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Cestonaro C, Terranova C, Carollo M, Russo A, Rosa-Rizzotto M, Viel G, Favretto D, Aprile A. Hair toxicological analysis of infants and their mothers: a 5-year retrospective study focusing on cocaine. Int J Legal Med 2024; 138:1307-1314. [PMID: 38400921 DOI: 10.1007/s00414-024-03180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
Prenatal and infant exposure to drugs of abuse is an emerging social and public health problem affecting children health and which may relate to child abuse and neglect. Exposure to drugs of abuse may occur through different routes, including intrauterine, breastfeeding, accidental intake, passive inhalation, and intentional administration. Currently, cases of suspected exposure can be investigated by hair toxicological analysis, the interpretation of which is, however, often difficult, leading to consequent difficulties in the management of such cases. In order to provide a contribution in terms of interpretation of the analytical results, this study aimed to search for the possible existence of elements, from a toxicological point of view, indicative towards the route of exposure. A retrospective study was performed on cases of suspected exposure to drugs of abuse in children aged 0-1 year, evaluated at a University Hospital between 2018 and 2022. Data of children hair toxicological analysis were analyzed and then compared with those of their mothers, when available; 41.6% children tested positive for cocaine. The study found a significant correlation between cocaine and benzoylecgonine concentrations, and a benzoylecgonine/cocaine ratio that tends to decrease as the age of children increases. From the comparison with mothers, a child/mother cocaine concentration ratio lower than 1 was found in all cases of hair sampled within the first week of life, and a ratio greater than or equal to 1 in all cases in which the sampling was performed later. These results, if confirmed in a larger cohort, could represent a contribution in the interpretation of cases of infant exposure to drugs of abuse and be integrated in the context of their multidisciplinary evaluation.
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Affiliation(s)
- Clara Cestonaro
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Massimo Carollo
- Clinical Pharmacology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessia Russo
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Melissa Rosa-Rizzotto
- Child Abuse and Neglect Crisis Unit, Paediatrics Department, Padua University Teaching Hospital, Padua, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Donata Favretto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Anna Aprile
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Bertaso A, Gottardo R, Murari M, Mazzola M, Porpiglia NM, Taus F, Beghini R, Gandini F, Bortolotti F. Hair testing applied to the assessment of in utero exposure to drugs: Critical analysis of 51 cases of the University Hospital of Verona. Drug Test Anal 2023; 15:980-986. [PMID: 37154073 DOI: 10.1002/dta.3515] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
The work discusses the results of hair and urine testing performed in 51 cases of suspected in utero drug exposure handled at the University Hospital of Verona from 2016 to 2022. On the day of birth or the day after birth, urine from mother and newborn (UM and UN) and hair from mother (HM), newborn (HN) and father (HF), if possible, were collected. Urine underwent immunoassay and GC-MS analysis, whereas hair underwent LC-MS/MS and GC-MS/MS analysis. In 50 out of 51 cases, HM and/or HN were available. In 92% of them, hair testing resulted in a positive, often (>50% cases) for more than one class of substance. The most detected substances were cocaine, opiates, methadone and cannabinoids. Maternal segmental analysis showed a prevalent decreasing concentration trend during pregnancy in case of positivity for one class of substances, whereas, as expected, a neatly prevalent increasing trend in the case of positivity for more than one class of substances. In nine cases, HF was also available, resulting in all being positive, usually for the same classes of substances identified in HM, thus questioning parental responsibility. In 33 cases, urine samples from the mother or newborn were also collected. Of them, 27 cases (82%) tested positive, showing peri-partum drug consumption and then confirming the severity of the addiction. Hair testing showed to be a reliable diagnostic tool to investigate in utero drug exposure because of the possibility of obtaining a complete picture of maternal addictive behaviour and family background, thanks to segmental maternal hair analysis and father hair testing.
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Affiliation(s)
- Anna Bertaso
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Rossella Gottardo
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Matilde Murari
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Mara Mazzola
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Nadia Maria Porpiglia
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Francesco Taus
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
- Department of Diagnostic and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Renzo Beghini
- Department of Pediatrics, Verona University Hospital, Verona, Italy
| | - Fabio Gandini
- Social Services, Verona University Hospital, Verona, Italy
| | - Federica Bortolotti
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
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Gish A, Richeval C, Wiart JF, Hennart B, Hakim F, Demarly C, Balgairies A, Hédouin V, Allorge D, Gaulier JM. Interpretation of hair and nails findings in an infant death case related to maternal addiction to tramadol. Drug Test Anal 2023; 15:1022-1026. [PMID: 37105763 DOI: 10.1002/dta.3485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
An 11-month-old boy was found dead. Autopsy findings (cyanosis and polyvisceral congestion) and blood tramadol (TR) concentration of 6240 μg/L were consistent with an acute TR intoxication. In this poisoning situation, owing to the mother's statements (TR addiction leading to daily TR-orange juice mixture preparation accidentally used for the baby bottle preparation by the mother's partner), and the question of possible previous TR administrations to the infant, hair and/or nails (infant, mother, partner, 6-year-old sister) analysis was performed. Hair (2-cm-long hair segments from proximal [S1] to distal [S3]) and nails concentrations (pg/mg; nd: not detected) were as follows: Infant (hair: TR 1420 [S1], 1622 [S2], 2736 [S3]; O-DMT 16-38; N-DMT 34-100 [TR in significant quantities in the hair decontamination bath]-toenails: TR 584; O-DMT 8; N-DMT 15), mother (hair: TR 2340 [S1], 2150 [S2], 2500 [S3]; O-DMT 704-1170; N-DMT 827-1360), mother's partner (fingernails: TR 72; O-DMT nd; N-DMT nd) and sister (hair: TR 261 [S1], 524 [S2]; O-DMT 15 [S1], 16 [S2]; N-DMT 20 [S1], 38 [S2]). Metabolite ratio (infant and sister hair) was comparable to those observed in hair of pharmaceutical industry employees manufacturing tramadol. TR in washing baths, low observed nail concentrations (infant and partner) confirm (i) TR-related mother's addiction and (ii) external contamination issues (TR in sweat of the child at the time of death and in living environment) to explain the infant's keratinized samples results. This case report illustrates the interest of analyzing keratinized matrices of the whole family in such a situation.
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Affiliation(s)
- Alexandr Gish
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | - Camille Richeval
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | | | | | - Florian Hakim
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | | | | | | | - Delphine Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | - Jean-Michel Gaulier
- CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France
- Univ. Lille, URL 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
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Monfort A, Ferreira E, Leclair G, Lodygensky GA. Pharmacokinetics of Cannabis and Its Derivatives in Animals and Humans During Pregnancy and Breastfeeding. Front Pharmacol 2022; 13:919630. [PMID: 35903331 PMCID: PMC9315316 DOI: 10.3389/fphar.2022.919630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Cannabis is one of the most widely used illicit drugs during pregnancy and lactation. With the recent legalization of cannabis in many countries, health professionals are increasingly exposed to pregnant and breastfeeding women who are consuming cannabis on a regular basis as a solution for depression, anxiety, nausea, and pain. Cannabis consumption during pregnancy can induce negative birth outcomes such as reduced birth weight and increased risk of prematurity and admission to the neonatal intensive care unit. Yet, limited information is available regarding the pharmacokinetics of cannabis in the fetus and newborn exposed during pregnancy and lactation. Indeed, the official recommendations regarding the use of cannabis during these two critical development periods lack robust pharmacokinetics data and make it difficult for health professionals to guide their patients. Many clinical studies are currently evaluating the effects of cannabis on the brain development and base their groups mostly on questionnaires. These studies should be associated with pharmacokinetics studies to assess correlations between the infant brain development and the exposure to cannabis during pregnancy and breastfeeding. Our project aims to review the available data on the pharmacokinetics of cannabinoids in adults, neonates, and animals. If the available literature is abundant in adult humans and animals, there is still a lack of published data on the exposure of pregnant and lactating women and neonates. However, some of the published information causes concerns on the exposure and the potential effects of cannabis on fetuses and neonates. The safety of cannabis use for non-medical purpose during pregnancy and breastfeeding needs to be further characterized with proper pharmacokinetic studies in humans feasible in regions where cannabis has been legalized. Given the available data, significant transfer occurs to the fetus and the breastfed newborn with a theoretical risk of accumulation of products known to be biologically active.
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Affiliation(s)
- Anaëlle Monfort
- Platform of Biopharmacy, Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - Ema Ferreira
- CHU Sainte-Justine, Montréal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - Grégoire Leclair
- Platform of Biopharmacy, Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - Gregory Anton Lodygensky
- CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montréal, QC, Canada
- *Correspondence: Gregory Anton Lodygensky,
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5
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Hair analysis interpretation in post-mortem situations: Key considerations and proposals to overcome main hurdles. Leg Med (Tokyo) 2022; 56:102032. [DOI: 10.1016/j.legalmed.2022.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 11/21/2022]
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6
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Muckensturm A, Cheze M, Valet D, Quinton MC, Bodeau S, Lemaire-Hurtel AS, Deveaux M, Hoizey G. Trouble factice imposé à autrui : à propos d’un cas d’intoxication par la lamotrigine, documenté par l’analyse des cheveux. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2020. [DOI: 10.1016/j.toxac.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Is there an interest for hair analysis in non-intentional pediatric cannabis intoxication? Forensic Sci Int 2020; 313:110377. [DOI: 10.1016/j.forsciint.2020.110377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022]
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Pelissier-Alicot AL, Kintz P, Ameline A, Bosdure E, Chabrol B, Neant N, Torrents R, Sastre C, Baillif-Couniou V, Tuchtan-Torrents L, Leonetti G. Bromazepam intoxication in an infant: Contribution of hair and nail analysis. Drug Test Anal 2020; 12:397-401. [PMID: 31997564 DOI: 10.1002/dta.2774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 02/05/2023]
Affiliation(s)
| | - Pascal Kintz
- Laboratoire de Toxicologie, Institut de Médecine Légale, Strasbourg, France
| | - Alice Ameline
- Laboratoire de Toxicologie, Institut de Médecine Légale, Strasbourg, France
| | - Emmanuelle Bosdure
- Aix Marseille University, APHM, Hôpital La Timone, Service de Pédiatrie Spécialisée et de Médecine Infantile, Marseille, France
| | - Brigitte Chabrol
- Aix Marseille University, APHM, Hôpital La Timone, Service de Pédiatrie Spécialisée et de Médecine Infantile, Marseille, France
| | - Nadège Neant
- Laboratoire de Pharmacocinétique et Toxicologie, Aix Marseille University, APHM, INSERM, CNRS, CRCM SMARTc, Hôpital La Timone, Marseille, France
| | - Romain Torrents
- Aix Marseille University, APHM, Hôpitaux Sud, Pharmacologie Toxicologie Clinique - Centre Anti-Poison et de ToxicoVigilance (CAP-TV), Marseille, France
| | - Caroline Sastre
- Service de Médecine Légale, Aix Marseille University, APHM, Hôpital La Timone, Marseille, France
| | - Valérie Baillif-Couniou
- Service de Médecine Légale, Aix Marseille University, APHM, Hôpital La Timone, Marseille, France
| | - Lucile Tuchtan-Torrents
- Service de Médecine Légale, Aix Marseille University, APHM, Hôpital La Timone, Marseille, France
| | - Georges Leonetti
- Service de Médecine Légale, Aix Marseille University, APHM, Hôpital La Timone, Marseille, France
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Pragst F, Krumbiegel F, Thurmann D, Westendorf L, Methling M, Niebel A, Hartwig S. Hair analysis of more than 140 families with drug consuming parents. Comparison between hair results from adults and their children. Forensic Sci Int 2019; 297:161-170. [DOI: 10.1016/j.forsciint.2019.01.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/25/2022]
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10
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Affiliation(s)
- Pascal Kintz
- Institut de Médecine légale Strasbourg France
- X‐Pertise Consulting Oberhausbergen France
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11
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12
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High risk of misinterpreting hair analysis results for children tested for methadone. Forensic Sci Int 2017; 280:176-180. [PMID: 29073515 DOI: 10.1016/j.forsciint.2017.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/05/2017] [Accepted: 10/07/2017] [Indexed: 02/06/2023]
Abstract
The major problem after testing the hair of a child for drugs is the interpretation of the findings. In 2016, the laboratory received several hair specimens with the request to verify if there was any evidence of previous methadone exposure by the donor of the sample. Case 1 was a child admitted to the Emergency Unit for intense sedation and breathing difficulties. Cases 2-4 involved children found dead at home. In all cases, methadone and EDDP, its metabolite, were found in blood. After decontamination, the hair was analysed with LC-MS/MS for methadone and EDDP. The LOQ for both drugs was 10pg/mg. Concentrations were in the range 60-1590 and <10-220pg/mg for methadone and EDDP, respectively. In all of the cases, segmental analysis revealed approximately the same amount of drug along the hair lock. As a consequence, contamination was considered as an issue and interpretation of the results was a challenge that deserves particular attention. It must be considered that the amount of hair from children, available for analysis, can be low, particularly when several drugs have to be tested. This has consequences on the limit of quantitation and the identification of the metabolite(s). It must be also noted that hair from children is finer and more porous in comparison with adult (risk of higher contamination by sweat versus adults). It is very difficult to put any window of detection when testing for drugs in young children as hair growing is asynchronous. It is even more complicated as it has been demonstrated that drugs can be incorporated during pregnancy in the hair of the foetus, which will contribute to the positive findings after delivery. Several weeks or months after delivery, identification of a drug in hair can indicate: 1, in-utero exposure, or 2, exposure after delivery, or 3, a mix of both situations. Whereas the detection of drugs in a child's hair unambiguously shows drug handling in the environment of the child, it is difficult to distinguish between systemic incorporation into hair after ingestion or inhalation and external deposition into hair from smoke, dust, or contaminated surfaces. However, the interpretation of hair results with respect to systemic or only external exposure is particularly important in case of children for a realistic assessment of the toxic health risk. Practising scientists have the responsibility to inform the child protection authorities, courts, etc about these limitations.
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Cuypers E, Flanagan RJ. The interpretation of hair analysis for drugs and drug metabolites. Clin Toxicol (Phila) 2017; 56:90-100. [DOI: 10.1080/15563650.2017.1379603] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Eva Cuypers
- KU Leuven Toxicology and Pharmacology, University of Leuven, Leuven, Belgium
| | - Robert J. Flanagan
- Toxicology Unit, Department of Clinical Biochemistry, King’s College Hospital, London, UK
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Intoxication par le bromazépam chez un nourrisson : apport des analyses capillaire et unguéale pour confirmer une exposition post-natale. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2017.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Bartoli M, Allibe N, Tonini J, Fonrose X, Bardet J, Scolan V, Eysseric H, Stanke-Labesque F. Exposition d’un nourrisson au tramadol : contribution des analyses urinaires et capillaires. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2017.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Pélissier-Alicot AL. Difficultés d’interprétation des concentrations capillaires chez le jeune enfant. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2016.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Kintz P. Difficultés d’interprétation des concentrations de méthadone dans les cheveux d’enfants. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2016.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Gaulier JM. Cannabis et analyses capillaires des enfants. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2016.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Wang X, Drummer OH. Review: Interpretation of drug presence in the hair of children. Forensic Sci Int 2015; 257:458-472. [DOI: 10.1016/j.forsciint.2015.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/20/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
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20
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Jamey C, Kintz P, Raul JS. Poisoning of a child by levamisole: Evidence by hair testing. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2015. [DOI: 10.1016/j.toxac.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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