scholarly journals Baclofen: To Screen or Not to Screen in Postmortem Blood?

2020 ◽  
Author(s):  
Limon Khatun Nahar ◽  
Kevin G Murphy ◽  
Sue Paterson
Keyword(s):  
Illicit Drug ◽  
Ethanol Concentration ◽  
Femoral Vein ◽  
Hydroxybutyric Acid ◽  
Postmortem Blood ◽  
Illicit Use ◽  
Low Incidence ◽  
The Uk ◽  
Recreational Use ◽  
Screening Approaches

ABSTRACT Baclofen (BLF) has been prescribed in the UK since 1972 for the alleviation of spasticity. However, evidence suggests BLF is also recreationally misused. It has been associated with ethanol, gamma-hydroxybutyric acid (GHB), pregabalin (PGL) and gabapentin (GBP) use/abuse, and deaths have been reported. With current postmortem (PM) toxicological screening approaches, BLF is not routinely included in the general drugs screen and is only screened for if specifically mentioned in the case documents. The extent of BLF misuse is thus unclear. This study was carried out to determine the prevalence and concentrations of BLF in Coroners’ toxicology, to investigate whether BLF misuse with ethanol, GHB, PGL and GBP is causing death and to determine the potential extent of the underreporting of BLF-associated deaths. Between 1 January 2016 and 31 December 2017, 3,750 PM femoral vein bloods were screened for BLF; all positive cases were quantified. Only 0.56% of samples screened positive for BLF, with concentration ranging from 0.08 to 102.00 µg/mL (median = 0.28). It was determined that if routine analysis without additional screening of BLF had been performed, 43% of BLF positives cases would have been missed. However, given the low incidence of detection, this only represents 0.25% of the cohort. Likely illicit use of BLF with GHB was seen in one case only. Death from the recreational use of BLF with PGL and GBP was not observed. Only two cases positive for BLF had an ethanol concentration of ≥50 mg%. Two cases of presumed intentional overdose of BLF were observed. This study highlights that although BLF abuse may be occurring, deaths are rare. It is therefore not cost- or time-effective to screen for BLF in all PM cases. With BLF currently being investigated for the treatment of alcoholism and withdrawal symptoms of illicit drug use, BLF-related deaths may rise in the future.

scholarly journals The temporal relationship between cancer and adult onset anti-transcriptional intermediary factor 1 antibody–positive dermatomyositis

Rheumatology ◽  
2018 ◽  
Vol 58 (4) ◽  
pp. 650-655 ◽  
Author(s):  
Alexander Oldroyd ◽  
Jamie C Sergeant ◽  
Paul New ◽  
Neil J McHugh ◽  
Zoe Betteridge ◽  
...  
Keyword(s):  
Proportional Hazard ◽  
Adult Onset ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Specific Cancer ◽  
Associated Malignancy ◽  
Cancer Types ◽  
The Uk ◽  
Screening Approaches

Abstract Objectives To characterize the 10 year relationship between anti-transcriptional intermediary factor 1 antibody (anti-TIF1-Ab) positivity and cancer onset in a large UK-based adult DM cohort. Methods Data from anti-TIF1-Ab-positive/-negative adults with verified diagnoses of DM from the UK Myositis Network register were analysed. Each patient was followed up until they developed cancer. Kaplan–Meier methods and Cox proportional hazard modelling were employed to estimate the cumulative cancer incidence. Results Data from 263 DM cases were analysed, with a total of 3252 person-years and a median 11 years of follow-up; 55 (21%) DM cases were anti-TIF1-Ab positive. After 10 years of follow-up, a higher proportion of anti-TIF1-Ab-positive cases developed cancer compared with anti-TIF1-Ab-negative cases: 38% vs 15% [hazard ratio 3.4 (95% CI 2.2, 5.4)]. All the detected malignancy cases in the anti-TIF1-Ab-positive cohort occurred between 3 years prior to and 2.5 years after DM onset. No cancer cases were detected within the following 7.5 years in this group, whereas cancers were detected during this period in the anti-TIF1-Ab-negative cases. Ovarian cancer was more common in the anti-TIF1-Ab-positive vs -negative cohort: 19% vs 2%, respectively (P < 0.05). No anti-TIF1-Ab-positive case <39 years of age developed cancer, compared with 21 (53%) of those ≥39 years of age. Conclusion Anti-TIF1-Ab-positive-associated malignancy occurs exclusively within the 3 year period on either side of DM onset, the risk being highest in those ≥39 years of age. Cancer types differ according to anti-TIF1-Ab status, and this may warrant specific cancer screening approaches.

Cross-sectional study of British wild deer for evidence of Schmallenberg virus infection

2020 ◽  
Vol 187 (8) ◽  
pp. e64-e64
Author(s):  
Rebecca Marie Southwell ◽  
Kenneth Sherlock ◽  
Matthew Baylis
Keyword(s):  
Great Britain ◽  
Fallow Deer ◽  
Cross Sectional Study ◽  
Schmallenberg Virus ◽  
Biting Midges ◽  
Cross Sectional ◽  
Single Region ◽  
Postmortem Blood ◽  
The Uk ◽  
Wild Deer

BackgroundSchmallenberg virus (SBV) is an orthobunyavirus, carried by Culicoides biting midges, that causes reproductive problems in adult ruminants when infected during their gestation period. SBV was first detected in ruminants in the UK in 2011/2012 and then again in 2016. The reason behind the 2016 re-emergence of SBV is unknown, but one possibility is that it can be maintained in wildlife, such as deer. SBV has been detected at high seroprevalence in deer in a number of European countries, but only once in the UK in a single region.MethodsThe purpose of this study was to survey wild deer across Great Britain for recent evidence of SBV. Deer hunters were recruited for the purpose of providing postmortem blood samples to be tested for SBV antibodies.ResultsThe seroprevalence of SBV in the British wild deer population was 13.8 per cent; found in red, roe, muntjac and fallow deer species, with more in deer further south.ConclusionThese results support the growing concern that SBV is now endemic in Great Britain and highlight the need to know the role of wildlife in SBV transmission.

scholarly journals Commentary

2000 ◽  
Vol 6 (1) ◽  
pp. 39-40
Author(s):  
Roch Cantwell
Keyword(s):  
Illicit Drugs ◽  
Substance Misuse ◽  
Illicit Drug ◽  
Information Gathering ◽  
Drug Misuse ◽  
High Prevalence ◽  
The Rich ◽  
The Uk ◽  
Tabloid Journalism ◽  
Timely Reminder

In the sometimes sensational world of illicit drug reportage, there is one unsung villain. While heroin misuse remains the bête noir of tabloid journalism, ecstasy the demon of the dance floors and cocaine caricatured as the choice of the rich and famous, amphetamine misuse has lurked the shadows. Its use defies such simple categorisation and spans several groups in society. Bruce has provided a timely reminder of this neglected area in substance misuse literature and, in the process, has highlighted the relevance of basic information gathering as the most important tool in the armamentorium of drug misuse workers. The lack of prominence given to what they describe as a “hidden epidemic” is striking. Could this be because amphetamine misuse is a less prevalent problem than that of other illicit drugs? Evidence suggests otherwise. Amphetamine is the second most common illicit drug seized in the UK (after cannabis). It is easily produced and used in a variety of modes, and recent research confirms a high prevalence of misuse in this country reflecting that found in North American and Australian literature.

scholarly journals Illicit Drug Markets, Consumer Capitalism and the Rise of Social Media: A Toxic Trap for Young People

2019 ◽  
Vol 27 (4) ◽  
pp. 591-610 ◽  
Author(s):  
Keir Irwin-Rogers
Keyword(s):  
Social Media ◽  
Young People ◽  
Illicit Drug ◽  
Drug Distribution ◽  
Drug Markets ◽  
Drug Dealing ◽  
Consumer Capitalism ◽  
Online Social Media ◽  
Media Platform ◽  
The Uk

Abstract This article explores young people’s involvement in illicit drug markets in England. It focuses in particular on why young people become involved in illicit drug distribution, the extent to which their involvement is predicated on adults’ use of threats and violence, and how young people frame the morality of drug dealing. The article’s findings are based on a unique dataset generated by a six-month period of online social media platform analysis, alongside additional data drawn from periods of observation, focus groups and interviews with young people and professionals. In short, I argue that drug prohibition, consumer capitalism, severe levels of inequality, and emerging problems associated with the rise of online social media are combining to produce a toxic trap that is dragging tens of thousands of young people into street-level drug dealing. Considered in this context, the inadequacy of the UK government’s response to some of the main harms associated with illicit drug markets is clear: children and young people will continue to be coerced and exploited until either drug markets are legalized and regulated, or they have realistic opportunities to pursue lives that offer genuine meaning, decent levels of income, and levels of status and respect that are comparable to those provided by drug distribution.

Benefit of Targeted Intensification for NCI High Risk Childhood Lymphoblastic Leukaemia: Results of the United Kingdom Medical Research Council Trial ALL97 and ALL97/99.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1869-1869
Author(s):  
Ajay Vora ◽  
Rachel Ward ◽  
Jeanette Payne ◽  
Chris Mitchell ◽  
Tim Eden ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Groups ◽  
Cell Phenotype ◽  
Cranial Radiotherapy ◽  
Childhood All ◽  
Relapse Risk ◽  
Treatment Regimens ◽  
Cns Relapse ◽  
Low Incidence ◽  
The Uk

Abstract In November1999, the UK childhood ALL trial, ALL 97, adopted CCG risk stratification and treatment regimens in favour of the UKALL approach due to concerns over lower event-free survival (EFS) in the UK compared to the US. A key new feature in the amended trial, ALL97/99, was NCI risk group and early marrow response targeted intensification. Of 1935 patients registered in the trial between January 1997 and June 2002, 997 were treated on ALL97 and 938 on ALL97/99. EFS was better in ALL97/99 compared with ALL 97 (5 year EFS: ALL 97 = 74.1%, 95% CI 71.4%–76.8% vs ALL 97/99 = 78.9%, 76.0%–81.8%, p=0.002). To investigate whether particular sub-groups benefited more or less with the CCG approach, we compared outcomes for different risk groups within the two parts of the trial in regard to EFS, overall survival (OS) and CNS relapse risk. All p values quoted are two-sided. EFS and OS were significantly better in ALL97/99 compared with ALL97 for NCI high risk (HR) patients (5 year EFS: ALL 97 = 61.8%, 95% CI: 56.9–66.7%, ALL 97/99 = 71.8% 95% CI: 66.7–76.9%, p = 0.0006. 5 year OS: ALL97 = 71.3%, 95% CI: 66.8–75.8%, ALL97/99 = 80.3% 95% CI: 76.0–84.6%, p = 0.005), but did not differ significantly for NCI standard risk (SR) patients (5 year EFS: ALL 97 = 81.7% 95% CI: 78.6–84.8%, ALL 97/99 = 83.3% 95% CI: 79.8–86.8%, p = 0.3. 5 year OS: ALL97 = 91.2% 95% CI: 89.0–93.4%, ALL97/99 = 92.6% 95% CI: 90.4–94.8%, p = 0.5). The incidence of isolated CNS relapse was also significantly lower in ALL97/99 for NCI HR (ALL97 = 8% vs ALL97/99 = 3.5%, p = 0.01) but not NCI SR patients (ALL97 = 3.5% vs ALL97/99 = 2.7%, p = 0.6). Despite restricting the use of cranial radiotherapy to patients with overt CNS disease (CNS 3, <5% of all patients), the incidence of isolated CNS relapse in ALL97/99 was reassuringly low, even for sub-groups at high risk of CNS relapse such as those with WCC > 100 × 10 9/l (4.8%) or T cell phenotype (3.8%). Isolated CNS relapse risk in ALL97/99 patients randomised to dexamethasone (which was compared with prednisolone in the trial) was 1.8%, similar to that reported with use of cranial radiotherapy for a higher proportion of patients. A targeted intensification approach improves EFS for NCI HR patients and, especially when combined with systemic dexamethasone, results in a low incidence of isolated CNS relapse for high risk sub-groups without use of cranial radiotherapy.

scholarly journals Recreational use of offshore wind farms: Experiences and opinions of sea anglers in the UK

Marine Policy ◽  
2017 ◽  
Vol 78 ◽  
pp. 55-60 ◽  
Author(s):  
Tara Hooper ◽  
Caroline Hattam ◽  
Melanie Austen
Keyword(s):  
Wind Farms ◽  
Offshore Wind ◽  
Offshore Wind Farms ◽  
The Uk ◽  
Recreational Use

Is there a case for MDMA-assisted psychotherapy in the UK?

2007 ◽  
Vol 21 (2) ◽  
pp. 220-224 ◽  
Author(s):  
Ben Sessa
Keyword(s):  
Medical Profession ◽  
Popular Literature ◽  
Double Blind ◽  
Psychedelic Drugs ◽  
History Of ◽  
Randomised Controlled ◽  
The Uk ◽  
New Research ◽  
Effective Use ◽  
Recreational Use

Much has been written in scientific and popular literature in recent years about the dangers surrounding the recreational use of the drug MDMA/ecstasy. What is little known and understood however is the history of the apparently safe and effective use of MDMA as a therapeutic tool for psychotherapy. In this paper the author explores this history and describes the recent re-emergence of scientific interest in MDMA and other psychedelic drugs. There are currently several new double-blind randomised controlled trials underway re-visiting the subject. By acknowledging the limitations of this new research and emphasising the importance of exercising appropriate but realistic caution, the author asks that the medical profession consider a dispassionate and open-minded debate to examine whether MDMA might have a legitimate place as an adjunct to psychotherapy in modern psychiatric practice.

“Doing Gender”—“Doing Drugs”: Conceptualizing the Gendering of Drugs Cultures

2002 ◽  
Vol 29 (2) ◽  
pp. 335-373 ◽  
Author(s):  
Fiona Measham
Keyword(s):  
Drug Use ◽  
Cultural Context ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Lifetime Prevalence ◽  
Doing Gender ◽  
The Uk ◽  
And Behavior ◽  
Attitudes And Behavior ◽  
Developed World

Women's illicit drug use has been increasing rapidly in the 1990s in the UK and elsewhere in the developed world. Lifetime prevalence rates show that gender is no longer a significant predictor of, or protector from, illicit drug use. The concentration on lifetime prevalence in the academic debate, however, has been to the detriment of the wider cultural context of drug-related attitudes and behavior in drug-using groups and wider society. This paper considers the socio-cultural context of gender and drug use, and reasserts the central importance of gender to our understanding of drugs cultures. Drug use is not just mediated by gender, but, far more significantly, drug use and the associated leisure, music and style cultures within which drug use is located are themselves ways of accomplishing a gendered identity. Building on Messerschmidt's concept of crime as structured action, the author suggests that gender does not just influence “doing drugs”–drug use itself can be seen as a way of “doing gender.”

scholarly journals Pneumomediastinum, subcutaneous emphysema and pneumorrhachis following cocaine insufflation: a case report

2020 ◽  
Vol 19 (3) ◽  
pp. 154-158
Author(s):  
Jill Burns ◽  
◽  
Allen Roby ◽  
Tom Jaconelli ◽  
◽  
...  
Keyword(s):  
Case Report ◽  
Subcutaneous Emphysema ◽  
Illicit Drug ◽  
Plain Radiograph ◽  
Posterior Mediastinum ◽  
Valsalva Manoeuvre ◽  
Computerised Tomography ◽  
Coronary Syndrome ◽  
Rapid Absorption ◽  
The Uk

A case report on a 36-year-old male patient presenting to the emergency department (ED) with chest tightness, nasal sounding voice and subcutaneous emphysema 72 hours after the nasal insufflation of approximately 0.5g of cocaine. A plain radiograph of the chest demonstrated an extensive pneumomediastinum with subcutaneous emphysema extending into his neck. A computerised tomography (CT) scan confirmed the above findings, along with a pneumorrhachis of the thoracic spine. He was admitted locally for further investigation and observation. Cocaine is the second most used illicit drug in the UK. The associated complications of cocaine can vary from acute coronary syndrome to acute psychosis. Pulmonological trauma secondary to cocaine misuse is commonly associated with inhalation of cocaine; we present this rare case of subcutaneous emphysema, pneumomediastinum and pneumorrhachis secondary to nasal insufflation. It is believed that deep nasal insufflation of cocaine is followed by forceful Valsalva manoeuvre, which allows for the rapid absorption of the drug and increases the euphoric effect. This forceful inhalation can lead to barotrauma and leakage of air into the posterior mediastinum.

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