The impact of creatinine reference value: Normalization of urinary drug concentrations

Many illicit drug users attempt to manipulate urine drug testing; dilution is one of the methods. In screening tests, false-negative results below the cut-off values can create positive results after creatinine normalization. This study aimed to evaluate the impact of a creatinine reference value on the normalization of the drug concentration in diluted urine. The study focused on 25 630 cases and the following information: gender, age, urine collection time, drug screening test results, creatinine concentration (CR), and confirmation analysis result. Mean CR value was 143.71 +/- 83.68 mg/dl. There was a significant difference between CR and gender (p = 0.03). The mean CR for women was lower than that for men. The correlation between age and CR was not significant (r = -0.08, p = 0.00). However, after grouping the sample into age groups of 10 years, there was a significant difference between age groups and mean CR (p = 0.00). The mean CR was significantly lower in the 0-9 year age group (n = 34) than in the 20-29 year age group (n = 10 943). According to the urine specimen collection time, CR levels during the early hours of the day (06:00-06:59) were lower than those during the remaining hours (p = 0.00). The highest converted drug-negative to drug-positive results were obtained from 153.23 mg/dl CR reference value. Reference CR values were evaluated according to gender, age, and urine collection time. Different rates of positive results were obtained for each reference value. There is no published local creatinine value for spot urine samples in many countries, including Turkey. This will be useful to develop appropriate normalization models when reporting drug test results

Evaluation of substance use in Izmir during the COVID-19 pandemic

Background: Substance use can vary in extraordinary periods, such as natural disasters and epidemics. This study scrutinized the toxicological test results of the people who used different types of substances during the 2020 COVID-19 pandemic period in Izmir. Methods: Due to the COVID-19 outbreak, extreme security measures were implemented in March, April, and May of 2020, and the lockdown was imposed at different levels. The patients who were urine tested for illegal substances were also investigated from the point of the socio-demographic characteristics and clinical data. Results: Thirty-six percent of the cases (n = 32) were positive for illegal substances in urinalysis. These substances were: 60% (n = 12) amphetamine-type stimulants (ATS), 20% (n = 4) benzodiazepine, 10% (n = 2) cannabis, 5% (n = 1) buprenorphine, 5% (n = 1) cocaine. Multiple substance use observed in 12 cases. Conclusions: When the pandemic period data were compared with the previous years, the drug test positive rate in the same periods of 2017 and 2018 was 25.9% and 23.9%, respectively. However, this rate increased to 36% during the pandemic period in 2020. In 2017 and 2018, cannabis was the most frequently found substance in the urine on testing with the rate of 41.5% (n = 184) and 50.8% (n = 219), respectively, it was ATS with 60% (n = 2) in 2020

Morphine Concentrations in Human Urine Following Poppy Seed Paste Consumption

WOS: 000456165500014PubMed ID: 30579243Papaver somniferum (opium poppy) is one of the world's oldest medicinal plants which are widely used for medicinal, nutritive and scientific purposes. Turkey is one of the major legal opium poppy producer countries in the world and the seed paste of the poppies is consumed in great deal, even more than 100 g per meal. The main objective of this study is to investigate the influence of poppy seed paste ingestion on urine tests for opiates whether or not could lead to opiate positive urine test results. For this purpose, a variety of poppies were used and the morphine content of white, yellow and blue-black poppies were determined as 1.9, 4.0 and 2.6 mg/kg, respectively. 100g of these seed pastes were consumed in the breakfast by ten healthy adults enrolled in the study over three days and urine samples were collected before and after the breakfast. Opiate screening analysis was carried out by enzyme immunoassay method and the results were evaluated by two different cut-off values (300 and 2000 ng/mL). Morphine confirmation analysis was made by GC-MS system and the chromatographic method was validated in terms of selectivity, extraction efficiency, linearity (25-2000 ng/ml), intra-assay precision, accuracy, limit of detection (LOD) and limit of quantitation (LOQ) (3 and 10 ng/ml), carryover, matrix effect, dilution integrity and stability. According to cut-off value 300 ng/ml, opiate concentrations were found positive up to 48 h. For cut-off value 2000 ng/mL; this time was up to 12 h in collected urine samples after consumption of three different colored poppy seed pastes. In all urine samples, thebaine was detected while the heroin abuse metabolite 6-acetyl morphine (6-AM) was not. Urine drug testing legislation was revised on 2016 in Turkey and opiate screening cut-off values increased from 300 to 2000 ng/mL. Overall results have shown that poppy seed paste as food consumption could lead to opiate positive urine test result even if increased cut off levels are used. It can also be deduced that thebaine can be taken as supportive biomarker for poppy seed paste consumption. Awareness of interpretation of urine test results and defining the procedures especially for forensic drug testing must be done in legal aspect to ensure justice for each individual (workplace, traffic, court etc.). (C) 2018 Published by Elsevier B.V

Central Nervous System Fungal Infections in Children With Leukemia and Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Multicenter Study

Background: Central nervous system fungal infections (CNSFI) are seen in patients with hematologic malignancies and have high morbidity and mortality. Because of their rarity, there is limited data on CNSFI in children with no established treatment protocols or guidelines