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Stephenson L, Van Den Heuvel C, Scott T, Byard RW. Difficulties associated with the interpretation of postmortem toxicology. J Anal Toxicol 2024; 48:405-412. [PMID: 38850225 PMCID: PMC11245884 DOI: 10.1093/jat/bkae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/07/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024] Open
Abstract
While postmortem (PM) toxicology results provide valuable information towards ascertaining both the cause and manner of death in coronial cases, there are also significant difficulties associated with the interpretation of PM drug levels. Such difficulties are influenced by several pharmacokinetic and pharmacodynamic factors including PM redistribution, diffusion, site-to-site variability in drug levels, different drug properties and metabolism, bacterial activity, genetic polymorphisms, tolerance, resuscitation efforts, underlying conditions, and the toxicity profile of cases (i.e. single- or mixed-drug toxicity). A large body of research has been dedicated for better understanding and even quantifying the influence of these factors on PM drug levels. For example, several investigative matrices have been developed as potential indicators of PM redistribution, but they have limited practical value. Reference tables of clinically relevant therapeutic, toxic, and potentially fatal drug concentrations have also been compiled, but these unfortunately do not provide reliable reference values for PM toxicology. More recent research has focused on developing databases of peripheral PM drug levels for a variety of case-types to increase transferability to real-life cases and improve interpretations. Changes to drug levels after death are inevitable and unavoidable. As such, guidelines and practices will continue to evolve as we further our understanding of such phenomena.
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Affiliation(s)
- Lilli Stephenson
- School of Biomedicine, The University of Adelaide, Adelaide, SA 5005, Australia
| | | | - Timothy Scott
- Forensic Science SA (FSSA), Adelaide, SA 5000, Australia
- College of Science and Engineering, Flinders University, Bedford Park, SA 5042, Australia
| | - Roger W Byard
- School of Biomedicine, The University of Adelaide, Adelaide, SA 5005, Australia
- Forensic Science SA (FSSA), Adelaide, SA 5000, Australia
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O'Brien DJ, Mills D, Farina J, Paranjape M. A Needle-Free Transdermal Patch for Sampling Interstitial Fluid. IEEE Trans Biomed Eng 2023; 70:2573-2580. [PMID: 37028334 DOI: 10.1109/tbme.2023.3253811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Modern diagnostics is pivoting towards less invasive health monitoring in dermal interstitial fluid, rather than blood or urine. However, the skin's outermost layer, the stratum corneum, makes accessing the fluid more difficult without invasive, needle-based technology. Simple, minimally invasive means for surpassing this hurdle are needed. METHODS To address this problem, a flexible, Band-Aid-like patch for sampling interstitial fluid was developed and tested. This patch uses simple resistive heating elements to thermally porate the stratum corneum, allowing the fluid to exude from the deeper skin tissue without applying external pressure. Fluid is then transported to an on-patch reservoir through self-driving hydrophilic microfluidic channels. RESULTS Testing with living, ex-vivo human skin models demonstrated the device's ability to rapidly collect sufficient interstitial fluid for biomarker quantification. Further, finite-element modeling showed that the patch can porate the stratum corneum without raising the skin's temperature to pain-inducing levels in the nerve-laden dermis. CONCLUSION Relying only on simple, commercially scalable fabrication methods, this patch outperforms the collection rate of various microneedle-based patches, painlessly sampling a human bodily fluid without entering the body. SIGNIFICANCE The technology holds potential as a clinical device for an array of biomedical applications, especially with the integration of on-patch testing.
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Al-Asmari AI, Alharbi H, Al-Zahrani AE, Zughaibi TA. Heroin-Related Fatalities in Jeddah, Saudi Arabia, between 2008 and 2018. TOXICS 2023; 11:248. [PMID: 36977013 PMCID: PMC10099738 DOI: 10.3390/toxics11030248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
To date, epidemiological studies have not evaluated heroin-related deaths in the Middle East and North African regions, especially Saudi Arabia. All heroin-related postmortem cases reported at the Jeddah Poison Control Center (JPCC) over a 10-year period (21 January 2008 to 31 July 2018) were reviewed. In addition, liquid chromatography electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) was utilized to determine the 6-monoacetylmorphine (6-MAM), 6-acetylcodeine (6-AC), morphine (MOR), and codeine contents in unhydrolyzed postmortem specimens. Ninety-seven heroin-related deaths were assessed in this study, and they represented 2% of the total postmortem cases at the JPCC (median age, 38; 98% male). In the blood, urine, vitreous humor, and bile samples, the median morphine concentrations were 280 ng/mL, 1400 ng/mL, 90 ng/mL, and 2200 ng/mL, respectively; 6-MAM was detected in 60%, 100%, 99%, and 59% of the samples, respectively; and 6-AC was detected in 24%, 68%, 50%, and 30% of the samples, respectively. The highest number of deaths (33% of total cases) was observed in the 21-30 age group. In addition, 61% of cases were classified as "rapid deaths," while 24% were classified as "delayed deaths." The majority (76%) of deaths were accidental; 7% were from suicide; 5% were from homicide; and 11% were undetermined. This is the first epidemiological study to investigate heroin-related fatalities in Saudi Arabia and the Middle East and North African region. The rate of heroin-related deaths in Jeddah remained stable but increased slightly at the end of the study period. Most patients were heroin-dependent abusers and from the middle-aged group. The availability of urine, vitreous humor, and bile specimens provided valuable information regarding the opioids that were administered and the survival time following heroin injection.
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Affiliation(s)
- Ahmed I. Al-Asmari
- Laboratory Department, Ministry of Health, King Abdul-Aziz Hospital, Jeddah 21442, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hassan Alharbi
- Poison Control and Forensic Chemistry Center, Ministry of Health, Jeddah 21176, Saudi Arabia
| | | | - Torki A. Zughaibi
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Letter-to-the-editor, concerning the article entitled "Common opioids and stimulants in autopsy and DUID cases: A comparison of measured concentrations.". Forensic Sci Int 2023; 344:111569. [PMID: 36708657 DOI: 10.1016/j.forsciint.2023.111569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
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Howell BA, Black AC, Grau LE, Lin HJ, Greene C, Lee H, Heimer R, Hawk KE, D'Onofrio G, Fiellin DA, Becker WC. Concordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: A statewide analysis. Drug Alcohol Depend 2023; 244:109788. [PMID: 36738634 PMCID: PMC9975083 DOI: 10.1016/j.drugalcdep.2023.109788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/16/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Opioid overdoses are a leading cause of preventable death in the United States. There is limited research linking decedents' receipt of controlled substances and presence of controlled substances on post-mortem toxicology (PMT). METHODS We linked data on opioid-detected deaths in Connecticut between May 3, 2016, and December 31, 2017 from the Office of the Chief Medical Examiner, Department of Consumer Protection, and Department of Mental Health and Addiction Services. Exposure was defined as receipt of an opioid or benzodiazepine prescription within 90 days prior to death. Our primary outcome was concordance between medication received and metabolites in PMT. RESULTS Our analysis included 1412 opioid-detected overdose deaths. 47 % received an opioid or benzodiazepine 90 days prior to death; 36 % received an opioid and 27 % received a benzodiazepine. Concordance between receipt of an opioid or benzodiazepine and its presence in PMT was observed in 30 % of opioid-detected deaths. Concordance with an opioid was present in 17 % of opioid-detected deaths and concordance with a benzodiazepine was present in 21 % of opioid-detected deaths. Receipt of an opioid or benzodiazepine and concordance with PMT were less common in fentanyl or heroin-detected deaths and more common in pharmaceutical opioid-detected deaths. DISCUSSION Our results suggest medically supplied opioids and benzodiazepines potentially contributed to a substantial number, though minority, of opioid-detected deaths during the study period. Efforts to reduce opioid and benzodiazepine prescribing may reduce risk of opioid-detected deaths in this group, but other approaches will be needed to address most opioid-detected deaths that involved non-pharmaceutical opioids.
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Affiliation(s)
- Benjamin A Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, the United States of America; Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America.
| | - Anne C Black
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; VA Connecticut Healthcare System, West Haven, CT, the United States of America
| | - Lauretta E Grau
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America
| | - Hsiu-Ju Lin
- School of Social Work, University of Connecticut, Storrs, CT, the United States of America; Department of Mental Health and Addiction Services, Hartford, CT, the United States of America
| | - Christina Greene
- U.S. Food and Drug Administration, Silver Spring, MD, the United States of America
| | - Hana Lee
- U.S. Food and Drug Administration, Silver Spring, MD, the United States of America
| | - Robert Heimer
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America
| | - Kathryn E Hawk
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, the United States of America
| | - Gail D'Onofrio
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, the United States of America
| | - David A Fiellin
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, the United States of America
| | - William C Becker
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; VA Connecticut Healthcare System, West Haven, CT, the United States of America
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Simão AY, Monteiro C, Marques H, Rosado T, Margalho C, Barroso M, Andraus M, Gallardo E. Analysis of opiates in urine using microextraction by packed sorbent and gas Chromatography- Tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1207:123361. [PMID: 35849978 DOI: 10.1016/j.jchromb.2022.123361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022]
Abstract
Opiates recreational consumption has always been a concern in society, public health, and in clinical toxicology analysis. The aim of this study was to develop and fully validate an analytical method, which was simple and rapid for the determination of tramadol, codeine, morphine, 6- acetylcodeine, 6-monoacetylmorphine and fentanyl using gas chromatography coupled to tandem mass spectrometry. The procedure includes the use of microextraction by packed sorbent for sample clean-up. A mixed mode sorbent was used, allowing the minimal use of solvents. The method was validated in urine samples, with the ability to detect and quantify all analytes with satisfactory linearity (in the range of 1 - 1000 ng/mL for all analytes, except for fentanyl (10-1000 ng/mL)). Extraction efficiency varied from 17 to 107%, which did not impair sensitivity, taking into account the low LLOQs obtained (1 ng/ mL for all analytes; and 10 ng/mL for fentanyl). The developed procedure proved to be fast, selective, and accurate for use in routine analysis, with a low volume of sample (250 µL).
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Affiliation(s)
- Ana Y Simão
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI) Covilhã, Portugal; Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, Covilhã, Portugal
| | - Catarina Monteiro
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI) Covilhã, Portugal
| | - Hernâni Marques
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI) Covilhã, Portugal; Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, Covilhã, Portugal
| | - Tiago Rosado
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI) Covilhã, Portugal; Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, Covilhã, Portugal; C4 - Centro de Competências em Cloud Computing da Universidade da Beira Interior, Covilhã, Portugal
| | - Cláudia Margalho
- Serviço de Química e Toxicologia Forenses, Instituto Nacional de Medicina Legal e Ciências Forenses - Delegação do Centro, Coimbra, Portugal
| | - Mário Barroso
- Serviço de Química e Toxicologia Forenses, Instituto Nacional de Medicina Legal e Ciências Forenses - Delegação do Sul, Lisboa, Portugal
| | | | - Eugenia Gallardo
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI) Covilhã, Portugal; Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, Covilhã, Portugal.
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Edvardsen HME, Clausen T. Opioid related deaths in Norway in 2000-2019. Drug Alcohol Depend 2022; 232:109281. [PMID: 35042099 DOI: 10.1016/j.drugalcdep.2022.109281] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/03/2022]
Abstract
AIMS The aim of the study is to present autopsy-based findings of the most prevalent opioids in overdose deaths in Norway from 2000 to 2019, as such data are lacking in the current literature. METHODS Data on cause of death obtained from the Norwegian Cause of Death Registry (NCoDR) were linked with forensic toxicological results from forensic autopsies. RESULTS From year 2000 the annual numbers of overdose deaths decreased, specifically during 2000-2003, thereafter a relatively stable annual number was observed. Opioids were detected in 93% of the cases. Heroin related deaths have decreased, whereas medical opioids for pain treatment have increased with time. Men in their early 40's dominate the overall numbers of deaths, but significantly different sex patterns emerge when studying the specific drugs. During the past 20 years, the mean age at overdose death has increased by 10 years (from 33 to 43 years). Overdose deaths without any illicit drugs present at autopsy have increased in recent years. These deaths, where only potentially prescription medications were detected, were more common among women and with higher age. CONCLUSIONS In Norway during the past 20 years, we observe a dynamic shift in overdose deaths caused by heroin and illicit drugs, to include a gradually increasing trend of overdose deaths from pill based pain medications and also methadone and buprenorphine. This warrants a shift in preventive responses, as the target groups differ.
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Affiliation(s)
- Hilde Marie Erøy Edvardsen
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Lappas NT, Lappas CM. Heroin. Forensic Toxicol 2022. [DOI: 10.1016/b978-0-12-819286-3.00024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stevens C, Li T, Ton E, Zou J, Douglas E, Jones P. Longitudinal Opioid Surveillance Project Involving Toxicologic Analysis of Postmortem Specimens from 9 Counties in Michigan Suggests the Discovery of New High-Intensity Drug Trafficking Areas. Am J Forensic Med Pathol 2021; 42:216-224. [PMID: 33853105 DOI: 10.1097/paf.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ABSTRACT Acetyl fentanyl (AF) is a Schedule I fentanyl analog that has been increasingly seen in heroin and fentanyl polydrug toxicity overdoses in Michigan (MI). Drug users are often unaware of the presence of AF in their drugs because it is often sold mixed into or disguised as heroin. High levels of AF in heroin drug products can cause increased incidence of overdose. This article describes data from a longitudinal opioid surveillance program and details 102 decedents in MI who were found to have evidence of heroin in their postmortem blood. A large portion of these decedents were also found to have evidence of fentanyl and AF. Our data further show significant overlap in incidence rates of AF and heroin-related overdose deaths in several MI counties, suggesting that AF is becoming enmeshed in heroin trafficking. Furthermore, we report unprecedented high incidence rates of AF and heroin-related overdose deaths in Calhoun county, and we propose that it is a high-intensity drug trafficking area. Highways US-131 and US-31 are likely used to transport these drugs. More study is needed into the drug trafficking trends in MI to ascertain drug sources and monitor the ever developing and dangerous polydrug heroin combinations.
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Affiliation(s)
- Christine Stevens
- From the Toxicology Department, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
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Vearrier D, Grundmann O. Clinical Pharmacology, Toxicity, and Abuse Potential of Opioids. J Clin Pharmacol 2021; 61 Suppl 2:S70-S88. [PMID: 34396552 DOI: 10.1002/jcph.1923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022]
Abstract
Opioids were the most common drug class resulting in overdose deaths in the United States in 2019. Widespread clinical use of prescription opioids for moderate to severe pain contributed to the ongoing opioid epidemic with the subsequent emergence of fentanyl-laced heroin. More potent analogues of fentanyl and structurally diverse opioid receptor agonists such as AH-7921 and MT-45 are fueling an increasingly diverse illicit opioid supply. Overdose from synthetic opioids with high binding affinities may not respond to a typical naloxone dose, thereby rendering autoinjectors less effective, requiring higher antagonist doses or resulting in a confusing clinical picture for health care providers. Nonscheduled opioid drugs such as loperamide and dextromethorphan are associated with dependence and risk of overdose as easier access makes them attractive to opioid users. Despite a common opioid-mediated pathway, several opioids present with unique pharmacodynamic properties leading to acute toxicity and dependence development. Pharmacokinetic considerations involve half-life of the parent opioid and its metabolites as well as resulting toxicity, as is established for tramadol, codeine, and oxycodone. Pharmacokinetic considerations, toxicities, and treatment approaches for notable opioids are reviewed.
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Affiliation(s)
- David Vearrier
- Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida, USA
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Le Daré B, Degremont A, Couty C, Baert A, Bouvet R, Morel I, Gicquel T. Alcohol and drug consumption among motor vehicle drivers in the Brittany region of France: A 9-year cross-sectional population study. Prev Med Rep 2021; 23:101454. [PMID: 34194961 PMCID: PMC8227838 DOI: 10.1016/j.pmedr.2021.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
The primary objective of the present study was to evaluate the frequency of positive tests for alcohol and drugs during roadside testing or after road accidents among drivers in the Brittany region of France. The study’s secondary objective was to describe the blood concentrations of the substances found during these tests, in order to provide a scientific basis for the establishment or modification of legislative threshold values for road injuries prevention. We performed a cross-sectional study of a database compiled by Rennes University Hospital’s toxicology laboratory in the Brittany region of France between 2010 and 2018. Driver’s age, sex, and test status (positive or negative), and blood levels of ethanol, 9-tetrahydrocannabinol (THC), methylene dioxymethamphetamine (MDMA), amphetamine, benzoylecgonine and 6-monoacetylmorphine (6-MAM) were collected. Twelve thousand four hundred and ninety-seven drivers (males: 86.1%; median (range) age: 29 (15–94)) have provided roadside blood samples, giving a total of 25,998 test results. Among the 10,996 drivers with at least one positive test, the median blood concentrations of ethanol, THC, MDMA, amphetamine, benzoylecgonine, and 6-MAM were respectively 1.82 g/L, 2.41 ng/mL, 138.4 ng/mL, 67.7 ng/mL, 173.3 ng/mL, and 0.97 ng/mL. 1159 (10.54%) of the 10,996 drivers tested positive for two or more substances, and 151 (1.4%) tested positive for three or more substances. With the exception of heroin, the currently recommended threshold values appear to be appropriate for road injuries prevention with regard to the concentrations observed in offenders.
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Affiliation(s)
- Brendan Le Daré
- Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France
- Univ. Rennes, INSERM, INRA, CHU Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer), F-35000 Rennes, France
- Corresponding author at: 2 Rue Henri Le Guilloux, Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France.
| | - Adeline Degremont
- Rennes University Hospital, Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, F-35033 Rennes, France
- Univ Rennes, EA 7449 REPERES ‘Pharmacoepidemiology and Health Services Research’, F-35000 Rennes, France
| | - Clémence Couty
- Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France
| | - Alain Baert
- Rennes University Hospital, Department of Forensic Medicine, F-35000 Rennes, France
| | - Renaud Bouvet
- Rennes University Hospital, Department of Forensic Medicine, F-35000 Rennes, France
- Univ. Rennes, EA IDPSP – UR1_RS438, F-35000 Rennes, France
| | - Isabelle Morel
- Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France
- Univ. Rennes, INSERM, INRA, CHU Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer), F-35000 Rennes, France
| | - Thomas Gicquel
- Rennes University Hospital, Forensic Toxicology Laboratory, F-35000 Rennes, France
- Univ. Rennes, INSERM, INRA, CHU Rennes, Institut NuMeCan (Nutrition, Metabolism and Cancer), F-35000 Rennes, France
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Ferreira E, Corte Real F, Pinho e Melo T, Margalho C. A Novel Bioanalytical Method for the Determination of Opioids in Blood and Pericardial Fluid. J Anal Toxicol 2020; 44:754-768. [DOI: 10.1093/jat/bkaa064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 12/28/2022] Open
Abstract
Abstract
Opioids are the drugs most commonly detected in overdose deaths and the second most consumed worldwide. An analytical methodology has been optimized and fully validated for the determination of codeine, morphine, 6-acetylmorphine, 6-acetylcodeine, oxycodone, oxymorphone and fentanyl in whole blood and pericardial fluid. The internal standards used were codeine-d3, morphine-d3, 6-acetylmorphine-d3 and fentanyl-d5. Before solid-phase extraction, volumes of 250 μL of blood and pericardial fluid were subjected to a protein precipitation (with 750 μL of ice-cold acetonitrile) and a microwave-induced oximation was performed using a solution of 1% aqueous hydroxylamine hydrochloride in phosphate-buffered saline (1:2, v/v). Finally, the dried extracts were further derivatized with a solution of n-methyl-n-(trimethylsilyl) trifluoroacetamide + 5% trimethylchlorosilane under microwave irradiation. The chromatographic analysis was carried out using gas chromatography–mass spectrometry operating in electron impact and selected ion monitoring mode. For all analytes, the method was linear between 5 and 1,000 ng/mL with determination coefficients (r2) >0.99. Depending on the analyte and matrix, the limit of detection varies between 3 and 4 ng/mL. Intra- and intermediate precision (<20%) and bias (±20%) were acceptable for all analytes in both matrices. The stability of the substances in the studied matrices was guaranteed, at least, 24 h in the autosampler, 4 h at room temperature and 30 days after three freeze/thaw cycles. This methodology was applied to real samples from the Laboratory of Chemistry and Forensic Toxicology, Centre Branch, of the National Institute of Legal Medicine and Forensic Sciences, Portugal.
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Affiliation(s)
- Elisa Ferreira
- Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF, I.P.), Laboratório de Toxicologia Forense da Delegação do Centro, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
- Departamento de Química da Faculdade de Ciências e Tecnologia da Universidade de Coimbra, R. Larga 2, 3004-535 Coimbra, Portugal
| | - Francisco Corte Real
- Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF, I.P.), Laboratório de Toxicologia Forense da Delegação do Centro, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
| | - Teresa Pinho e Melo
- Departamento de Química da Faculdade de Ciências e Tecnologia da Universidade de Coimbra, R. Larga 2, 3004-535 Coimbra, Portugal
| | - Cláudia Margalho
- Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF, I.P.), Laboratório de Toxicologia Forense da Delegação do Centro, Azinhaga de Santa Comba - Polo das Ciências da Saúde, 3000-548 Coimbra, Portugal
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Wang L, Ni C, Shen H, Sheng Z, Liang C, Wang R, Zhang Y. Comparison of the Detection Windows of Heroin Metabolites in Human Urine Using Online SPE and LC-MS/MS: Importance of Morphine-3-Glucuronide. J Anal Toxicol 2020; 44:22-28. [PMID: 31095707 DOI: 10.1093/jat/bkz040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/21/2019] [Accepted: 04/24/2019] [Indexed: 11/12/2022] Open
Abstract
Heroin abuse is a serious problem that endangers human health and affects social stability. Though often being used as confirmation of heroin use, 6-monoacetylmorphine (6-MAM) has limitations due to its short detection window. To compare the detection windows of heroin metabolites (morphine (MOR), 6-MAM, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G)) in human urine, an automated online solid phase extraction (SPE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and fully validated. The limits of detections (LODs) of the four metabolites were in the range of 1.25-5 ng/mL. Intra and inter-day precision for all the metabolites was 0.4-6.7% and 1.8-7.3%, respectively. Accuracy ranged from 92.9 to 101.7%. This method was then applied to the analysis of urine samples of 20 male heroin abusers. M3G was detected 9-11 days after admission to the drug rehabilitation institute in 40% of heroin users while MOR or M6G was not always detected. The detection window of M3G was thus the longest. Furthermore, M3G had a much higher concentration than MOR and M6G. Therefore, M3G could provide diagnostic information with regard to heroin exposure in the combination with other clues (e.g., heroin seizures at the scene).
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Affiliation(s)
- Luying Wang
- State Key Laboratory of New Drug and Pharmaceutical Process, China State Institute of Pharmaceutical Industry, Shanghai, China.,Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Institute of Forensic Science, Shanghai, China
| | - Chunfang Ni
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Institute of Forensic Science, Shanghai, China
| | | | - Zhenhai Sheng
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Institute of Forensic Science, Shanghai, China
| | - Chen Liang
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Institute of Forensic Science, Shanghai, China
| | - Rong Wang
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Institute of Forensic Science, Shanghai, China
| | - Yurong Zhang
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Institute of Forensic Science, Shanghai, China
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14
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Instrumental and chemometric analysis of opiates via gas chromatography-vacuum ultraviolet spectrophotometry (GC-VUV). Anal Bioanal Chem 2020; 412:1123-1128. [PMID: 31900537 DOI: 10.1007/s00216-019-02337-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
Since its introduction, gas chromatography (GC) coupled to vacuum ultraviolet spectrophotometry (VUV) has been shown to complement mass spectrometry (MS) for materials such as petrochemicals, explosives, pesticides, and drugs. In forensic chemistry, opioids are commonly encountered but rarely are the samples pure. This work focuses on GC-VUV analysis applied to naturally occurring (e.g., morphine), semi-synthetic (e.g., heroin), and synthetic (fentanyl) opioids as well as common adulterants and diluents (e.g., lidocaine and quinine). The specificity of the VUV spectra were examined visually as well as via descriptive statistical methods (e.g., correlation coefficients and sums of square residuals). Multivariate pattern recognition techniques (principal component analysis and discriminant analysis (DA)) were used to prove the opioid spectra can be reliably differentiated. The accuracy of the DA model was 100% for a test set of VUV spectra. Finally, three "street" heroin samples were analyzed to show "real-world" performance for forensic analyses. These samples contained adulterants such as caffeine, as well as by-products of heroin manufacture.
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15
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Ma J, He Y, Zeng K, Liu X. Positive Urine Morphine Test in a Chinese Patient Receiving Methadone Maintenance Treatment After Eating Hot Pot: A Case Report. Front Psychiatry 2020; 11:637. [PMID: 32719626 PMCID: PMC7348055 DOI: 10.3389/fpsyt.2020.00637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
Poppy shells contain opioids. It is a popular, but illegal spice in China. If these shells are added to food, urine morphine test of the patients involved in methadone maintenance treatment (MMT) can turn out positive. A 44-year-old male patient, who had been receiving MMT for 12 years with an extremely good treatment adherence, presented with positive urine morphine test in routine clinical compliance monitoring. However, the patient denied the use of any opioids recently. Coincidently, all of his four family members (none with a history of heroin abuse) showed positive results in urine morphine test. Considering that all these people ate a hot pot together a day before the test added to the speculation that the positive result could be due to the addition of poppy shell to the hot pot. Based on our results, we propose that this unusual phenomenon is worthy of clinical attention when managing patients at MMT clinics.
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Affiliation(s)
- Jun Ma
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yafei He
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Kuan Zeng
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Xuebing Liu
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
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16
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Fenwick A, Woodworth A, Yu M. An Unexpected Result of Meconium Drug Testing. Clin Chem 2019; 64:1671-1672. [PMID: 30377181 DOI: 10.1373/clinchem.2018.293209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/25/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Alexander Fenwick
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Kentucky, Lexington, KY
| | - Alison Woodworth
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Kentucky, Lexington, KY
| | - Min Yu
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Kentucky, Lexington, KY.
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17
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Wolf CE, Pierce KL, Goldfine BL, Nanco CR, Poklis JL, Korzun WJ. Using Papaverine and Its Metabolites, 6-Desmethyl Papaverine and 4',6-Didesmethyl Papaverine as Biomarkers to Improve the Detection Time of Heroin Use. J Anal Toxicol 2019; 43:600-606. [PMID: 31436291 DOI: 10.1093/jat/bkz069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/02/2019] [Accepted: 06/15/2019] [Indexed: 11/14/2022] Open
Abstract
Opioid usage in the USA has increased over the past decade, with prescriptions increasing from 76 million in 1991 to 207 million in 2013. New regulations have curbed the number of prescriptions, leading to an increase in heroin use. Heroin-related overdoses have quadrupled between 2000 and 2015. The traditional urinary biomarkers for indicating heroin use are a combination of morphine and 6-acetyl morphine (6-AM). Morphine is detectable in urine for several days. 6-AM is detected in urine for 2-8 hours. Papaverine has been proposed as an alternative heroin biomarker. It has been reported to have a 1-2 day detection window. Papaverine metabolites have been reported to have up to a 3-day detection window. Presented is a method for the detection of papaverine and its metabolites, 6-desmethyl papaverine (6-DMP) and 4', 6-didesmethyl papaverine (4,6-DDMP), in urine using a modified Waters® MCX™ microelution method. An ultra-performance liquid chromatography and tandem mass spectrometry (UPLC-MS-MS), with a Waters' BEH C18 column, and 20 mM ammonium formate water: 20 mM ammonium formate methanol mobile phase was employed. Calibration curves were linear from 0.1 to 50 ng/mL. No interferences were observed from the analysis of multicomponent therapeutic drug or drugs of abuse control materials; intra- and inter-run precision tests were acceptable. A total of 428 genuine urine specimens where heroin use was suspected were analyzed. These included 101 6-AM and 179 morphine only positive samples as well as 6 morphine-negative samples where papaverine and/or metabolites were detected. The determined concentrations in these samples for papaverine, 6-DMP and 4,6-DDMP ranged from 0.10 to 994, 0.10 to 462 and 0.12 to 218 ng/mL, respectively. The method was rugged and robust for the analysis of papaverine and metabolites, 6-DMP and 4,6-DDMP. The use papaverine and metabolites, 6-DMP and 4,6-DDMP has the potential to increase the detection window of heroin use.
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Affiliation(s)
| | | | | | | | - Justin L Poklis
- Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, USA
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18
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Knapp-Gisclon A, Fabresse N, Fuss-Ohlen I, Dugues P, Martin M, Larabi IA, Etting I, Mayer C, Alvarez JC. Graines de pavot présentes sur du pain anormalement contaminées aux alcaloïdes de l’opium en France. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Metabolism and metabolomics of opiates: A long way of forensic implications to unravel. J Forensic Leg Med 2019; 61:128-140. [DOI: 10.1016/j.jflm.2018.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 12/27/2022]
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20
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Abstract
Drug use and the associated overdose deaths have been a serious public health threat in the United States and the world. While traditional drugs of abuse such as cocaine remain popular, recreational use of newer synthetic drugs has continued to increase, but the prevalence of use is likely underestimated. In this review, epidemiology, chemistry, pharmacophysiology, clinical effects, laboratory detection, and clinical treatment are discussed for newly emerging drugs of abuse in the following classes: (1) opioids (e.g., fentanyl, fentanyl analogues, and mitragynine), (2) cannabinoids [THC and its analogues, alkylindole (e.g., JWH-018, JWH-073), cyclohexylphenol (e.g., CP-47,497), and indazole carboxamide (e.g., FUB-AMB, ADB-FUBINACA)], (3) stimulants and hallucinogens [β-keto amphetamines (e.g., methcathinone, methylone), pyrrolidinophenones (e.g., α-PVP, MDPV), and dimethoxyphenethylamine ("2C" and "NBOMe")], (4) dissociative agents (e.g., 3-MeO-PCP, methoxetamine, 2-oxo-PCE), and (5) sedative-hypnotics (e.g., gabapentin, baclofen, clonazolam, etizolam). It is critically important to coordinate hospital, medical examiner, and law enforcement personnel with laboratory services to respond to these emerging threats.
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Affiliation(s)
- Kenichi Tamama
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Clinical Laboratories, University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, PA, USA. .,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA. .,Clinical Laboratory, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
| | - Michael J Lynch
- Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Pittsburgh Poison Center, Pittsburgh, PA, USA.
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21
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Thaulow CH, Øiestad ÅML, Rogde S, Andersen JM, Høiseth G, Handal M, Mørland J, Vindenes V. Can measurements of heroin metabolites in post-mortem matrices other than peripheral blood indicate if death was rapid or delayed? Forensic Sci Int 2018; 290:121-128. [DOI: 10.1016/j.forsciint.2018.06.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
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22
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Mishra P, Banga I, Tyagi R, Munjal T, Goel A, Capalash N, Sharma P, Suri CR, Gandhi S. An immunochromatographic dipstick as an alternate for monitoring of heroin metabolites in urine samples. RSC Adv 2018; 8:23163-23170. [PMID: 35540121 PMCID: PMC9081577 DOI: 10.1039/c8ra02018c] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/10/2018] [Indexed: 12/19/2022] Open
Abstract
Pathway of heroin degradation post oral administration in mice.
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Affiliation(s)
- Priya Mishra
- Amity Institute of Biotechnology (AIB)
- Amity University
- Noida-201313
- India
- Amity Institute of Neuropsychology and Neurosciences (AINN)
| | - Ivneet Banga
- Amity Institute of Biotechnology (AIB)
- Amity University
- Noida-201313
- India
| | - Roshika Tyagi
- Amity Institute of Biotechnology (AIB)
- Amity University
- Noida-201313
- India
| | - Tanya Munjal
- Amity Institute of Biotechnology (AIB)
- Amity University
- Noida-201313
- India
| | - Aditya Goel
- Amity Institute of Biotechnology (AIB)
- Amity University
- Noida-201313
- India
| | - Neena Capalash
- Department of Biotechnology and Microbiology
- Panjab University
- Chandigarh-160014
- India
| | - Prince Sharma
- Department of Biotechnology and Microbiology
- Panjab University
- Chandigarh-160014
- India
| | - C. R. Suri
- CSIR-Institute of Microbial Technology
- Chandigarh-160036
- India
| | - Sonu Gandhi
- Amity Institute of Biotechnology (AIB)
- Amity University
- Noida-201313
- India
- Department of Biotechnology and Microbiology
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