Validation and application of an automated multitarget LC-MS/MS method for drugs of abuse testing using exhaled breath as specimen.

Aerosol microparticles in exhaled breath carry non-volatile compounds from the deeper parts of the lung. When captured and analyzed, these aerosol microparticles constitute a non-invasive and readily available specimen for drugs of abuse testing. The present study aimed to evaluate a simple breath collection device in a clinical setting. The device divides a breath sample into three parallel "collectors" that can be individually analyzed. Urine was used as the reference specimen, and parallel specimens were collected from 99 patients undergoing methadone maintenance treatment. Methadone was used as the primary validation parameter. A sensitive multi-analyte method using tandem liquid chromatography - mass spectrometry was developed and validated as part of the project. The method was successfully validated for 36 analytes with a limit of detection of 1 pg/collector for most compounds. Based on the validation results tetrahydrocannabinol THC), cannabidiol (CBD), and lysergic acid diethylamide (LSD) are suitable for qualitative analysis, but all other analytes can be quantitively assessed by the method. Methadone was positive in urine in 97 cases and detected in exhaled breath in 98 cases. Median methadone concentration was 64 pg/collector. The methadone metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) was detected in 90 % of the cases but below 10 pg/collector in most. Amphetamine was also present in the urine in 17 cases and in exhaled breath in 16 cases. Several other substances were detected in the exhaled breath and urine samples, but at a lower frequency. This study concluded that the device provides a specimen from exhaled breath, that is useful for drugs of abuse testing. The results show that high analytical sensitivity is needed to achieve good detectability and detection time after intake.

Managing children with sialorrhoea (drooling): Experience from the first 301 children in our saliva control clinic.

OBJECTIVES: Sialorrhoea (drooling) is defined as the involuntary escape of saliva from the mouth. It is considered normal in young children but may cause social problems in older children. Sialorrhoea is frequently seen in children with cerebral palsy, with rates between 10% and 58% and in other neurodevelopmental diseases. Management of these children can be challenging and often requires an individual and stepwise approach. This is a large case series of children managed at the saliva control clinic in Glasgow, Scotland. METHODS: A chart review of all children attending the saliva control clinic between 2006 and June 2012 was performed. This was to ensure that all children would have long term follow up (3 years minimum). Drooling severity was assessed on the child's first attendance at clinic, and at review following a treatment option, using the Teacher Drooling Scale (TDS). RESULTS: The total number of children attending this clinic was 301, of which 274 had adequate records for inclusion in the study. 176 (64%) were male. The mean age was 7.3 (median 5) years. In terms of development 35 (13%) of children were developing normally and 50 (18%) had general developmental delay. There were 105 (38%) children with cerebral palsy. The final management of sialorrhoea in these children was simple reassurance and advice for 34 (12%), speech and language therapy for 62 (23%) anticholinergics in 90 patients (33%), botox for 30 (11%) and surgery for 71 (26%) children. The rate of non-tolerance of anticholinergics is 30%; 90 of the 298 children tried on anticholinergics had side effects leading to the treatment being stopped. The average teachers drooling score was 4.24 before clinic and 1.59 after clinic. Satisfactory results were achieved in 215 (78%) of children. CONCLUSION: Our data illustrates that effective patient management requires all treatment options to be available, including speech therapy, medications, botulinum toxin and surgery. This is one of the larger case series of children attending a saliva control clinic.