The use of serial measurement of plasma cholinesterase in the management of acute poisoning with organophosphates and carbamates.

OBJECTIVE: To evaluate the benefits of using serial measurements of plasma cholinesterase (butyrylcholinesterase, BuChE) activity in the management of cholinesterase inhibitor insecticidal poisoning. METHOD: After establishing and validating BuChE activity test, and making it available for clinical service in the toxicology laboratory at Jordan University Hospital. Serial measurements of BuChE were performed on samples taken from 10 symptomatic patients presented with the manifestations of poisoning due to acetylcholinesterase inhibitor insecticides during the year 2001. The number of serial repeats of BuChE activity tests ranged from 2 to 4 and from 8 to 11 for patients with carbamates and organophosphates (OPs) poisoning, respectively. The results of serial measurement of BuChE obtained from each patient's samples were used to draw a curve; three different types of curves were obtained from all patients samples. RESULT: The obtained curves were found to follow our three proposed curves, which support our point view regarding the importance of the proposed curves in the differential diagnosis and treatment of cholinesterase inhibitor pesticides poisoning. CONCLUSION: This study pointed out the importance of utilizing serial measurements of BuChE activity in the diagnosis and the management of organophosphates and carbamates poisoning. The BuChE activity results were used to support diagnostic and prognostic criteria that guided patient management and follow up. Applying those curves to large number of patients' samples will enhance its credibility. The study also demonstrated the importance of direct contract between toxicologist and physician in treatment of the pesticides poisoned patients.

A comparative study of Ferula hermonis root extracts and sildenafil on copulatory behaviour of male rats.

The effect of 600 mg/kg given by oral route to rats of Ferula hermonis roots extracts (petroleum ether, ethyl acetate, methanol and water) was evaluated on sexual behaviour of male rats. Petroleum ether and ethyl acetate extracts produced a significant decrease in both the mount rate (MR) and the intromission rate (IR), significant prolongation of intromission latency (IL) was observed when these extracts were compared with both controls and sildenafil. Methanolic extract produced a significant increase in MR while no effect has been observed on IR or IL in comparison with control. The effect of water extract was not significantly different from controls for the MR and IR, but there was a significant prolongation in the IL.

Hubble-bubble (water pipe) smoking: levels of nicotine and cotinine in plasma, saliva and urine.

OBJECTIVES: The purpose of the present study was to assess the levels of nicotine and cotinine in biological fluids (plasma, saliva, and urine) following hubble-bubble (HB) smoking. METHODS: Fourteen healthy male volunteers, aged 28 +/- 8 years, body weight of 82.7 +/- 13.53 kg, participated in the study. All volunteers were habitual HB smokers for 3.29 +/- 1.90 years who smoked at least 3 runs per week with an average of 20 g Mua'sel per run. Volunteers were requested to avoid smoking, at least 84 hours prior to the time of the study. After baseline samples were taken, volunteers started smoking 20 g of Mua'sel for a period of 45 minutes. Heparinized blood samples (5 or 10 ml each) were drawn for nicotine and cotinine analysis before, during and after the smoking period. Saliva samples were collected just before smoking (time 0) and at the end of smoking (45 min). Urine also was collected at time 0 and 24-hour urine collection was also taken to measure nicotine and cotinine excretion. Nicotine and cotinine were extracted from samples and assayed by gas chromatography. All data are presented as mean +/- SEM throughout the text, Tables and Figures unless indicated otherwise. RESULTS: Plasma nicotine levels rose from 1.11 +/- 0.62 ng/ml at baseline to a maximum of 60.31 +/- 7.58 ng/ml (p < 0.001) at the end of smoking (45 min). Plasma cotinine levels increased from 0.79 +/- 0.79 ng/ml at baseline to its highest concentration of 51.95 +/- 13.58 ng/ml (p < 0.001) 3 hours following the end of smoking. Saliva nicotine levels significantly rose from 1.05 +/- 0.72 to 624.74 +/- 149.3 ng/ml and also saliva cotinine levels significantly increased from 0.79 +/- 0.79 ng/ml to 283.49 +/- 75.04 ng/ml. Mean amounts of nicotine and cotinine excreted in urine during the 24-hour urine collection following smoking were equal to 73.59 +/- 18.28 and 249 +/- 54.78 microg, respectively. CONCLUSION: Following a single run of HB smoking, plasma, saliva and urinary nicotine and cotinine concentration increased to high values. This observation suggests that HB may not be an innocent habit, as people believe.

Stability of fluoxetine in stored plasma, aqueous, and methanolic solutions determined by HPLC with UV detection.

The stability of fluoxetine was studied in plasma, and in aqueous and methanolic solutions at a concentration of 6 micrograms/ml under different storage temperatures and time intervals up to three months. Fluoxetine exhibited good stability at -20 and 5 degrees C, but was unstable at room temperature under the same conditions. A significant loss was observed at the second, third and fifth weeks in plasma, aqueous solution and methanolic solution respectively (P > 0.95). At the end of the experiment, the amount of fluoxetine-recovered was at least 55.25% regardless of the storage conditions. Chromatography was performed using a C8 column and the mobile phase consisted of methanol/acetonitrile/triethylamine solution (35:20:45) adjusted to pH 5.5. UV detection was at 230 nm. Fluoxetine was isolated from plasma by liquid-liquid extraction (LLE) with dichloromethane as extracting solvent after addition of 20% ammonia solution. The standard curve was linear over the range of 0.05-10 micrograms/ml. The inter-day coefficient of variation and the lower detectable limit were 6.92% and 0.05 microgram/ml respectively.

Fatal poisoning with alcohol and drugs in the Greater Amman County.

A study of fatal poisoning due to alcohol and drugs was carried out, to examine the mortality resulting from alcohol and drugs in the Greater Amman County, Jordan. A retrospective review of all autopsy records and certified deaths issued by the Department of Forensic Medicine at Jordan University Hospital in the greater Amman county was undertaken. During the 18 years (1978-1996) 6109 postmortem cases were performed in our department. A total of 60 cases were identified and analyzed according to age, race, sex, manner of death of the victims along with blood alcohol concentration, the drug detected at autopsies, the scene circumstances, and the geographic location of the accident and death.

Reliability of clinical decisions regarding alcohol influence.

In Jordan, pursuing legal procedures related to alcohol intake usually depends on the physicians' clinical judgment. A study was carried out on 825 medico-legal cases over a 2 year period to evaluate the extent of physicians' clinical decisions on patients suspected to be under the influence of alcohol. A significant number of cases (12.6%, n = 104) were found to be positive for alcohol. The study showed that the clinical examination failed to diagnose a large number of cases (78.9%, n = 82). Also, the majority of diagnosed cases (50%, n = 11) had a blood alcohol concentration (BAC) range of 50-100 mg/dl. 32% (n = 33) of the cases with positive BAC were admitted to hospital. A high admission rate was observed when BAC was <50 mg/dl and >150 mg/dl, which constituted 39.3% (n = 13) and 48.5% (n = 16) of the admitted cases respectively. A large number of the admitted cases had either simple or no trauma (48.4%, n = 16) as compared with the control group of cases (21.8%, n = 10). The admission rate of positive BAC cases in traffic accidents was double that of control group. These findings may reflect the unreliability of the clinical decision in positive BAC. Implementing a certain BAC level locally for both clinical and a jurisdiction purposes is strongly recommended.

Stability of trihexyphenidyl in stored blood and urine specimens.

Trihexyphenidyl (THP) is an anticholinergic agent with forensic toxicological interest. The stability of THP was studied in postmortem blood and urine samples at a concentration of 0.25 microgram/ml under different storage temperatures. After solid phase extraction (SFE), THP was measured by gas chromatography. On day zero and at intervals over a 6 months period, there was no significant loss of THP at the storage temperatures -20 degrees C and 4 degrees C in the spiked and authentic samples. Blood and urine samples stored at 25 degrees C showed a maximum recovery loss (about 14%) of THP after 3 months of storage. This loss was considered a significant change and corresponded to a P value < 0.046. The study demonstrates that the analysis of blood and urine samples containing THP would produce consistent results when they are stored for 6 months at -20 or 4 degrees C and for 3 months at 25 degrees C.

Stability of morphine and buprenorphine in whole blood.

Delays between time of sampling and time of toxicological analysis are common, therefore the length of time that postmortem blood can be stored at various temperatures (e.g. 4 degrees, 25 degrees, -20 degrees C) was evaluated for the effect on the stability of morphine and buprenorphine from day one up to one year. Solid phase extraction and GC-MS were used for the isolation and quantification of the drugs. Morphine and buprenorphine were found to be very stable for up to 6 months under these storage conditions, where at least 85% and 77% of morphine and buprenorphine respectively, were recovered. The study showed that a reasonable amount of the drugs (not less than 70%) was still detectable after one year of storage regardless of the temperature when blood samples were stored in silanized glass vessels.

Alcohol in medicolegal cases seen at Jordan University Hospital.

The magnitude of alcohol-associated incidents in relation to medicolegal cases, including road traffic accidents and acts of violence, has not been evaluated in Jordan. Between 1993 and 1995, 825 such cases received at Jordan University Hospital were screened for the presence of alcohol. Blood alcohol was positive in 9.1% of vehicle passengers, 9.6% of pedestrians, 12.4% of cases involving violence, 13.6% of drivers, 65% of cases brought by police and in 12.5% of other cases. Blood alcohol concentrations (BAC) ranged from 10-350 mg/dL. BAC of more than 50mg/dL was found in 65% and 55% of driver and violence cases respectively, and in 33% to 69% of the other categories. Alcohol may have contributed to some of these incidents. In cases with positive BAC, prior alcohol intake was frequently denied. There was no association between cases with positive BAC and a particular time, date or occasion.

Stability of temazepam in blood.

The stability of temazepam in blood under different storage temperatures was studied. The drug was found to be very stable over a twelve-month interval when stored at -20 degrees C with a recovery of 82%, while samples stored at 5 degrees C and 25 degrees C showed a significant decrease in their concentration with time. This information can assist the forensic toxicologist with the interpretation of results, particularly in cases where analysis has been delayed.