The Chameleon-Like Properties of Psychoactive Drugs: Examinations with HR LC-MS/MS Technology of Patients Presenting at the Emergency Department Following the Use of Synthetic Cannabinoids: A Case Series and Literature Review

The chameleon can disguise itself in nature by taking on different colors and forms. As synthetic cannabinoids (SC) have clinically similar effects to those of several psychoactive agents, they are one of the most difficult intoxications to diagnose. The reasons for this are due to clinical variations throughout the world and the differences in symptoms having not been determined due to their similarity to the intoxication of several other drugs. The aim of this study was to obtain prospective data of patients presenting at the Emergency Department (ED) with suspected SC intoxication, and as a result of prospective examination of samples, to determine a new generation of SC use, SC types, clinical findings, and treatments. Method: A total of a 15 patients with suspected SC intoxication who presented at the ED of the Health Sciences University Kayseri Training and Research Hospital between January 2017 and January 2018 were examined. Samples taken prospectively from patients who were followed-up for a diagnosis of SC intoxication were examined with the HR LC-MS/MS method; SC were determined, and the test results of other psychoactive agents that were used concurrently were examined. Conclusions: Three significant findings emerged as a result of this study. Firstly, due to the different clinical forms of presentation at ED associated with SC use and the range of intoxications that cannot be diagnosed, advanced laboratory tests are required, in addition to routine tests for the determination of SC. Secondly, those diagnosed as having taken SC were also determined to have used it concurrently with substances that have a high potential for addiction, such as amphetamines and quetiapine. Thirdly, in regard to examples of cases presented in the literature, anti-psychotics, fluid hydration, and anxiolytics can be used as treatment options for those diagnosed with SC use

Comparison of Inflammatory Reactions Following Two Different Cesarean Section Techniques: The Modified Misgav-Ladach Versus the Pfannenstiel-Kerr; A Prospective Randomized Trial

Objectives: There is not yet a consensus on the optimal surgical technique for cesarean section. This is the first study comparing two different (Cesarean Section) with respect to the following inflammatory reaction in means of changes in inflammatory marker levels. To evaluate the differences in inflammatory reactions following two different (Cesarean Section) techniques, the modified Misgav-Ladach versus the Pfannenstiel-Kerr technique. Study Desıgn: The study population included 88 pregnant women who met the inclusion criteria. These women were randomized into two groups according to Consolidated Standards of Reporting Trials guidelines: Group 1 (Misgav-Ladach group) and Group 2 (Pfannenstiel Kerr group). To compare the inflammatory reactions following surgery, Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) levels were measured in venous blood samples drawn from the patients just before (0 hour) and 24 hours (24th hour) after the surgery. In 5 women from Group 1 and 2 women from Group 2, the 24th hour blood samples could not be obtained or were lost. Thus, a total of 81 women, 39 women from Group 1 and 42 women from Group 2, comprised the population of study. The differences in inflammatory reactions between the 0 and 24th hours were analyzed by calculating the percent change in IL-6 and TNF-α levels, and these percentages were then compared between the groups. Results: There was a statistically significant difference between Group 1 and Group 2 regarding the serum IL-6 level change between 0 and 24th hour (530±653% and 196±168%, respectively, p=0.022. The difference in TNF-α was also higher in Group 2, but the difference was not statistically significant (229±306% vs. 571±824%, p=0.12). The mean operation time was significantly shorter in Group 1 (9.44 min. vs. 16.86 min, p=0.0001). Conclusions: The results of this study indicate that the modified Misgav-Ladach technique has a weaker inflammatory reaction, which indicates fewer short- and long-term surgical complications

The use of serum hypoxia-inducible factor two alpha levels and diagnostic values in adult carbon monoxide poisoning

Carbon monoxide poisoning (COP) is a life-threatening intoxication which should be interfered immediately to be prevented from serious damages. The effect of carbon monoxide (CO) in the body at the cell level is mediated by a CO-releasing molecule. This molecule results in heme degradation via heme oxygenase. Because of the high affinity of CO on heme, many enzymes with biological signal transduction cause heme protein increase. Universally, this signal activation with similar enzymes and mechanisms are used in COP. The most widely used test is Carboxyhaemoglobin (COHb) in serum. The COHb is used as a standard parameter in the diagnosis of COP. COHb levels, are high after CO poisoning and decrease rapidly with oxygen therapy in the first four hours. So COHb is insufficient to demonstrate chronic ischemic damage of hypoxia. Hypoxia-inducible factors (HIFs) are the master regulators of oxygen homeostasis. The best known HIF isoforms in the literature are HIF-1α and HIF-2α. Recently, more data have found about selective HIF-2α responsive genes and indicate the importance of this isoform in hypoxic gene regulation. The present study purposed to determine the change in HIF-2α values in adult patients in diagnosing COP. A significant statistical correlation was found between (p=0.05) serum HIF-2α levels and the first COHb level. HIF-2α levels at 4th hour in COP patients were significantly higher like first COHb. HIF-2α levels can be used as a new biomarker in long-term for monitoring COP patients. [Med-Science 2018; 7(4.000): 748-53

The Scope, Quality And Safety Requirements Of Drug Abuse Testing

The aim of this review is to inform about the scopes and requirements of drug abuse testing. Drug abuse testing is one of the tools for determination of drug use. It must fulfill the quality and safety requirements in judgmental legal and administrative decisions. Drug abuse testing must fulfill some requirements like selection of the appropriate test matrix, appropriate screening test panel, sampling in detection window, patient consent, identification of the donor, appropriate collection site, sample collection with observation, identification and control of the sample, specimen custody chain in preanalytical phase; analysis in authorized laboratories, specimen validity tests, reliable testing methods, strict quality control, two-step analysis in analytical phase; storage of the split specimen, confirmation of the split specimen in the objection, result custody chain, appropriate cut-off concentration, the appropriate interpretation of the result in postanalytical phase. The workflow and analytical processes of drug abuse testing are explained in last regulation of the Department of Medical Laboratory Services, Ministry of Health in Turkey. The clinical physicians have to know and apply the quality and safety requirements in drug abuse testing according to last regulations in Turkey.WoSScopusTr-Dizi

Soluble Receptor for Advanced Glycation End Products (sRAGE) Level and Its Prognostic Significance in Children with Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemias are the most common malignancies in childhood. Although its etiology is still unclear, it is thought that disorders in oxidative stress metabolism may contribute to leukemogenesis. Advanced glycation end products (AGEs) are formed as a result of the non-enzymatic binding of sugars to biomolecules. Oxidation reactions are triggered through AGE–Receptor (RAGE) interaction, resulting in the formation of reactive oxygen species. These can play crucial roles in cancer pathogenesis and leukemogenesis. It is thought that sRAGE (soluble RAGE) is the end product of glycation and circulates freely in the circulation by binding to RAGE ligands. We investigate novel leukemia biomarkers and focus on soluble RAGE (sRAGE) for acute lymphoblastic leukemia (ALL) diagnosis and prognosis. Thirty children (1–17 years) diagnosed with ALL were included in the study. Patients were divided into standard, medium, and high risk groups according to the Berlin–Frankfurt–Münster (BFM) treatment protocol. Patients were evaluated twice; at the time of diagnosis and at the sixth month of remission. sRAGE and blood parameters were compared with healthy controls (n = 30, 1–17 years). The sRAGE levels in ALL patients at diagnosis (138.7 ± 177.3 pg/mL) were found to be significantly higher than they were during the sixth month of remission (17.6 ± 21.1 pg/mL) and in healthy controls (22.2 ± 23.7 pg/mL). The cut-off value of the sRAGE level for the diagnosis of ALL was found to be 45 pg/mL in ROC analysis (sensitivity: 73.3%, specificity: 86.7%, AUC: 0.681). At the same time, the sRAGE level was found to be significantly higher in T-ALL patients (490.9 ± 236.9 pg/mL) than in B-ALL patients (84.5 ± 82.7 pg/mL). No significant difference was found in terms of the sRAGE level between standard (45.8± 33.1 pg/mL), medium (212 ± 222.1 pg/mL), and high (143.9 ± 111.5 pg/mL) risk group ALL patients classified according to the BFM protocol. Despite the fact that this was a small, single-center study, our findings highlight the potential use of sRAGE as a biomarker for diagnosing ALL and assessing response to treatment

Evaluation of Fibrosis Markers: Apelin and Transforming Growth Factor-beta 1 in Autosomal Dominant Polycystic Kidney Disease Patients

Renal interstitial fibrosis is an important pathological feature of autosomal dominant polycystic kidney disease (ADPKD), which progressively develops to endstage renal disease (ESRD). It has been shown that apelin and transforming growth factor-beta 1 (TGF-beta 1) play important roles in the renal fibrosis process. The aim of the present study is to evaluate the relationship of these fibrosis markers and ADPKD. Forty-five patients with ADPKD and 28 healthy controls were studied cross-sectionally. Estimated glomerular filtration rate (eGFR), apelin, TGF-beta 1 were measured in all participants, using conventional methods. Apelin levels were lower (1.2 +/- 0.9 ng/mL vs. 2.5 +/- 1.3 ng/mL, P< 0.001), while TGF-beta 1 levels were higher in the patient group according to healthy controls (466.5 +/- 200.5 ng/L vs. 367.1 +/- 163.45 ng/L, P= 0.031), respectively. Apelin was negatively correlated with TGF-beta 1 and highly sensitive C-reactive protein (hs-CRP); and positively correlated with eGFR. In all subjects, eGFR was independently predicted by TGF-beta 1 and apelin. Apelin and TGF-beta 1 may be used as biomarkers of renal fibrosis that is an important pathological feature of ADPKD, which progressively develops to ESRD in ADPKD patients

Level and Effect of Adrenomedullin on Endotoxin Induced Disseminated Intravascular Coagulation Model in Rabbits

Adrenomedullin (ADM) is a regulatory peptide having a variety of pharmacological properties secreted from vascular endothelial cells and adrenal medulla. There are only a few studies about the effects of ADM on coagulation and platelets which is secreted from endothelial cells. The aim of this study is to assay ADM levels in rabbits with endotoxin induced disseminated intravascular coagulation (DIC) model and to investigate the probable effects of ADM on coagulation parameters in this model. Four groups (Control, DIC, Heparin, ADM) each consisting of eight New Zeland rabbits were formed randomly. A DIC model was developed by infusion of endotoxin from Escherichia coli. Then the effect of standard dose heparin and 0.05 mu g/kg/min ADM infusion were evaluated. Administration of endotoxin resulted in severe changes of coagulation parameters as shown by the significant prolongation of the prothrombin time and activated partial thromboplastin time, decrease in platelet count, plasma fibrinogen level, antithrombin, and protein C activity. These results were in accordance with DIC findings and were significantly different from baseline and control group. In DIC group, the baseline, second, and sixth hour mean ADM levels were 7.09+/-1.63, 8.10+/-1.55, 9.35+/-0.76 ng/dl, respectively. ADM levels on sixth hour were significantly higher than baseline and control group. Heparin and ADM were used in the DIC model but both of them were not effective. In conclusion, ADM levels were found elevated during the progress of endotoxin induced DIC model. ADM were not effective in overt DIC model but it might be useful in the early phase of the DIC

Regional drug abuse prevalence depending on laboratory based urine illicit drug screening results

Objectives: To determine the laboratory based drug abuse prevalence of persons who have illicit and/or addictive substance test requests instead of alcohol in a city in Middle Anatolia in Turkey. Methods: Laboratory information system's data of urine samples, submitted to Biochemistry Laboratory from various clinics, between January 2014 and June 2016 were retrospectively investigated. In comprehension of illicit drug use amphetamin, cannabis, opiate, cocaine and benzodiazepin group tests were screened with Cloned Enzyme Donor Immunoassay method. Positivity-negativity rates according to years, age-gender distribution and number of multiple substance usage were investigated. Results: Totally 79873 illicit drugs were screened in 19763 urine samples. 18080 males (% 91.5) and 1683 females (% 8.5), with a mean age of 30.7 +/- 10.8 years (range: 4-86) and 27.2 +/- 10.5 years (range: 1-86) respectively were included. The average positivity rate according to the sample size in last 2.5 years was 23%; 19% in 2014, 23% in 2015, and 27% in 2016. The positivity rates according to number of analyzed tests were 5.9%, 6.7% and 7.5% respectively. In 2014 the maximum positivity rate was in benzodiazepine (12.5%) and secondly in cannabinoids (11.9%). Whereas amphetamine were the most common drug used (16.3%) with a 4.17 fold increase in 2015 compared to 2014. The increase in amphetamine group substance positivity continued in the first half of 2016 compared to previous year. The most common and the second most common multiple substance usage were amphetamine+cannabis and amphetamine+ opiate respectively. Conclusion: According to laboratory information of illicit drug screening results in urine, drug abuse is increasing through years. Amphetamine group is the most common used substance in the last two years in this region. This is the first study contributing to the prevalence of substance use in a city of Middle Anatolia in Turkey with a large sample volume and patient population

A novel hemostatic scaffold material and the importance of scaffold formation on ending hemorrhage: An experimental rat study

BACKGROUND: Different pharmacological agents are developed to control bleeding. However, it is critical for these agents to induce thrombin formation and have an effect on vasoconstriction, coagulation, and scaffold. In this study, we aimed to demonstrate the agents' ability to stop bleeding properties on minor and major open bleedings after skin clefts, extracorporal injuries, traumatic cuts, spontaneous or surgical intervention besides scaffold properties. For this purpose, a new and authentic hemostatic agent, processed diatomite (PD) and the most preferred chitosan in the medical area were used to test blood stopping and scaffold effects in a rat femoral bleeding model. The samples were examined by scanning electron microscopy (SEM), and the results on blood stopping were shared