Multiple Substances Research Articles

An Experimental and Modeling Approach to Study Tangential Flow Filtration Performance for mRNA Drug Substance Purification

ABSTRACTFollowing the recent COVID‐19 pandemic, mRNA manufacturing processes are being actively developed and optimized to produce the next generation of mRNA vaccines and therapeutics. Herein, the performance of the tangential flow filtration (TFF) was evaluated for high‐recovery, and high‐purity separation of mRNA from unreacted nucleoside triphosphates (NTPs) from the in vitro transcription (IVT) reaction mixture. For the first time, the fouling model was successfully validated with TFF experimental data to describe the adsorption of mRNA on filtration membrane. The fouling model enables monitoring of the mRNA purification processes, designing an appropriate strategy for filter clean‐up, replacing the column at the right time and reducing the process cost. Recovery greater than 70% mRNA without degradation was obtained by implementing a capacity load of ∼19 g/m2, <2.5 psi transmembrane pressure (TMP) and feed flux of 300 LMH. This approach also enables the purification of multiple mRNA drug substance sequences for the treatment of a wide range of different diseases.

Kinetic study of methanol oxidation for multiple hydrogen-rich substances blending mode

Kinetic study of methanol oxidation for multiple hydrogen-rich substances blending mode

Syndemic Conditions Associated with Hazardous Alcohol Consumption among Sexual Minority Men in San Francisco

BackgroundHazardous alcohol consumption (HAC) is prevalent among sexual minority men (SMM). Using syndemic theory, this study aimed to identify the number of syndemic conditions, including their combinations, and their association with HAC among SMM in San Francisco. MethodWe conducted a secondary analysis of cross-sectional data from 246 SMM who consume alcohol. Syndemic factors included multiple substance use, depressive symptoms, HIV/STI status, and houselessness. We conducted a multivariable logistic regression to estimate the odds of HAC associated with increasing syndemic conditions. We further examined which combinations of three syndemic factors were associated with the highest odds for HAC. ResultsThe average age was 40.7; participants were predominantly White (33.3%) and Black/African American (29.7%) and graduated from high school (92.7%). The prevalence of HAC increased with the number of syndemic conditions: 13.6% with none, 30.9% with one, 51.9% with two, 65.1% with three, and 69.2% with four conditions. A significant log-linear trend was observed, with two syndemic conditions increasing the odds of HAC over fivefold (AOR=5.05, 95% CI=1.68–15.15), and three and four syndemic conditions increasing the odds by more than eightfold (AOR=8.82, 95% CI=2.74–28.39; AOR=8.55, 95% CI=2.26–32.28). The combination of depressive symptoms, HIV/STI status, and houselessness tripled the odds for HAC (OR=3.07, 95% CI=1.34–7.04). ConclusionHAC was associated with increasing syndemics, and specific conditions (depression, HIV/STI, and houselessness) had the greatest odds of HAC. These findings underscore the need for comprehensive screening and integrated interventions targeting these co-occurring conditions to reduce HAC in this population.

Chemotactic activity of products of Elizabethkingia anophelis derived from Aedes albopictus against RAW264 murine macrophage cell line.

Dengue viruses enter dermal macrophages which are derived from other tissues after mosquito bites. We examined chemotactic factors derived from the dengue vector mosquito, Aedes albopictus, toward a RAW264 murine macrophage cell line. We found that Elizabethkingia anophelis that was isolated from mosquitoes exhibited migration-inducing activity toward RAW264 cells. The active substances were extracted using ethyl acetate to induce chemotactic movements. Chemotactic activity was eluted in the several fractions using the reversed-phase chromatography, suggesting that multiple substances were responsible for the activity. We isolated three bacterial colonies from the wild A. albopictus mosquitoes collected in Toyama Park, Tokyo prefecture, Japan. The bacterial 16S rRNA gene sequences were the most similar to those of Lonsdalea quercina. These bacteria also exhibited migration-inducing activity toward RAW264 cells. The migration-inducing activity of mosquito bacteria might be a new aspect of mosquito-mediated viral infections.

Characterizing a syndemic: STI symptoms, substance use & violence among incarcerated Peruvian women

Abstract Background Despite increasing rates of incarceration and sexually transmitted infections (STIs) among women globally, STI epidemiological data for this vulnerable at-risk population is limited. We therefore characterized patterns of STI symptoms and explored covariates and drivers of STI symptoms among incarcerated women in Peru. Methods Among 249 incarcerated women surveyed on substance use, depression, sexual behavior, STI symptoms and violence, univariate and bivariate analysis informed a latent profile analysis (LPA) and logistic regression assessing for syndemic associations between violence, substance use, and STI symptoms. Results Most participants were Peruvian (93.5%), in their late 30s (median=37; range:18-70 years), sentenced to < 5 years (86.6%) and had completed high school (78.7%). 36.9 had ≥2 STI; A minority were pregnant (2.6%), had children residing with them in prison (7.2%); symptoms. The LPA model with the best fit revealed the largest (39%) group with a ‘syndemic’ profile involving co-occurrence of multiple STI symptoms, substance use, and experiences of interpersonal violence (IPV); 86.6% of this latent class were <50 years old. The substance use and violence ‘syndemic’ profile was associated significantly higher likelihood of having multiple STI symptoms (2+ symptoms: PR = 1.88 (95% CI 1.18, 2.99) or 3+ symptoms PR = 2.55 (95% CI 1.32, 4.93). Conclusions and Recommendations The syndemic of younger incarcerated women with substance use and IPV with STI symptoms portends a group at substantially higher risk for HIV and given the structured setting of prisons, should be routinely screened for and treated for STIs. Moreover, these settings can and should screen for and address substance use and IPV and intervene before these women are released to community settings to not only improve individual but public health needs. Key messages • In line with syndemic theory, incarcerated women presenting with multiple STI symptoms (≥2) were more likely to be engaged in substance use (illicit drug use and/or alcohol) and experience violence. • Post-hoc analysis also revealed the rate of substance use was higher among women who engaged in commercial sex work (CSW) pre-incarceration compared to those who were not engaged in CSW.

Innovations in residential treatment that promote multi-drug addiction recovery

Abstract Background As the drug addiction crisis deepens in many countries across the globe, governments are rapidly expanding publicly funded treatment facilities. At the same time, the illicit drug market has evolved with many substances now containing multiple addictive drugs that complicate recovery. The evidence base for treatment remains primarily focused on single substances. The purpose of this study was to examine the lived experience of adults who attended in-patient treatment centres for multi-drug addiction in Canada. Methods This qualitative study was conducted in 2022 with 32 adults who voluntarily attended an in-patient treatment centre for drug addiction (44% female, 23-53 years). All had been addicted to multiple substances including opioids, crack and methamphetamines. Most (70%) were homeless before treatment. In 1-hour semi-structured interviews adults described the structures and programming that helped them recover in these facilities. Many tried multiple facilities and thus had a rich history of lived experience to draw from. Narrative inquiry was used to characterize qualitative themes across interviews using a phenomenological lens. Results Seven qualitative themes emerged from the data. Residential treatment centres that were effective at helping adults recover from multi-drug addiction: (1) provided flexible stays up to 100 days; (2) felt like a home not a prison; (3) permitted opioid replacement therapies; (4) provided a variety of recovery tools (e.g., cognitive behavioural therapy, Narcotics Anonymous, cultural supports); (5) helped adults reunite with family, find a safe place to stay, and find work before discharge; (6) provided transitional housing after discharge if needed; and (7) provided free long-term recovery support and check-ins after discharge. Conclusions The findings of this study highlight 7 actions that treatment facilities can adopt and test with their own clients in an effort to better support multi-drug addiction recovery. Key messages • A stronger evidence base is needed to inform in-patient multi-drug addiction treatment. • Findings underline 7 actions treatment facilities can take to promote multi-drug addiction recovery.

The Impact of Parental Monitoring on Exposure to Multiple Substances and Bullying in Croatian Students

Background/Objectives: Adolescence is a critical period for experimenting with a wide range of risky behaviors, which are often influenced by family dynamics, including parental monitoring. This study aims to analyze the patterns of exposure to multiple substances and bullying among Croatian students by age and gender in 2022 and examine the association of exposure to multiple substances and bullying with maternal and paternal monitoring. Methods: The data were obtained from the 2022 Health Behaviour in School-aged Children (HBSC) study conducted in Croatia among students aged 11, 13, and 15. Two multinomial logistic regressions were performed separately by age and gender. Results: Exposure to multiple instances of bullying is more common among boys than girls in all three age groups, while exposure to multiple substances varies depending on age. The analysis revealed the strong protective effect of maternal monitoring against both substance use and bullying. Paternal monitoring showed less consistent effects but still indicated that lower paternal monitoring was associated with higher exposure to multiple substances and bullying, particularly at age 13. Conclusions: The patterns of multiple substance use and bullying vary by gender and age, emphasizing the need for tailored intervention strategies. Programs that strengthen parental monitoring, particularly maternal monitoring, should be prioritized.

Club Drugs and Psychiatric Outcomes: A Descriptive Case Series from Spain

Background: illegal drugs significantly contribute to global health issues, with health complications often occurring not only in regular users with Substance Use Disorders (SUDs) but also in first-time and occasional users. Methods: this study examines five clinical cases from a public hospital in Ibiza, Spain, where patients presented with acute psychiatric symptoms due to recreational drug use. Results: Contrary to previous studies on SUDs, our patients typically had higher education levels and stable employment. Most of them used multiple substances, with cannabis, cocaine, and alcohol being the most frequently used. There was also a common occurrence of consuming drugs with uncertain contents. Upon admission, typical symptoms included aggression, hallucinations, mood swings, and disorientation in time and space. Conclusions: Our findings underscore the significant mental health risks posed by illicit drugs, even for individuals with no prior psychiatric history. Factors like the drug’s potency, frequency and amount of use, past mental health issues, personality traits, and previous traumatic experiences might influence the onset of these symptoms.

Evaluation of a Point of Care Urine Drug Test System for Application in Outpatient Pain Management Clinics

Abstract Introduction/Objective Most states require testing for illicit and controlled substances in ambulatory, non-terminal pain management populations to ensure prescription compliance. Point of care (POC) urine drug testing (UDT) is a widely adopted testing method that assists with clinical decision making within minutes. However, these immunoassays may lack the sensitivity and specificity needed for potent medications such as fentanyl. This study compares the performance characteristics of a POC UDT to an in-house, high throughput, automated chemistry analyzer and the reference method, gas chromatography-mass spectrometry (GC-MS). Providers should be aware of the limitations of each methodology given the rise of synthetic opioid misuse, and the need to quantify multiple substances and metabolites within the same drug class. Methods/Case Report 100 residual deidentified patient urine samples from an ambulatory pain management population were analyzed using GC-MS, Profile®-V MEDTOX Scan® POCT device (Burlington, NC), and a Beckman Coulter AU480® Chemistry Analyzer using EMIT® II Plus reagents (Beckman Coulter; Brea, CA). Drug classes on the Profile®-V included: amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolite, methamphetamine, methadone, opiates, oxycodone, cannabinoids and phencyclidine. Drug classes on the AU480® included the same except without a methamphetamine-specific immunoassay. Results (if a Case Study enter NA) The results from GC-MS showed that 99% (99/100) of the samples were positive for one or more of the drug classes. Overall, the AU480® was 90% sensitive and 98% specific while the MEDTOX Scan® was 87% sensitive and 98% specific. Both devices exhibited variable performance across drug classes. Neither the AU480® nor the MEDTOX Scan® detected fentanyl in five specimens. Conclusion POCT-UDS systems like the Profile®-V MEDTOX Scan® can provide good accuracy and may offer a time and cost benefit when compared to higher throughput analyzers like the AU-480®. Due to the low reference values of immunoassays, definitive testing such as GC-MS is recommended for use in the pain management population.

Detection of serum alterations in polysubstance use patients by FT-Raman spectroscopy

Substance use disorders pose significant health risks and treatment challenges due to the diverse interactions between substances and their impact on physical and mental health. The chemical effects of multiple substance use on bodily fluids are not yet fully understood. Therefore, this study aimed to investigate the chemical changes induced by a combination of substances compared to a control group. Analysis of FT-Raman spectra revealed structural alterations in the amide III, I, and C = O functional groups of lipids in subjects treated with opioids, alcohol and cannabis (polysubstance group). These changes were evident in the form of peak shifts compared to the control group. Additionally, an imbalance in the amide-lipid ratio was observed, indicating perturbations in serum protein and lipid levels. Furthermore, a 2D plot of two-track two-dimensional correlation spectra (2T2D-COS) demonstrated a shift towards dominance of lipid vibrations in the polysubstance use groups, contrasting with the predominance of the amide fraction in the control group. This observation suggests distinct molecular changes induced by multiple substance use, potentially contributing to the pathophysiology of substance use disorders. Principal Component Analysis (PCA) was utilized to visualize the data structure and identify outliers. Subsequently, Partial Least Squares Discriminant Analysis (PLS-DA) was employed to classify the polysubstance use and control groups. The PLS-DA model demonstrated high classification accuracy, achieving 100.00 % in the training dataset and 94.74 % in the test dataset. Furthermore, receiver operating characteristic (ROC) analysis yielded perfect AUC values of 1.00 for both the training and test sets, underscoring the robustness of the classification model.This study highlights the quantitative and qualitative changes in serum protein and lipid levels induced by polysubstance use groups, as evidenced by FT-Raman spectroscopy. The findings underscore the importance of understanding the chemical effects of polysubstance use on bodily fluids for improved diagnosis and treatment of substance use disorders. Moreover, the successful classification of spectral data using machine learning techniques emphasizes the potential of these approaches in clinical applications for substance abuse monitoring and management.

Determination of terpene-based VOCs emitted from pine wood using NIR spectroscopy

ABSTRACT In the search for a quick and less labor-intensive method for determining terpene emissions of high emitting wood like Pinus sylvestris, this study utilized near-infrared spectroscopy (NIR) combined with multivariate analysis methods and compared it to the standard measurement method according to the EN 16516 standard. The spectra were measured on the surface of solid-wood samples and correlated with the simultaneously determined air concentrations of terpenes. For α-pinene and 3-carene, prediction models were created using partial least squares regression (PLSR). Both work with determination coefficients of 0.77 and a Root Mean Square Error of Prediction (RMSEP) of 12% of the maximum emissions achievable in this study. A model based on the sum of the two terpenes was built and tested to determine the predictive capability of multiple similar substances simultaneously from the NIR recording. The model performs slightly worse, with a determination coefficient of 0.71 and RMSEP of 13%. Despite continuous expansion of the datasets for multiple models, no better metrics were achieved, likely because of the heterogeneous structure of wood when scanning a solid-wood surface. Systematic deviations were observed in particularly low reference ranges, which may indicate non-linearity in the relationship between terpenes and the NIR signal.

Shedding Light on Hidden Methamphetamine Abuse: A Nation-wide 7-year Post-mortem Study in Taiwan.

The number of methamphetamine-related deaths has been increasing in recent decades. However, current data primarily rely on a few large-scale national surveys, highlighting the need for diverse data sources. Post-mortem studies offer advantages that compensate for the limitations of cohort studies. In this study, we aimed to (1) examine mortality rates and years of potential life lost, (2) compare proportionate mortality with previous cohort studies, and (3) quantitatively investigate causes of death as potential risk factors associated with each manner of death. We analyzed 740 cases from 2013 to 2019 in Taiwan. The mean age of cases was 38.4 years, with a notable loss of 30 or more years of potential life, and 79.6% were male. The crude mortality rate was 0.45 per 100,000 person-years. The proportionate mortality indicated that autopsy dataset, compared to cohort studies, provided more accurate estimations for accidental deaths, equivalent suicides, underestimated natural deaths, and overestimated homicides. Accidental deaths were evident in 67% of cases with 80% attributed to drug intoxication. Multiple substances were detected in 61% of cases, with psychiatric medications detected in 43% of cases. Higher methamphetamine concentrations and a greater proportion of multiple substances and benzodiazepines were detected in suicidal deaths. Among accidental deaths, traffic accidents (7.9%) were the second most common cause, particularly motorcycle riders. Using autopsy dataset as a secondary source, we identified that over half of the cases involved drug intoxication-related accidental deaths. The significant proportion of cases involving multiple substances, psychiatric medications, and drug-impaired driving raises concerns.

How machine learning algorithms can examine patterns in multiple substance addictions: predicting the effects and interactions of psychoactive substances

Addiction is a complex issue that involves various factors, including substance use and mental health conditions. Alcohol, opioids, tobacco, anxiety, depression, and insomnia are categories associated with it. The current literature often examines these categories separately, limiting the comprehensive understanding of their impact on addiction. This study examines the correlations between those categories, using five Machine Learning algorithms and Principal Component Analysis (PCA). By identifying patterns and correlations, an in-depth understanding of addiction dynamics is offered. Combining supervised and unsupervised techniques, we aim to bridge this gap and improve predictive modeling. PCA is used for dimensionality reduction, highlighting its direct impact on the effectiveness of our analysis. Hyperparameter tuning is performed to optimize the performance of the models, enhancing their predictive accuracy. This work contributes to the advancement of addiction research and has practical implications for clinical interventions, enabling healthcare providers to better predict and treat addiction.

Chemical leaching − Flexible precipitation for sustainable recovery of fluoride from aluminum electrolysis multisource hazardous waste

The spent carbon materials, including anode and cathode, generated from the aluminum electrolysis process contain high fluoride levels and are unavoidable hazardous solid wastes. Chemical leaching, as a promising strategy for large-scale industrial treatment, must address the challenge of secondary recovery of the solution. The co-recovery mechanism preparing various fluorides from acidic and alkaline fluoride-aluminum solutions was investigated. In this process, the F/Al molar ratio and the pH value of the substrate environment are critical factors for achieving synergistic recovery. Different acid and alkali adjustment modalities resulted in a diverse array of products. For instance, adding an alkali to an acid solution generated aluminum hydroxyfluoride hydrate, whereas the reverse sequence yielded cryolite. The precipitation mechanism of acidic solutions is characterized by a complex interplay of multiple substances, whereas the process in alkaline solutions is comparatively straightforward. Specifically, as the pH value increases, the sequence of phase transformations progresses through aluminum hydroxyfluoride hydrate, chiolite, aluminum hydroxide, and cryolite. In addition to pH, localized over-alkalinity was the primary factor contributing to impurity generation. The precipitation phase in an alkaline substrate environment is significantly better controlled. During this process, pure cryolite can be synthesized by adjusting the F/Al molar ratio to 6.0 using the neutralization solution. The synergistic synthesis of fluoride from both acidic and alkaline fluorine-containing solutions is not only feasible but also anticipated to effectively address the significant issues of water swelling and secondary solution recovery that are commonly encountered in industrial applications.

Microelimination of Hepatitis C in Patients with Substance Use and Dual Disorders - a Portuguese Study.

Chronic hepatitis C (CHC) is a serious condition of public health importance. In Portugal, the prevalence of detectable hepatitis C virus (HCV) antibodies is approximately 0.54%, with a higher prevalence in high-risk groups. Compared with the general population, the prevalence of HCV infection is higher in individuals with psychiatric disorders. As no studies have reported the prevalence of HCV antibodies in Portuguese patients with psychiatric conditions and substance use disorders, we conducted an observational, prospective study of patients followed in the Dual Pathology Outpatient and Inpatient Unit of Coimbra Hospital and University Center (CHUC), Patients were tested for HCV antibodies. Of the 149 patients, 17.4% were positive for HCV antibodies and 7.4% had detectable HCV RNA indicating CHC. Most patients with confirmed CHC were male inpatients, aged 50 to 59 years, and reported unprotected sex with more than one concurrent partner in the past 6 months. Their most common psychiatric diagnosis was "Disorders due to use of multiple specified psychoactive substances, including medications." The prevalence of HCV antibodies and confirmed CHC were higher in patients followed in the Dual Pathology Outpatient and Inpatient Unit than in the general Portuguese population.

Flavored Tobacco User Characteristics in U.S. young Adults: Wave 5 of the Population Assessment of Tobacco and Health Study

Introduction: Flavorings are one of the major appealing factors of current tobacco products, especially for young adults. They constantly evolve, and new flavorings are introduced to the market every year, but little is known about user profiles of flavored tobacco products (FTPs). Methods: We analyzed young adult (ages 18–24) tobacco product users (N = 4,707) from Wave 5 of the Population Assessment of Tobacco and Health Study. We applied bivariate analyses to compare individuals who use FTP and non-FTPs by different flavor types (i.e., menthol/mint, fruit, candy/sweets, and tobacco). Parameter estimates were weighted by applying the sample and replicate weights for the complex study design to produce population-representative estimates. Results: Sixty percent of the current combustible tobacco users and 90% of electronic nicotine delivery systems (ENDS) users were FTP users. FTP users were more likely to be multiple product users than non-FTP users. Being non-Hispanic White, drinking alcohol in the past year, experiencing internalizing problems in the past month, and having tobacco dependence were associated with FTP use. Flavored ENDS users had different sociodemographic characteristics by flavor types but did not differ significantly in vaping-related behaviors (e.g., frequency). Also, preferred flavors differed among tobacco user groups (i.e., ENDS, hookah, and cigars). Conclusions: FTPs appear to be gaining popularity among young adults and tend to show co-use with multiple tobacco products and other substances. Future studies are warranted to monitor the risk factors of young adult FTP use, especially in the context of flavor ban on ENDS products.

Authentication of indigenous Brazilian specialty canephora coffees using smartphone image analysis

The prevention of coffee fraud through the use of digital and intelligence-based technologies is an analytical challenge because depending on the adulterant, visual inspection is unreliable in roasted and ground coffee due to the similarity in color and texture of the materials used. In this work, a 3D-printed apparatus for smartphone image acquisiton is proposed. The digital images are used to authenticate the geographical origin of indigenous canephora coffees produced at Amazon region, Brazil, against canephora coffees from Espírito Santo, Brazil, and to capture the adulteration of indigenous samples. The results evidenced that the technology is favorable to identify the geographical origin and adulteration with multiple substances using smartphone technology. Pure coffees were adulterated with arabica coffee, spent coffee ground, low-quality Canephora coffee, coffee husks, açaí, corn, and soybean in increasing proportions of 10, 20, 30, 40, 50, 60, and 70 %. These adulterants were roasted and grounded similarly to Canephora coffees to mimetize a highly-sophisticated fraud. The images were converted into Red-Green-Blue (RGB) fingerprinting and used as analytical response to construct Data-Driven Soft Independent Modeling of Class Analogy (DD-SIMCA) models. A total of 95 % of all target and non-target samples in the test set were correctely identified, aiding producers and consumers in ensuring accurate labeling and supporting traditional communities economically and culturally. Smartphone-based method demonstrated potential to innovate the coffee safety control representing a new analytical tecnology.

High-sensitive electrochemical sensor based on Ni/NiCx-integrated functional carbon nanotubes for simultaneous determination of acetaminophen and dopamine

In complex environmental substance monitoring, the simultaneous detection of single and multiple substances with high sensitivity has been a research focus in the field of electrochemical sensors. Rational selection of appropriate dopants to optimize the electrode material is crucial in this regard. In this work, we employed a multi-doping strategy to effectively enhance the electrocatalytic performance of multi-walled carbon nanotubes (MWCNTs). By doping Ni/NiCx onto MWCNTs, we successfully constructed a heterojunction material (Ni/NiCx-N-MWCNTs). The successful doping of Ni/NiCx allows for the synergistic effects of multiple elements. Ni/NiCx serves as a conductive bridge, forming a three-dimensional network of nanotubes, which effectively reduces the aggregation of carbon nanotubes, exposes more active sites, and enhances electrocatalytic activity. The electrochemical sensor based on Ni/NiCx-N-MWCNTs demonstrated high sensitivity, selectivity, and simultaneous electrochemical detection for acetaminophen (1–150 μM, limit of detection (LOD)=0.56 μM) and dopamine (1–80.0 μM, LOD=0.19 μM). Its excellent reproducibility (relative standard deviation (RSD)=2.01 %) and interference resistance provide Ni/NiCx-N-MWCNTs with significant advantages over other electrode materials, indicating a promising application potential.

Extracorporeal membrane oxygenation in cardiovascular medication poisoning. A German-wide retrospective study

Medication poisoning, resulting from the ingestion of cardiotoxic drugs, presents a significant health issue. The mortality rate remains high for patients with myocardial dysfunction refractory to conventional treatments. Venoarterial Extracorporeal Membrane Oxygenation (V-A ECMO) provides temporary support, potentially enhancing patient outcomes. This study aims to assess the efficacy of V-A ECMO in treating cardiovascular failure induced by cardiovascular medication poisoning. We utilized inpatient data from all hospitalisations in Germany from 2007 to 2022 due to cardiovascular medication poisoning treated with V-A ECMO. Patient characteristics, comorbidities, complications and application of ECMO were described descriptively and analysed for statistical significance between survivors and non-survivors. Overall, 49 patients received V-A ECMO for cardiovascular medication poisoning, with a survival rate of 63.6%. The most ingested medications were calcium-channel blockers (38.8%) and beta-adrenoceptor antagonists (34.7%). Half of non-survivors received in-hospital CPR, compared to 12.9% of survivors. Early ECMO implantation (within 24 h of admission) was common (83.7%) but did not significantly impact survival rates. A substantial number of patients presented with multiple substances ingested. V-A ECMO represents a viable option for patients experiencing cardiac failure due to medication poisoning. A structured implementation of V-A ECMO for cardiovascular medication poisoning could lead to higher survival rates.

Male Predominance in West Virginia Unintentional Overdose Deaths is Influenced by Alcohol and Co-Intoxicants.

To examine sex differences in overdose (OD) mortality based upon substances involved. A retrospective database analysis of West Virginia OD decedents (12,666 unintentional OD deaths, 2005-early 2023). Exposures were substances judged to contribute to death. The main outcome measure was determination of male to female death ratios with varying co-intoxicant involvement, particularly related to alcohol and fentanyl. Secondary outcomes included associations of fentanyl concentrations with alcohol concentrations and male sex, including fentanyl (F) and inactive metabolite norfentanyl (N) concentration variability between sexes. Alcohol co-intoxication in OD deaths was associated with higher male:female death ratios, from 2.0 (alcohol absent) to 3.3 (alcohol present). There was a greater increase over time in alcohol involvement in recent deaths involving females compared to males (relative increases of 52% vs. 6%, respectively). Male:female ratios with alcohol and fentanyl co-involvement ranged from 5.9:1 (only two drugs involved) to 2.4:1 (= 5 substances), with females significantly more likely to have multiple substances contributing to death. Overall, males had statistically significantly larger fentanyl (F) to norfentanyl (N) median concentration ratios compared to females (8.8 vs. 6.9, respectively). Multivariable analyses found alcohol presence was associated with a statistically significant 22% reduction in predicted fentanyl concentrations. Male:female ratios in unintentional OD deaths were higher with greater alcohol involvement and lower with fewer co-intoxicants. Fentanyl and norfentanyl concentration differences by sex were observed. It is important to determine possible contributors to sex differences in OD death rates to better target prevention and treatment initiatives.