Heroin Research Articles

Bilateral wallerian degeneration of middle cerebellar peduncles following unilateral pontine infarction

Bilateral lesions of medial cerebellar peduncles are rare and are most frequently observed in acute cerebral infarction due to large-artery atherosclerosis, wallerian degeneration, neurodegenerative diseases (i.e. multiple system atrophy), inflammatory diseases (i.e. neuromyelitis optica, acute demyelinating encephalomyelitis), toxic encephalopathies (i.e. heroin abuse) and primary central nervous system lymphomas [3]. Wallerian degeneration regards progressive anterograde demyelination of the distal axons following injury to the proximal axon. As a result, fibrosis and atrophy of the affected fiber tracts occurs [2]. We present a case report of a patient with the rare finding of bilateral middle cerebral peduncle lesions, due to wallerian degeneration following pontine infarction. We further discuss differential diagnosis upon imaging findings and their clinical utility.

EEG Spectral Power Analysis: A Comparison Between Heroin Dependent and Control Groups.

Previous studies indicated that heroin abuse would result in abnormal functional organization of the brain. However, studies of heroin abuse- related brain dysfunction are scarce. The purpose of the present study was to investigate heroin effects on brain function by studying relationships between Electroencephalograph (EEG) spectral power and heroin abuse. The resting EEG signals were acquired from 15 male heroin dependent group and 15 male control group. The differences in the EEG components of each group were evaluated using the statistical Mann-Whitney examination and Davis Bouldin Index. The results show that heroin dependent group has an attenuated relative beta-2 power compared with other EEG frequency sub bands. Nevertheless, the results indicate heroin dependent group have an increase of power spectrum density for theta at all locations, as well as delta in the temporal, frontal and central areas compared with control group. Compared to control group, the heroin dependent group decreased its spectral power more than the control group in all three alpha bands. The present findings using the Davis Bouldin Index provide evidence that alpha-3 band in the FZ channel is more affected by heroin abuse than other frequency sub bands.

A rare case of renal infarction due to heroin and amphetamine abuse: case report

BackgroundRenal infarctions as a result of recreational drug use are rare and are commonly associated with cocaine use. Although amphetamines have a similar mechanism of action as cocaine, there are few reports linking them to ischemic events, and only one to renal infarction. Similarly, few reports link heroin use with infarcts, but never in the kidney. Although uncommon, several mechanisms have been implicated in heroin and amphetamine-induced infarction, including vasculopathy, vasculitis and the activation of the coagulation cascade.Case Presentation47-year-old female with a past medical history of non-intravenous heroin and amphetamine abuse, chronic obstructive pulmonary disease, hypertension, hyperlipidemia presented with right lower extremity swelling and rash, which was diagnosed as cellulitis and treated appropriately. Incidentally, the patient was found to have an acute kidney injury and further workup identified multiple renal infarcts in the right kidney. The patient had no past medical history of clotting disorders. Blood culture and urine cultures were sterile; autoimmune and hypercoagulable workup were negative. Urinalysis was unremarkable. Urine toxicology was only positive for opiates and amphetamines, which were thought to be the most likely cause of the renal infarct. Patient was lost to outpatient follow up due to noncompliance, but returned to the hospital for re-emergence of her cellulitis, during which no new infarcts were discovered, and the previous renal infarct had scarred over.ConclusionThere are very few reports of heroin and amphetamine-induced infarctions. This case report describes a rare but important complication of heroin/amphetamine abuse that could be easily overlooked.

Intervensi Farmakologi Sindrom Putus Obat pada Penyalahguna Opioid

Opioid withdrawal syndrome appears after abrupt discontinuation of opioids characterized by watery eyes, runny nose, muscle pain, anxiety, yawning, gooseflesh, mydriasis, gastrointestinal discomfort, and rapid heartbeat. Globally, opioid abuse remains a significant problem, necessitating adequate treatment of drug syndrome in opioid addicts, particularly pharmaceutical therapy. Therefore, this study aimed to identify, evaluate, and analyze pharmacological management in opioid abusers. The articles used were retrieved based on specific limitations using the main keywords "opioid withdrawal syndrome treatment" and additional keywords "heroin, fentanyl, morphine" that were published in PubMed, ScienceDirect, and SpringerLink. From the 21 articles included, heroin abuse was the most prevalent. The primary treatment for opioid abuse is substitution therapy of opioid or non-opioid such as lofexidine, naltrexone, buprenorphine, dronabinol, methadone, pregabalin, oxytocin, antagonist corticotropin-releasing factor type 1 (CRF1), tramadol, clonidine, and pioglitazone. Additionally, the patient received symptomatic therapy based on the condition. The drugs used for treatment and willingness to obtain therapy are the factors for the withdrawal completion rate. The results were evaluated using opioid withdrawal assessment, either from a subjective, objective, or clinical perspective.

Pharmacokinetics of diphenhydramine following single-dose intravenous and oral administration in non-fasted adult horses.

Diphenhydramine is an H1 receptor antagonist used to control urticaria and other allergic signs caused by type I hypersensitivity reactions in horses (Equus caballus). Limited studies have been conducted on pharmacokinetics of this drug in horses, with no studies involving oral formulations. Our study investigated pharmacokinetics of an oral diphenhydramine formulation compared to intravenous administration in non-fasted adult horses. Six healthy horses underwent a single administration of three different doses of diphenhydramine (1mg/kg intravenously, 1mg/kg intragastrically, and 5mg/kg intragastrically) with a two-week washout period between doses. Bioavailability of intragastric diphenhydramine was less than one percent and six percent for 1mg/kg and 5mg/kg intragastric doses, respectively. This poor bioavailability is similar to what is reported in dogs. Two of six horses experienced transient side effects after intravenous diphenhydramine administration, emphasizing the need for determining therapeutic plasma levels in efforts to determine the lowest effective dose minimizing risk of adverse effects. The main conclusion of our study was that oral diphenhydramine at doses up to 5mg/kg are unlikely to achieve therapeutic plasma levels in adult horses.

Prefrontal fNIRS-based clinical data analysis of brain functions in individuals abusing different types of drugs

BackgroundThe activation degree of the orbitofrontal cortex (OFC) functional area in drug abusers is directly related to the craving for drugs and the tolerance to punishment. Currently, among the clinical research on drug rehabilitation, there has been little analysis of the OFC activation in individuals abusing different types of drugs, including heroin, methamphetamine, and mixed drugs. Therefore, it becomes urgently necessary to clinically investigate the abuse of different drugs, so as to explore the effects of different types of drugs on the human brain.MethodsBased on prefrontal high-density functional near-infrared spectroscopy (fNIRS), this research designs an experiment that includes resting and drug addiction induction. Hemoglobin concentrations of 30 drug users (10 on methamphetamine, 10 on heroin, and 10 on mixed drugs) were collected using fNIRS and analyzed by combining algorithm and statistics.ResultsLinear discriminant analysis (LDA), Support vector machine (SVM) and Machine-learning algorithm was implemented to classify different drug abusers. Oxygenated hemoglobin (HbO2) activations in the OFC of different drug abusers were statistically analyzed, and the differences were confirmed. Innovative findings: in both the Right-OFC and Left-OFC areas, methamphetamine abusers had the highest degree of OFC activation, followed by those abusing mixed drugs, and heroin abusers had the lowest. The same result was obtained when OFC activation was investigated without distinguishing the left and right hemispheres.ConclusionsThe findings confirmed the significant differences among different drug abusers and the patterns of OFC activations, providing a theoretical basis for personalized clinical treatment of drug rehabilitation in the future.

Solid-Phase Extraction and GC/MS Confirmation of Heroin Abuse in Urine

A method for the analysis of urine for the heroin abuse is described. The analytical procedure uses solid-phase extraction (SPE), gas chromatography/mass spectrometry (GC/MS). It allows extraction, derivatization and analysis of 6-MAM and Morphine from urine. After solid-phase extraction was complete, the eluate was selectively derivatized with N-Methyltrimethylsilyltrifluoroacetamide (MSTFA). Analysis was performed using a GC/MS system operating in full scan mode. The mass spectrum of the derivatized metabolites was searched manually against reference libraries for positive identification and the retention time checked against that of the standard. This procedure has increased both the amount and the reliability of information given to analyst. The system has been in routine operation processing 100-150 urine samples per week. The results of the analysis of standard reference material and actual samples are presented and discussed. The developed method is sensitive enough to assess relevant 6-MAM and morphine levels in urine for forensic investigations.

The Effectiveness of Memory Reconsolidation Interference by Propranolol on Craving and Emotion in Heroin Abusers

The Effectiveness of Memory Reconsolidation Interference by Propranolol on Craving and Emotion in Heroin Abusers

Paradoxical and Retrograde Air Embolism from Pressurized Peripheral Bolus

Introduction Cerebral air embolism is a rare, yet serious neurological occurrence with unclear incidence and prevalence. Here, we present a case of fatal cerebral arterial and venous cerebral gas embolism in a patient with infective endocarditis and known large right-to-left shunt and severe tricuspid regurgitation following pressurized fluid bolus administration. Case Presentation. A 32-year-old female was admitted to the medical intensive care unit from a long-term acute care facility with acute on chronic respiratory failure. Her medical history was significant for intravenous heroin and cocaine abuse, methicillin-sensitive Staphylococcus aureus tricuspid valve infective endocarditis on vancomycin, patent foramen ovale, septic pulmonary embolism with cavitation, tracheostomy with chronic ventilator dependence, multifocal cerebral infarction, hepatitis C, nephrolithiasis, anxiety, and depression. After intravenous fluid administration, she became unresponsive with roving gaze, sluggish pupils, and hypotensive requiring vasopressors. CT of the brain showed diffuse arterial and venous cerebral air embolism secondary to accidental air administration from fluid bolus. Magnetic resonance imaging of the brain showed diffuse global anoxic injury and flattening of the globe at the optic nerve insertion. Given poor prognosis, her family chose comfort measures and she died. Conclusions Fatal cerebral air embolism can occur through peripheral intravenous routes when the lines are inadequately primed and fluids administered with pressure. Caution must be exercised in patients with right-to-left shunting as air may gain access to systemic circulation.

A SIZEABLE COMPLICATION OF UNTREATED PNEUMONIA: A VIRIDANS STREPTOCOCCI POST PNEUMONIC EMPYEMA THORACIS

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Community acquired pneumonia (CAP) can result in significant morbidity and mortality. Among the patients admitted with CAP, a rare complication is a parapneumonic or post pneumonic empyema thoracis. Although the course may vary patient to patient, these complications can lead to a prolonged treatment course thus leading to a longer hospital stay and increased mortality. Early detection of CAP is key to avoiding these fatal complications. CASE PRESENTATION: We describe a 36 year-old-male with a past medical history of asthma, tobacco and heroin abuse who presented with a chief complaint of shortness of breath. The patient was previously admitted to the hospital two months prior and he was treated for an asthma exacerbation and community acquired pneumonia. Upon discharge, the patient did not complete the antibiotic course he was prescribed. He also reportedly developed worsening dyspnea on exertion with associated fever, chills, unintentional weight loss and pleuritic chest pain. Due to his worsening dyspnea, he subsequently returned to the hospital to seek emergency treatment. On this presentation, a CT chest was ordered and demonstrated a 17 x 15 x 23.5 cm cystic structure. Along with this, a right middle and lower lobe collapse and leftward mediastinal shift were also noted. CT surgery was consulted and the patient underwent a right thoracoscopy that converted to a right thoracotomy, pulmonary decortication, and parietal pleurectomy with eventual chest tube placement. Per the operative report, three liters of purulent foul smelling material was drained from the lung during the procedure. The purulent material was sent for cultures and grew pan-sensitive Streptococcus intermedius. The patient was then treated with antibiotics and he was discharged home with close follow-up. DISCUSSION: Pneumonia is the leading cause of empyema thoracis, therefore, it is important to recognize this serious complication. Early intervention is crucial as mortality significantly rises the longer patients are without treatment. A subset of patients require urgent exploratory thoracotomy within 24 to 48 hour with indications including: parenchymal, multiple loculations or a trapped lung. CONCLUSIONS: Although empyema thoracis does not have any age preference, pneumonia is typically more common in the elderly population with comorbidities. Interestingly, our patient was younger than the expected age range and he demonstrated a rare complication of pneumonia that resulted from early termination of antibiotic therapy. REFERENCE #1: Garvia V, Paul M. Empyema. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459237/ DISCLOSURES: No relevant relationships by Sara Khalid, source=Web Response No relevant relationships by Mahnoor Khan, source=Web Response No relevant relationships by Robert Ondracek, source=Web Response

Monitoring geographical differences in illicit drugs, alcohol, and tobacco consumption via wastewater-based epidemiology: Six major cities in Turkey

A national wastewater-based epidemiology (WBE) monitoring campaign has been initiated to determine the trends in drug consumption in Turkey since 2019. This study aimed to present the wastewater monitoring results for four periods in 2019 for six major cities with 17 wastewater treatment plants. The study investigated heroin (HER), amphetamine (AMP), methamphetamine (METH), cocaine (COC), 3,4-methylenedioxymethamphetamine (MDMA), cannabis, alcohol, and tobacco to understand the temporal and geographical drug consumption trends. The results indicated a trend of regular cannabis use in all the cities. Considering geographical variations, the drug usage trends were not homogeneous within the country for any of the investigated drugs, except cannabis. HER consumption was predominant in Denizli (1042.48 mg/1000 inh/day), while İzmir and Antalya (154.10 and 79.56 mg/1000 inh/day, respectively) topped for COC consumption. Aydın had the highest consumption levels of AMP (90.03 mg/1000 inh/day) and METH (358.13 mg/1000 inh/day), while MDMA consumption was the highest in Samsun (157.64 mg/1000 inh/day). Tobacco consumption was high in Aydın (8791.69 mg/1000 inh/day) and Antalya (5375.17 mg/1000 inh/day), whereas alcohol consumption was higher in Bursa than in the other cities (53434.61 mL/1000 inh/day). There were no statistically significant differences in the weekend consumption levels of the investigated drugs among these six cities. Although this study included the results of 1 year of consumption monitoring, the data confirms internationally published information on the drug trafficking routes of conventional drugs in this region, especially the Heroin-Balkan route. Results from further sampling will enable accurate evaluation of global drug consumption and trafficking, in addition to alcohol and tobacco use.

Increased Expression of Plasma miRNA-320a and let-7b-5p in Heroin-Dependent Patients and Its Clinical Significance.

Heroin use disorder is a chronic and relapsing disease that induces persistent changes in the brain. The diagnoses of heroin use disorders are mainly based on subjective reports and no valid biomarkers available. Recent researches have revealed that circulating miRNAs are useful non-invasive biomarkers for diagnosing brain diseases such as Alzheimer's disease, multiple sclerosis, schizophrenia, and bipolar disorder. However, studies on circulating miRNAs for the diagnosis of heroin use disorders are rarely reported. In this study, we investigated the differential expression of plasma miRNAs in 57 heroin-dependent patients. Based on literature research and microarray analysis, two candidate miRNAs, miR-320a and let-7b-5p, were selected and analyzed by quantitative real-time RT-PCR. The results showed miR-320a and let-7b were significantly upregulated in plasma of the heroin-dependent patients compared to that in healthy controls. The area under curves (AUCs) of receiver operating characteristic (ROC) curves of miR-320a and let-7b-5p were 0.748 and 0.758, respectively. The sensitivities of miR-320a and let-7b-5p were 71.9 and 70.2%, while the specificities of miR-320a and let-7b-5p were 76.1 and 78.3%, respectively. The combination of these two miRNAs predicted heron dependence with an AUC of 0.782 (95% CI 0.687–0.876), with 73.7% sensitivity and 82.6% specificity. Our findings suggest a potential use for circulating miRNAs as biomarkers for the diagnosis of heroin abuse.

Chest imaging of hypersensitivity pneumonitis induced by heroin abuse.

Long‐term abuse of nasally inhaled substances such as heroin can result in life‐threatening hypersensitivity pneumonitis and respiratory distress. In the setting of hypoxia, a chest CTA is often necessary to see the extent of the lung involvement and to rule out pulmonary emboli.

Detection of 6-monoacetylemorphine in hair sample of heroin addicts using gas chromatography\u2013mass spectrometry and significance of rehabilitation program

BackgroundThe analysis of hair samples for the detection of drugs has become one of the convincing strategies in the field of forensic toxicology. A large number of cases concerning heroin abuse or its byproducts have been documented under the Control of Narcotic Substances Act, 1997, over the past decade. The present study was carried out with an aim to evaluate the primary metabolite of heroin, i.e., 6-monoacetylemorphine (6-MAM), in hair samples of addicts and subjects undergoing rehabilitation, thereafter accessing the success rate of the rehabilitation program at the de-addiction center.ResultsHair samples were randomly collected from 20 regular heroin addicts and 20 heroin addicts from their past, from the rehabilitation center, of different age groups. Samples were cleaned, digested, and extracted using an alkaline digestion mediator methyl tertiary butyl ether, followed by quantification of 6-MAM via gas chromatography–mass spectrometry (GC–MS). The mean concentration of 6-MAM in regular heroin addicts detected was 7.80 ng/mg and 2.34 ng/mg in samples of subjects undergoing rehabilitation at the de-addiction center, respectively.ConclusionTraces of 6-MAM in the hair sample of heroin addicts can be efficiently detected days after the last intake of heroin. In addition to that, our findings also give an idea for future evaluating the approximate timeframe for detection of 6-MAM and/or other metabolites of heroin in the hair sample. However, in the future, by carefully analyzing the hair samples that can be taken from rehabilitation centers from target subjects at different time intervals, the exact duration of traceable quantity of 6-MAM can be determined in the hair sample. Finally, it can be concluded that there is a significant success rate of the rehabilitation program at de-addiction centers in connection with dragging the 6-MAM level from the body.

P044 Tibia honest, it takes a lot of spine to diagnose DISC

Abstract Background/Aims CRMO is a rare autoinflammatory condition characterised by sterile bone osteolytic lesions which is described mainly in children with a female preponderance. Methods A 31 year-old male presented with a 4-week history of productive cough, abdominal pain, left sided chest pain and right hip pain. He is a smoker with a background of heroin addiction and alcohol abuse. He was homeless and no family history available as he was fostered. His chest radiography was unremarkable but he had inflammatory markers. He was treated for as chest infection and heroin withdrawal. CT abdomen and pelvis demonstrated multiple osteolytic lesions in the pelvis, sternum, thoracic and lumbar spine. His HIV, Quantiferon and blood cultures were negative. His immunoglobulins, urine Bence Jones protein and echocardiogram were normal. In-depth assessment by the Infectious Disease team failed to isolate an infective pathogen. Bone marrow aspirate and trephine were unremarkable. Two CT-guided bone biopsies done twice showed plasma cells and macrophages. His condition deteriorated rapidly over 2 months. He mobility was reduced to wheelchair-bound and had dramatic 10kg weight loss. Results In the absence of an infective or malignant cause, the Rheumatology service was consulted. Having reviewed the extensive data available, he was diagnosed with a likely but unusually aggressive form of adult-onset chronic recurrent multifocal osteomyelitis (CRMO). He was commenced initially on IV methylprednisolone, zoledronic acid, methotrexate and, etoricoxib. Subsequently he was treated with, tocilizumab and teriparatide. Whole body MRI revealed numerous other lesions not evident on previous imaging including lesions of the distal right humerus, proximal right femur and both tibias. His symptoms and inflammatory markers improved substantially over several days following treatment. A repeat full body MRI demonstrated dramatic improvement in the bony lesions. Soon he was able to walk again and gained some weight before he absconded from the hospital. His treatment was changed to tocilizumab infusion and denosumab injection to facilitate compliance. Conclusion This is an unusual fascinating case which posed a significant diagnostic dilemma. Ruling out infection particularly in great challenge in diagnosing CRMO in a male adult who is homeless and a heroin abuser presenting with multifocal osteolytic lesions was challenging. The severity of his condition necessitated using novel treatments such as tocilizumab. Disclosure W. Ng: None. A. Anjum: None. J. Devlin: None. A. Fraser: None.

Snapshot of narcotic drugs and psychoactive substances in Kuwait: analysis of illicit drugs use in Kuwait from 2015 to 2018

BackgroundThe misuse of illicit substances is associated with increased morbidity and mortality; thus, substance abuse is a global health concern. The Arabian Gulf region is considered a crossing point and a consumer of illicit drugs. However, a lack of laboratory-based research has limited the scientific assessment of drug misuse in the Arabian Gulf region. Thus, an up-to-date analytical representation of the drug situation is warranted.MethodsWe investigated the type and quantity of detained narcotic drugs and psychotropic substances from 2015 to 2018, representing a population of approximately 4 million people, in addition to the number of abusers and mortality among abusers. In total, 6220 cases from the Narcotic and Psychotropic Laboratory and 17,755 cases from the Forensic Toxicology Laboratory were reviewed and analyzed. Substances were identified and documented using gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry.ResultsCannabis, including marijuana, was the most seized substance, followed by heroin, opium, and cocaine. Amphetamines, including methamphetamine, in the form of powder or pills, were seized in larger quantities than other psychoactive substances. The most consumed substances were, in order, amphetamines (including methamphetamine), benzodiazepines, cannabis, and heroin. We identify the common drugs in postmortem specimens, according to sex, from suspected drug-related deaths. The most common single drug identified were heroin, benzodiazepines, and methamphetamine. Similarly, the multiple-drug cocktail of heroin–benzodiazepines, cannabis–benzodiazepines, and cannabis–amphetamines, were detected frequently.ConclusionsThe data shows that cannabis is the leading type of illicit substance seized. Deaths resulting from benzodiazepines and heroin abuse were the highest in the single drug category, while heroin-benzodiazepines combination deaths were the highest in the multiple-drug category. Methamphetamine was the most abused illicit drug in Kuwait. These findings revealed the illicit drug abuse situation in the State of Kuwait, in a region that suffers from the scarcity of information regarding illicit substances. Thus, providing valuable information for drug enforcement, forensic analyst, health workers on national and international levels.

Biogenesis, physiological functions and potential applications of extracellular vesicles in substance use disorders.

Substance use disorder (SUD) is a growing health problem that affects several millions of people worldwide, resulting in negative socioeconomic impacts and increased health care costs. Emerging evidence suggests that extracellular vesicles (EVs) play a crucial role in SUD pathogenesis. EVs, including exosomes and microvesicles, are membrane-encapsulated particles that are released into the extracellular space by most types of cells. EVs are important players in mediating cell-to-cell communication through transfer of cargo such as proteins, lipids and nucleic acids. The EV cargo can alter the status of recipient cells, thereby contributing to both physiological and pathological processes; some of these play critical roles in SUD. Although the functions of EVs under several pathological conditions have been extensively reviewed, EV functions and potential applications in SUD remain less studied. In this review, we provide an overview of the current knowledge of the role of EVs in SUD, including alcohol, cocaine, heroin, marijuana, nicotine and opiate abuse. The review will focus on the biogenesis and cargo composition of EVs as well as the potential use of EVs as biomarkers of SUD or therapeutic targets in SUD.

Palatal perforation from intranasal abuse of heroin. Case report and literature review

Palatal perforation is a lesion of various etiologies, including chronic intranasal abuse of cocaine. Only a few data, however, correlate this damage with heroin. The growing intranasal abuse of heroin and the fact that it is one of the five most popular drugs in most European countries, especially in the lower social classes, increase the need for further investigation of its effects on the oral cavity and nasopharynx. This report presents a case of chronic snorting of heroin, which caused perforation of the hard palate, the diagnostic approach, the selected surgical technique, the final outcome, as well as a review of literature.

Synergistic Effect and Mechanism of Apoptosis Induction by Morphine and the HIV-1gp120V3 Loop in Hippocampal Neurons.

HIV-associated neurocognitive disorders (HAND) are a collective name for neurological disorders associated with HIV-1 infection. The incidence and severity of HAND are increased by concomitant opioid use disorder, such as heroin and morphine abuse. Our previous study showed that the HIV-1 envelope protein gp120 and morphine synergistically induce apoptosis in rat hippocampal neurons. However, the underlying mechanism remains unclear. We hypothesized that morphine and gp120 activated the neuronal apoptosis signaling pathway via their typical membrane receptors. If they shared key signaling molecules, their induction of neuronal apoptosis could be inhibited by blocking these targets. We found that morphine and gp120V3 loop synergistically induced hippocampal neuron apoptosis, mediated by activating the extracellular signal-regulated kinase (ERK) pathway, increasing the intracellular Ca2 + concentration and expression of caspase-, and reducing the mitochondrial membrane potential. The ERK inhibitor PD98509 and the phosphatidylinositol 3-kinase activator IGF-1 blocked this effect. These results indicate that ERK plays a crucial role in the apoptosis of hippocampal neurons in HAND.

The structure of a confiscated street drug: 6-Monoacetyl morphine hydrochloride trihydrate - C19H22NO4Cl·3H2O

Since street drugs are frequently and rapidly modified, in order to circumvent the current laws that make them illicit, it is necessary to fully identify them by single crystal X-ray diffraction; subsequently, ideal powder patterns are computed for rapid identification of additional confiscations, which are mostly available in powder form. Monoacetyl morphine is found in samples of heroin as a by-product of incomplete synthesis, or from degradation of diacetyl morphine caused by heat, humidity, or pH changes. It is formed by the hydrolysis of the acetyl function on the benzene moiety of the morphine ring, thereby inserting an OH moiety at that site. This compound, 6-monoacetyl morphine, is the primary and active metabolite of heroin, rapidly hydrolyzed in the user’s blood. Herein, we describe the structure of 6-monoacetyl morphine, IUPAC name: [(4R,4aR,7S,7aR,12bS)-9-hydroxy-3-methyl-2,4,4a,7,7a,13-hexahydro-1H-4,12-methanobenzofuro[3,2-e]isoquinolin-7-yl] acetate (A), as the trihydrated hydrochloride, whose structure has not been described previously. Our crystals belong in space group P212121 with cell parameters of a = 6.9367(2), b = 13.0374(3), c = 21.9856(6) Å, V = 1988.30 (9) Å3; its composition is C19H22NO4Cl·3H2O, and Z = 4.0. A full sphere of data was collected at 100 K using CuKα radiation (λ = 1.54178 Å), yielding 3594 unique reflections measured and a final R-factor = 4.1%, with a Flack parameter = 0.05(1).