RESUMO
Knowledge of drug composition consumed on the streets and the identification and quantification of their adulterants is essential for understanding unexpected side effects, tracking routes, and drug profiling. Therefore, this work aimed to determine the purity and to identify and quantify the main adulterants found in personal doses of cocaine (perico) and coca paste (bazuco) in Cartagena de Indias (Colombia). The data collected in this study describe a first attempt to introduce the qualitative and quantitative analyses of adulterants present in street drugs in Cartagena de Indias to improve surveillance. Through gas chromatography coupled to mass spectrometry (GC-MS), the purity and adulterants were quantified in 45 personal doses of cocaine powder and coca paste. 100% of the personal doses in the city were adulterated; caffeine, phenacetin, and levamisole were the main adulterants identified in cocaine. Besides the above, lidocaine was also found in coca paste. The purity of cocaine varied from 8% to almost 70%, with caffeine ranging from 6% to 42%. In the case of coca paste, the maximum content of cocaine found was 60%, while some samples contained as little as 14%. The results are consistent with other research in terms of the widespread use of caffeine as an adulterant, but they also follow the growing trend of the use of levamisole and phenacetin. The wide range of cocaine content in samples sold in the illicit market could cause undesirable effects on cocaine users who do not know the exact intended dose for consumption; so, this study intends to make these results available not only to academic, public health, and national security agencies but also to tourists entering Cartagena de Indias, so that they are aware of what they are consuming and the risks to which they are exposed.
Assuntos
Coca , Cocaína/normas , Contaminação de Medicamentos , Coca/efeitos adversos , Coca/química , Cocaína/efeitos adversos , Cocaína/análise , Transtornos Relacionados ao Uso de Cocaína/complicações , Colômbia , Contaminação de Medicamentos/estatística & dados numéricos , Cromatografia Gasosa-Espectrometria de Massas , HumanosRESUMO
RESUMO Objetivos: Analisar a prevalência da microbiota nos tonômetros de aplanação de Goldmann nos consultórios do SUS e definir o grau de contaminação dos tonômetros e a eficácia da assepsia do cone do tonômetro de aplanação. Métodos: Estudo transversal em que foi realizado a coleta de 60 "swabs", divididos nos três tonômetros de aplanação dos ambulatórios do SUS em dois momentos distintos. No primeiro realizou-se a coleta no início dos atendimentos e no segundo momento, a coleta foi realizada ao final de todos os atendimentos. Todos "swabs" foram colhidos no meio Stuart e foi realizada a cultura em meio de bactérias. Resultados: Das 60 amostras, apenas uma apresentou crescimento de agente patogênico, a Escherichia coli. Conclusão: Independente dos vários métodos que o oftalmologista escolher para realizar a assepsia, a mesma é imprescindível para a manutenção de uma boa saúde ocular do paciente, evitando assim a transmissão e propagação de patógenos por meio do exame oftalmológico e concluímos também que o método utilizado pelo nosso serviço parece ser eficaz nesta profilaxia.
ABSTRACT Objective: Analyze the microbiota prevalence in the Goldmann applanation tonometers in the clinic of the SUS to define the contamination of the tonometers and the efficacy of asepsis of the applanation tonometer cone. Methods: A cross-sectional study was carried out to collect 60 "swabs" divided into the three aplanation tonometers of SUS clinics at two different times. In the first one, the collection will be performed at the beginning of the visits and at the second moment, the collection will be performed at the end of all the visits. All swabs will be harvested in the Stuart medium and culture was carried to sow bacteria. Results: Of the 60 samples, only one showed pathogen growth, Escherichia coli. Conclusion: Regardless of the various ways the ophthalmologist chooses to perform asepsis, it is essential for the maintenance of good patient eye health, thus avoiding the transmission and propagation of pathogens through ophthalmologic examination, and we also conclude that the method used by our patient seems to be effective in this prophylaxis.
Assuntos
Bactérias/isolamento & purificação , Bactérias/crescimento & desenvolvimento , Tonometria Ocular/instrumentação , Contaminação de Equipamentos , Escherichia coli/isolamento & purificação , Escherichia coli/crescimento & desenvolvimento , Tonometria Ocular/efeitos adversos , Assepsia/métodos , Glaucoma/diagnóstico , Contaminação de Medicamentos/estatística & dados numéricos , Estudos Transversais , Técnicas Bacteriológicas , Reutilização de Equipamento , Fluoresceína/efeitos adversos , Meios de Cultura , Fômites/microbiologia , Pressão IntraocularRESUMO
We found a 6.1% bacterial contamination rate among 198 propofol vials collected after clinical use in 12 operating rooms of a high-complexity hospital in Cali, Colombia. Some propofol vials were used for extended periods (up to 72 hours), and only 26.1% of vials were punctured once. Median time of use, although not statistically significant, was higher in positive samples (7.2 vs 3.5 hours, P = .08). Education on the topic should stress that vials are single-patient use and must be immediately discarded after use.
Assuntos
Anestésicos Intravenosos/uso terapêutico , Bactérias/crescimento & desenvolvimento , Contaminação de Medicamentos/estatística & dados numéricos , Propofol/uso terapêutico , Colômbia , Hospitais/normas , Humanos , Salas Cirúrgicas/normas , SeringasRESUMO
INTRODUCTION: The contamination of serum or lithium heparin blood with ethylenediaminetetraacetic acid (EDTA) salts may affect accuracy of some critical analytes and jeopardize patient safety. The aim of this study was to evaluate the effect of lithium heparin sample contamination with different amounts of K2EDTA. MATERIALS AND METHODS: Fifteen volunteers were enrolled among the laboratory staff. Two lithium heparin tubes and one K2EDTA tube were collected from each subject. The lithium-heparin tubes of each subject were pooled and divided in 5 aliquots. The whole blood of K2EDTA tube was then added in scalar amount to autologous heparinised aliquots, to obtained different degrees of K2EDTA blood volume contamination (0%; 5%; 13%; 29%; 43%). The following clinical chemistry parameters were then measured in centrifuged aliquots: alanine aminotranspherase (ALT), bilirubin (total), calcium, chloride, creatinine, iron, lactate dehydrogenase (LD), lipase, magnesium, phosphate, potassium, sodium. RESULTS: A significant variation starting from 5% K2EDTA contamination was observed for calcium, chloride, iron, LD, magnesium (all decreased) and potassium (increased). The variation of phosphate and sodium (both increased) was significant after 13% and 29% K2EDTA contamination, respectively. The values of ALT, bilirubin, creatinine and lipase remained unchanged up to 43% K2EDTA contamination. When variations were compared with desirable quality specifications, the bias was significant for calcium, chloride, LD, magnesium and potassium (from 5% K2EDTA contamination), sodium, phosphate and iron (from 29% K2EDTA contamination). CONCLUSIONS: The concentration of calcium, magnesium, potassium, chloride and LD appears to be dramatically biased by even modest K2EDTA contamination (i.e., 5%). The values of iron, phosphate, and sodium are still reliable up to 29% K2EDTA contamination, whereas ALT, bilirubin, creatinine and lipase appear overall less vulnerable towards K2EDTA contamination.
Assuntos
Anticoagulantes , Coleta de Amostras Sanguíneas/normas , Contaminação de Medicamentos/estatística & dados numéricos , Ácido Edético/análise , Contaminação de Equipamentos/estatística & dados numéricos , Heparina , Lítio , Adulto , Anticoagulantes/química , Anticoagulantes/normas , Análise Química do Sangue , Coleta de Amostras Sanguíneas/instrumentação , Coleta de Amostras Sanguíneas/métodos , Ácido Edético/sangue , Feminino , Heparina/química , Humanos , Lítio/química , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Gestão da Qualidade TotalRESUMO
This paper describes the studies performed with the candidate Certified Reference Material (CRM) of captopril, the first CRM of an active pharmaceutical ingredient (API) in Brazil, including determination of impurities (organic, inorganic and volatiles), homogeneity testing, short- and long-term stability studies, calculation of captopril content using the mass balance approach, and estimation of the associated measurement uncertainty.
Este artigo descreve os estudos realizados com o candidato a Material de Referência Certificado (MRC) de captopril, primeiro MRC de fármacos no Brasil, incluindo a determinação de impurezas (orgânicas, inorgânicas e voláteis), testes de homogeneidade, testes de estabilidade de curta e longa duração, cálculo do teor de captopril por balanço de massa e estimativa da incerteza de medição associada ao valor certificado.
Assuntos
Captopril/análise , Captopril/farmacologia , Captopril/química , Preparações Farmacêuticas/normas , Cromatografia Líquida de Alta Pressão , Contaminação de Medicamentos/estatística & dados numéricos , Estudos de Avaliação como Assunto , Controle de Qualidade , Padrões de ReferênciaRESUMO
AIMS: Although illicit drug purity is a widely discussed health risk, research explaining its geographic variation within a country is rare. This study examines whether proximity to the US-Mexico border, the United States' primary drug import portal, is associated with geographic variation in US methamphetamine, heroin and cocaine purity. DESIGN: Distances (proximity) between the US-Mexico border and locations of methamphetamine, cocaine and heroin seizures/acquisitions (n = 239,070) recorded in STRIDE (System to Retrieve Information from Drug Evidence) were calculated for the period of 1990-2004. The association of drug purity with these distances and other variables, including time and seizure/acquisition size, was examined using hierarchical multivariate linear modeling (HMLM). SETTING: Coterminous United States. FINDINGS: Methamphetamine, cocaine and heroin purity generally decreased with distance from the US-Mexico border. Heroin purity, however, after initially declining with distance, turned upwards-a U-shaped association. During 2000-04, methamphetamine purity also had a U-shaped association with distance. For each of the three drugs, temporal changes in the purity of small acquisitions (<10 g) were typically more dynamic in areas closer to the US-Mexico border. CONCLUSIONS: Geographic variance in methamphetamine, cocaine and heroin purity throughout the coterminous United States was associated with US-Mexico border proximity. The U-shaped associations between border-distance and purity for heroin and methamphetamine may be due to imports of those drugs via the eastern United States and southeast Canada, respectively. That said, areas closer to the US-Mexico border generally had relatively high illicit drug purity, as well as more dynamic change in the purity of small ('retail level') drug amounts.
Assuntos
Cocaína/química , Contaminação de Medicamentos/estatística & dados numéricos , Controle de Medicamentos e Entorpecentes/estatística & dados numéricos , Heroína/química , Metanfetamina/química , Modelos Estatísticos , Cocaína/provisão & distribuição , Comércio/legislação & jurisprudência , Comércio/estatística & dados numéricos , Interpretação Estatística de Dados , Composição de Medicamentos , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Heroína/provisão & distribuição , Humanos , Armazenamento e Recuperação da Informação , Modelos Lineares , Metanfetamina/provisão & distribuição , México , Fatores de Tempo , Estados UnidosRESUMO
BACKGROUND: Nosocomial bacteremia caused by the contamination of intravenous (IV) infusates is considered rare. Unfortunately, this problem has been underestimated because its identification requires culturing infusates, a procedure not performed routinely. METHODS: This study was conducted in a referral hospital where IV infusates are admixed in nursing areas. The aim was to determine the prevalence of infusate contamination in adult patients with gram-negative rod (GNR) bacteremia. Over a period of 32 months, a specimen of infusate was drawn for culture from each patient recruited after the laboratory reported a GNR in the blood. RESULTS: A total of 384 infusates were cultured from 384 patients who had been diagnosed with GNR bacteremia. Seven infusates grew a GNR in culture, for a contamination rate of 2% (7/384; 95% confidence interval [CI] = 1% to 3%). In all cases, the infectious organism was the same as the organism isolated from the blood. Infusate contamination was responsible for 7% (7/108; 95% CI = 2% to 11%) of all primary bloodstream infections and 11% (7/62; 95% CI = 2% to 22%) of all primary bloodstream infections not associated with central venous catheter infection. CONCLUSIONS: For patients in hospitals where IV drugs are admixed in nursing units, we recommend instituting infusate culture as routine practice following the diagnosis of a GNR in the blood.
Assuntos
Bacteriemia/etiologia , Infecção Hospitalar/etiologia , Contaminação de Medicamentos/estatística & dados numéricos , Bacilos e Cocos Aeróbios Gram-Negativos/isolamento & purificação , Infusões Intravenosas/métodos , Injeções Intravenosas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The past two decades have seen an increase in heroin-related morbidity and mortality in the United States. We report on trends in US heroin retail price and purity, including the effect of entry of Colombian-sourced heroin on the US heroin market. METHODS: The average standardized price ($/mg-pure) and purity (% by weight) of heroin from 1993 to 2004 was from obtained from US Drug Enforcement Agency retail purchase data for 20 metropolitan statistical areas. Univariate statistics, robust Ordinary Least Squares regression and mixed fixed and random effect growth curve models were used to predict the price and purity data in each metropolitan statistical area over time. RESULTS: Over the 12 study years, heroin price decreased 62%. The median percentage of all heroin samples that are of South American origin increased an absolute 7% per year. Multivariate models suggest percent South American heroin is a significant predictor of lower heroin price and higher purity adjusting for time and demographics. CONCLUSION: These analyses reveal trends to historically low-cost heroin in many US cities. These changes correspond to the entrance into and rapid domination of the US heroin market by Colombian-sourced heroin. The implications of these changes are discussed.
Assuntos
Comércio/estatística & dados numéricos , Contaminação de Medicamentos/estatística & dados numéricos , Heroína/economia , Heroína/provisão & distribuição , Comércio/tendências , Controle de Medicamentos e Entorpecentes/economia , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Humanos , Modelos Estatísticos , América do Sul , Estados UnidosRESUMO
OBJECTIVE: To determine the rate of contamination of intravenous solutions and injection ports in pediatric patients. MATERIAL AND METHODS: During non-epidemic periods, eight pediatric wards in Mexican hospitals were studied. Qualitative cultures were performed from the surface of injection ports and from intravenous solutions in use in pediatric patients younger than 2 years, culturing 750 infusion systems from 728 patients. RESULTS: The rate of contamination of intravenous solutions was 2.4% (18/750; CI 95%: 1.3% to 3.5%) and for injection ports it was 3.2% (24/750; CI 95%: 2.1% to 4.3%). Enterobacteriaceae predominated; in four cases the organisms isolated from the port and from the solutions were coincident (Klebsiella spp. and Enterobacter sp.). The rate of contamination for solutions mixed in the wards was 5.1%, against 1.3% of those not mixed (chi2 = 9.19, p < 0.01). DISCUSSION: Contamination of parenteral solutions is not a rare phenomenon and it could be related to inappropriate practices in the preparation of intravenous solutions and medications as well as the contamination of injection ports. In hospitals working with standards similar to those reported here, the monitoring of sterility of intravenous solutions could contribute to reduce the rate of nosocomial bacteremia.
Assuntos
Bactérias/isolamento & purificação , Contaminação de Medicamentos/estatística & dados numéricos , Soluções , Estudos Transversais , Unidades Hospitalares , Humanos , Lactente , Nutrição Parenteral , PediatriaRESUMO
In a study of injection drug users (IDUs) in Tijuana, Mexico, logistic regression identified factors associated with injection of colored vs. clear methamphetamine in the prior six months (N = 613). Colors injected most often were clear (50%), white (47%), yellow (2%), and pink (1%). IDUs injecting colored meth were more likely to experience recent abscesses (34%) compared to those injecting clear meth (24%; p = 0.008), an association that persisted after adjusting for confounders. Market characteristics, possibly relating to purity or adulterants, may be associated with abscesses among methamphetamine injectors. Further study is needed to confirm and determine the mechanism of this association to better inform prevention messages.
Assuntos
Abscesso/epidemiologia , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Estimulantes do Sistema Nervoso Central/toxicidade , Contaminação de Medicamentos/estatística & dados numéricos , Drogas Ilícitas/toxicidade , Metanfetamina/toxicidade , Dermatopatias Bacterianas/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abscesso/etiologia , Adulto , Estudos de Coortes , Cor , Comparação Transcultural , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , México , Estudos Prospectivos , Medição de Risco , Dermatopatias Bacterianas/etiologia , Fatores Socioeconômicos , Estados UnidosRESUMO
BACKGROUND: In developing countries, intravenous liquids are mixed and administered by nurses, sometimes under suboptimal infection control conditions. We hypothesized that outbreaks of infusate-associated neonatal bacteremias are common, and we evaluated whether they can be detected by vigilant microbiologic surveillance of infusates. METHODS: We studied intravenous infusates administered to neonates in a Mexican hospital where mixtures of infusates were prepared in hospital wards. The study was performed in 3 stages: stage 1, initial culturing of in-use infusates under basal conditions; stage 2, prospective culturing during a cluster of clinical sepsis; and stage 3, final culturing once the outbreak was controlled. RESULTS: In stage 1, 68 infusates were sterile, and 1 was contaminated with Staphylococcus aureus (1.45%), from 23 patients. In stage 2, of 182 infusates from 39 patients, 51 infusates (28%) were contaminated with Gram-negative rods. On the first day of stage 2, 11 of 15 infusates were contaminated with the same strain of Klebsiella pneumoniae, which continued to appear for 26 days. Another 4 strains of Gram-negative rods were also isolated during stage 2. The association between contaminated infusate and death was significant (odds ratio, 9.4; 95% confidence interval, 2-44.3; P < 0.001). Mixtures made by nurses were more likely contaminated than commercial preparations (odds ratio, 3.1; 95% confidence interval, 1.1-8.5; P = 0.037). In stage 3, there were 42 sterile infusates from 22 patients. CONCLUSIONS: Our study suggests that poor standards of care common in hospitals from developing countries sometimes result in outbreaks of sepsis and death for newborn patients.