The prevalence of fentanyl in drug-related deaths in Philadelphia 2004-2006.

Fentanyl is an increasingly common drug of abuse. The Philadelphia Medical Examiner's Office reported 252 drug-related deaths in Philadelphia that tested positive for fentanyl during the year 2006 in comparison to 22 and 19 in 2005 and 2004, respectively. We reviewed the data from 2004 to 2006 from the Philadelphia Medical Examiner's office.

Detection of clenbuterol in heroin users in twelve postmortem cases at the Philadelphia medical examiner's office.

The presence of clenbuterol, a beta2-adrenergic agonist banned for human use in the United States because of its serious side effects, is reported in a series of 12 postmortem cases in which the cause of death was attributed to illicit drug use. During the first three months of 2007, postmortem specimens from cases previously screening positive for opiates or fentanyl were screened specifically for clenbuterol using enzyme-linked immunosorbent assay. Confirmation of clenbuterol was performed using solid-phase extraction, derivatization with trimethylboroxine, and analysis utilizing a gas chromatograph-mass spectrometer (GC-MS) operated in the full-scan mode.

Concurrent detection of heroin, fentanyl, and xylazine in seven drug-related deaths reported from the Philadelphia Medical Examiner's Office.

Recreational drugs, such as cocaine and heroin, are often adulterated with other pharmacological agents to either enhance or diminish the drug effects. Between April 21, 2006 and August 8, 2006, the Philadelphia Medical Examiner's Office detected xylazine (a veterinary sedative) and fentanyl (a synthetic opioid) in specimens taken from seven cases. Initial immunoassay screening was performed on urine and blood for fentanyl, opiate, cocaine, phencyclidine (PCP), and benzodiazepines.

Possible role of pseudoephedrine and other over-the-counter cold medications in the deaths of very young children.

The Philadelphia Medical Examiners Office has reported a series of 15 deaths between February 1999 and June 2005 of infants and toddlers 16 months and younger in which drugs commonly found in over-the-counter (OTC) cold medications were present. A total of 10 different drugs were detected: pseudoephedrine, dextromethorphan, acetaminophen, brompheniramine, carbinoxamine, chlorpheniramine, ethanol, doxylamine and the anticonvulsants, phenobarbital, and phenytoin. The drugs were confirmed and quantified by gas chromatography (GC)-mass spectrometry, with the exception of ethanol, which was analyzed by headspace GC and of phenobarbital and phenytoin that were quantified by GC with a nitrogen phosphorus detector.

Lowering cutoffs for initial and confirmation testing for cocaine and marijuana: large-scale study of effects on the rates of drug-positive results.

A large-scale study was conducted to determine whether lowering the initial testing and confirmation testing cutoffs in urine would significantly affect the positive rates for cocaine (COC) and marijuana (THC). Customary cutoffs for COC are 300 microg/L and 150 microg/L for initial testing (screening) and gas chromatography-mass spectrometry (GC-MS; confirmation), respectively; for THC, the usual respective cutoffs are 50 microg/L and 10 microg/L. By applying a screening cutoff of 100 microg/L for COC and lowering the GC-MS cutoff to 50 microg/L, the COC-positive rate increased from 1.

Snake venom poisoning in the United States: a review of therapeutic practice.

Snake venom poisoning constitutes a medical emergency. It is a complex type of poisoning that not only affects the local bite site but may involve multiple organ systems as well. In the United States, poisonous snakes account for approximately 8,000 bites annually, resulting in about 9 to 15 fatalities.

A comparison of meconium, maternal urine and neonatal urine for detection of maternal drug use during pregnancy.

A large scale drug screening study was done to determine the prevalence of drug use in a large metropolitan, obstetric population. Meconium and first voided urine, as well as maternal urine were collected from 423 consecutive deliveries. Urine samples and methanolic extracts of meconium were initially screened by Enzyme Multiplied Immunoassay Technique (EMIT) and then confirmed by Gas Chromatography/Mass Spectrometry (GC/MS).

What happens to babies exposed to phencyclidine (PCP) in utero?

Fifty-seven infants exposed to phencyclidine (PCP) in utero were followed for the first year of life. Thirty-six (65%) of the 55 for whom birth records were available manifested symptoms of neonatal narcotic withdrawal syndrome, including 16 (52%) of those whose mothers denied opiate abuse during pregnancy. Temperament problems were noted in 47% of the babies and sleep problems in 14%.

Rattlesnake bites in southern California and rationale for recommended treatment.

Rattlesnake bite is most common in young men who often are intoxicated and have purposely handled a venomous snake. The incidence of bites is highest in the spring and early summer months, and they most often occur in the afternoon. The hands and feet only are involved in 95% of all bites.

Abnormal sleeping ventilatory pattern in infants of substance-abusing mothers.

Infants born to opiate-abusing mothers have a decreased ventilatory response to carbon dioxide and a five to ten times increased risk of sudden infant death syndrome (SIDS). These abnormalities of ventilatory control may be associated with abnormal sleeping ventilatory patterns. Therefore, 28 overnight pneumograms (respiratory pattern recording and electrocardiogram) were obtained from 27 infants of substance-abusing mothers (ISAM) (five opiate, seven phencyclidine hydrochloride, three cocaine, and 12 polydrug abusers) and compared with pneumograms from 43 control infants.

Differences between dropouts and active participants in a pediatric clinic for substance abuse mothers.

We compared the maternal and birth characteristics of 87 first-year dropouts with 103 active participants of a pediatric clinic which provides long-term follow-up care to offspring exposed in utero to substance abuse mothers. The age, ethnicity, and marital status of the mother; the type of drug used during pregnancy; and the length, gender, number, and type of addiction problems of the newborn were not significantly different between the two groups. However, the dropouts differed significantly from the active participants in many other aspects.

Mucin biosynthesis. Properties of a bovine tracheal mucin beta-6-N-acetylglucosaminyltransferase.

We have characterized a bovine tracheal mucin beta-6-N-acetylglucosaminyltransferase that catalyses the transfer of N-acetylglucosamine from UDP-N-acetylglucosamine to the C-6 of the N-acetylgalactosamine residue of galactosyl-beta 1----3-N-acetylgalactosamine. Optimal enzyme activity was obtained between pH 7.5-8.

Preparation of a new antivenin by affinity chromatography.

Polyacrylamide gel affinity chromatography was employed to isolate and purify antibodies to the antigens of the venoms of four rattlesnakes. The antivenins were studied for their neutralizing properties on a number of pharmacologic preparations. It was found that the purified antibodies (IgG) were more efficacious than the commercially prepared antivenin in neutralizing the lethal, cytolytic, hemorrhagic, platelet aggregating, and other deleterious effects of the venoms.

Medicated versus saline nose drops in the management of upper respiratory infection.

Seventy-four children from three weeks to two years of age with various upper respiratory symptoms were randomly assigned to three groups: two intervention groups (saline nose drops; medicated nose drops) and a control group (no nose drops). Forty-six children returned for check-up two days later. Subjects in all three groups improved between first and second contact.

Prolonged defibrination after a bite from a 'nonvenomous' snake.

The distinction between venomous, potentially dangerous snakes and snakes considered to be harmless to humans is not always clear. A man was bitten by an assumed harmless pet snake, Rhabdophis subminatus (the red neck keelback), that had been obtained from a pet store. The patient experienced a severe coagulopathy with life-threatening hemorrhage unresponsive to transfusion.

Mucin biosynthesis: characterization of rabbit small intestinal UDP-N-acetylglucosamine:galactose beta-3-N-acetylgalactosaminide (N-acetylglucosamine----N-acetylgalactosamine) beta-6-N-acetylglucosaminyltransferase.

We have characterized a UDP-GlcNAc:Gal beta-3-GalNAc (GlcNAc----GalNAc) beta-6-N-acetylglucosaminyltransferase from rabbit small intestinal epithelium by using freezing point depression glycoprotein as the acceptor. Optimal enzyme activity was obtained at pH 7.0-7.

Attachment interaction behavior between young teenage mothers and their infants.

Behavioral interaction between teenage mothers and their infants was explored. Twenty-six (low income level) Hispanic teenage mothers (mean age 15 years) and their infants (mean age 13.5 months) were compared with an older control group of 30 mothers (mean age 26 years) and their infants (mean age 14.

Infants with birth weight under 1500 g: physical, neurological, and developmental outcome.

One hundred and seventy-eight infants with birth weights less than or equal to 1500 g born in 1973-1975 were followed for a period of 1-3 years, and the physical, neurological, and developmental outcome evaluated. Although there was a high incidence of maternal problems, these did not correlate with outcome. Asphyxia at birth followed by neonatal complications leading to ventilatory assistance was significantly correlated with poor outcome.