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Dos Santos BP, Birk L, Schwarz P, Sebben VC, Sgaravatti ÂM, de Gouveia GC, Silva Petry AU, de Menezes FP, Gonzaga AP, Schlickmann PF, Arbo MD, de Oliveira TF, Eller S. A validated dilute-and-shoot LC-MS-MS urine screening for the analysis of 95 illicit drugs and medicines: Insights from clinical and forensic Brazilian cases. J Anal Toxicol 2024; 48:314-331. [PMID: 38334744 DOI: 10.1093/jat/bkae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/16/2023] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
Urine toxicological analysis is a relevant tool in both clinical and forensic scenarios, enabling the diagnosis of acute poisonings, elucidation of deaths, verification of substance use in the workplace and identification of drug-facilitated crimes. For these analyses, the dilute-and-shoot technique associated with liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS) is a promising alternative since it has demonstrated satisfactory results and broad applicability. This study developed and validated a comprehensive LC-MS-MS screening method to analyze 95 illicit drugs and medicines in urine samples and application to clinical and forensic Brazilian cases. The dilute-and-shoot protocol was defined through multivariate optimization studies and was set using 100 µL of sample and 300 µL of solvent. The total chromatographic run time was 7.5 min. The method was validated following the recommendations of the ANSI/ASB Standard 036 Guideline. The lower limits of quantification varied from 20 to 100 ng/mL. Within-run and between-run precision coefficient of variations% were <20%, and bias was within ± 20%. Only 4 of the 95 analytes presented significant ionization suppression or enhancement (>25%). As proof of applicability, 839 urine samples from in vivo and postmortem cases were analyzed. In total, 90.9% of the analyzed samples were positive for at least one substance, and 78 of the 95 analytes were detected. The most prevalent substances were lidocaine (40.2%), acetaminophen (38.0%) and benzoylecgonine (31.5%). The developed method proved to be an efficient and simplified alternative for analyzing 95 therapeutic and illicit drugs in urine samples. Additionally, the results obtained from sample analysis are essential for understanding the profile of Brazilian substance use, serving as a valuable database for the promotion of health and safety public policies.
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Affiliation(s)
- Bruno Pereira Dos Santos
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
- Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS 90010-150, Brazil
| | - Letícia Birk
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Patrícia Schwarz
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | | | - Ângela Malysz Sgaravatti
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
- General Institute of Expertise of Rio Grande do Sul, Porto Alegre, RS 90230-010, Brazil
| | - Giovanna Cristiano de Gouveia
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Adriana Ubirajara Silva Petry
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
- Division of Postmortem Inspection, Associação Hospitalar Vila Nova, Porto Alegre, RS 91750-040, Brazil
| | - Francisco Paz de Menezes
- Division of Postmortem Inspection, Associação Hospitalar Vila Nova, Porto Alegre, RS 91750-040, Brazil
| | - Alexsandro Pinto Gonzaga
- Division of Postmortem Inspection, Associação Hospitalar Vila Nova, Porto Alegre, RS 91750-040, Brazil
| | - Paula Flores Schlickmann
- Division of Postmortem Inspection, Associação Hospitalar Vila Nova, Porto Alegre, RS 91750-040, Brazil
| | - Marcelo Dutra Arbo
- Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS 90010-150, Brazil
| | - Tiago Franco de Oliveira
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Sarah Eller
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
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Rodrigo Valero AM, Jorge OQ, Serrano BB, Tejedor SA. Optimization of a rapid method for screening drugs in blood by liquid chromatography tandem mass spectrometry. ADVANCES IN LABORATORY MEDICINE 2023; 4:365-371. [PMID: 38106497 PMCID: PMC10724859 DOI: 10.1515/almed-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Objectives In the recent years, liquid chromatography with tandem mass spectrometry has gained popularity in laboratories. This technique has a higher specificity, detects different analytes from a single specimen, measures analytes in distinct matrices, and substantially reduce analytical interference, with respect to immunoassay. The processing and preparation of biological samples are crucial in chromatography. Interferences in blood testing are usually caused by the presence of phospholipids and proteins. The main objective of this study was to improve analytical processes for drug screening by LC-MS/MS using a novel blood sample preparation method based on protein precipitation and removal of phospholipids. Methods An evaluation was performed of a new method for the preparation of blood samples based on protein precipitation and removal of phospholipids by LC-Q-q-LIT. Results Limit of detection, limit of quantification and measurement range were determined for 56 molecules. The results of 11 cases were compared with those obtained using standard blood collection methods and instruments. Conclusions The novel blood preparation and testing method based on LC-Q-q-LIT, a more sensitive technique, has demonstrated to yield comparable results to traditional methods. In addition, this new technique reduces turnaround time and costs.
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Affiliation(s)
- Alba M. Rodrigo Valero
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
| | - Oscar Quintela Jorge
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
| | - Begoña Bravo Serrano
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
| | - Sara Ayuso Tejedor
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
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Rodrigo Valero AM, Quintela Jorge O, Bravo Serrano B, Ayuso Tejedor S. Optimización de un método de cribado rápido de fármacos en sangre mediante la técnica de cromatografía de líquidos acoplada a espectrometría de masas. ADVANCES IN LABORATORY MEDICINE 2023; 4:372-378. [PMID: 38106500 PMCID: PMC10724858 DOI: 10.1515/almed-2023-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Objetivos La cromatografía líquida acoplada a la espectrometría de masas ha ganado en popularidad en los laboratorios en los últimos años debido a una mayor especificidad de la técnica, la posibilidad de determinar múltiples analitos en una sola inyección de la muestra, la medición de analitos en una variedad de matrices diferentes y a una drástica reducción de las interferencias analíticas en comparación con el inmunoensayo. El tratamiento y preparación de las muestras biológicas es un proceso esencial cuando éstas han de ser analizadas mediante sistemas cromatográficos. Los principales interferentes en el análisis de las muestras de sangre son los fosfolípidos y las proteínas. El objetivo principal de este estudio es mejorar la sistemática analítica toxicológica en el cribado general de fármacos mediante la técnica LC-MS/MS a través de un nuevo método de preparación de muestras en sangre basado en la precipitación de proteínas y eliminación de fosfolípidos. Métodos Se ha evaluado el nuevo método de preparación de muestras en sangre basado en la precipitación de proteínas y eliminación de fosfolípidos mediante la tecnología LC-Q-q-LIT. Resultados Se ha determinado el límite de detección, el límite de cuantificación y rango de medición para las 56 moléculas seleccionadas y se han comparado los resultados de once casos con las extracciones e instrumentación tradicionales. Conclusiones La metodología propuesta de preparación de muestras en sangre y análisis mediante técnicas más sensibles como LC-Q-q-LIT ha resultado comparable a la metodología tradicional en cuanto a resultados y, ofreciendo, además, una reducción de tiempo y coste.
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Affiliation(s)
- Alba M. Rodrigo Valero
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
| | - Oscar Quintela Jorge
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
| | - Begoña Bravo Serrano
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
| | - Sara Ayuso Tejedor
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
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Peters FT, Wissenbach D. Current state-of-the-art approaches for mass spectrometry in clinical toxicology: an overview. Expert Opin Drug Metab Toxicol 2023; 19:487-500. [PMID: 37615282 DOI: 10.1080/17425255.2023.2252324] [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: 05/16/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Hyphenated mass spectrometry (MS) has evolved into a very powerful analytical technique of high sensitivity and specificity. It is used to analyze a very wide spectrum of analytes in classical and alternative matrices. The presented paper will provide an overview of the current state-of-the-art of hyphenated MS applications in clinical toxicology primarily based on review articles indexed in PubMed (1990 to April 2023). AREAS COVERED A general overview of matrices, sample preparation, analytical systems, detection modes, and validation and quality control is given. Moreover, selected applications are discussed. EXPERT OPINION A more widespread use of hyphenated MS techniques, especially in systematic toxicological analysis and drugs of abuse testing, would help overcome limitations of immunoassay-based screening strategies. This is currently hampered by high instrument cost, qualification requirements for personnel, and less favorable turnaround times, which could be overcome by more user-friendly, ideally fully automated MS instruments. This would help making hyphenated MS-based analysis available in more laboratories and expanding analysis to a large number of organic drugs, poisons, and/or metabolites. Even the most recent novel psychoactive substances (NPS) could be presumptively identified by high-resolution MS methods, their likely presence be communicated to treating physicians, and be confirmed later on.
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Affiliation(s)
- Frank T Peters
- Institute of Forensic Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Daniela Wissenbach
- Institute of Forensic Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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Ren W, Sun M, Shi X, Wang T, Wang Y, Wang C, Li M. Progress of Mass Spectrometry-Based Lipidomics in the Dairy Field. Foods 2023; 12:foods12112098. [PMID: 37297344 DOI: 10.3390/foods12112098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/11/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Lipids play important biological roles, such as providing essential fatty acids and signaling. The wide variety and structural diversity of lipids, and the limited technical means to study them, have seriously hampered the resolution of the mechanisms of action of lipids. With advances in mass spectrometry (MS) and bioinformatic technologies, large amounts of lipids have been detected and analyzed quickly using MS-based lipidomic techniques. Milk lipids, as complex structural metabolites, play a crucial role in human health. In this review, the lipidomic techniques and their applications to dairy products, including compositional analysis, quality identification, authenticity identification, and origin identification, are discussed, with the aim of providing technical support for the development of dairy products.
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Affiliation(s)
- Wei Ren
- School of Agricultural Science and Engineering, Liaocheng Research Institute of Donkey High-Efficiency Breeding and Ecological Feeding, Liaocheng University, Liaocheng 252000, China
| | - Mengqi Sun
- School of Agricultural Science and Engineering, Liaocheng Research Institute of Donkey High-Efficiency Breeding and Ecological Feeding, Liaocheng University, Liaocheng 252000, China
| | - Xiaoyuan Shi
- School of Agricultural Science and Engineering, Liaocheng Research Institute of Donkey High-Efficiency Breeding and Ecological Feeding, Liaocheng University, Liaocheng 252000, China
| | - Tianqi Wang
- School of Agricultural Science and Engineering, Liaocheng Research Institute of Donkey High-Efficiency Breeding and Ecological Feeding, Liaocheng University, Liaocheng 252000, China
| | - Yonghui Wang
- School of Agricultural Science and Engineering, Liaocheng Research Institute of Donkey High-Efficiency Breeding and Ecological Feeding, Liaocheng University, Liaocheng 252000, China
| | - Changfa Wang
- School of Agricultural Science and Engineering, Liaocheng Research Institute of Donkey High-Efficiency Breeding and Ecological Feeding, Liaocheng University, Liaocheng 252000, China
| | - Mengmeng Li
- School of Agricultural Science and Engineering, Liaocheng Research Institute of Donkey High-Efficiency Breeding and Ecological Feeding, Liaocheng University, Liaocheng 252000, China
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Noguez JH, Koch CD. Bridging the gap: The critical role of laboratory developed tests in clinical toxicology. J Mass Spectrom Adv Clin Lab 2023; 28:70-74. [PMID: 36872953 PMCID: PMC9982682 DOI: 10.1016/j.jmsacl.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
•Toxicology testing provides valuable information for patient management.•Current in vitro diagnostics (IVDs) are unable to meet all clinical needs.•Lab-developed tests (LDTs) in toxicology can be used to close clinical care gaps.•LDTs in clinical toxicology are almost exclusively mass spectrometry-based methods.
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Affiliation(s)
- Jaime H Noguez
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA.,Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher D Koch
- Department of Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.,Sanford Laboratories, Sanford Health, Sioux Falls, SD, USA
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Smith JL, McCutcheon D, Weber C, Soderstrom J, Burcham J, Fatovich DM. ‘Trial by fire’: An online survey exploring confidence of junior doctors in managing toxicology presentations to the emergency department. Drug Alcohol Rev 2022; 41:1554-1564. [DOI: 10.1111/dar.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer L. Smith
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- East Metropolitan Health Service Department of Health Perth Australia
| | - David McCutcheon
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- Emergency Department Royal Perth Hospital Perth Australia
- Emergency Medicine The University of Western Australia Perth Australia
- Royal Perth Hospital Research Foundation Royal Perth Hospital Perth Australia
| | - Courtney Weber
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- East Metropolitan Health Service Department of Health Perth Australia
| | - Jessamine Soderstrom
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- Emergency Department Royal Perth Hospital Perth Australia
- Emergency Medicine The University of Western Australia Perth Australia
| | - Jonathon Burcham
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- East Metropolitan Health Service Department of Health Perth Australia
- Emergency Department Royal Perth Hospital Perth Australia
| | - Daniel M. Fatovich
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- East Metropolitan Health Service Department of Health Perth Australia
- Emergency Department Royal Perth Hospital Perth Australia
- Emergency Medicine The University of Western Australia Perth Australia
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Su H, Huang MZ, Shiea J, Lee CW. Thermal desorption ambient ionization mass spectrometry for emergency toxicology. MASS SPECTROMETRY REVIEWS 2022:e21784. [PMID: 35603997 DOI: 10.1002/mas.21784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 06/15/2023]
Abstract
In the emergency department, it is important to rapidly identify the toxic substances that have led to acute poisoning because different toxicants or toxins cause poisoning through different mechanisms, requiring disparate therapeutic strategies and precautions against contraindicating actions, and diverse directions of clinical course monitoring and prediction of prognosis. Ambient ionization mass spectrometry, a state-of-the-art technology, has been proved to be a fast, accurate, and user-friendly tool for rapidly identifying toxicants like residual pesticides on fruits and vegetables. In view of this, developing an analytical platform that explores the application of such a cutting-edge technology in a novel direction has been initiated a research program, namely, the rapid identification of toxic substances which might have caused acute poisoning in patients who visit the emergency department and requires an accurate diagnosis for correct clinical decision-making to bring about corresponding data-guided management. This review includes (i) a narrative account of the breakthrough in emergency toxicology brought about by the advent of ambient ionization mass spectrometry and (ii) a thorough discussion about the clinical implications and technical limitations of such a promising innovation for promoting toxicological tests from tier two-level to tier one level.
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Affiliation(s)
- Hung Su
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Min-Zong Huang
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Jentaie Shiea
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wei Lee
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Delaney SR, Tacker DH, Snozek CLH. The North American opioid epidemic: opportunities and challenges for clinical laboratories. Crit Rev Clin Lab Sci 2022; 59:309-331. [PMID: 35166639 DOI: 10.1080/10408363.2022.2037122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since 1999, the opioid epidemic in North America has resulted in over 1 million deaths, and it continues to escalate despite numerous efforts in various arenas to combat the upward trend. Clinical laboratories provide drug testing to support practices such as emergency medicine, substance use disorder treatment, and pain management; increasingly, these laboratories are collaborating in novel partnerships including drug-checking services (DCS) and multidisciplinary treatment teams. This review examines drug testing related to management of licit and illicit opioid use, new technologies and test strategies employed by clinical laboratories, barriers hindering laboratory response to the opioid epidemic, and areas for improvement and standardization within drug testing. Literature search terms included combinations of "opioid," "opiate," "fentanyl," "laboratory," "epidemic," "crisis," "mass spectrometry," "immunoassay," "drug screen," "drug test," "guidelines," plus review of PubMed "similar articles" and references within publications. While immunoassay (IA) and point-of-care (POC) test options for synthetic opioids are increasingly available, mass spectrometry (MS) platforms offer the greatest flexibility and sensitivity for detecting novel, potent opioids. Previously reserved as a second-tier application in most drug test algorithms, MS assays are gaining a larger role in initial screening for specific patients and DCS. However, there are substantial differences among laboratories in terms of updating test menus, algorithms, and technologies to meet changing clinical needs. While some clinical laboratories lack the resources and expertise to implement MS, many are also slow to adopt available IA and POC tests for newer opioids such as fentanyl. MS-based testing also presents challenges, including gaps in available guidance for assay validation and ongoing performance assessment that contribute to a dramatic lack of standardization among laboratories. We identify opportunities for improvement in laboratory operations, reporting, and interpretation of drug test results, including laboratorian and provider education and laboratory-focused guidelines. We also highlight the need for collaboration with providers, assay and instrument manufacturers, and national organizations to increase the effectiveness of clinical laboratory and provider efforts in preventing morbidity and mortality associated with opioid use and misuse.
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Affiliation(s)
- Sarah R Delaney
- Department of Laboratory Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Danyel H Tacker
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Christine L H Snozek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, AZ, USA
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Lierheimer S, Beck O, Keller T, Monticelli FC, Böttcher M. Hydromorphone and codeine concentrations in oral fluid specimens from patients receiving substitution therapy with Substitol™ (morphine sulfate). Drug Test Anal 2021; 13:1743-1748. [PMID: 34250761 DOI: 10.1002/dta.3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 11/07/2022]
Abstract
This study aimed to determine whether hydromorphone and codeine can be detected in oral fluid specimens following administration of Substitol™, a slow-release formulation of morphine. This is of interest for those monitoring treatment compliance using drug testing. Oral fluid specimens collected for compliance assessment in routine clinical practice or as part of a clinical trial were subjected to quantitative analysis of hydromorphone, morphine, codeine, and 6-acetylmorphine using highly sensitive mass spectrometric methods. Oral fluid was collected using a Greiner Bio-One saliva collection system. Patients undergoing substitution treatment with Substitol™, methadone, or buprenorphine were included, together with patients undergoing pain treatment with hydromorphone. Hydromorphone was detected in 642 of the 663 (97%) samples from substitol-treated patients. Concentrations were not higher in methadone- and buprenorphine-treated patients who relapsed into heroin use, or in patients on hydromorphone therapy. Codeine was detected in 29% of the samples. These concentrations were lower than those in patients who had relapsed to heroin use. Clinical administration of morphine can lead to detectable concentrations of both hydromorphone and codeine in oral fluids. This should be taken into consideration when using drug testing in oral fluid samples for compliance assessment in this patient group.
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Affiliation(s)
- Stefan Lierheimer
- Department of Toxicology, MVZ Medizinische Labore Dessau Kassel GmbH, Dessau-Roßlau, Germany
| | - Olof Beck
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
| | - Thomas Keller
- Institute of Forensic Medicine, University of Salzburg, Salzburg, Austria
| | | | - Michael Böttcher
- Department of Toxicology, MVZ Medizinische Labore Dessau Kassel GmbH, Dessau-Roßlau, Germany
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Washaya N, Evans A, Muloiwa R, Smith P, Buys H. The prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. BMC Pediatr 2021; 21:42. [PMID: 33461521 PMCID: PMC7812651 DOI: 10.1186/s12887-021-02500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Paediatric poisoning is a common presentation to emergency departments worldwide. There is a paucity of data on the role of liquid chromatography-tandem mass spectrometry (LC-MS/MS), in the management of paediatric poisoning in low-and middle-income countries (LMICs). In high-income countries, most studies are retrospective, and few include children. Objective The study describes the prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Methods Children admitted with suspected poisoning between 1 January 2017 and 31 December 2017, were recruited. All patients had a urine and/or blood sample sent for LC-MS/MS toxicology. Data collected included demographic data, clinical features, investigations, management, outcome and social interventions. Results One hundred fifty-two children, with median age of 39 (IQR 25–61) months were enrolled of which 128 (84%) were poisoning cases. Of the 128 poisoning cases, 88 (69%) presented with a history of ingesting a known substance, 16 (12%) an unknown substance and 24 (19%) were cases of occult poisoning. LC-MS/MS was able to identify a substance in 92% of the cases of occult poisoning. In those who had presented with a seemingly known substance, LC-MS/MS found a different substance in 15 cases. LC-MS/MS was also able to detect multiple drugs in 40 patients. Of the poisoning cases, six (5%) cases were attempted homicide cases and 5 (4%) cases were attempted suicide cases. No children died. Individualized social interventions were instituted in poisoning cases. Emergency placement safety reasons was required in 6 children. Conclusion When the limitations are known, LC-MS/MS is useful in identifying cases of occult poisoning, identifying patients who have ingested multiple substances and/or an unknown substance and when targeted towards child protection. As LC-MS/MS is an expensive test, it should be used judiciously in LMICs.
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Affiliation(s)
- Norbertta Washaya
- Division of Ambulatory and Emergency Paediatrics, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Alicia Evans
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Peter Smith
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
| | - Heloise Buys
- Division of Ambulatory and Emergency Paediatrics, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Nedelkov D, Hu Y. Complexity, cost, and content – three important factors for translation of clinical protein mass spectrometry tests, and the case for apolipoprotein C-III proteoform testing. Clin Chem Lab Med 2019; 58:858-863. [DOI: 10.1515/cclm-2019-0977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022]
Abstract
Abstract
Complexity, cost, and content are three important factors that can impede translation of clinical protein mass spectrometry (MS) tests at a larger scale. Complexity stems from the many components/steps involved in bottom-up protein MS workflows, making them significantly more complicated than enzymatic immunoassays (EIA) that currently dominate clinical testing. This complexity inevitably leads to increased costs, which is detrimental in the price-competitive clinical marketplace. To successfully compete, new clinical protein MS tests need to offer something new and unique that EIAs cannot – a new content of proteoform detection. The preferred method for proteoform profiling is intact protein MS analysis, in which all proteins are measured as intact species thus allowing discovery of new proteoforms. To illustrate the importance of intact proteoform testing with MS and its potential clinical implications, we discuss here recent findings from multiple studies on the distribution of apolipoprotein C-III proteoforms and their correlations with key clinical measures of dyslipidemia. Such studies are only made possible with assays that are low in cost, avoid unnecessary complexity, and are unique in providing the content of proteoforms.
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Affiliation(s)
- Dobrin Nedelkov
- Isoformix Inc. , 9830 S, 51st St. Suite B-113 , Phoenix AZ 85044 , USA , Phone: +1-602-295-4874
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Target Analysis and Retrospective Screening of Multiple Mycotoxins in Pet Food Using UHPLC-Q-Orbitrap HRMS. Toxins (Basel) 2019; 11:toxins11080434. [PMID: 31344880 PMCID: PMC6723864 DOI: 10.3390/toxins11080434] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 11/21/2022] Open
Abstract
A comprehensive strategy combining a quantitative method for 28 mycotoxins and a post-target screening for other 245 fungal and bacterial metabolites in dry pet food samples were developed using an acetonitrile-based extraction and an ultrahigh-performance liquid chromatography coupled to high-resolution mass spectrometry (UHPLC-Q-Orbitrap HRMS) method. The proposed method showed satisfactory validation results according to Commission Decision 2002/657/EC. Average recoveries from 72 to 108% were obtained for all studied mycotoxins, and the intra-/inter-day precision were below 9 and 14%, respectively. Results showed mycotoxin contamination in 99% of pet food samples (n = 89) at concentrations of up to hundreds µg/kg, with emerging Fusarium mycotoxins being the most commonly detected mycotoxins. All positive samples showed co-occurrence of mycotoxins with the simultaneous presence of up to 16 analytes per sample. In the retrospective screening, up to 54 fungal metabolites were tentatively identified being cyclopiazonic acid, paspalitrem A, fusaric acid, and macrosporin, the most commonly detected analytes.
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