RESUMO
Background: Autoimmune hepatitis (AIH) can result in end-stage liver disease that requires inpatient treatment of the hepatic complications. Given this phenomenon, it is important to analyse the impact of gender and race on the outcomes of patients who are admitted with AIH using a national hospital registry. Methods: The 2012-2017 National Inpatient Sample database was used to select patients with AIH, who were stratified using gender and race (Hispanics and blacks as cases and whites as reference). Propensity score matching was employed to match the controls with cases and compare mortality, length of stay and hepatic complications. Results: After matching, there were 4609 females and 4609 males, as well as 3688 blacks and 3173 Hispanics with equal numbers of whites, respectively. In multivariate analysis, females were less likely to develop complications, with lower rates of cirrhosis, ascites, variceal bleeding, hepatorenal syndrome, encephalopathy and acute liver failure (ALF); they also exhibited lower length of stay (adjusted OR, aOR 0.96 95% CI 0.94 to 0.97). When comparing races, blacks (compared with whites) had higher rates of ALF and hepatorenal syndrome related to ALF, but had lower rates of cirrhosis-related encephalopathy; in multivariate analysis, blacks had longer length of stay (aOR 1.071, 95% CI 1.050 to 1.092). Hispanics also exhibited higher rates of hepatic complications, including ascites, varices, variceal bleeding, spontaneous bacterial peritonitis and encephalopathy. Conclusion: Males and minorities are at a greater risk of developing hepatic complications and having increased hospital costs when admitted with AIH.
RESUMO
Forensic laboratories around the world have seen an increase in the number of drug seizures containing methorphan. Levomethorphan is a narcotic and a controlled substance, and its enantiomer dextromethorphan is an antitussive agent used in over-the-counter medications. For the forensic analysis of seized drugs containing methorphan, it is important to report the stereochemical composition of the drug. Ideally, a method based on common forensic laboratory instrumentation is desirable. The use of the chiral derivatizing agent (-)-menthyl chloroformate followed by routine gas chromatography-mass spectrometry analysis of the derivative was shown to successfully determine the stereochemical composition of methorphan. This approach was applied to a street seizure containing methorphan proving that it was pure dextromethorphan. The derivatives of dextro- and levomethorphan were subjected to mass spectroscopic and nuclear magnetic resonance analysis, which confirmed that the structure of the derivatives remained unchanged as a result of the derivatization process.
RESUMO
Clandestine synthesis of methamphetamine in Australia has predominantly started from pseudoephedrine extracted from over the counter cold and flu medications. However, recently introduced restrictions on the sale of these products have made pseudoephedrine much more difficult to obtain. As a result clandestine chemists have had to resort to other means of obtaining the necessary chemical precursors. A recent drug raid (Adelaide, January 2008) resulted in the seizure of an unusual reaction mixture that indicated a novel approach involving the fermentation of glucose by yeast in the presence of benzaldehyde to give 1-hydroxy-1-phenylpropanone, also known as l-phenylacetylcarbinol (l-PAC), a known precursor to ephedrine and pseudoephedrine and hence methamphetamine. A study was undertaken into this process with the aim of determining the characteristic reaction by-products associated with methamphetamine made in this way. The study also looked at the stereochemical selectivity of the fermentation reaction and the stereochemistry of the subsequent reaction products, ephedrine and pseudoephedrine, and the final methamphetamine.