Urine Drug Research Articles

Analytical and Clinical Performance Evaluation of ARK Fentanyl II Assay on Beckman Coulter AU System

Abstract Introduction/Objective Drugs of abuse, specifically opioids, have been in recent years an important focus in both medicine and media due to the ‘opioid epidemic’ and large numbers of overdose deaths. Synthetic opioids such as fentanyl have contributed to this epidemic. The CDC reports that of roughly 50,000 opioid overdose deaths in 2019, nearly 73% were due to synthetic opioids. The objective of this study is to assess the analytical and clinical performance of the Fentanyl II Assay by ARK Diagnostics, Inc. Methods/Case Report Fentanyl was qualitatively determined by the ARK Fentanyl II Assay, a homogenous enzyme immunoassay based on competition between drug in the specimen and drug labeled with recombinant glucose-6- phosphate dehydrogenase (rG6PDH) for antibody binding sites. The presence of drug in urine increases enzyme activity, which converts nicotinamide adenine dinucleotide (NAD) to NADH in the presence of glucose-6-phosphate, resulting in an absorbance change measured by spectrophotometry. The evaluation was performed following CLSI guidelines. The analytical performance was evaluated for accuracy and precision. Results (if a Case Study enter NA) To evaluate the accuracy, twelve positive and eight negative specimens were tested by the ARK immunoassay performed on two Beckman Coulter instruments (AU480 and AU680) and by LC- MS/MS. The results from both instruments showed 100% agreement with the results from LC-MS/MS. On instrument AU480, the within-run CVs were 18.0% at the level of 22.510 ng/mL and 0.8% at the level of 552.628 ng/mL. The between-run CVs were 8.8% at the level of 68.928 ng/mL and 3.7% at the level of 158.947 ng/mL. On instrument AU680, the within-run CVs were 273.4% at the level of 1.052 ng/mL and 0.8% at the level of 523.788 ng/mL. The between-run CVs were 7.8% at the level of 53.779 ng/mL and 3.1% at the level of 145.263 ng/mL. In May 2021, 2,075 fentanyl assays were run at UAB. Of those, 476 returned a positive result with a positive rate of 22.9%, and 1,599 were negative with a negative rate of 77.1%. One positive result was confirmed by LC-MS/MS as negative for fentanyl but positive for norfentanyl, a metabolite of fentanyl. The clinical specificity was 99.9% and sensitivity was 100%. Conclusion In Conclusion, the ARK fentanyl Assay II on Beckman Coulter AU system has good accuracy, sensitivity and specificity. The precision at medium and high levels are good. However, the precision at low level needs to be improved.

VERIFIKASI METODE ANALISIS METAMFETAMINA DAN AMFETAMINA DALAM MATRIKS URIN SECARA AUTOMATISASI DENGAN GERSTEL® DISPOSABLE PIPETTE EXTRACTION (DPX) MULTIPURPOSE SAMPLER (MPS)


 
 
 
 Method analytical validation and verification is crucial in routine qualitative and quantitative analysis. Analysis laboratory need objective evidences about specific parameters in their drugs/analytes or drugs metabolites in matrices biology. Urine is the most preferable matrix biology for determining drugs metabolites especially in drug abuses cases because urine’s sampling process is not invasive. There are many methods extracting drugs in urine, especially methamphetamine and amphetamine as those two analytes are excreted via urine. This study presented method verification for determination of methamphetamine and amphetamine in urine using Gerstel® automated Disposable Pipette Extraction (DPX) Multipurpose Sampler (MPS). Result of this study showed that retention time of methamphetamine is in minute 6.21, and amphetamine is in minute 3.15. Methampethamine’s curve displayed a coefficient of determination r2=0,9999 with the equation y=170,19x+33183. The equation of amphetamine showed y=44390x – 17513 with coefficient of determination r2= 0,9974. Limit of detection (LOD) of methamphetamine in urine is 59,73 ppb, and LOD of amphetamine is 36 ppb.
 
 
 

P130 An audit of urinary drug screening use in multiple sleep latency and maintenance of wakefulness testing in an Australian tertiary centre

Abstract Multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT) are objective measures of excessive daytime sleepiness, used in diagnosing and monitoring patients with sleep disorders. MSLT and MWT can be affected by substances such as psychotropics, stimulants, opioids and sedatives. Recent studies demonstrate high prevalence of positive urine drug screening (UDS) results in patients undergoing MSLT and MWT. We retrospectively audited patients who underwent UDS with MSLT/MWT at a tertiary centre from 1st January 2019 to 1st January 2020. The following data was collected: MSLT/MWT/UDS results, sleep disorder diagnosis/es, return to driving/work after testing and pre-existing and subsequent prescription of stimulants/wakefulness-promoting agents/psychotropics/sodium oxybate. Our cohort featured 32 patients (23 female). 29 MSLTs and 3 MWTs were performed. Median age was 31 years old. 13 patients were on wakefulness-promoting agents/psychotropics when tested, where 8 were on serotonin–norepinephrine reuptake inhibitors/selective serotonin reuptake inhibitors. 13 patients (~45%) had a reduced mean sleep latency (MSL), where 10 minutes was used as the cut-off. All 3 MWTs were within normal limits. 5 patients (~16%) had a positive UDS. 1 patient had a low MSL and tested positive for cannabinoids and opioids. The other 4 patients with normal MSL tested positive for benzodiazepines (2), cannabinoids (1) and opioids (1). All patients were cleared for work and 85% of patients who had a low MSL returned to work during follow-up. The rate of positive UDS in patients undergoing MSLT/MWT was comparable to existing publications and re-emphasizes the relevance of mandating UDS prior to MSLT/MWT.

Development of a chemosensor probe based on functionalised poly[β-(1→4)-2-amino-2-deoxy-D-glucopyranose]-cobalt nanoparticles for the selective detection of flunitrazepam

ABSTRACT Flunitrazepam abuse as ‘date-rape’ drug is on the increase. A colorimetric probe was developed by grafting cobalt nanoparticles (CoNPs) onto poly[β-(1→4)-2-amino-2-deoxy-D-glucopyranose] functionalized thymol blue (CFTB) backbone for the detection of flunitrazepam drug in human urine (ex-situ). Studies revealed an interaction between CFTB and Co with the formation of a five-membered ring chelated compound (FTIR), while high thermal stability properties were displayed by CFTB-CoNPs without any change in the composition of the material (TGA). The distribution of CoNPs showed an irregular spherical pore deposited on the surface of CFTB (SEM) in the dimension of 100 nm (TEM). The interaction between the CFTB-CoNPs probe and the flunitrazepam was due to ionic bonding between the protonated amine group in the biopolymer and the fluoro group of flunitrazepam. The highly selective and sensitive CFTB-CoNPs probe was able to detect at 1.00µg/L with an instant and distinct colour change from wine to orange.

Determination of multiple drugs of abuse in human urine using dispersive liquid–liquid microextraction and capillary electrophoresis with PDA detection

A new method was developed for pre-concentration and determination of multiple drugs of abuse in human urine using dispersive liquid–liquid microextraction (DLLME) and capillary electrophoresis (CE) with photodiode array detection. The method was based on the formation of tiny droplets of an organic extractant in the prepared sample solution using water-immiscible organic solvent (chloroform) dissolved in water-miscible organic dispersive solvent (isopropyl alcohol). The organic phase, which extracted eight drugs of abuse from the prepared urine solution, was separated by centrifugation. The sedimented phase was transferred into a small volume CE auto-sampler vial with 10 µL of 1% HCl methanol solution and evaporated to dryness. The residue was reconstituted in lidocaine hydrochloride (internal standard) aqueous solution and introduced by electrokinetic injection into CE. Under the optimum conditions, acceptable linear relationship was observed in the range of 3.0–500 ng/mL with the correlation coefficient ( r ) of 0.9982–0.9994 for spiked urine samples. The limit of detection (LOD) (S/N = 3) was estimated to be 1.0 ng/mL. A recovery of 75.7%–90.6% was obtained for spiked samples. The mean relative error (MRE) was within ±7.0% and the relative standard deviation (RSD) was less than 6.9%. The proposed DLLME-CE procedure offers an alternative analytical approach for the sensitive detection of drugs of abuse in real urine samples. Key points: The dispersive liquid-liquid microextraction (DLLME) was involved for the determination of drugs in urine with capillary electrophoresis with photodiode array detection (CE-PDA). Good linearity, sensitivity, recovery and precision were achieved. The proposed method was eco-friendly with microliter scale solvent consumption.

Self-Reported Medication Use and Urinary Drug Metabolites in the German Chronic Kidney Disease (GCKD) Study.

Polypharmacy is common among patients with CKD, but little is known about the urinary excretion of many drugs and their metabolites among patients with CKD. To evaluate self-reported medication use in relation to urine drug metabolite levels in a large cohort of patients with CKD, the German Chronic Kidney Disease study, we ascertained self-reported use of 158 substances and 41 medication groups, and coded active ingredients according to the Anatomical Therapeutic Chemical Classification System. We used a nontargeted mass spectrometry-based approach to quantify metabolites in urine; calculated specificity, sensitivity, and accuracy of medication use and corresponding metabolite measurements; and used multivariable regression models to evaluate associations and prescription patterns. Among 4885 participants, there were 108 medication-drug metabolite pairs on the basis of reported medication use and 78 drug metabolites. Accuracy was excellent for measurements of 36 individual substances in which the unchanged drug was measured in urine (median, 98.5%; range, 61.1%-100%). For 66 pairs of substances and their related drug metabolites, median measurement-based specificity and sensitivity were 99.2% (range, 84.0%-100%) and 71.7% (range, 1.2%-100%), respectively. Commonly prescribed medications for hypertension and cardiovascular risk reduction-including angiotensin II receptor blockers, calcium channel blockers, and metoprolol-showed high sensitivity and specificity. Although self-reported use of prescribed analgesics (acetaminophen, ibuprofen) was <3% each, drug metabolite levels indicated higher usage (acetaminophen, 10%-26%; ibuprofen, 10%-18%). This comprehensive screen of associations between urine drug metabolite levels and self-reported medication use supports the use of pharmacometabolomics to assess medication adherence and prescription patterns in persons with CKD, and indicates under-reported use of medications available over the counter, such as analgesics.

Are glucocorticoids or NSAIDs effective in idiopathic feline urinary tract disease signs than no treatment or placebo?

PICO question&#x0D; In cats with idiopathic feline urinary tract disease (FLUTD), are glucocorticoid or non-steroidal anti-inflammatory drugs more effective than placebo or no treatment in reducing clinical signs attributable to cystitis?&#x0D; &#x0D; Clinical bottom line&#x0D; Category of research question&#x0D; Treatment&#x0D; The number and type of study designs reviewed&#x0D; Three randomised controlled trials have examined the efficacy of prednisolone or non-steroidal anti-inflammatory drugs (NSAIDs) in reducing the clinical signs of feline lower urinary tract disease compared to a placebo whilst one retrospective cohort study compared the reoccurrence of FLUTD in cats treated with meloxicam and without meloxicam&#x0D; Strength of evidence&#x0D; Weak&#x0D; Outcomes reported&#x0D; One small controlled trial compared prednisolone to a placebo and found no clinical differences in dysuria, microscopic haematuria, and occult blood for cats diagnosed with idiopathic non-obstructive feline lower urinary tract disease (FLUTD) hospitalised for 10 days. The study however had a very small sample size. Furthermore, the external validity of the study to similar patients discharged to their home environment is unclear.&#x0D; The second small controlled trial compared meloxicam to a placebo in cats diagnosed with obstructive FLUTD. Statistical analysis was applied to determine if there were significant differences in voiding behaviour, general demeanour, haematuria, food intake and abdominal pain as assessed by the veterinarians in charge during hospitalisation and owners at discharge. No statistically significant differences (P&gt;0.05) were calculated between the two treatment groups based on the owner questionnaire and veterinarian assessment but small samples in each treatment probably limited statistical power.&#x0D; The third small controlled trial compared the reoccurrence of feline idiopathic cystitis (FIC), related clinical signs and recurrent urinary obstruction in cats at 10 days, 1, 2 and 6 months after discharge when treated with phenoxybenzamine and alprazolam, with or without the addition of meloxicam. No statistically significant differences were found in the reoccurrence of obstructed or non-obstructed FIC for cats treated with either meloxicam or no meloxicam. However, full details of each intervention group were not sufficient to assess for balance of prognostic factors, subjective scoring of clinical signs was not detailed, and the study was underpowered for the actual obstruction rates reported.&#x0D; The fourth paper was a retrospective cohort study that examined the association of different treatment factors with 30 days reobstruction. The study found no significant association between the use of meloxicam and the rate of reobstruction but a number of confounders were present&#x0D; Conclusion&#x0D; Three small randomised controlled trials and a single retrospective cohort study failed to find a significant association between the use of glucocorticoids or NSAIDs with severity of FLUTD clinical signs or risk of reobstruction. Clinical outcome measures were heterogeneous and studies were significantly underpowered and/or at risk for bias and/or confounding. There is insufficient evidence to recommend the use of either drug category in decreasing time to resolution or severity of clinical signs in cases of idiopathic FLUTD or FIC&#x0D; &#x0D; How to apply this evidence in practice&#x0D; The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.&#x0D; Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.&#x0D; &#x0D;

Dispersive solid-phase extraction for simultaneous determination of four amphetamines drugs in urine using gas chromatography–mass spectrometry

Dispersive solid-phase extraction for simultaneous determination of four amphetamines drugs in urine using gas chromatography–mass spectrometry

Rapid Formation of Nanoclusters for Detection of Drugs in Urine Using Surface-Enhanced Raman Spectroscopy.

We developed a method based on surface-enhanced Raman spectroscopy (SERS) and a sample pretreatment process for rapid, sensitive, reproducible, multiplexed, and low-cost detection of illegal drugs in urine. The abuse of new psychoactive substances (NPS) has become an increasingly serious problem in many countries. However, immunoassay-based screening kits for NPS are usually not available because of the lack of corresponding antibodies. SERS has a great potential for rapid detection of NPS because it can simultaneously detect multiple kinds of drugs without the use of antibodies. To achieve highly sensitive SERS detection of drugs, sodium bromide was first employed to induce the rapid formation of Ag nanoclusters by aggregating silver nanoparticles (AgNPs) in the extracted sample solution. SERS measurements were performed immediately after the sample pretreatment without incubation. The three-dimensional SERS hot spots were believed to form significantly within the nanoclusters, providing strong SERS enhancement effects. The displacement of citrate molecules on the surfaces of the AgNPs by bromide ions helped increase the adsorption of drug molecules, increasing their areal density. We demonstrated the simultaneous detection of two kinds of NPS, methcathinone and 4-methylmethcathinone, in urine at a concentration as low as 0.01 ppm.

Preliminary Evidence for Cannabis and Nicotine Urinary Metabolites as Predictors of Verbal Memory Performance and Learning Among Young Adults.

Verbal memory deficits are linked to cannabis use. However, self-reported episodic use does not allow for assessment of variance from other factors (e.g., cannabis potency, route of consumption) that are important for assessing brain-behavior relationships. Further, co-occurring nicotine use may moderate the influence of cannabis on cognition. Here we utilized objective urinary measurements to assess the relationship between metabolites of cannabis, 11-nor-9-carboxy-∆9-tetrahydrocannabinol (THCCOOH), and nicotine (cotinine) on verbal memory in young adults. Adolescents and young adults (n = 103) aged 16-22 completed urinary drug testing and verbal memory assessment (RAVLT). Linear regressions examined the influence of THCCOOH and cotinine quantitative concentrations, and their interaction, on RAVLT scores, controlling for demographics and alcohol. Cannabis intake frequency was also investigated. Secondary analyses examined whether past month or recency of use related to performance, while controlling for THCCOOH and cotinine concentrations. THCCOOH concentration related to both poorer total learning and long delay recall. Cotinine concentration related to poorer short delay recall. Higher frequency cannabis use status was associated with poorer initial learning and poorer short delay. When comparing to self-report, THCCOOH and cotinine concentrations were negatively related to learning and memory performance, while self-report was not. Results confirm the negative relationship between verbal memory and cannabis use, extending findings with objective urinary THCCOOH, and cotinine concentration measurements. No moderating relationship with nicotine was found, though cotinine concentration independently associated with negative short delay performance. Findings support the use of both urinary and self-report metrics as complementary methods in substance use research.

MM-013 Phase 2, Multicenter Study of Pomalidomide (POM) Plus Low-Dose Dexamethasone (LoDEX) in Patients (pts) with Relapsed/Refractory Multiple Myeloma (RRMM) and Renal Impairment (RI): Pharmacokinetics (PK) Analysis

MM-013 Phase 2, Multicenter Study of Pomalidomide (POM) Plus Low-Dose Dexamethasone (LoDEX) in Patients (pts) with Relapsed/Refractory Multiple Myeloma (RRMM) and Renal Impairment (RI): Pharmacokinetics (PK) Analysis

The prevalence of constipation and its relation to sweet taste preference among patients receiving methadone maintenance treatment

BackgroundPreference for sweet-tasting foods, weight gain, and constipation characterize patients receiving methadone maintenance treatment (MMT). The prevalence of constipation in MMT and its relation to preference for sweet taste and body mass index (BMI) are undetermined. MethodsA random sample of 83 patients was interviewed for constipation with the Patient Assessment Constipation Quality of Life (PAC-QOL) questionnaire. They rated taste intensity and reward of sweet, salty, and sour solutions by means of a nine-point Likert scale. Data on their BMI, drugs in urine, methadone dose, and serum levels were analyzed. ResultsForty-two patients reported minimum to severe constipation. They characterized as having longer durations of opioid usage before MMT and worse sleep quality than non-constipated patients (logistic regression). Constipation intensity was inversely correlated with duration in MMT and linearly correlated with the Patient Assessment Constipation Quality of Life score. Patients with constipation rated reward to sweet taste significantly higher with no differences in taste intensity compared to non-constipated patients. Patients with high methadone serum levels (≥750 ng/mL) rated taste intensity significantly lower compared to those with normal methadone serum levels (<750 ng/mL), and the lowest rates were reported among patients with no constipation and high methadone serum levels. ConclusionsConstipation was highly prevalent among MMT patients and associated with poor sleep and lower quality of life. The relation to preference for sweets, as reflected by higher reward rating, strongly supports the need for nutritional intervention to alleviate constipation symptoms and improve quality of life and sleep.

Prevalence of Urinary Tract Infection and Drug Resistance among Infants and Children in Pakistan

In infancy most common and a serious disease is known as Urinary tract infection (UTI). The aim of the current study is to evaluate the frequency and antibiotic resistant among infant presenting with UTI in Lahore General hospital, Lahore-Pakistan. The current observational study comprised 100 (n=100) cases diagnosed with UTI. The study was conducted at Lahore General Hospital, Pakistan, between March 2019 and January 2020. Data were collected and recorded on specified proformas that had information on demographics, biochemical analysis, and complaints, as well as the antibiotic used and blood cultures. The most common gram-negative bacilli (GNB) causing UTI was E. coli constitute about 72% followed by Klebsiella (11%), Enterobacter (7%) and Enterococcus (4%). Most of the isolated pathogens are highly resistant to ampicillin, cotrimoxazole, and cephalexin (72%–95%), have intermediate sensitivity to third- generation cephalosporins, and high sensitivity to amikacin, nitrofurantoin and ciprofloxacin. Similarly, the other pathogens showed different degree of occurrence and resistance against empirically used antibiotics. The most prevalent UTI causative organism among children was E. coli. The insulated microorganisms were highly resistant to ampicillin, and highly sensitive to amikacin.

The Negative Impact of Maternal Perinatal Opioid Use on Neonatal Outcomes.

Objective: To compare outcomes among newborns of opioid-using and nonopioid drug-using mothers with those of control mothers who did not report substance use.Methods: Using the Rochester Epidemiology Project, newborns diagnosed with drug withdrawal syndrome (per ICD-9 or ICD-10 codes) from January 2010 through June 2017 were identified. For mothers, data collected included age, race, drug use, number of prenatal visits, and results of the urinary drug abuse survey, meconium test, and self-report survey. Demographic and perinatal data collected for newborns included birth date; sex; Apgar scores at 1, 5, and 10 minutes; neonatal intensive care stay; and vital status. Controls (n = 771) were similarly selected in regard to sex, birth date, and county.Results: Of 328 infants identified, 168 were born with opioid neonatal abstinence syndrome and 160 with a nonopioid withdrawal syndrome. Control mothers had more prenatal visits than mothers in the nonopioid and opioid groups. Newborns of control mothers had higher Apgar scores at 1 and 5 minutes than both substance-using groups. Opioid-using mothers were almost twice as likely to have newborns requiring intensive care and 3 times as likely to use benzodiazepines compared to the other substance-using mothers. Substance-using mothers had more premature babies than controls.Conclusions: Prenatal opioid use is a substantial risk factor for prematurity. Newborns diagnosed with neonatal abstinence syndrome are at risk of perinatal complications. Mothers using opioids during pregnancy also tend to use other substances. Longitudinal research should clarify how prenatal substance use interacts with other risk factors during a child's first years.

Profiling Delirium Progression in Elderly Patients via Continuous-Time Markov Multi-State Transition Models.

Poor recognition of delirium among hospitalized elderlies is a typical challenge for health care professionals. Considering methodological insufficiency for assessing time-varying diseases, a continuous-time Markov multi-state transition model (CTMMTM) was used to investigate delirium evolution in elderly patients. This is a longitudinal observational study performed in September 2016 in an Italian hospital. Change of delirium states was modeled according to the 4AT score. A Cox model (CM) and a CTMMTM were used for identifying factors affecting delirium onset both with a two-state and three-state model. In this study, 78 patients were enrolled and evaluated for 5 days. Both the CM and the CTMMTM show that urine catheter (UC), aging, drugs, and invasive devices (ID) are risk factors for delirium onset. The CTMMTM model shows that transition from no-delirium/cognitive impairment to delirium was associated with aging (HR = 1.14; 95%CI, 1.05, 1.23) and neuroleptics (HR = 4.3; 1.57, 11.77), dopaminergic drugs (HR = 3.89; 1.2, 12.6), UC (HR = 2.92; 1.09, 7.79) and ID (HR = 1.67; 103, 2.71). These results are confirmed by the multivariable model. Aging, ID, antibiotics, drugs affecting the central nervous system, and absence of moving ability are identified as the significant predictors of delirium. Additionally, it seems that modeling with CTMMTM may show associations that are not directly detectable with the traditional CM.

Population Pharmacokinetic Analysis of Rivipansel in Healthy Subjects and Subjects with Sickle Cell Disease.

BackgroundSickle cell disease is an inherited blood disorder with reduced blood-carrying capacity. It is associated with a tendency to form microclots in blood vessels, leading to painful episodes known as a vaso-occlusive crisis. Rivipansel is a pan-selectin inhibitor being studied for the treatment of a vaso-occlusive crisis in patients with sickle cell disease.MethodsA population pharmacokinetic model of rivipansel plasma and urine concentrations was constructed using a two-compartment model and data from nine different clinical studies. Creatinine clearance was calculated using the Schwartz formula for children and the Chronic Kidney Disease Epidemiology Collaboration formula for adults. Urine volume and concentration of the study drug in urine from subjects in five clinical studies were used to estimate renal and nonrenal clearance.ResultsRivipansel drug concentrations were well described by the model. The post hoc estimates of average steady-state concentrations were predicted to be similar for the adult and pediatric cohorts of the pivotal phase III study. Parameter estimates showed almost exclusively renal excretion of rivipansel, which is consistent with the known properties of the drug.ConclusionsThe pharmacokinetics of rivipansel was well characterized by a two-compartment population pharmacokinetic model. Our results illustrate the important role of simulations in optimizing a potential drug dosing regimen for patients with sickle cell disease and progressive renal impairment.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40268-021-00346-3.

Iron and cobalt-containing magnetic ionic liquids for dispersive micro-solid phase extraction coupled with HPLC-DAD for the preconcentration and quantification of carbamazepine drug in urine and environmental water samples

The pollution of water bodies by pharmaceutical drugs has been on the increase in recent times. Because, their presence is in trace amount, their detection is very difficult. In this study, a simple, efficient, and sensitive method was developed based on dispersive micro-solid phase extraction coupled with high-performance liquid chromatography for the detection and preconcentration of carbamazepine drug, an anticonvulsant medication, in human urine and wastewater samples using magnetic ionic liquids, (Z)-octadec-9-en-1-aminium tetrachloroferrate (III) and (Z)-octadec-9-en-1-aminium trichlorocobaltate (II) as sorbents at room temperature. The MILs were characterized by several techniques such as proton nuclear magnetic resonance, Fourier-transform infrared spectroscopy, electron paramagnetic resonance, scanning electron microscopy, thermogravimetric analysis, Raman spectroscopy, and Zeta potential. Major factors influencing extraction efficiency such as pH, amount of sorbent, extraction time, desorption time, elution solvent, elution solvent volume, and ionic strength have been optimized. The method showed excellent performance. The linearity range of 1–1000 μg/L was obtained with a correlation coefficient of 0.9989, relative standard deviation for intra-day and inter-day was found to be 0.4 and 2.1% respectively. The limit of detection recorded was 0.51 μg/L. The real sample applicability of the method has been evaluated on human urine and wastewater samples.

The impact of creatinine reference value: Normalization of urinary drug concentrations.

Many illicit drug users attempt to manipulate urine drug testing; dilution is one of the methods. In screening tests, false-negative results below the cut-off values can create positive results after creatinine normalization. This study aimed to evaluate the impact of a creatinine reference value on the normalization of the drug concentration in diluted urine. The study focused on 25630 cases and the following information: gender, age, urine collection time, drug screening test results, creatinine concentration (CR), and confirmation analysis result. Mean CR value was 143.71±83.68mg/dl. There was a significant difference between CR and gender (p=0.03). The mean CR for women was lower than that for men. The correlation between age and CR was not significant (r=-0.08, p=0.00). However, after grouping the sample into age groups of 10years, there was a significant difference between age groups and mean CR (p=0.00). The mean CR was significantly lower in the 0-9year age group (n=34) than in the 20-29year age group (n=10943). According to the urine specimen collection time, CR levels during the early hours of the day (06:00-06:59) were lower than those during the remaining hours (p=0.00). The highest converted drug-negative to drug-positive results were obtained from 153.23mg/dl CR reference value. Reference CR values were evaluated according to gender, age, and urine collection time. Different rates of positive results were obtained for each reference value. There is no published local creatinine value for spot urine samples in many countries, including Turkey. This will be useful to develop appropriate normalization models when reporting drug test results.

Urinary drug metabolite testing in chronic heart failure patients indicates high levels of adherence with life-prolonging therapies.

AimsDespite medical therapy for heart failure (HF) having proven benefits of improving quality of life and survival, many patients remain under‐treated. This may be due to a combination of under‐prescription by medical professionals and poor adherence from patients. In HF, as with many other chronic diseases, adherence to medication can deteriorate over time particularly when symptoms are well controlled. Therefore, detecting and addressing non‐adherence has a crucial role in the management of HF. Significant flaws and inaccuracies exist in the methods currently used to assess adherence such as patient reporting, pill counts, and pharmacy fill records. We aim to use high‐performance liquid chromatography–tandem mass spectrometry (HPLC‐MS) to detect metabolites of HF medications in the urine samples of chronic HF patients.Methods and resultsUrine samples were collected from 35 patients in a specialist HF clinic. Patients were included if they had an ejection fraction <45% and were taking at least two disease‐modifying HF medications. They were excluded if they had been admitted to hospital for HF in the 3 months preceding clinic attendance. These samples were sent for HPLC‐MS and tested for all HF medications prescribed for that patient. A high rate of complete adherence of 89% was detected in these patients, with 94% being partially adherent (at least one HF medication detected) to therapy (at least one HF medication detected). This analysis also highlighted that mineralocorticoid antagonists represent both the most under‐prescribed (67%) and poorly adhered (75%) medication class.ConclusionsThis analysis revealed a surprisingly high level of adherence to disease‐modifying therapy in chronic HF patients and highlights that most of our ‘total’ under‐treatment is likely to be from a failure to prescribe rather than a failure to adhere. Testing for metabolites of disease‐modifying HF drugs in urine using HPLC‐MS is feasible and is a useful adjunct to a specialist HF service. At present, the distinction between treatment failure and failure to take treatment is not always clear, which is important because the investigation and potential solutions are different. The former needs initiation of additional therapies and consideration of additional diagnoses, whereas the latter requires strategies to understand reasons underlying poor adherence and collaborative working to improve this: the wrong strategy will be ineffective.

Multiple drug resistance bacterial isolates and associated factors among urinary stone patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

BackgroundThe urinary stone and urinary tract infection (UTI) are invariably associated and are frequent causes of morbidity. Date on burden of UTI among urinary stone patients is lacking in Ethiopia. This study was aimed to assess bacterial profile, antimicrobial susceptibility and associated factors among urinary stone patients at the University of Gondar Comprehensive Specialized Hospital.MethodsAn institution based cross sectional study was conducted. Basic sociodemographic data were collected using a structured questionnaire. Bacterial identification of uropathogens and drug susceptibility testing were done following standard microbiological techniques. The data were entered and analyzed using SPSS version-23. Bivariate and multivariate logistic regressions were used to identify possible associated risk factors. Results with P value < 0.05 was considered statistically significant.ResultA total of 300 urinary stone patients were enrolled. Of these, 153 (51%) were male and 261(87%) were urban residents. The overall prevalence of urinary tract infection was 49 (16.3%) (95% CI 12–21%). A high level of resistance was observed to ampicillin, penicillin and trimethoprim-sulfamethoxazole while majority of isolates were most sensitive to nitrofurantoin and ciprofloxacin. Multi-drug resistant isolates were 16/49 (32.7%), 75% of them being Enterobacteriaceae isolates. More than one-third 9/26 (34.6%) of Gram-negative isolates were Extended Spectrum Beta-Lactamase (ESBL) producing E. coli and K. pneumoniae. Being female, history of urinary tract infection and history of drug use were the independent risk factors.ConclusionMost of the bacterial isolates from urinary stone patients were resistant to ampicillin, penicillin and trimethoprim-sulfamethoxazole. E. coli and K. pneumoniae were the most common extended spectrum beta-lactamase producing isolates. Sex, history of urinary tract infection and previous drug use were found to be risk factors. Routine diagnosis of urinary stone patients for urinary tract infection should be promoted and further researches are encouraged.