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Feld K, Dahm P, Kieliba T, Klee A, Rothschild MA, Andresen-Streichert H, Beike J. Evidence for the transfer of methadone and EDDP by sweat to children's hair. Int J Legal Med 2021; 135:1799-1811. [PMID: 33821333 PMCID: PMC8354883 DOI: 10.1007/s00414-021-02576-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/15/2021] [Indexed: 11/15/2022]
Abstract
In cases where there is a question as to whether children have come into contact with drugs, examinations of their scalp hair are frequently carried out. Positive test results are often discussed in the forensic community due to the various possible modes via which drugs and their metabolites can be incorporated into the hair. These include drug uptake by the child (e.g. oral ingestion or inhalation), but also contamination of hair via contact with the sweat from drug users. In this study, the possibility of methadone and its metabolite EDDP being incorporated into children’s hair by contact with sweat from persons undergoing opiate maintenance therapy (methadone) was examined. The transfer of methadone and EDDP via sweat from methadone patients (n = 15) to children’s hair was simulated by close skin contact of drug-free children’s hair, encased in mesh-pouches, for 5 days. Sweat-collecting patches (hereafter referred to as ‘sweat patches’) were applied to the test persons’ skin. One strand of hair and one sweat patch were collected daily from each patient. Analyses were performed using GC–MS/MS (hair) and LC–MS/MS (serum, sweat patches). After 4 days of skin contact, methadone was detectable in the formerly drug-free hair strands in all 15 study participants. EDDP was detectable in 34 of 75 hair strands, with the maximum number of positive results (11 EDDP-positive hair strands) being detected after 5 days. These results show that transfer of methadone and EDDP to drug-free hair is possible through close skin contact with individuals taking part in methadone substitution programmes. A correlation between serum concentration, sweat concentration and substance concentration in hair strands could not be demonstrated, but a tendency towards higher concentrations due to longer contact time is clearly evident.
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Affiliation(s)
- Katharina Feld
- Institute of Legal Medicine, Medical Faculty, University of Cologne, Melatengürtel 60/62, 50823, Cologne, Germany.
| | - Patrick Dahm
- Institute of Legal Medicine, Medical Faculty, University of Cologne, Melatengürtel 60/62, 50823, Cologne, Germany
| | - Tobias Kieliba
- Institute of Legal Medicine, Medical Faculty, University of Cologne, Melatengürtel 60/62, 50823, Cologne, Germany
| | - Axel Klee
- Department of Dependency Diseases and Psychotherapy, LVR-Clinic Bonn, Bonn, Germany
| | - Markus A Rothschild
- Institute of Legal Medicine, Medical Faculty, University of Cologne, Melatengürtel 60/62, 50823, Cologne, Germany
| | - Hilke Andresen-Streichert
- Institute of Legal Medicine, Medical Faculty, University of Cologne, Melatengürtel 60/62, 50823, Cologne, Germany
| | - Justus Beike
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
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Findings of illicit drugs in hair of children at different ages. Int J Legal Med 2021; 135:465-471. [PMID: 33392654 DOI: 10.1007/s00414-020-02479-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Hair is a preferred material to detect exposure or use of illegal drugs in children. In the present study, we investigated a total of 387 hair samples for commonly applied illegal drugs of children up to 16 years. Analysis was by liquid chromatography/mass spectrometry with LOQs of 0.01 ng/mg hair for all analytes except tetrahydrocannabinol carboxylic acid with an LOQ of 0.1 pg/mg hair. Results were firstly compared with our in-house statics on results from adults' hair, and secondly to literature data. We started from the assumption that drug concentrations decrease with increasing age.Results were assigned to 4 different age groups (< 1 year, 1-< 6 years, 6-< 14 years, 14-16 years). As expected, higher results were obtained in age groups 1 and 2. The lowest concentrations were present in age group 3, whereas an increase could be observed in group 4 except heroin. In babies, positive results may be due to in utero exposure, breast milk feeding, and a close physical contact. All drugs under investigation such as cannabinoids, cocaine, amphetamines, and opiates have been detected in breast milk as well as in skin excretions such as sebum, sweat and cutaneous cells. For most drugs, average concentrations in children hair were lower than in adult hair when compared with our in-house statistics. Interestingly, the increase of cannabinoids, cocaine, and amphetamines concentrations in adolescents' hair points to a deliberate use of these drugs possibly in addition to passive exposure. This observation shows that age groups 1 and 4 are most vulnerable if caregivers or parents are drug users, even if the sources of positive drug findings differ.
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De Stefano R, Bruno A, Muscatello MR, Cedro C, Cervino G, Fiorillo L. Fear and anxiety managing methods during dental treatments: a systematic review of recent data. ACTA ACUST UNITED AC 2020; 68:317-331. [PMID: 32052621 DOI: 10.23736/s0026-4970.19.04288-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The management of anxiety and fear of patients experiencing medical treatment is always a major issue. Dentistry is a branch of medicine that is daily in managing these problems, especially in the case of pediatric patients. Odontophobia can be managed in different ways, and the purpose of this study is to eventually review which methods are currently accepted and which are the most effective. EVIDENCE ACQUISITION The literature analysis was conducted on a number of articles, suitably skimmed, after a first research, obtained from the most common scientific databases. The number of works included in the review is 28. EVIDENCE SYNTHESIS From the RCTs evaluated we could highlight that there are different methods in the literature, equally effective and certainly conditioned by the systemic condition of the patient. Another chapter instead turns out to be that linked to the management of the syndromic patient. CONCLUSIONS It is clear that there are different methods and equally different ways to manage our patients in the event of non-cooperation in the case of dental care. In addition to proper management by the clinician, in the literature methods linked to audiovisual distractions, hypnosis or pharmacological methods that produce conscious sedation are effectively reported.
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Affiliation(s)
- Rosa De Stefano
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Maria R Muscatello
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University of Messina, Messina, Italy - .,Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Luigi Vanvitelli University of Campania, Naples, Italy
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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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Balducci C, Green DC, Romagnoli P, Perilli M, Johansson C, Panteliadis P, Cecinato A. Cocaine and cannabinoids in the atmosphere of Northern Europe cities, comparison with Southern Europe and wastewater analysis. ENVIRONMENT INTERNATIONAL 2016; 97:187-194. [PMID: 27665117 DOI: 10.1016/j.envint.2016.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Abstract
This study reports the first investigation of atmospheric illicit drug concentrations in Northern Europe using measurements of cocaine and cannabinoids in Amsterdam, London and Stockholm. Further, these measurements were compared to those made in Rome to explore the geographical and inter-city variability. Co-located measurements of atmospheric particulate mass and PAHs were used to help describe and interpret the illicit drug measurements with respect to atmospheric dispersion. Cocaine concentrations ranged from 0.03 to 0.14ng/m3 in Amsterdam, from 0.02 to 0.33ng/m3 in London and were below quantification limit (3pg/m3) in Stockholm. Cannabinol was the only cannabinoid molecule detected in the three cities. During this campaign, London reported the highest concentrations of cocaine and meaningful differences were detected between the urban background and city centre London sites. Mean cocaine concentrations measured in Amsterdam during March 2011 were also compared with those measured simultaneously in eight Italian cities. The cocaine concentration in Amsterdam was comparable to that measured at an urban background in Milan and at a densely populated site in Florence. Although correlating atmospheric concentrations directly with drug prevalence is not possible using current data, links between concentrations of cocaine and estimates of abuse prevalence assessed by the more routinely used wastewater analysis were also examined. A statistically significant correlation was found between the two sets of data (R2=0.66; p=0.00131). Results confirmed that meteorology, population rate and habits of consumption influence the atmospheric concentrations of drugs. If these confounding factors were better controlled for, the techniques described here could became an easy and cost effective tool to index the impact of cocaine abuse in the area; especially where local hot spots need to be identified.
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Affiliation(s)
- Catia Balducci
- National Research Council of Italy, Institute of Atmospheric Pollution Research (IIA), Monterotondo, RM, Italy.
| | - David C Green
- MRC PHE Centre for Environment and Health, King's College London, United Kingdom
| | - Paola Romagnoli
- National Research Council of Italy, Institute of Atmospheric Pollution Research (IIA), Monterotondo, RM, Italy
| | - Mattia Perilli
- National Research Council of Italy, Institute of Atmospheric Pollution Research (IIA), Monterotondo, RM, Italy
| | - Christer Johansson
- Stockholm University, Dept. of Environmental Science and Analytical Chemistry (ACES), Stockholm, Sweden; Environment and Health Administration, City of Stockholm, Sweden
| | - Pavlos Panteliadis
- Public Health Service (GGD), Dept. of Air Quality Research, Amsterdam, Netherlands
| | - Angelo Cecinato
- National Research Council of Italy, Institute of Atmospheric Pollution Research (IIA), Monterotondo, RM, Italy
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Garcia-Algar Ó, Cuadrado González A, Falcon M. Toxicology screening in paediatrics. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2015.07.026] [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] Open
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Garcia-Algar Ó, Cuadrado González A, Falcon M. Utilidad del cribado toxicológico en pediatría. An Pediatr (Barc) 2016; 85:160.e1-4. [DOI: 10.1016/j.anpedi.2015.07.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022] Open
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Les cheveux stupéfiants d’une fillette. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2016.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Joya X, Marchei E, Salat-Batlle J, García-Algar O, Calvaresi V, Pacifici R, Pichini S. Fetal exposure to ethanol: relationship between ethyl glucuronide in maternal hair during pregnancy and ethyl glucuronide in neonatal meconium. ACTA ACUST UNITED AC 2016; 54:427-35. [DOI: 10.1515/cclm-2015-0516] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/18/2015] [Indexed: 11/15/2022]
Abstract
AbstractIn recent years, fatty acid ethyl esters (FAEEs) and ethyl glucuronide (EtG) in meconium emerged as reliable, direct biological markers for establishing gestational ethanol exposure. We investigated whether EtG in maternal hair measured during the three trimesters of pregnancy correlated with EtG and FAEEs in neonatal meconium.In a prospective sample of 80 mother-infant dyads from Barcelona (Spain), we measured EtG and FAEE in maternal hair segments and meconium samples using a validated UHPLC-MS/MS method.Fifty-eight (72.5%) women had EtG concentrations in the hair shafts >7 pg/mg in one or more pregnancy trimesters, and EtG and FAEEs in meconium samples were documented in 50 and 24 of their neonates, respectively. The best significant correlations (p<0.0001) were found between EtG concentration in the proximal 0–3 and 3–6 hair shaft segments corresponding to the last two pregnancy trimesters and EtG in neonatal meconium (ρ=0.609 and ρ=0.577, respectively). Using the combination of EtG in meconium ≥30 ng/g and a median of EtG >11 pg/mg in maternal hair during the second and third trimesters of pregnancy, prenatal ethanol exposure could be predicted with a sensitivity of 85.7% and specificity of 73.7%.This study provides evidence of proven fetal exposure to ethanol during the second and third trimesters of pregnancy by linking detection of ethanol biomarkers (EtG) in maternal hair segments and EtG in neonatal meconium.
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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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Pichini S, García-Algar O, Alvarez AT, Mercadal M, Mortali C, Gottardi M, Svaizer F, Pacifici R. Pediatric exposure to drugs of abuse by hair testing: monitoring 15 years of evolution in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8267-75. [PMID: 25153461 PMCID: PMC4143861 DOI: 10.3390/ijerph110808267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/06/2014] [Accepted: 08/11/2014] [Indexed: 11/16/2022]
Abstract
Hair testing is a useful tool to investigate the prevalence of unsuspected chronic exposure to drugs of abuse in pediatric populations and it has been applied to three different cohorts of children from Barcelona, Spain along fifteen years to evaluate eventual changes in this exposure. Children were recruited from three independent studies performed at Hospital del Mar (Barcelona, Spain) and approved by the local Ethics Committee. Hair samples were collected from the first 187 children cohort (around 4 years of age) in 1998, from the second 90 children cohort (1.5–5 years of age) in 2008 and from the third 114 children cohort (5–14 years of age) in 2013. Hair samples were analysed for the presence of opiates, cocaine, amphetamines, and cannabis by validated methodologies using gas or liquid chromatography-mass spectrometry. Familiar sociodemographics and eventual consumption of drugs of abuse by parents, and caregivers were recorded. Hair samples from 24.6% children in 1998 were positive for any drug of abuse (23.0% cocaine), 25.5% in 2008 (23.3% cocaine), and 28.1% in 2013 (20.1% cocaine and 11.4% cannabis). In none of the cohorts, parental sociodemographics were associated with children exposure to drugs of abuse. The results of the three study cohorts demonstrated a significant prevalence of unsuspected pediatric exposure to drugs of abuse which mainly involved cocaine maintained along fifteen years in Barcelona, Spain. We recommend to be aware about unsuspected passive exposure to drugs of abuse in general population and to use general or selected hair screening to disclose exposure to drugs of abuse in children from risky environments to provide the basis for specific social and health interventions.
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Affiliation(s)
- Simona Pichini
- Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation National Institute of Health, Roma 00161 Italy.
| | - Oscar García-Algar
- Unitat de Recerca Infància i Entorn (URIE), Paediatric Service, Institut de Recerca Hospital del Mar-IMIM, Barcelona 80003, Spain.
| | - Airam-Tenesor Alvarez
- Unitat de Recerca Infància i Entorn (URIE), Paediatric Service, Institut de Recerca Hospital del Mar-IMIM, Barcelona 80003, Spain.
| | - Maria Mercadal
- Unitat de Recerca Infància i Entorn (URIE), Paediatric Service, Institut de Recerca Hospital del Mar-IMIM, Barcelona 80003, Spain.
| | - Claudia Mortali
- Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation National Institute of Health, Roma 00161 Italy.
| | - Massimo Gottardi
- Laboratorio di Sanità Pubblica (LSP), Azienda Provinciale Servizi Sanitari, Trento 38121, Italy.
| | - Fiorenza Svaizer
- Laboratorio di Sanità Pubblica (LSP), Azienda Provinciale Servizi Sanitari, Trento 38121, Italy.
| | - Roberta Pacifici
- Drug Abuse and Doping Unit, Department of Therapeutic Research and Medicines Evaluation National Institute of Health, Roma 00161 Italy.
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Abstract
The use of alternative matrices such as oral fluid and hair has increased in the past decades because of advances in analytical technology. However, there are still many issues that need to be resolved. Standardized protocols of sample pretreatment are needed to link the detected concentrations to final conclusions. The development of suitable proficiency testing schemes is required. Finally, interpretation issues such as link to effect, adulteration, detection markers and thresholds will hamper the vast use of these matrices. Today, several niche areas apply these matrices with success, such as drugs and driving for oral fluid and drug-facilitated crimes for hair. Once those issues are resolved, the number of applications will markedly grow in the future.
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