The duration of ketamine detection in hair after treatment cessation: Case study and review of the literature in forensic and clinical casework

The disappearance of drug from hair does not occur immediately after abstinence because dormant hair may contribute to the positivity of freshly grown hair. The aim of this study was to assess ketamine disappearance from hair after treatment cessation and to review the literature data. A 22-year-old female received three intravenous doses of ketamine (171 mg) for major depression treatment. Seventeen weeks later, a 26 cm lock of hair was sampled, and ketamine was determined by liquid chromatography tandem mass spectrometry (LC–MS/MS) on seven segments: A (proximal, 0–2 cm), B (2–4 cm), C (4–6 cm, period of ketamine therapy), and D to G (4 × 5 cm). Ketamine concentration was 58 pg/mg in Segment C and remained detectable over 4 months after treatment cessation at 67 pg/mg in Segment B and 2 pg/mg in Segment A, representing a 97% drop from the initial concentration. Ketamine elimination half-life in hair was estimated at 0.88 month, implying that indetectable concentration should be expected 7 months after cessation. Axial diffusion was excluded as ketamine was not detected in Segments D–G. Given the low ketamine concentrations, norketamine was not detected. While no data on ketamine disappearance from hair have been published to date, previous studies have shown that discontinuation resulted in negative hair results after 3 months for heroin, 3–4 months for cocaine and tramadol, 6 months for amphetamine and methamphetamine, and 6–7 months for THC-COOH. This study provides useful findings for ketamine hair concentration interpretation, which should be validated by more consistent and comprehensive investigations.     

Evaluation of Perinatal and Developmental Outcomes in Neonates with Abstinence Syndrome Admitted to NICU

Drug abuse by pregnant women is one of the significant problems for mothers and their neonates. This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental criteria. In a case-control study, clinical records of 90 neonates diagnosed with neonatal abstinence syndrome who were admitted to NICU in one of four hospitals affiliated with Shahid-Beheshti University of Medical Sciences in Tehran, Iran between 2017 and 2020 were compared to 90 neonates without neonatal abstinence syndrome (control group). Demographic information and data for neonatal developmental characteristics and complications were extracted from the clinical records of this convenience sample. Data for the type and method of maternal substance use during pregnancy were collected through a telephone call with mothers. Our data showed that the prevalence of drug addiction was 1.8% among pregnant women, and the most common drugs used by mothers were opium (n = 45%, 50%), amphetamine (n = 30%, 33%), and methadone (n = 14%, 16%). Neonates with abstinence syndrome had a higher prevalence of transient tachypnea of the newborn (TTN) (P = 0.004), and a prevalence of being admitted to NICU (P = 0.05) and for a longer duration (P < 0.001). Their mothers had a higher prevalence of having pre-eclampsia (P = 0.010). Using morphine vs. amphetamine showed no difference based on their effects on mothers and neonates. Substance use during pregnancy increased the prevalence of pregnancy complications (pre-eclampsia) and neonatal complications (TTN and prevalence and duration of hospitalization). Therefore, planning for the development of health policies to raise awareness among women and more broadly, all members of the community, is important to prevent the tendency to engage in this potentially high-risk behavior.     

The effects of Selective Serotonin Reuptake Inhibitors on newborn adaptation and withdrawal symptoms: A scoping review

BackgroundSince becoming the most frequently prescribed antidepressants in pregnancy, the effects of Selective Serotonin Reuptake Inhibitors on newborns is hotly debated. The aims of this review were to examine terminology and adaptation, withdrawal, and toxicity risks for newborns.MethodScoping review methodology guided the search of electronic databases EBSCOhost, PubMed Central and Springer Online Journals.ResultsOut of 90 articles screened, 23 were eligible for inclusion in the synthesis. Terminology is used interchangeably with poor delineation. Poor Neonatal Abstinence Syndrome is usually mild and transient with newborns experiencing neuro-behaviour and/or respiratory symptoms, initial lowered Apgar score, inhibited respiratory regulation, and hypoglycaemia. Limited studies examined Serotonin toxicity.ConclusionsNewborns exposed to Selective Serotonin Reuptake Inhibitors in-utero are affected, however the evidence is limited due to a lack of high-quality, robust studies to accurately make generalisations regarding Poor Neonatal Adaptation Syndrome or to support the diagnosis over withdrawals. Further research is needed to adequately differentiate between the conditions.     

基于数据挖掘探究针灸治疗阿片类毒品稽延性戒断综合征的选穴规律

目的：采用数据挖掘技术探究针灸治疗阿片类毒品稽延性戒断综合征（POAS）的用穴规律。方法：通过检索中英文数据库收集有关治疗POAS的针灸临床文献，建立其处方数据库，采用SPSS 21.0对其进行描述性分析和聚类分析，采用SPSS Modeler18.0对其进行关联规则分析，探究针灸治疗POAS的腧穴运用特点及其规律。结果：对纳入的36篇文献进行分析，结果显示：针灸治疗POAS最常用的干预措施为电针；所选腧穴以特定穴为主体，注重上下配穴；腧穴配伍存在固定搭配，经穴置信度最高的关联群为足三里-内关；通过聚类分析可得到4个聚类群。结论：通过数据挖掘技术发现针灸治疗POAS存在一定规律，特定穴是处方的主要组成部分，足三里-三阴交-神门-内关为针灸治疗POAS的主要腧穴。