Clinical testing for ketamine: How it inspires the need to develop emerging drugs-of-abuse analysis in a clinical laboratory

Ketamine ◽  
2015 ◽  
pp. 356-403
Keyword(s):  
Drugs Of Abuse ◽  
Clinical Laboratory ◽  
Clinical Testing

Single-pH Extraction Procedure for Detecting Drugs of Abuse

1974 ◽  
Vol 20 (2) ◽  
pp. 309-311 ◽  
Author(s):  
Ramon E Stoner ◽  
Connie Parker
Keyword(s):  
Thin Layer ◽  
Thin Layer Chromatography ◽  
Drugs Of Abuse ◽  
Clinical Laboratory ◽  
Extraction Procedure ◽  
Organic Salt ◽  
Basic Drugs ◽  
Laboratory Service ◽  
The Individual ◽  
Layer Chromatography

Abstract A method is presented for determining certain drugs of abuse in a single extract of urine. The urine sample is adjusted to pH 6.0 with a buffer containing bromcresol purple. Basic drugs, such as amphetamines and narcotics, form an organic salt with the ionized bromcresol purple, which is extractable with a mixture of chloroform and 2-propanol (3:1 by volume). At pH 6.0, weak acids such as barbiturates and neutral drugs such as glutethimide are also soluble in this solvent. Consequently, the major classes of drugs are extracted simultaneously. The extract is then concentrated and the individual drugs are determined by thin-layer chromatography in a solvent that will separate bromcresol purple from the drugs. Additional Keyphrases: drug screening #{ 149} toxicology #{ 149} thin-layer chromatography #{ 149} screening procedure Clinical Laboratory Service, West Side VA Hosp., 820 S. Damen Ave., Chicago, Ill. 60612.

Cobas Integra: clinical laboratory instrument with continuous and random-access capabilities

1995 ◽  
Vol 41 (12) ◽  
pp. 1751-1760 ◽  
Author(s):  
S M Palmer ◽  
R A Kaufman ◽  
S J Salamone ◽  
J Blake-Courtney ◽  
W Bette ◽  
...  
Keyword(s):  
Drugs Of Abuse ◽  
Clinical Laboratory ◽  
Random Access ◽  
Diagnostic Systems ◽  
Therapeutic Drugs ◽  
Specific Proteins ◽  
Assay Precision ◽  
Laboratory Analyzer ◽  
Specific Reagent ◽  
Good Agreement

Abstract The Cobas Integra from Roche Diagnostic Systems is a new clinical laboratory analyzer with continuous and random-access features for routine chemistries, specific proteins, electrolytes, hormones, therapeutic drugs, and drugs of abuse. The system maintains 68 test-specific reagent cassettes on board, along with multiple ion-selective electrodes (ISEs) for electrolyte determinations. This gives the Cobas Integra the capability of analyzing as many as 72 analytes without having to load additional reagents. We describe the basic analyzer configuration and the subsystems for absorbance, fluorescence polarization, and ISE measurements. Performance characteristics for precision, methods comparison, and on-board stability are given for assays representative of the various test groups. The 29 Cobas Integra tests evaluated in the present study show good agreement (r > or = 0.98 and slopes generally 0.90 to 1.12) with the respective methods available on either the Olympus AU5000, Hitachi 911 or 717, Behring BNA, or Abbott TDx systems. Total assay precision (CV) ranged from 0.8% to 8.5%, and calibration curves were stable for as long as 20 weeks. Test throughput, which is dependent on pipetting sequence, was determined to be up to 600 tests per hour without ISE and up to 750 tests per hour with ISE; the time to first result was 2.0-10.0 min.

scholarly journals 9-year review of new psychoactive substance use in Hong Kong: A clinical laboratory perspective

2018 ◽  
Vol 26 (3) ◽  
pp. 179-185 ◽  
Author(s):  
Magdalene HY Tang ◽  
LY Hung ◽  
CK Lai ◽  
CK Ching ◽  
Tony Wing Lai Mak
Keyword(s):  
Substance Use ◽  
Clinical Features ◽  
Drugs Of Abuse ◽  
Clinical Laboratory ◽  
Demographic Data ◽  
New Psychoactive Substances ◽  
Psychoactive Substance ◽  
Psychoactive Substances ◽  
New Psychoactive Substance ◽  
Psychoactive Substance Use

Background: New psychoactive substances are constantly evolving structural analogues of traditional drugs of abuse that have become a threat to public health worldwide and within our locality. An understanding of the local pattern of new psychoactive substance use will help guide frontline clinical management. Objectives: This study was conducted to review the new psychoactive substances detected in cases referred to the authors’ laboratory (a tertiary clinical toxicology centre), as well as the associated clinical features and toxicological findings. Methods: All cases referred to the laboratory for toxicology analysis between January 2009 and December 2017, and which were analytically confirmed to involve new psychoactive substance use, were retrospectively reviewed. Demographic data, clinical features and toxicology findings were studied. Results: A total of 111 cases involving 104 patients and 22 types of new psychoactive substances were identified, with an increasing trend in the number of cases and subclass of new psychoactive substances detected. Up to half of the cases (n = 64) were related to the use of 2-phenyl-2-(ethylamino)-cyclohexanone (2-oxo-PCE, a ketamine analogue); other new psychoactive substances detected included para-methoxymethamphetamine, 4-fluoroamphetamine, phenazepam, 3-trifluoromethylphenylpiperazine, 5-methoxy-diisopropyltryptamine, 2-diphenylmethylpyrrolidine, methoxyphenidine, the N-methoxybenzyl drugs, cathinones, synthetic cannabinoids and opioids. Among the acute poisoning cases attributable to new psychoactive substance use, the severity was fatal (n = 3), severe (n = 17), moderate (n = 67) and minor (n = 17). And 11 patients required intensive care unit admission. All three fatal cases were associated with para-methoxymethamphetamine use. Conclusion: A rising trend of new psychoactive substance use is observed locally, which is associated with considerable morbidity and mortality. Continued vigilance from frontline clinicians and medical professionals is imperative in the combat against new psychoactive substance use.

scholarly journals Effective Use of Mass Spectrometry in the Clinical Laboratory

2016 ◽  
Vol 62 (1) ◽  
pp. 92-98 ◽  
Author(s):  
Paul J Jannetto ◽  
Robert L Fitzgerald
Keyword(s):  
Mass Spectrometry ◽  
Drugs Of Abuse ◽  
Clinical Laboratory ◽  
Cost Effective ◽  
Laboratory Medicine ◽  
Practice Of Medicine ◽  
Steroid Analysis ◽  
Almost All ◽  
Effective Use ◽  
New Applications

Abstract BACKGROUND Historically the success of mass spectrometry in the clinical laboratory has focused on drugs of abuse confirmations, newborn screening, and steroid analysis. Clinical applications of mass spectrometry continue to expand, and mass spectrometry is now being used in almost all areas of laboratory medicine. CONTENT A brief background of the evolution of mass spectrometry in the clinical laboratory is provided with a discussion of future applications. Prominent examples of mass spectrometry are covered to illustrate how it has improved the practice of medicine and enabled physicians to provide better patient care. With increasing economic pressures and decreasing laboratory test reimbursement, mass spectrometry testing has been shown to provide cost-effective solutions. In addition to pointing out the numerous benefits, the challenges of implementing mass spectrometry in the clinical laboratory are also covered. SUMMARY Mass spectrometry continues to play a prominent role in the field of laboratory medicine. The advancement of this technology along with the development of new applications will only accelerate the incorporation of mass spectrometry into more areas of medicine.

Clinical Laboratory Assays for HER-2/neu Amplification and Overexpression

2002 ◽  
Vol 126 (7) ◽  
pp. 803-808 ◽  
Keyword(s):  
In Situ Hybridization ◽  
Additional Data ◽  
Clinical Laboratory ◽  
Clinical Testing ◽  
Breast Carcinomas ◽  
Cell Markers ◽  
The Past ◽  
Her 2 ◽  
Invasive Breast Carcinomas

Abstract Objective.—To present and contrast the results of immunohistochemistry and fluorescence in situ hybridization (FISH) proficiency testing surveys for HER-2/neu, as conducted by the Cell Markers and Cytogenetics Committees of the College of American Pathologists. Design.—During the past 2 years, unstained sections from invasive breast carcinomas have been used for both immunohistochemistry and interphase FISH proficiency surveys. In most instances, the same cases were used for both the Cell Markers and Cytogenetics surveys. Additional data regarding interpretative variability for immunohistochemistry surveys have also been captured. Results.—The number of laboratories performing FISH for HER-2/neu testing doubled during the 2-year period. The results of FISH testing have been remarkably concordant for laboratories submitting results. In contrast, the results of immunohistochemistry testing continue to highlight substantial variability among laboratories evaluating the same cases. The data show that this variability is at least in part due to variability in interpretation among observers, as well as inherent differences between immunohistochemistry and FISH techniques. Conclusions.—College of American Pathologists proficiency survey programs provide useful information about clinical testing for HER-2/neu amplification/overexpression.

scholarly journals National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department

2003 ◽  
Vol 49 (3) ◽  
pp. 357-379 ◽  
Author(s):  
Alan H B Wu ◽  
Charles McKay ◽  
Larry A Broussard ◽  
Robert S Hoffman ◽  
Tai C Kwong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Laboratory Tests ◽  
Drug Testing ◽  
Drugs Of Abuse ◽  
Clinical Laboratory ◽  
Clinical Biochemistry ◽  
Clinical Chemistry ◽  
Clinical Toxicology ◽  
New Drugs ◽  
Background Exposure

Abstract Background: Exposure to drugs and toxins is a major cause for patients’ visits to the emergency department (ED). Methods: Recommendations for the use of clinical laboratory tests were prepared by an expert panel of analytical toxicologists and ED physicians specializing in clinical toxicology. These recommendations were posted on the world wide web and presented in open forum at several clinical chemistry and clinical toxicology meetings. Results: A menu of important stat serum and urine toxicology tests was prepared for clinical laboratories who provide clinical toxicology services. For drugs-of-abuse intoxication, most ED physicians do not rely on results of urine drug testing for emergent management decisions. This is in part because immunoassays, although rapid, have limitations in sensitivity and specificity and chromatographic assays, which are more definitive, are more labor-intensive. Ethyl alcohol is widely tested in the ED, and breath testing is a convenient procedure. Determinations made within the ED, however, require oversight by the clinical laboratory. Testing for toxic alcohols is needed, but rapid commercial assays are not available. The laboratory must provide stat assays for acetaminophen, salicylates, co-oximetry, cholinesterase, iron, and some therapeutic drugs, such as lithium and digoxin. Exposure to other heavy metals requires laboratory support for specimen collection but not for emergent testing. Conclusions:Improvements are needed for immunoassays, particularly for amphetamines, benzodiazepines, opioids, and tricyclic antidepressants. Assays for new drugs of abuse must also be developed to meet changing abuse patterns. As no clinical laboratory can provide services to meet all needs, the National Academy of Clinical Biochemistry Committee recommends establishment of regional centers for specialized toxicology testing.

scholarly journals Novel Benzodiazepines (Clonazolam and Flubromazolam) Identified in Candy-Like Pills

2018 ◽  
Vol 3 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Jeffrey D Pope ◽  
Kay Weng Choy ◽  
Olaf H Drummer ◽  
Hans G Schneider
Keyword(s):  
Drugs Of Abuse ◽  
Clinical Laboratory ◽  
Toxic Substance ◽  
High Energy ◽  
Accurate Mass ◽  
Urine Specimen ◽  
Mass Data ◽  
Flight Mass Spectrometry ◽  
Online Vendor ◽  
Ultrahigh Performance Liquid Chromatography

Abstract Objectives To identify the contents of pills found on an intoxicated patient by ultrahigh-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC-QTof).5 To highlight the potential ability that this technique can add to the clinical laboratory. Methods Illicit PEZ-like pills purchased from an online vendor, containing unknown substances, were investigated by UHPLC-QTof. Accurate mass and experimental data were obtained. Tentative identifications were subsequently confirmed with commercial standards. Results Accurate mass data, high-energy mass spectra, elucidation software, and a review of the scientific literature enabled the tentative identification of clonazolam and flubromazolam in the PEZ-like pills. On the basis of these tentative identifications, commercial standards were purchased to confirm the initial findings. On subsequent reinterrogation of the data, flubromazolam was identified in the urine specimen of the patient. Conclusions Utilizing high-resolution mass data, 2 novel benzodiazepines were tentatively identified by reinterrogation of a routine analysis for drugs of abuse. Use of UHPLC-QTof in a clinical toxicology laboratory provides additional capabilities to explain and potentially improve treatment of patients presenting to the emergency department with symptoms possibly due to toxic substance ingestion.

scholarly journals ARBoR: an identity and security solution for clinical reporting

2019 ◽  
Vol 26 (11) ◽  
pp. 1370-1374
Author(s):  
Eric Venner ◽  
Mullai Murugan ◽  
Walker Hale ◽  
Jordan M Jones ◽  
Shan Lu ◽  
...  
Keyword(s):  
Medical Record ◽  
Genome Sequencing ◽  
Clinical Laboratory ◽  
Paper Copy ◽  
Data File ◽  
Structured Data ◽  
Variant Interpretation ◽  
Clinical Testing ◽  
Human Genome Sequencing ◽  
Clinical Genome Sequencing

Abstract Motivation Clinical genome sequencing laboratories return reports containing clinical testing results, signed by a board-certified clinical geneticist, to the ordering physician. This report is often a PDF, but can also be a paper copy or a structured data file. The reports are frequently modified and reissued due to changes in variant interpretation or clinical attributes. Materials and Methods To precisely track report authenticity, we developed ARBoR (Authenticated Resources in a Hashed Block Registry), an application for tracking the authenticity and lineage of versioned clinical reports even when they are distributed as PDF or paper copies. ARBoR tracks clinical reports as cryptographically signed hash blocks in an electronic ledger file, which is then exactly replicated to many clients. Results ARBoR was implemented for clinical reporting in the Human Genome Sequencing Center Clinical Laboratory, initially as part of the National Institute of Health's Electronic Medical Record and Genomics (eMERGE) project. Conclusions To date, we have issued 15 205 versioned clinical reports tracked by ARBoR. This system has provided us with a simple and tamper-proof mechanism for tracking clinical reports with a complicated update history.

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