Recreational drug use and the emerging challenges of psychoactive substances in Malta : a case series

Introduction: Recreational drug-related hospital admissions, excluding alcohol, appeared to be relatively constant in Mater Dei Hospital (MDH), Malta’s sole public, acute general hospital. While ‘classical’ recreational drugs such as cocaine, heroin and Methylenedioxymethamphetamine (MDMA) were always seen as the main culprits, intoxications secondary to novel psychoactive substances (NPS) have recently emerged in MDH. The aim of this study was to determine the challenges of recreational drug intoxication, including NPS, in MDH. Methods: All the MDH admissions secondary to recreational drug intoxication between 2010 and 2015 were investigated. MDH clinical performance unit (CPU), hospital data files, hospital discharge letters and the hospital database software system were utilised for data collection. Intoxications associated with self-harm, trauma and lone alcohol ingestions were excluded. Results: 286 patients were admitted to MDH with recreational drug intoxication between 2010-2015, with a peak of 71 patients in 2015. 78.3% were males and the median age was 26 years. While 79% of the admissions were Maltese nationals, there was a surge in foreigner admissions, from 11.8% between 2010-2012 to 28.3% between 2013-2015 (p<0.001). Admissions occurred mostly in spring and summer, on Saturday or Sunday, and at night. 52.4% of admissions were acutely confused. Ethanol co-ingestion (40.9%) and polydrug use (39.9%) were common in these admissions. 16% needed admission to critical care. 91.3% admissions were secondary to ‘Classical’ recreational drugs, mostly heroin and cocaine. In 2015, 36.6% of admissions were secondary to NPS, mostly synthetic cannabinoids (SCRA). SCRA admissions were associated with severe sympathomimetic and neuropsychiatric features. An SCRA toxidrome mnemonic (MEET_SCRA) is proposed from the most common features of lone intoxications. Conclusion: Recreational drugs were associated with significant hospital burden, with NPS representing a new threat to MDH and Maltese public health. The toxidrome mnemonic MEET_SCRA could potentially aid in the identification of SCRA intoxications.peer-reviewe

Toxic tea : case report

A young gentleman presents with deliberate unidentified plant ingestion, complaining of abdominal pain and vomiting. He is found to have junctional rhythm at 37 beats per minute. On further questioning, he is noted to have ingested Nerium oleander leaf tea extract as part of a ritual. The mechanism of action, diagnosis and management of oleander poisoning is discussed in this case report. Awareness to the common oleander plant and its toxicity in the Maltese islands and around the Mediterranean is emphasized.peer-reviewe

Mite Diet Sequences Obtained by High Throughput Sequencing of Gut Contents of Freshly Collected Water Mites

Cytochrome oxidase subunit I (COI) barcode sequences in this file were obtained from gut DNA extracted from 54 freshly collected water mites, comprising 21 Lebertia quinquemaculosa , 30 Lebertia davidcooki , 1 Limnesia , and 2 Arrenurus specimens. Methods and other details about these sequences are described in a paper by the same authors in a submitted publication (2021: URL to be given here when published). Data on collection locations, primers (mLep and LCOI), amino acid translations, etc. are included in corresponding sequences uploaded to GenBank. The right column below contains additional notes on naming the taxa of the sequences that were not included in the GenBank annotation. These notes include the highest percentage identity to a previous sequence in GenBank as determined by BLASTN in June 2018. The FASTA file name given here includes the Accession ID, followed by the best match taxon (at an appropriate taxonomic level, dependent on the percent identity, as described in the notes in the right-hand column), the phrase water mite diet isolate , a specific RamLab sequence identifier of the sequence, and then the COI gene description. Accession IDs of sequences uploaded to GenBank begin with MW; other sequences begin with RL and a RamLab sequence identifier. The RamLab sequence identifier in the FASTA name includes information as follows: RamLab ID number-location and date of collection with three location letters (e.g., BHL stands for Blue Heron Lagoon) and the date usually in a 6-character format of MMDDYY-information on the location of sequence on the Illunina sequencing plate-and a 4- to 6-character identifier of the mite species (Lq=L. quinquemaculosa ; Ldc=L. davidcooki ; Lim=Limnesia ; Arr=Arrenurus ) and the animal number in that series of experiments (2 digits)

The biodiversity of freshwater Crustaceans revealed by taxonomy and mitochondrial DNA barcodes

Cytochrome oxidase subunit I (COI) barcode sequences in this file were obtained from specimens collected by plankton net in western Lake Erie in 2012 & 2013, along with later specimens collected at various locations and times, including some collected in Belize in 2015. Methods and other details about these sequences are described in a paper by the same authors in a submitted publication (2021: URL to be given here when published). The right columns below contain additional notes on lengths of sequences, GenBank accession ID (when obtained), and annotation as to whether the sequence represents a new barcode for its genus or species taxon. According to our experience, a DNA identity of \u3e96.5% with previous GenBank barcodes is a reliable range for determining a species level barcode for that morpho species; a DNA identity of 90.5% to 96.5% with previous barcodes is sufficient to identify genus. DNA identities within these ranges are considered to be barcode confirmations. Conversely, DNA identities outside of these ranges are considered to be new barcodes for that species or genus, respectively. Contradictions with previous GenBank sequences are discussed in the manuscript. The submitted manuscript includes the highest percentage identity to a previous sequence in GenBank as determined by BLASTN in June2021. The FASTA file name given here begins with a Ram Lab ID number-location and date of collection with format varying somewhat between various collections/collectors but generally including several (usually three) location letters (e.g., BHL stands for Blue Heron Lagoon) and the date usually in a 6-character format of MMDDYY, and optionally a sample number for that date either preceding the location letters or following the date. Collection location abbreviations include the following: All sequences starting with PM, Toledo Harbor in western Lake Erie; LMUSK, Lake Muskoday, Belle Isle, Detroit; SCL, Saint Clair River; BHL, Blue Heron Lagoon, Belle Isle; LE, LakeErie; LSC, Lake St.Clair; MMLE; Metzgers Marsh, LakeErie; MM, Metzgers Marsh; LP, Leonard Preserve, Manchester, Michigan; HR, Huron River Drive, Ypsilanti, Michigan; LCL, Little Cedar Lake, Orion, MI; HLE, Harbor Lake Erie; LHLE, Lorain Harbor Lake Erie; BZEB1P, Cenote in Shipstern Reserve, Corozal, Belize, Central America

Clinical effects of cannabis compared to synthetic cannabinoid receptor agonists (SCRAs): a retrospective cohort study of presentations with acute toxicity to European hospitals between 2013 and 2020.

INTRODUCTION Cannabis is the most common recreational drug worldwide and synthetic cannabinoid receptor agonists are currently the largest group of new psychoactive substances. The aim of this study was to compare the clinical features and outcomes of lone acute cannabis toxicity with lone acute synthetic cannabinoid receptor agonist toxicity in a large series of presentations to European emergency departments between 2013-2020. METHODS Self-reported drug exposure, clinical, and outcome data were extracted from the European Drug Emergencies Network Plus which is a surveillance network that records data on drug-related emergency department presentations to 36 centres in 24 European countries. Cannabis exposure was considered the control in all analyses. To compare the lone cannabis and lone synthetic cannabinoid receptor agonist groups, univariate analysis using chi squared testing was used for categorical variables and non-parametric Mann-Whitney U- testing for continuous variables. Statistical significance was defined as a P value of < 0.05. RESULTS Between 2013-2020 there were 54,314 drug related presentations of which 2,657 were lone cannabis exposures and 503 lone synthetic cannabinoid receptor agonist exposures. Synthetic cannabinoid receptor agonist presentations had statistically significantly higher rates of drowsiness, coma, agitation, seizures and bradycardia at the time of presentation. Cannabis presentations were significantly more likely to have palpitations, chest pain, hypertension, tachycardia, anxiety, vomiting and headache. DISCUSSION Emergency department presentations involving lone synthetic cannabinoid receptor agonist exposures were more likely to have neuropsychiatric features and be admitted to a psychiatric ward, and lone cannabis exposures were more likely to have cardiovascular features. Previous studies have shown variability in the acute toxicity of synthetic cannabinoid receptor agonists compared with cannabis but there is little comparative data available on lone exposures. There is limited direct comparison in the current literature between lone synthetic cannabinoid receptor agonist and lone cannabis exposure, with only two previous poison centre series and two clinical series. Whilst this study is limited by self-report being used to identify the drug(s) involved in the presentations, previous studies have demonstrated that self-report is reliable in emergency department presentations with acute drug toxicity. CONCLUSION This study directly compares presentations with acute drug toxicity related to the lone use of cannabis or synthetic cannabinoid receptor agonists. It supports previous findings of increased neuropsychiatric toxicity from synthetic cannabinoid receptor agonists compared to cannabis and provides further data on cardiovascular toxicity in lone cannabis use

Consultants

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Improved Chironomid Barcode Database Enhances Identification of Water Mite Dietary Content

Chironomids are one of the most biodiverse and abundant members of freshwater ecosystems. They are a food source for many organisms, including fish and water mites. The accurate identification of chironomids is essential for many applications in ecological research, including determining which chironomid species are present in the diets of diverse predators. Larval and adult chironomids from diverse habitats, including lakes, rivers, inland gardens, coastal vegetation, and nearshore habitats of the Great Lakes, were collected from 2012 to 2019. After morphological identification of chironomids, DNA was extracted and cytochrome oxidase I (COI) barcodes were PCR amplified and sequenced. Here we describe an analysis of biodiverse adult and larval chironomids in the Great Lakes region of North America based on new collections to improve chironomid identification by curating a chironomid DNA barcode database, thereby expanding the diversity and taxonomic specificity of DNA reference libraries for the Chironomidae family. In addition to reporting many novel chironomid DNA barcodes, we demonstrate here the use of this chironomid COI barcode database to improve the identification of DNA barcodes of prey in the liquefied diets of water mites. The species identifications of the COI barcodes of chironomids ingested by Lebertia davidcooki and L. quinquemaculosa are more diverse for L. davidcooki and include Parachironomus abortivus, Cryptochironomus ponderosus. Parachironomus tenuicaudatus, Glyptotendipes senilis, Dicrotendipes modestus, Chironomus riparius, Chironomus entis/plumosus, Chironomus maturus, Chironomus crassicaudatus, Endochironomus subtendens, Cricotopus sylvestris, Cricotopus festivellus, Orthocladius obumbratus, Tanypus punctipennis, Rheotanytarsus exiguus gr., and Paratanytarsus nr. bituberculatus

Variation of drugs involved in acute drug toxicity presentations based on age and sex: an epidemiological approach based on European emergency departments.

OBJECTIVE To analyse the relative percentage of acute recreational drug toxicity emergency department (ED) presentations involving the main drug groups according to age and sex and investigate different patterns based on sex and age strata. METHODS We analysed all patients with acute recreational drug toxicity included by the Euro-DEN Plus dataset (22 EDs in 14 European countries) between October 2013 and December 2016 (39 months). Drugs were grouped as: opioids, cocaine, cannabis, amphetamines, gamma-hydroxybutyrate (GHB), hallucinogens, new psychoactive substances (NPS), benzodiazepines and ketamine. Descriptive data by age and sex are presented and compared among age/sex categories and among drug families. RESULTS Of 17,371 patients were included during the 39-month period, 17,198 (99.0%) had taken at least one of the investigated drugs (median age: 31 years; 23.9% female; ethanol co-ingestion recorded in 41.5%, unknown in 31.2%; multiple drug use in 37.9%). Opioids (in 31.4% of patients) and amphetamines (23.3%) were the most frequently involved and hallucinogens (1.9%) and ketamine (1.7%) the least. Overall, female patients were younger than males, both in the whole cohort (median age 29 vs. 32 years; p < 0.001) and in all drug groups except benzodiazepines (median age 36 vs. 36 years; p = 0.83). The relative proportion of each drug group was different at every age strata and some patterns could be clearly described: cannabis, NPS and hallucinogens were the most common in patients <20 years; amphetamines, ketamine and cocaine in the 20- to 39-year group; GHB/GBL in the 30- to 39-year group; and opioids and benzodiazepines in patients ≥40 years. Ethanol and other drug co-ingestion was more frequent at middle-ages, and multidrug co-ingestion was more common in females than males. CONCLUSION Differences in the drugs involved in acute drug toxicity presentations according to age and sex may be relevant for developing drug-prevention and education programs for some particular subgroups of the population based on the increased risk of adverse events in specific sex and/or age strata

Clinical relevance of ethanol coingestion in patients with GHB/GBL intoxication

International audienc

Seizures as a complication of recreational drug use: Analysis of the Euro-DEN Plus data-set

International audienc