Breath Test Research Articles

A qualitative study of the first COVID-19 pandemic lockdown: The impact on alcohol consumption and driving behaviours

COVID-19 influenced life in a multitude of ways beyond immediate health impacts. This included driving behaviours. People drove less often during the early months of the pandemic, yet crash rates increased. There were reports of increased alcohol consumption during this same time which was considered to impact on driving behaviours such as drink driving. This study explores the thoughts and opinions of Queensland, Australian drivers (n = 798) concerning driving behaviours, alcohol consumption, and drink driving behaviours during the early phases of the pandemic (April – August 2020). Participants responded to qualitative questions in online questionnaires over three phases that prompted thoughts in these domains. Bronfenbrenner’s bioecological model was found to explain participants’ comments with the six layers seeming to impact driving, alcohol consumption, and drink driving behaviours. That is, these behaviours were influenced at an individual level (e.g., coping mechanisms), the microsystem level (e.g., reduced opportunities for socialisation), the mesosystem (e.g., work demands impacting family), the exosystem (e.g., large scale random breath testing was suspended and road police deployed to border control), the macrosystem (e.g., Australian drinking culture), and the chronosystem (the pandemic). Understanding the perspectives of individuals during a sudden shift in life caused by COVID-19 highlights the broader impact of the pandemic on people’s behaviours. In addition, this study also provides important insights into the intricacies of driving, drinking and drink driving behaviours. These understandings can inform future research and countermeasures to prevent these risky behaviours.

Antimicrobial susceptibility of clinical Helicobacter pylori isolates and its eradication by standard triple therapy: a study in west central region of Colombia.

The aim of the present study was first to isolate Helicobacter pylori from gastric biopsy specimens and to test their antibiotic susceptibility. Second, it was to evaluate the efficacy of the standard triple therapy from patients of the west central region of Colombia. H. pylori positive patients received standard triple therapy with proton pump inhibitor (PPI) (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), and amoxicillin (1 g b.i.d.) for 14 days. Thereafter, antibiotic susceptibility of the isolates was assessed by E-Test. From 94 patients enrolled, 67 were positive for H. pylori by histology or culture. Overall resistance to metronidazole, levofloxacin, rifampicin, clarithromycin, and amoxicillin was 81%, 26.2%, 23.9%, 19%, and 9.5%, respectively. No resistance was found for tetracycline. A total of 54 patients received standard triple therapy, 48 attended follow-ups testing, and of them, 30 had resistance test reports. Overall eradication rate was 81.2%. Second-line treatment was given to eight patients, four of whom were followed up with a 13C urea breath test (UBT) and remained positive for H. pylori. Eradication was significantly higher in patients with clarithromycin susceptible than in resistant strains (95.6% vs 42.8% P = 0.001). The updated percentages of resistance to clarithromycin in this geographical area had increased, so this value must be considered when choosing the treatment regimen.IMPORTANCEAntibiotic resistance in Helicobacter pylori has increased worldwide, as has resistance to multiple antimicrobials (MDRs), which seriously hampers the successful eradication of the infection. The ideal success rate in eradicating H. pylori infection (≥90%) was not achieved in this study (81.2%). This is the first time that MDR is reported (14.3%) in the region; the resistance to clarithromycin increased over time (3.8%-19%), and levofloxacin (26.2%) and rifampicin (23%) resistant isolates were detected for the first time. With these results, strain susceptibility testing is increasingly important, and the selection of treatment regimen should be based on local antibiotic resistance patterns.

Application of citric acid can enhance the accuracy for 13C-urea breath tests in the diagnosis of Helicobacter pylori infection in Chinese patients

Previous published data have confirmed that the addition of a citric acid meal improves the accuracy of the 13C-urea breath test (13C-UBT). However, some studies have suggested that a citric acid test meal may not be necessary. Thus, the aim of this study was to evaluate the combination of a 13C-UBT with a citric acid meal for the diagnosis of Helicobacter pylori (Hp) infection in a Chinese population, particularly for patients with results in the gray zone. In this paired self-controlled study, all subjects had previously undergone 13C-UBTs without citric acid meals and were randomly divided into two groups based on different doses of citric acid (a low-dose citric acid group and a high-dose citric acid group, comprising meals with 0.68 g and 3.84 g citric acid powder, respectively). Positive rapid urease test (CLO) test and histology results were considered the 'gold standard'. The mean delta over baseline (DOB) value, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were compared between the two groups, particularly for patients with results in the gray zone. In total, 285 patients were tested. Of these patients, 189 were included in the low-dose citric acid group, and 96 were included in the high-dose citric acid group. Among patients with a positive 13C-UBT result without citric acid [delta over baseline (DOB) value ≥ 4‰, n = 174] and a negative 13C-UBT result without citric acid (DOB value < 4‰, n = 111), 8.0% (14/174) were false positive, and 0.9% (1/111) was false negative as determined by gold standard. Of 14 patients with false positive, 78.6% (11/14) false positive were in the gray zone of 4–10‰. However, there were no false positive 13C-UBT results with citric acid in the the gray zone of 4–10‰. In the comparison of the commercial 13C-UBT with the 13C-UBT in the low-dose citric acid group, the sensitivity, specificity, PPV, NPV and accuracy at 15 min were as follows: 99.1% vs. 99.1%, 97.5% vs. 88.9%, 98.2% vs. 92.2%, 98.8% vs. 98.6% and 98.4% vs. 94.7%, respectively. In the the gray zone of 4.0–10.0‰, the comparison of the commercial 13C-UBT with the 13C-UBT in the low-dose citric acid group, the sensitivity, specificity, PPV, and accuracy at 15 min were as follows: 94.4% vs. 100.0%, 100.0% vs. 0%, 100.0% vs. 75.0% and 95.8% vs. 75.0%, respectively. No significant difference was observed between the 15-min and 30-min measurement intervals in the low- and high-dose citric acid groups, including patients with results in the gray zone. The low-dose citric acid test, with an optimal measurement interval of 15 min, was highly accurate in the diagnosis of Hp infection in the Chinese population, especially for individuals with results in the gray zone.

Volatile organic compounds: A promising new frontier for cancer screening

The late onset of cancer symptoms can cause a significant delay in diagnosis, impacting patients&amp;rsquo; prognosis and quality of life, thus prompting a need for alternative screening and detection methods. Neoplastic processes cause distinct and immediate changes to the body&amp;rsquo;s metabolism, creating unique patterns in the volatile organic compounds (VOCs) produced and released through exhaled breath. For this reason, VOC profiles have emerged as diagnostic indicators for several types of malignancies, facilitating early cancer detection. Both non-invasive and accessible, the analysis of breath VOCs for cancer screening and detection has gained recognition as a new frontier in cancer diagnostics. Using exhaled breath instead of gold-standard cancer detection and screening tools that are traditionally invasive and uncomfortable for the patient could be revolutionary in improving patient compliance. Further, compared to the gold-standard tools, breath testing is relatively inexpensive, and the method of analysis, storage, and transporting the samples is simplified. Several studies have demonstrated the accuracy of VOC analysis in detecting various types of cancer, including breast cancer, colon cancer, prostate cancer, gastric cancer, and melanoma. This article summarizes the evidence supporting VOC analysis for cancer screening and detection. It reviews the clinical utility, current limitations, and necessity for standardization across all VOC screening tools to ensure the standardization and reliability of measurements. The evidence supporting breath tests to detect cancer accurately is strong, demonstrating that VOC sampling improves patient outcomes and decreases the global burden of malignant conditions by detecting cancer earlier.

Prolonged Consumption of A2 β-Casein Milk Reduces Symptoms Compared to A1 and A2 β-Casein Milk in Lactose Maldigesters: A Two-Week Adaptation Study.

Approximately 30% of milk protein is β-casein. We aimed to determine whether lactose maldigesters who chronically consumed two cups of A1/A2 milk (containing 75% A1 β-casein and 25% A2 β-casein) would adapt to have fewer intolerance symptoms, lower serum inflammatory markers, and/or altered glutathione levels similar to those consuming A2 milk (containing 100% A2 β-casein). A double-blinded, randomized, crossover trial was conducted. Sixteen confirmed lactose maldigesters consumed 250 mL of A1/A2 milk and A2 milk twice daily with meals for two weeks. At the end of the adaptation period on day 15, lactose maldigestion was measured after a challenge with the same milk used for adaptation (0.5 g of lactose per kg of body weight) with a hydrogen breath test. Fecal urgency was higher during the two-week consumption of A1/A2 milk compared to A2 milk (p = 0.04, n = 16). Bloating (p = 0.03, n = 16) and flatulence (p = 0.02, n = 16) were also higher on the 15th day with A1/A2 milk compared to A2 milk challenge. However, day-to-day symptoms, hydrogen, serum inflammatory markers, and antioxidant concentrations were not different after A1/A2 and A2 milk consumption adaptation periods. Adaptation over two weeks did not improve lactose digestion or tolerance of A1/A2 milk to match that of A2 milk.

How do perceptions of procedural justice, police legitimacy, and legitimacy of laws influence intentions to drug drive?

Introduction: There is a need for improved drug driving enforcement to promote greater driver compliance with drug driving laws. In Australia, Roadside Drug Testing (RDT) suffers from operational challenges that undermine its effectiveness in reducing drug driving. Objective: To identify potential improvements to RDT, this study investigated the extent to which drivers perceive RDT to be procedurally just and that the policing of drug driving and the associated laws are legitimate. These perceptions were then compared with those applying to Random Breath Testing (RBT) and examined in relation to their respective influence on intentions to drug and drink drive in the future. Method: A sample of 1,483 licensed drivers from three Australian states completed an online survey. Results: Those participants who reported engaging in drug driving perceived RDT to be less procedurally just than non-drug drivers. Similarly, drug drivers perceived the police and associated drug driving laws to be less legitimate than non-drug drivers. Furthermore, drug drivers who had been tested at an RDT operation in the past perceived RDT to be less procedurally just and considered drug driving policing and laws to be less legitimate, compared with the corresponding perceptions of drink drivers who had been tested at an RBT operation. A regression analysis indicated that stronger intentions to drug drive in the future were associated with lower perceptions of police legitimacy and the legitimacy of drug driving laws, but not with the elements of procedural justice. However, follow-up analyses indicated that the influence of procedural justice on intentions was mediated by the two legitimacy variables, thus weakening its direct impact on intentions. Practical applications: The results highlight the need for road safety authorities to enhance the perceived legitimacy of drug driving enforcement and associated laws. Changes to current police practices and/or drug-driving laws may also be needed to enhance the effectiveness of RDT.

Small intestinal bacterial overgrowth – current, novel and possible future methods of treatment and diagnosis

Small intestinal bacterial overgrowth (SIBO) is a prevalent issue, frequently overlooked in clinical practice. Its prevalence is unknown because SIBO requires diagnostic testing, however, in most studies, SIBO has been detected anywhere from &lt;2% to 22% of healthy controls. Breath tests, which detect the presence of hydrogen in exhaled air, are the most used diagnostic method. However, their low sensitivity and specificity indicate the need for research into new more accurate methods. The standard treatment is antibiotic therapy with rifaximin. After antibiotic therapy, there is a risk of recurrence and the emergence of multidrug-resistant bacterial strains. Recurrence ratio after antibiotic therapy have been documented in 12.6% of patients after 3 months, 27.5% after 6 months and 43.7% after 9 months. There are promising results from studies on the use of probiotics and herbal preparations in treatment, but these studies have been conducted on relatively small groups of patients. This indicates the need for multicentre randomised trials with large numbers of patients to develop effective methods for the diagnosis and treatment of SIBO.

Culture-based susceptibility-guided tailored versus empirical concomitant therapy as first-line Helicobacter pylori treatment: A randomized clinical trial.

With the increasing resistance to antimicrobial agents, susceptibility-guided tailored therapy has been emerging as an ideal strategy for Helicobacter pylori treatment. However, susceptibility-guided tailored therapy requires additional cost, time consumption, and invasive procedure (endoscopy) and its superiority over empirical quadruple therapy as the first-line H. pylori treatment remains unclear. To compare the efficacy of culture-based susceptibility-guided tailored versus empirical concomitant therapy as the first-line Helicobacter pylori treatment. This open-label, randomized trial was performed in four Korean institutions. A total of 312 Patients with H. pylori-positive culture test and naïve to treatment were randomly assigned in a 3:1 ratio to either culture-based susceptibility-guided tailored therapy (clarithromycin-based or metronidazole-based triple therapy for susceptible strains or bismuth quadruple therapy for dual-resistant strains, n=234) or empirical concomitant therapy (n=78) for 10 days. Eradication success was evaluated by 13C-urea breath test at least 4weeks after treatment. Prevalence of dual resistance to both clarithromycin and metronidazole was 8%. H. pylori eradication rates for tailored and concomitant groups were 84.2% and 83.3% by intention-to-treat analysis (p=0.859), respectively, and 92.9% and 91.5% by per-protocol analysis, respectively (p=0.702), which were comparable between the two groups. However, eradication rates for dual-resistant strains were significantly higher in the tailored group than in the concomitant group. All adverse events were grade 1 or 2 based on the Common Terminology Criteria for Adverse Events and the incidence was significantly lower in the tailored group. The proportion of patients discontinuing treatment for adverse events was comparable between the two groups (2.1% vs. 2.6%). The culture-based susceptibility-guided tailored therapy failed to show superiority over the empirical concomitant therapy in terms of eradication rate. Based on these findings, the treatment choice in clinical practice would depend on the background rate of antimicrobial resistance, availability of resources and costs associated with culture and susceptibility testing.

The Lactulose Breath Test Can Predict Refractory Gastroesophageal Reflux Disease by Measuring Bacterial Overgrowth in the Small Intestine.

The diagnosis of RGERD in patients typically involves 24-hour esophageal pH monitoring, but due to its invasiveness and low patient compliance, new screening methods are needed. In this study, a lactulose breath test (LBT) was conducted to detect the growth of small intestine bacteria (SIBO) and explore the potential relationship between LBT and RGERD to identify a new treatment method for RGERD. A total of 178 patients with gastroesophageal reflux were enrolled from June 2020 to December 2022 in the Gastroenterology Department, Building 3, the First Affiliated Hospital of Kunming Medical University; these patients included 96 patients with nonrefractory GERD (NRGERD) and 82 patients with RGERD. The Gerd Q score, reflux symptom index (RSI) score, gastroscopy results, clinical symptoms, and other related indicators were collected. Statistical methods were used to analyze the gathered data. The incidence of acid reflux and heartburn in patients with RGERD was significantly greater than that in patients with NRGERD (67.10% vs. 42.70%, P<0.01 and 65.00% vs. 34.40%, P<0.01). The CH4 values of patients with RGERD were significantly greater than those of patients with NRGERD at each time point, and there was a correlation between the CH4 values at 60 min and RGERD (P<0.05). For patients with RGERD, the incidence of abdominal pain, acid regurgitation, and heartburn was greater in the CH4-positive group than in the CH4-negative group (61.90% vs. 57.50%, 69.05% vs. 65.00%, 69.05% vs. 57.50%, P>0.05). The incidence of nausea was also greater in the CH4-positive group than in the CH4-negative group (61.90% vs. 35.00%, P<0.05). Increased CH4 levels are correlated with RGERD. In addition, patients with RGERD may develop SIBO after long-term use of PPIs, and interventions involving SIBO could provide new ideas for the treatment of RGERD.

Hazard Perception in Visually Impaired Drivers Who Use Bioptic Telescopes.

Bioptic telescopic spectacles can allow individuals with central vision impairment to obtain or maintain driving privileges. The purpose of this study was to (1) compare hazard perception ability among bioptic drivers and traditionally licensed controls, (2) assess the impact of bioptic telescopic spectacles on hazard perception in drivers with vision impairment, and (3) analyze the relationships among vision and hazard detection in bioptic drivers. Visual acuity, contrast sensitivity, and visual field were measured for each participant. All drivers completed the Driving Habits Questionnaire. Hazard perception testing was conducted using commercially available first-person video driving clips. Subjects signaled when they could first identify a traffic hazard requiring a change of speed or direction. Bioptic drivers were tested with and without their bioptic telescopes in alternating blocks. Hazard detection times for each clip were converted to z-scores, converted back to seconds using the average response time across all videos, and then compared among conditions. Twenty-one bioptic drivers and 21 normally sighted controls participated in the study. The hazard response time of bioptic drivers was improved when able to use the telescope (5.4 ± 1.4 seconds vs 6.3 ± 1.8 seconds without telescope); however, it remained significantly longer than for controls (4.0 ± 1.4 seconds). Poorer visual acuity, contrast sensitivity, and superior visual field sensitivity loss were related to longer hazard response times. Drivers with central vision loss had improved hazard response times with the use of bioptic telescopic spectacles, although their responses were still slower than normally sighted control drivers. The use of a bioptic telescope by licensed, visually impaired drivers improves their hazard detection speed on a video-based task, lending support to their use on the road.

Helicobacter pylori: High dose amoxicillin does not improve primary or secondary eradication rates in an Irish cohort

BACKGROUND Helicobacter pylori (H. pylori ) eradication rates have fallen globally, likely in large part due to increasing antibiotic resistance to traditional therapy. In areas of high clarithromycin and metronidazole resistance such as ours, Maastricht VI guidelines suggest high dose amoxicillin dual therapy (HDADT) can be considered, subject to evidence for local efficacy. In this study we assess efficacy of HDADT therapy for H. pylori eradication in an Irish cohort. AIM To assess the efficacy of HDADT therapy for H. pylori eradication in an Irish cohort as both first line, and subsequent therapy for patients diagnosed with H. pylori . METHODS All patients testing positive for H. pylori in a tertiary centre were treated prospectively with HDADT (amoxicillin 1 g tid and esomeprazole 40 mg bid × 14 d) over a period of 8 months. Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy. A delta-over-baseline &gt; 4% was considered positive. Patient demographics and treatment outcomes were recorded, analysed and controlled for basic demographics and prior H. pylori treatment. RESULTS One hundred and ninety-eight patients were identified with H. pylori infection, 10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing. In all 139 were included in the analysis, 55% (n = 76) were female, mean age was 46.6 years. Overall, 93 (67%) of patients were treatment-naïve and 46 (33%) had received at least one previous course of treatment. The groups were statistically similar. Self-reported compliance with HDADT was 97%, mild side-effects occurred in 7%. There were no serious adverse drug reactions. Overall the eradication rate for our cohort was 56% (78/139). Eradication rates were worse for those with previous treatment [43% (20/46) vs 62% (58/93), P = 0.0458, odds ratio = 2.15]. Age and Gender had no effect on eradication status. CONCLUSION Overall eradication rates with HDADT were disappointing. Despite being a simple and possibly better tolerated regime, these results do not support its routine use in a high dual resistance country. Further investigation of other regimens to achieve the &gt; 90% eradication target is needed.

Helicobacter Pylori and Alopecia Areata: A True Association or Coincidental Finding?

Background: This article examines the possible correlation between Helicobacter pylori (H. pylori) infection and alopecia areata, a condition characterized by hair loss. Despite H. pylori's conventional association with gastrointestinal problems, recent investigations have explored its potential links to autoimmune disorders, including alopecia areata. Early research suggested a higher prevalence of H. pylori in alopecia patients, but subsequent studies presented conflicting findings. Some studies measured H. pylori surface antigen (HpSag) in stool samples, yielding diverse outcomes. Another study used the urea breath test (UBT) and found a significant association between H. pylori and alopecia areata. A unique case demonstrated symptom control and disease remission following H. pylori eradication. However, the article highlights the inconclusive nature of existing research, the limitations of study designs and the absence of post-eradication data on alopecia symptoms. Conclusion: The need for more advanced studies is emphasized, along with the importance of exploring therapeutic implications. The article concludes that while intriguing, the potential link between H. pylori and alopecia areata requires more comprehensive research, especially in diverse demographic groups, to gain a better understanding of its universality and broader implications.

Diagnosing and managing irritable bowel syndrome with predominant diarrhoea in clinical practice: online survey among gastroenterologists and general practitioners.

Irritable bowel syndrome (IBS) represents the most common disorder of gut-brain interaction encountered in clinical practice. The Rome IV criteria define the disorder. Over the years, many guidelines proposed guidance during the diagnostic and therapeutic approach of patients with presumed IBS. This study investigates the management of IBS with predominant diarrhoea (IBS-D) by Belgian gastroenterologists (GE) and general practitioners (GP) in daily practice. An online vignette-based survey was conducted exploring the diagnostic and therapeutic approach of patients suffering from IBS with predominant diarrhoea (IBS-D) in primary and secondary care. 64 GE and 31 GP completed the survey. Abdominal pain and discomfort led to an IBS diagnosis in 88% and 84% of cases, respectively. The diagnosis rate dropped to 58.3% with diarrhoea as main presentation and 26.8% for patients aged 65. Additional tests were ordered by 89.5% of physicians, including biochemistry (77.9%), stool culture and parasites (59.3%), iFOBT (60.5%), breath testing (17.4%), imaging (12.8%), and endoscopy (9.3%). Upon normal results, 57% of physicians did not order further investigations. Both GP and GE preferred spasmolytics (64.3%) and dietary interventions (23.9%) as first-line treatment for IBS. Second-line treatment options included referral to a specialist or colleague (19.4%), dietary intervention (22.6%), neuromodulators (19.4%), and spasmolytics (14.5%). No GP initiated neuromodulators. In Belgium, abdominal pain or discomfort are equivalent cardinal symptoms when diagnosing IBS. During the further diagnostic and therapeutic approach most physicians order only limited additional non-invasive testing. Spasmolytics and dietary interventions are favoured in first-line. Upon failure, only GE prescribe neuromodulators, while GP opt for referral. These findings are consistent with the general principles and recommendations outlined in the recently published Belgian guideline for IBS.

Preventing Impaired Driving Using IoT on Steering Wheels Approach

To drive safely, one must be attentive, coordinated, have good judgment, and be able to respond quickly to changing conditions. In certain countries, improving safety may depend largely on reducing the number of impaired drivers on the road. Therefore, solutions are required to reduce the risk that is posed on the road by drivers who have been consuming alcohol while driving. Previous research has proposed the use of sensors for detecting driver impairment caused by alcohol intoxication. However, relying on a gas sensor alone may not be appropriate for detection. To reduce drunk driving, this study proposes an Internet of Things (IoT)-based tool that measures heart rate and analyzes the breath of a driver for traces of alcohol. The tool represents a vehicle that is made up of a DC motor. In the circumstance that the tool detects a higher than resting heart rate in the driver as well as an amount of alcohol in the driver’s breath sample, the tool will immediately power down the DC motor and send an SMS to the registered emergency contact with the driver’s precise position using the GPS module. The initial prototype demonstrates the tool as a potential aftermarket accessory for vehicles. The implication of this paper is that the designed tool might be of practical use to researchers in their attempts to determine and obtain information on alcohol intoxication. Doi: 10.28991/HIJ-2024-05-02-012 Full Text: PDF

A Study on the Efficiency Measures of the Prevention Policy for Drunk Driving - Focused on the Foreign Cases and Trigger Factors -

A Study on the Efficiency Measures of the Prevention Policy for Drunk Driving - Focused on the Foreign Cases and Trigger Factors -

만성 편두통에 대한 기능의학적 이해 및 치료적 접목

Chronic migraine, affecting approximately 2% of the global population, markedly diminishes quality of life and imposes significant societal costs, surpassing the impacts of episodic migraine. Conventional medical treatments leave about 30% of patients with persistent chronic migraine, some of whom fluctuate between episodic and chronic migraine states. A holistic, functional medicine approach may provide supplementary benefits for these individuals. Clinical imbalances often identified in chronic migraine patients—such as mitochondrial dysfunction, oxidative stress, gut microbiota dysbiosis, leaky gut syndrome, food intolerance, histamine syndrome, vitamin D deficiency, and autonomic nervous system imbalances—can be detected through specific functional medical assessments, including urine organic acid profiles, hair tissue mineral analysis, hydrogen breath tests, comprehensive blood tests, and heart rate variability tests. Integrative functional medical interventions, encompassing lifestyle modifications, oral and intravenous nutrition therapies, and the comprehensive 5R program (remove, replace, reinoculate, repair, rebalance) for gut health, could offer therapeutic benefits. This review delves into the functional medicine paradigm and its potential role in managing chronic migraine.

Detection of helicobacter pylori by urea breathe test in a Nigerian population with upper gastrointestinal symptoms

Background: Helicobacter Pylori, a class one carcinogen is common globally with about 50% of the world’s population affected. It causes severe symptoms and complications including peptic ulcer disease and gastric cancer in infected persons. This study therefore aimed to determine the prevalence of Helicobacter Pylori as well as the clinical profile of patients with upper gastrointestinal symptoms seen at the Rivers State University Teaching hospital. Methodology: One hundred consecutive patients with upper GI symptoms undergoing Urea Breath test who fulfilled the inclusion criteria constituted the study population. The data was analyzed using IBM-SPSS Statistics for Windows, Version 22.0. Results were presented as means ± standard deviation and percentages/number for quantitative and qualitative variables respectively, while Categorical variables were compared with Pearson’s Chi-square. Result: Of the one hundred patients studied, 35 (35%) were males and 65 (65%) were females with a mean age of 49.56 ±14. 68. The prevalence of Helicobacter pylori was 33% affecting more females than males. The most common symptoms in the patients at presentation were heartburn (51%), epigastric pain (47%) and dyspepsia (35%). There was an insignificant positive correlation between the detection of Helicobacter pylori and a prior exposure to proton pump inhibitors. Conclusion: There is a high prevalence of Helicobacter pylori among patients with upper gastrointestinal symptoms. This buttresses the need for testing and treatment among Nigerians who present with such symptoms.

Ethyl acetate in e-liquids: Implications for breath testing.

Electronic cigarette liquids (e-liquids) can contain a variety of chemicals to impart flavors, smells and pharmacological effects. Surveillance studies have identified hundreds of chemicals used in e-liquids that have known health and safety implications. Ethyl acetate has been identified as a common constituent of e-liquids. Ethyl acetate is rapidly hydrolyzed to ethanol in vivo. Animal studies have demonstrated that inhaling >2,000 mg/L ethyl acetate can lead to the accumulation of ethanol in the blood at concentrations >1,000 mg/L, or 0.10%. A "Heisenberg" e-liquid was submitted to the Laboratory for Forensic Toxicology Research for analysis after a random workplace drug test resulted in a breath test result of 0.019% for a safety-sensitive position employee. Analysis of this sample resulted in the detection of 1,488 ± 6 mg/L ethyl acetate. The evaluation of purchased "Heisenberg" e-liquids determined that these products contain ethyl acetate. The identification of ethyl acetate in e-liquids demonstrates poor regulatory oversight and enforcement that potentially has consequences for breath ethanol testing and interpretations. The accumulation of ethanol in the breath from the ingestion/inhalation of ethyl acetate from an e-liquid used prior to a breath test may contribute to the detection of ethanol.

The Prevalence of Benzodiazepine Use among Italian Drivers in 15,988 Cases of Driving License Regranting from 2015 to 2023: Risks and Implications for Driving Fitness

The use of benzodiazepines is strongly associated with an increased risk of traffic accidents due to their side effects of sedation and drowsiness, which can significantly impair driving performance. The main aim of our study was to investigate the trend of benzodiazepine use over nine years (2015–2023) in a population of 15,988 subjects who had their license suspended for driving under the influence (DUI) of alcohol or drugs. Among the 15,988 users accessed to our laboratory, 924 tested positive for at least one benzodiazepine. An increase in the number of positive-testing users was observed in the period 2015–2018, followed by a slight decrease in 2019. Overall, the trend of benzodiazepine use was stable over the next four years (2020–2023), with the highest incidence in 2022. The most common benzodiazepines, and/or metabolites, found in urine samples were α-OH-alprazolam (28.66%; n = 366) and oxazepam (27.25%; n = 348). Several cases of mixed positivity were observed in the study population. The main substances taken with benzodiazepines were cocaine and Δ9-tetrahydrocannabinol. Our findings suggest that people taking benzodiazepines should be monitored, as these have a relevant impact on driving ability in addition to significant interindividual differences in the behavioral effects of benzodiazepines on driving performance.

Scheduling optimisation of alcohol test sites

Drink driving is an infamous factor in road crashes and fatalities. Alcohol testing is a major countermeasure, and random breath tests (RBTs) deter tested drivers and passersby (observers who are not tested). We propose a genetic algorithm (GA)-based RBT scheduling optimisation method to achieve maximal deterrence of drink driving. The RBT schedule denotes the daily plan of where, when, and for how long tests should occur in the road network. The test results (positive and negative) and observing drivers are considered in the fitness function. The limited testing resource capacity is modeled by a number of constraints that consider the total duration of tests, the minimum and maximum duration of a single test site, and the total number of test sites during the day. Clustering of the alcohol-related crash data is used to estimate the matrix for drink driving on the scheduled day. The crash data and traffic flow data from Victoria, Australia are analysed and used to describe sober/drink driving. A detailed synthetic example is developed and a significant improvement with 150% more positive results and 59% more overall tests is observed using the proposed scheduling optimisation method.