9.02ng/mL. The synthetic cannabinoid 5F-ADB and its methyl ester metabolite were identified and quantified in authentic human blood and/or urine specimens obtained from 70 fatal cases. The method was successfully applied to postmortem blood and urine samples.


Assuntos
Canabinoides/análise , Toxicologia Forense/métodos , Medicamentos Sintéticos/análise , Adolescente , Adulto , Idoso , Canabinoides/envenenamento , Cromatografia Líquida , Feminino , Humanos , Hidrólise , Masculino , Espectrometria de Massas , Éteres Metílicos/análise , Pessoa de Meia-Idade , Extração em Fase Sólida , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Medicamentos Sintéticos/envenenamento , Adulto Jovem
20.
Forensic Sci Int ; 301: 447-454, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31153676

RESUMO

This work has shown that it is a valid method for determining ketamine, norketamine and amphetamines derivates in hair samples of forensic cases. This method was validated meeting the criteria of sensitivity and accuracy for detecting repeated consumption of ketamine in hair samples of forensic interest, according to the proposed cut-off for ketamine of 0.5 ng/mg. The detection of norketamine allowed discriminating between active uses and external contamination. The assessed method was applied for analyzing 1189 hair samples of judicial interest received in the INTCF along 15 months, obtaining 62 positive in ketamine consumption. This means a 5.2% of positivity. Ketamine consumers present a profile of young age (21-30 years old), polydrug use with consumption of synthetic substances preferably MDMA and, then, amphetamine. As consumer is collective, prone to consume new psychoactive substances, requires special attention due to they show a consumer profile with higher prevalence in MDMA than amphetamine, indicating that ketamine consumers belong to a subgroup with a different profile within the INTCF casuistry. The results of the exercises of the proficiency tests performed satisfactorily in all cases. In conclusion, it is a suitable method also to evaluate the chronic consumption of ketamine, in addition to amphetamines in the same method of analysis.


Assuntos
Cromatografia Gasosa-Espectrometria de Massas/métodos , Cabelo/química , Ketamina/análogos & derivados , Ketamina/análise , Detecção do Abuso de Substâncias/métodos , Adulto , Anestésicos Dissociativos/análise , Humanos , Limite de Detecção , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto Jovem
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