Hair testing of GHB: an everlasting issue in forensic toxicology

In this paper, the authors present a critical review of different studies regarding hair testing of endogenous γ-hydroxybutyrate (GHB), concentrations in chronic users, and values measured after a single GHB exposure in drug facilitated sexual assault (DFSA) cases together with the role of a recently identified GHB metabolite, GHB-glucuronide. Content: The following databases (up to March 2017) PubMed, Scopus and Web of Science were used, searching the following key words: γ-hydroxybutyrate, GHB, GHB glucuronide, hair. The main key words “GHB” and “γ-hydroxybutyrate” were searched singularly and then associated individually to each of the other keywords. Summary: Of the 2304 sources found, only 20 were considered appropriate for the purpose of this paper. Summing up all the studies investigating endogenous GHB concentration in hair, a very broad concentration range from 0 to 12 ng/mg was found. In order to detect a single GHB dose in hair it is necessary to commonly wait 1 month for collecting hair and a segmental analysis of 3 or 5 mm fragments and the calculation of a ratio between the targeted segment and the others represent a reliable method to detect a single GHB intake considering that the ratios presently proposed vary from 3 and 10. The only two studies so far performed, investigating GHB-Glucuronide in hair, show that the latter does not seem to provide any diagnostic information regarding GHB exposure

Assisted suicide: article 17 of the Italian Code of Medical Ethics follows in the footsteps of the Italian Constitutional Court's landmark ruling

Less than a year ago, on September 25th 2019, the Italian Constitutional Court issued a landmark decision on assistance in dying, thus setting a long-awaited standard in terms of regulating assisted suicide1 . The ruling related to the case of Fabiano Antoniani, also known as DJ Fabo, a man in his forties who had made a pondered, steadfast decision to receive assistance in dying at a Swiss euthanasia clinic in 2017. Fabiano was left blind and tetraplegic in the aftermath of a catastrophic road accident in 2014. His death has since become the subject of heated debate in a country, such as Italy, where euthanasia, whether active (i.e., doctors actively causing the patient’s death) or passive (the self-administration by the patient of lethal drugs to end his or her life, the way Fabiano ended his), is adamantly opposed by the Catholic Church. Italy’s Constitutional Court has made it clear that euthanasia should be permitted by law in certain circumstances, including those in which a patient’s irreversible condition was “causing physical and psychological suffering that he or she considers intolerable”. The court’s ruling was centered around assisted dying and the “legal framework concerning end of life [situations]”. A request had in fact been made by a Milan court to provide a clear interpretation of the law in the trial against pro-euthanasia politician, activist and campaigner Marco Cappato, who had actively helped Antoniani with his journey to a Swiss clinic which provides assisted suicide

Synthetic cathinones related fatalities: an update

Synthetic cathinones, more commonly known as "bath salts", are synthetic drugs chemically related to cathinone, a psychostimulant found in the khat plant. They are the first most consumed products among new psychoactive substances, which cause psychostimulant and hallucinogenic effects determining a number of fatalities worldwide.  In this paper, we have systematically reviewed cases of synthetic cathinones-related fatalities analytically confirmed, which have occurred in the last few years.OBJECTIVE: Synthetic cathinones, more commonly known as “bath salts”, are synthetic drugs chemically related to cathinone, a psychostimulant found in the khat plant. They are the first most consumed products among new psychoactive substances, which cause psychostimulant and hallucinogenic effects determining a number of fatalities worldwide. In this paper, we have systematically reviewed cases of synthetic cathinones-related fatalities analytically confirmed, which have occurred in the last few years. MATERIALS AND METHODS: Relevant scientific articles were identified in Medline, Cochrane Central, Scopus, Web of Science and Institutional/ government websites up to November 2017 using the following keywords: synthetic cathinones, mephedrone, methylenedioxypyrovalerone, MDPV, methylone, ethylone, buthylone, fatal intoxication, fatalities and death. RESULTS: In total, 20 citations met the criteria for inclusion, representing several fatal cases with analytically confirmed synthetic cathinones in biological sample/s of the deceased. The death was attributed to hyperthermia, hypertension, cardiac arrest and more in general to the classic serotonin syndrome. Only rarely did the concentration of the parent drug causing fatality overcome the value of 1 mg/L in post-mortem biological fluids. CONCLUSIONS: Abuse of synthetic cathinones still represents a serious public health issue. Systematic clinical studies on both the animal and human model are lacking; therefore, the only available data are from the users who experience the possible hazardous consequences. Analytical methodologies for the identification of parent compounds and eventual metabolites both in ante-mortem and post-mortem cases need to be developed and validated. Analytical data should be shared through different communication platforms with the aim of stopping this serious health threat for drug users

Toxicological Characterization of GHB as a Performance-Enhancing Drug

Performance-enhancing drugs (PEDs) are represented by several compounds used to ameliorate the image, the appearance, or an athletic or non-athletic performance. Gamma-hydroxybutyrate (GHB) is an endogenous molecule first used as anesthetic and then marketed as a nutritional supplement with a wide diffusion in the bodybuilding community. The aim of the present work is to provide a toxicological characterization of the use of GHB as a PED, including the scientific basis for its use, the patterns of use/abuse, and the health risks arising from its consumption in this peculiar recreative setting. A literature search was performed on multiple databases including experimental studies on humans and animals as well as epidemiological reports and forensic case reports/series. Experimental studies demonstrated that the use of GHB as a PED is motivated by the release of growth hormone and the induction of sleep. However, the panel of desired performance-related effects was much wider in real cases and epidemiological studies. Even though the use of GHB among bodybuilders has decreased, its use to enhance some kind of performance, particularly sexual ones or social-communicative ones, as well as means to increase mood and perceived energy, is still common

Hepatotoxicity induced by greater celandine (Chelidonium majus L.): a review of the literature

The available literature assessing Chelidonium majus L. (CM) hepatotoxicity potential, and its risk to benefit assessment has been reviewed in this paper. Identification of significant scientific literature was performed via the following research databases: Cochrane Central, Google Scholar, EMBASE, Medline, Science Direct, Scopus, Web of Science, using the following keywords: "Chelidonium majus", "greater celandine", "Hepatotoxicity", "Liver" "Injury", "Toxicity" individually investigated and then again in association. CM named also greater celandine, swallow-wort, or bai-qu-cai (Chinese), has been used for a long time in traditional Chinese medicine and phytotherapy. Its extracts have been claimed to display a wide variety of biological activities: antimicrobial, anti-inflammatory, spasmolytic, antineoplastic, hepatoprotective, and analgesic. Moreover, herbal medicine suggests this plant have numerous additional effects which have not yet been scientifically evaluated, such as antitussive, diuretic, and eye-regenerative. However, despite its claimed hepatoprotective effects, several hepatotoxicity cases have been reported to be probably or highly probably connected with CM exposure, after their evaluation through liver-targeted causality assessment methods. CM hepatotoxicity has been defined as a distinct form of herb-induced liver injury (HILI), due to an idiosyncratic reaction of the metabolic type. This evidence has to be considered in relationship with the absence of considerable benefits of CM therapy. Therefore, the risk to benefit ratio of the use of herbal products containing greater celandine can actually be considered as negative

Correlation between blood and oral fluid psychoactive drug concentrations and cognitive impairment in driving under the influence of drugs

The effects of drugs on driving performance should be checked with drug concentration in the brain and at the same time with the evaluation of both the behavioural and neurophysiological effects. The best accessible indicator of this information is the concentration of the drug and/or metabolites in blood and, to a certain extent, oral fluid. We sought to review international studies on correlation between blood and oral fluid drug concentrations, neurological correlates and cognitive impairment in driving under the influence of drugs. Methods : Relevant scientific articles were identified from PubMed, Cochrane Central, Scopus, Web of Science, Science Direct, EMBASE up to April 2017. Results : Up to 2010, no epidemiological studies were available on this matter and International scientists suggested that even minimal amounts of parent drugs in blood and oral fluid could affect driving impairment. More recently, epidemiological data, systematic reviews and meta-analysis on drugged drivers allowed the suggestion of impairment concentration limits for the most common illicit drugs. These values were obtained comparing driving disability induced by psychotropic drugs with that of established blood alcohol limits. Differently from ethyl alcohol where both detection methods and concentration limits have been well established even with inhomogeneity of ranges within different countries, in case of drugs of abuse no official cut-offs have yet been established, nor any standardized analytical protocols. Conclusion : Multiple aspects of driving performance can be differently affected by illicit drugs, and even if for few of them some dose/concentration dependent impairment has been reported, a wider knowledge on concentration/impairment relationship is still missin

Evaluating the risk of toxicity and adverse drug interactions involving recreational GHB use and prescribed drugs

GHL is a small molecule and is present in human CN

Commentary: Tele-COVID-19: Does it improve the provision of health services?

Since the first Coronavirus Disease-19 (COVID-19) outbreak in the urban area of Wuhan (China) in December 2019, the entire society has been facing an unprecedented situation posing several challenges. The declaration of Covid-19 as pandemic by the World Health Organization (WHO) on March 11, 2020, depicted the necessity of changes in everyday life management as we usually intended1 . Due to the lack of an effective cure, prolonged isolation, restrictive measures, physical distancing represented the mandatory emergency measures to contrast, or at least try to contain, the uncontrolled spread of this dead- ly disease2 . Several emergency measures were adopted worldwide by the governments, with the promulgation of emergency decrees and the temporary restructuration of the public health system, to face the resources shortage, especially in the most affected countries3,4

Tele-COVID-19: Does it improve the provision of health services?

Since the first Coronavirus Disease-19 (COVID-19) outbreak in the urban area of Wuhan (China) in December 2019, the entire society has been facing an unprecedented situation posing several challenges. The declaration of Covid-19 as pandemic by the World Health Organization (WHO) on March 11, 2020, depicted the necessity of changes in everyday life management as we usually intended1 . Due to the lack of an effective cure, prolonged isolation, restrictive measures, physical distancing represented the mandatory emergency measures to contrast, or at least try to contain, the uncontrolled spread of this deadly disease2 . Several emergency measures were adopted worldwide by the governments, with the promulgation of emergency decrees and the temporary restructuration of the public health system, to face the resources shortage, especially in the most affected countrie

The importance of disclosing the conflict of interest (CoI) in the era of open access publishing

In pharmacological and biomedical sciences, most of the principle donators are progressively demanding open access as a condition in economical support, something which has already become common in various other areas1. The expression “open access” has been used since 2002: first in the Budapest Open Access Initiative (February 2002), then in the Bethesda Statement on Open Access Publishing (June 2003) and finally in the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities (October 2003). Open access was initially intended for scholarly journal manuscripts in order to provide an unrestricted online access to them. However, even though this term first appeared in the 2000s, free on-line access to journal manuscripts had started at least 10 years previousl