333 results on '"Ahlner J"'
Search Results
52. Cerebrospinal fluid concentrations of propofol during anaesthesia in humans
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Engdahl, O, primary, Abrahams, M, additional, Björnsson, A, additional, Vegfors, M, additional, Norlander, B, additional, Ahlner, J, additional, and Eintrei, C, additional
- Published
- 1998
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53. Patients' and Physicians' Assessment of Risks Associated with Hypertension and Benefits from Treatment
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Kjellgren, K. I., primary, Ahlner, J., additional, Dahlof, B., additional, Gill, H., additional, Hedner, T., additional, and Saljo, R., additional
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- 1998
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54. A population-based study of plasma cyclic guanosine monophosphate: relations to age, atrial natriuretic factor and angiotensin-converting enzyme activity
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Nyström, F. H., primary, Ahlner, J., additional, Karlberg, B. E., additional, and öhman, P. K., additional
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- 1998
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55. Plasma nitric oxide metabolite in women with primary Raynaud's phenomenon and in healthy subjects
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Ringqvist, Å., primary, Leppert, J., additional, Myrdal, U., additional, Ahlner, J., additional, Ringqvist, I., additional, and Wennmalm, Å., additional
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- 1997
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56. Treating hypertension in elderly people
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Hoffmann, M., primary and Ahlner, J., additional
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- 1996
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57. Cold exposure increases cyclic guanosine monophosphate in healthy women but not in women with Raynaud's phenomenon
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LEPPERT, J., primary, RINGQVIST, Å., additional, AHLNER, J., additional, MYRDAL, U., additional, SÖRENSEN, S., additional, and RINGQVIST, I., additional
- Published
- 1995
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58. Correlation between plasma cyclic GMP and systolic blood pressure in healthy volunteers
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Torfgård, K.E., primary, Gustafsson, Y., additional, and Ahlner, J., additional
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- 1992
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59. Role of nitric oxide and cyclic GMP as mediators of endothelium-independent neurogenic relaxation in bovine mesenteric artery.
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Ahlner, J, primary, Ljusegren, M E, additional, Grundström, N, additional, and Axelsson, K L, additional
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- 1991
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60. Effects of pertussis toxin on vasodilation and cyclic GMP in bovine mesenteric arteries and demonstration of a 40 kD soluble protein ribosylation substrate for pertussis toxin
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Ljusegren, M.Ekstam, primary, Axelsson, K.L., additional, Ahlner, J., additional, Karlsson, J.O.G., additional, Andersson, R.G.G., additional, Magnusson, B.R., additional, and Friedman, R.L., additional
- Published
- 1990
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61. Fatal intoxication cases: cytochromeP 4502D6 and 2C19 genotype distributions.
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Zackrisson, A.L., Holmgren, P., Gladh, A.B., Ahlner, J., and Lindblom, B.
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PHARMACOGENOMICS ,ANTIDEPRESSANTS ,ANTIPSYCHOTIC agents ,CYTOCHROME P-450 ,ENZYMES ,DRUG administration - Abstract
Objective: Many commonly used pharmaceuticals, such as antidepressants and neuroleptics as well as some illegal drugs, are metabolised by the cytochrome P 450 enzyme debrisoquine 4-hydroxylase (CYP2D6). Of Caucasians, 7-10% lack this enzyme, which can, upon administration of drugs in normal therapeutic doses, lead to adverse reactions and unexpected intoxication, leading in turn even to a fatal outcome in some cases. Methods: Individuals (n = 242) who had died due to intoxication by pharmaceuticals were genotyped for CYP2D6 and CYP2C19 and compared with a reference group of 281 blood donors. A single nucleotide polymorphism (SNP) method was used to identify five CYP2D6 alleles: *1 (wt), *2, *3, *4 and *6. The allele *5, a complete gene deletion, was identified by a multiplex amplification of long DNA fragments. Four CYP2C19 alleles *1 (wt), *2, *3 and *4 were also identified by SNP analysis. Results: The prevalence of the CYP2D6 poor metaboliser (PM) genotypes in individuals with fatal intoxication was lower (4.7%) than expected from the frequencies of these genotypes in the blood donors (8.5%). A significantly lower frequency Pc 0.005 (0.03 with correction according to Bonferroni) was found for the CYP2D6*4 allele among the fatal intoxication cases. The CYP2C19 genotype analyses showed the same results for the fatal intoxication cases and for the blood donors. Conclusions: The findings in this study confirm our earlier observations of a lower frequency of CYP2D6 PM genotypes in cases of fatal intoxication. To our knowledge, it has not been shown previously that intoxication victims might have a lower frequency of PMs than the general population. [ABSTRACT FROM AUTHOR]
- Published
- 2004
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62. No effect of Chinese acupuncture on isocapnic hyperventilation with cold air in asthmatics, measured with impulse oscillometry.
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Malmström M, Ahlner J, Carlsson C, and Schmekel V
- Abstract
The cost to society and the individual of treating asthma has been increasing in developed countries. This has given rise to studies of the efficacy of complementary treatments. The aim of this study was to evaluate the efficacy of traditional Chinese Acupuncture in patients with mild asthma. The method used for evaluation of efficacy was total airway resistance at 5Hz (R5) as measured by impulse oscillometry (IOS)--a forced oscillation technique, at baseline and after a bronchial challenge with voluntary isocapnic hyperventilation of cold air (IHCA). The study was a parallel group randomised placebo controlled trial with evaluator blinding. Twenty-seven asthmatics were recruited and 24 completed the study, 10 of them received acupuncture and 14 received a placebo treatment (mock-TENS). Treatment continued for 15 weeks, and efficacy was tested two weeks following the last treatment. Randomisation resulted in female over representation in the acupuncture group, but lung-function and bronchial responsiveness to IHCA were comparable in the two populations before the start of treatment (p>0.05 vs. p > 0.05). There were no statistically significant effects of the treatment before (p > 0.05) or after IHCA (p > 0.05) in either of the groups. The statistical power of the study to show a clinically relevant difference in bronchial responsiveness to IHCA after treatment was near 80%. We conclude that there were no significant effects of traditional Chinese Acupuncture on airway status in our patients with asthma. [ABSTRACT FROM AUTHOR]
- Published
- 2002
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63. Asthma care and factors affecting medication compliance: the patient's point of view.
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Lindberg, M, Ekström, T, Möller, M, and Ahlner, J
- Published
- 2001
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64. Effects of Dipyridamole on the Glyceryl-trinitrate-induced Inhibition of Coronary Artery Muscle Tone and Platelet Aggregation in Relation to Cyclic Nucleotide Metabolism.
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Ahlner, J., Andersson, R. G. G., Axelsson, K. L., Bunnfors, I., and Wallentin, L.
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- 1985
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65. Flunitrazepam: an evaluation of use, abuse and toxicity
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Druid, H., Holmgren, P., and Ahlner, J.
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- 2001
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66. Antihypertensive treatment and patient autonomy - the follow-up appointment as a resource for care
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Kjellgren, K. I., Svensson, S., Ahlner, J., and Saljo, R.
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- 2000
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67. Reasons for adherence with antihypertensive medication
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Svensson, S., Kjellgren, K. I., Ahlner, J., and Saljo, R.
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- 2000
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68. Cytochrome P450 2D6 (CYP2D6) genotyping on postmortem blood as a supplementary tool for interpretation of forensic toxicological results
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Druid, H., Holmgren, P., Carlsson, B., and Ahlner, J.
- Published
- 1999
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69. Antihypertensive medication in clinicalencounters
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Kjellgren, KarinI., Svensson, S., Ahlner, J., and Saaljo, R.
- Published
- 1998
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70. Urinary detection times and metabolite/parent compound ratios after a single dose of buprenorphine
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Ahlner, J., Andersson, M., Gunnarsson, L., Staffan Hägg, Josefsson, M., Kronstrand, R., and Nyström, I.
71. Nitrates
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Ahlner, J., primary and Axelsson, K. L., additional
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- 1987
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72. A novel neurogenic vasodilator mechanism in bovine mesenteric artery.
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Axelsson, K L, primary, Ljusegren, M E, additional, Ahlner, J, additional, and Grundström, N, additional
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- 1989
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73. A14: Is basal plasma cyclic guanosine monophosphate under different control in men and women? - A population based study with reference to gender, age, atrial natriuretic peptide and angiotensin-converting enzyme activity.
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Nyström, F., Ahlner, J., Karlberg, B.E., and Öhman, K.P.
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- 1997
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74. Taking antihypertensive medication - controlling or co-operating with patients?
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Kjellgren, K. I., Ahlner, J., and Saeljoe, R.
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- 1995
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75. Effects of Nitroglycerin on Platelet Aggregation Beyond the Effects of Acetylsalicylic Acid in Healthy Subjects
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Karlberg, K.-E., Ahlner, J., Henriksson, P., and Torfgaard, K.
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- 1993
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76. Correlation Between Plasma Cyclic GMP and Systolic Blood Pressure in Healthy Volunteers
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Torfgaard, K. E., Gustafsson, Y., and Ahlner, J.
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- 1992
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77. Evidence for Tolerance to the Platelet Inhibitory Effect of Nitroglycerin
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Karlberg, K.-E., Nowak, J., Ahlner, J., and Sylven, C.
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- 1994
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78. Recommended dosages of analgesic and sedative drugs in intensive care result in a low incidence of potentially toxic blood concentrations.
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Lennborn U, Johansson A, Lindgren E, Nielsen EI, Sandler H, Bertilsson M, Kronstrand R, Ahlner J, Kugelberg FC, and Rubertsson S
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- Humans, Male, Female, Middle Aged, Aged, Prospective Studies, Adult, Critical Care methods, Dexmedetomidine administration & dosage, Dexmedetomidine pharmacokinetics, Dexmedetomidine blood, Fentanyl administration & dosage, Fentanyl blood, Fentanyl pharmacokinetics, Critical Illness, Propofol administration & dosage, Propofol pharmacokinetics, Propofol blood, Clonidine administration & dosage, Clonidine pharmacokinetics, Clonidine blood, Ketamine administration & dosage, Ketamine blood, Ketamine pharmacokinetics, Morphine administration & dosage, Morphine blood, Morphine pharmacokinetics, Aged, 80 and over, Dose-Response Relationship, Drug, Thiopental administration & dosage, Thiopental pharmacokinetics, Acetaminophen administration & dosage, Acetaminophen blood, Acetaminophen pharmacokinetics, Hypnotics and Sedatives administration & dosage, Hypnotics and Sedatives pharmacokinetics, Hypnotics and Sedatives blood, Analgesics administration & dosage, Analgesics pharmacokinetics, Analgesics blood, Intensive Care Units, Midazolam administration & dosage, Midazolam pharmacokinetics, Midazolam blood
- Abstract
Background: Standard dosages of analgesic and sedative drugs are given to intensive care patients. The resulting range of blood concentrations and corresponding clinical responses need to be better examined. The purpose of this study was to describe daily dosages, measured blood concentrations, and clinical responses in critically ill patients. The purpose was also to contribute to establishing whole blood concentration reference values of the drugs investigated., Methods: A descriptive study of prospectively collected data from 302 admissions to a general intensive care unit (ICU) at a university hospital. Ten drugs (clonidine, fentanyl, morphine, dexmedetomidine, ketamine, ketobemidone, midazolam, paracetamol, propofol, and thiopental) were investigated, and daily dosages recorded. Blood samples were collected twice daily, and drug concentrations were measured. Clinical responses were registered using Richmond agitation-sedation scale (RASS) and Numeric rating scale (NRS)., Results: Drug dosages were within recommended dose ranges. Blood concentrations for all 10 drugs showed a wide variation within the cohort, but only 3% were above therapeutic interval where clonidine (57 of 122) and midazolam (38 of 122) dominated. RASS and NRS were not correlated to drug concentrations., Conclusion: Using recommended dose intervals for analgesic and sedative drugs in the ICU setting combined with regular monitoring of clinical responses such as RASS and NRS leads to 97% of concentrations being below the upper limit in the therapeutic interval. This study contributes to whole blood drug concentration reference values regarding these 10 drugs., Competing Interests: The authors report no conflict of interest., (© 2024 The Author(s).)
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- 2024
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79. Oxycodone-Related Deaths: The Significance of Pharmacokinetic and Pharmacodynamic Drug Interactions.
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Jakobsson G, Gustavsson S, Jönsson AK, Ahlner J, Gréen H, and Kronstrand R
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- Databases, Factual, Drug Interactions, Forensic Toxicology, Risk Factors, Analgesics, Opioid adverse effects, Oxycodone adverse effects
- Abstract
Background and Objectives: Oxycodone is frequently prescribed as well as detected in postmortem cases. Concurrent use of pharmacodynamically or pharmacokinetically interacting drugs can cause adverse effects or even fatal intoxication. The aims of this study were to investigate differences in prescriptions for and toxicological findings of pharmacodynamically and pharmacokinetically interacting drugs in fatal oxycodone-related intoxications and other causes of death. We also aimed to investigate the differences in prevalence of oxycodone prescriptions, and the detected postmortem oxycodone concentrations between fatal oxycodone-related intoxications and other causes of death., Methods: Forensic autopsy cases (2012-2018) where oxycodone was identified in femoral blood (n = 1236) were included. Medical history and prescription data were retrieved from national databases and linked to the forensic toxicology findings., Results: Oxycodone-related deaths were found to have higher blood concentrations of oxycodone (median 0.30 µg/g vs. 0.05 µg/g) and were less likely to have a prescription for oxycodone (OR 0.62) compared to nonintoxication deaths. Pharmacodynamically interacting drugs were prescribed in 79% and found in blood in 81% of the cases. Pharmacokinetically interacting drugs were rarely prescribed (1%). Oxycodone-related deaths were more likely to have prescriptions for a pharmacodynamically interacting drug (OR 1.7) and more often have co-findings of one or multiple pharmacodynamically interacting drugs (OR 5.6)., Conclusion: The results suggest that combined use of oxycodone and pharmacodynamically interacting drugs is associated with oxycodone-related death and that non-medical use of oxycodone is a potential risk factor for oxycodone-related intoxication., (© 2022. The Author(s).)
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- 2022
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80. Use of Lisdexamfetamine or Amphetamine? Interpretation of Chiral Amphetamine Analyses.
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Chermá MD, Nilsson GH, Johansson A, Jönsson AK, and Ahlner J
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- Amphetamine, Dextroamphetamine, Humans, Sweden, Central Nervous System Stimulants, Lisdexamfetamine Dimesylate
- Abstract
Amphetamine is frequently detected in forensic toxicological cases. Differentiating between the two isomers of amphetamine (d-amphetamine and l-amphetamine) and determining their relative proportion are fundamental to correctly interpret the results of toxicological analyses. The aim of this study was to examine the profile of amphetamine as well as storage stability of the isomers in authentic samples from patients chronically treated with lisdexamfetamine (LDX), the most prescribed medical amphetamine product in Sweden. Blood and urine samples were collected from 18 patients. The samples were analyzed with an achiral (racemate) method for quantification of amphetamine and with a chiral method to determine the proportion of each isomer of amphetamine. The median daily dose of LDX was 40 mg (range, 20-70 mg). The median amphetamine concentration was 0.06 µg/g (range, 0.02-0.15 µg/g) in blood and 6 µg/mL (range, 1-22 µg/mL) in urine. Only d-amphetamine was found in the blood and urine samples from the included patients. Furthermore, no formation of l-amphetamine occurred during the storage for 3 months at 4°C, 9 months at -20°C and three freeze-thaw cycles. The results from this study may be helpful in the interpretation of whether the source of identified amphetamine in biological samples is from LDX drug intake or not., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2022
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81. The Importance of BHB Testing on the Post-Mortem Diagnosis of Ketoacidosis.
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Ahlström S, Ahlner J, Jönsson AK, and Green H
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- Diagnosis, Humans, 3-Hydroxybutyric Acid metabolism, Alcoholism diagnosis, Alcoholism metabolism, Diabetic Ketoacidosis diagnosis, Diabetic Ketoacidosis metabolism, Hypothermia diagnosis, Hypothermia metabolism
- Abstract
Although beta-hydroxybutyrate (BHB) analysis has proved its importance in forensic pathology, its effects on cause-of-death diagnostics are unaddressed. Therefore, this study aims at evaluating the effects of BHB analysis on the number of deaths by DKA (diabetes ketoacidosis), AKA (alcoholic ketoacidosis), HHS (hyperosmolar hyperglycaemic state), hypothermia, diabetes, alcoholism, and acidosis NOS (not otherwise specified). All 2900 deaths from 2013 through 2019 in which BHB was analysed at the National Board of Forensic Medicine, and 1069 DKA, AKA, HHS, hypothermia, diabetes, alcoholism, and acidosis cases without BHB analysis were included. The prevalence of BHB-positive cases for each cause of death, and trends and proportions of different BHB concentrations, were investigated. The number of BHB analyses/year increased from 13 to 1417. AKA increased from three to 66 and acidosis from one to 20. The deaths from alcoholism, DKA, and hypothermia remained stable. It is unclear why death from alcoholism remained stable while AKA increased. The increase in unspecific acidosis deaths raises the question why a more specific diagnosis had not been used. In conclusion, BHB analysis is instrumental in detecting AKA and acidosis. The scientific basis for the diagnosis of DKA and hypothermia improved, but the number of cases did not change.
- Published
- 2021
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82. False negative results in testosterone doping in forensic cases: Sensitivity of the urinary detection criteria T/E and T/LH.
- Author
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Lood Y, Aardal E, Gustavsson S, Prasolov I, Josefsson M, and Ahlner J
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- Adult, Epitestosterone analysis, False Negative Reactions, Gas Chromatography-Mass Spectrometry, Humans, Luteinizing Hormone analysis, Male, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, Substance Abuse Detection methods, Sweden, Testosterone analysis, Young Adult, Doping in Sports prevention & control, Epitestosterone urine, Luteinizing Hormone urine, Testosterone urine
- Abstract
At the Swedish national forensic toxicology laboratory, a measured testosterone/epitestosterone (T/E) ratio ≥ 12 together with testosterone/luteinizing hormone (T/LH) in urine > 400 nmol/IU is considered as a proof of exogenous testosterone administration. However, according to the rules of the World Anti-Doping Agency (WADA), samples with T/E ratio > 4 are considered suspicious and shall be further analysed by gas chromatography-combustion-isotope ratio mass spectrometry (GC-C-IRMS) to confirm the origin of testosterone and its metabolites. The aim of this study was to investigate the possibility of false negative results and to estimate the frequency of negative results using the current criteria for detection of abuse of testosterone in forensic investigations. Urine and serum samples were collected by the police at suspected infringement of the doping law in Sweden. Fifty-eight male subjects were included in the study. Urinary testosterone was determined by gas chromatography-mass spectrometry (GC-MS), serum testosterone and LH-by immunoassay. The origin of testosterone and its metabolites was confirmed by means of GC-C-IRMS. Twenty-six of the 57 analysed subjects tested positive for exogenous testosterone using the criteria T/E ≥ 12 combined with T/LH > 400 nmol/IU. The IRMS analyses confirmed 47 positives; thus, 21 were considered false negatives. Negative predictive value was 32% (95% confidence interval [CI]: 16%-50%) and sensitivity 55%. No false positive subjects were found. The number of false negative cases using the current criteria for the detection of testosterone abuse and hence the low sensitivity indicates a need to discuss introduction of new strategies in forensic doping investigations., (© 2021 John Wiley & Sons, Ltd.)
- Published
- 2021
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83. Determination of testosterone in serum and saliva by liquid chromatography-tandem mass spectrometry: An accurate and sensitive method applied on clinical and forensic samples.
- Author
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Lood Y, Aardal E, Ahlner J, Ärlemalm A, Carlsson B, Ekman B, Wahlberg J, and Josefsson M
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- Adult, Child, Chromatography, Liquid, Female, Humans, Male, Reproducibility of Results, Spectrometry, Mass, Electrospray Ionization, Testosterone, Saliva, Tandem Mass Spectrometry
- Abstract
A highly sensitive and accurate electrospray liquid chromatography tandem-mass spectrometry (ESI-LC-MS/MS) method for determination of testosterone in human serum and saliva was developed and validated. Accurate quantification of testosterone in human matrices is essential in diagnosis and management of androgen status in men, women and children, and in forensic investigations of suspected abuse of anabolic androgenic steroids. Chromatography was performed on an HSS-T3 C18 column with a total run-time of 5.5 min. The tandem mass spectrometry was operated in positive electrospray ionization mode with multiple reaction monitoring. Serum and saliva samples of 200 μL, were prepared by solid-phase extraction using a 96-well plate following precipitation with 200 μL methanol.
13 C labeled testosterone was used as internal standard for quantification. The standard curve was linear within the range of 4-1000 pg/mL and the limit of quantification of both serum and salivary testosterone was 4 pg/mL. Accuracy were 99-101 % and 93-95 % with between-run imprecision in serum and saliva, respectively, and inter- and intra-assay coefficients of variation were less than 9.2 %. The method proved to be applicable for determination of testosterone over a wide range of concentrations in serum and saliva samples from clinical patients with various androgen disorders, healthy male and female adults as well as from forensic cases., Competing Interests: Declaration of competing interest No competing interest is declared for all authors., (Copyright © 2020 Elsevier B.V. All rights reserved.)- Published
- 2021
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84. Current Evidence on Abuse and Misuse of Gabapentinoids.
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Hägg S, Jönsson AK, and Ahlner J
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- Humans, Pharmacovigilance, Risk Factors, Gabapentin, Prescription Drug Misuse, Substance-Related Disorders
- Abstract
This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Pharmacovigilance studies, register-based studies, surveys, clinical toxicology studies, and forensic toxicology studies were identified and scrutinized with the goal to define the problem, identify risk factors, and discuss possible methods to reduce the potential for abuse and misuse. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored.
- Published
- 2020
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85. The unknown known: non-cardiogenic pulmonary edema in amlodipine poisoning, a cohort study.
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Lindeman E, Ålebring J, Johansson A, Ahlner J, Kugelberg FC, and Nordmark Grass J
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- Adolescent, Adult, Aged, Aged, 80 and over, Amlodipine blood, Cardiac Output, Extracorporeal Membrane Oxygenation, Female, Glucose metabolism, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Edema physiopathology, Pulmonary Edema therapy, Young Adult, Amlodipine poisoning, Pulmonary Edema chemically induced
- Abstract
Context: Amlodipine is the most common calcium channel blocker (CCB) on the Swedish market, and poison center (PC) consultations for amlodipine overdoses are increasing. The clinical picture is dominated by vasodilation with relative preservation of cardiac function. CCBs selectively dilate vessels on the afferent side of the capillary network which, in states of preserved or increased blood flow may lead to edema formation, including non-cardiogenic pulmonary edema (NCPE). This complication has been considered rare in CCB poisoning. In this cohort study of nineteen amlodipine poisonings with high amlodipine blood levels, the incidence and clinical significance of NCPE in severe amlodipine poisoning are explored. Methods: During 2017-2018 the Swedish PC prospectively encouraged the gathering of blood samples in amlodipine poisonings with symptoms requiring treatment with inotropes or vasopressors. Samples were sent by mail to the Forensic Toxicology Division at the Swedish National Board of Forensic Medicine for screening and quantification of relevant toxicants. Patients with blood amlodipine levels >0.25 µg/mL were included in a cohort whose case details were gathered from medical records and PC-case notes with a special focus on signs of NCPE. Results: Nineteen patients met the blood amlodipine inclusion criteria. Four (21%) died and one patient was treated with VA-ECMO. Nine patients developed NCPE defined as a need for positive pressure ventilation (PPV) while having an echocardiographically normal left ventricular function. Conclusion: In this prospective cohort study of consecutive and analytically confirmed significant amlodipine poisonings NCPE was a common finding occurring in 47% of the whole cohort and in 64% of patients who did not go on to develop complete hemodynamic collapse.
- Published
- 2020
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86. Do patients or their physicians more accurately assess long-term risk associated with hypertension? A population-based study.
- Author
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Hoffmann M, Nilsson PM, Ahlner J, Dahllöf B, Fredrikson M, Säljö R, and Kjellgren KI
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- Adult, Aged, Aged, 80 and over, Antihypertensive Agents therapeutic use, Female, Humans, Hypertension diagnosis, Hypertension drug therapy, Male, Middle Aged, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Sweden, Young Adult, Decision Making, Shared, Diagnostic Self Evaluation, Heart Failure etiology, Hypertension complications, Myocardial Infarction etiology, Physicians, Stroke etiology
- Abstract
Objective: To compare the assessments of 10-year probability by patients and their physicians of cardiovascular complications of hypertension with actual outcomes. Design: Patients with uncomplicated hypertension treated with at least one antihypertensive drug at inclusion were followed for 10 years through mandatory national health registers. Setting: 55 primary health care centres, 11 hospital outpatient clinics in Sweden Patients: 848 patient, 212 physicians. Main outcome measures: Patients and physicians estimated the probability of hypertension-related complications with treatment (death, heart failure, acute myocardial infarction/AMI, and stroke) for each patient in 848 pairs. Estimates were compared with the clinical outcomes 10 years later using data from the Mortality Register and the National Patient Register. Results: Patients were significantly better ( p < 0.001) than their physicians in estimating the average probability of heart failure compared with actual outcome data (14% vs. 24%, outcome 15%), AMI (16% vs. 26%, outcome 8%), and stroke (15% vs. 25%, outcome 11%). Patients were significantly worse ( p < 0.001) at estimating the average probability of death (10% vs. 18%, actual outcome 20%). Neither the patients nor the physicians were able to distinguish reliably between low-risk and high-risk patients after adjustment for age and sex. Conclusions: Patients were better than their physicians in estimating the average probability of morbidity due to hypertension. Both the patients and their attending physicians had difficulty in estimating the individual patient's risk of complications. The results support the use of evidence-based tools in consultations for assessing the risk of cardiovascular complications associated with hypertension.Key points • Shared decision making relies on a common understanding of risks and benefits. Tools for risk assessment of hypertension have been introduced in the last two decades. • Without tools for risk assessment, both patients and physicians had difficulties in estimating the individual patient's risk of cardiovascular morbidity. • Patients were better than physicians in estimating actual average cardiovascular morbidity due to hypertension during a follow-up of 10 years. • The results support the use of evidence-based tools in consultations for assessing the risk of cardiovascular complications associated with hypertension.
- Published
- 2020
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87. Metformin - Postmortem fatal and non-fatal reference concentrations in femoral blood and risk factors associated with fatal intoxications.
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Walz L, Jönsson AK, Ahlner J, Östgren CJ, and Druid H
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- Accidents mortality, Adult, Aged, Aged, 80 and over, Alcoholism epidemiology, Cardiovascular Diseases epidemiology, Case-Control Studies, Cohort Studies, Female, Humans, Male, Middle Aged, Registries, Retrospective Studies, Risk Factors, Social Isolation, Stroke epidemiology, Suicide statistics & numerical data, Sweden epidemiology, Hypoglycemic Agents blood, Hypoglycemic Agents poisoning, Metformin blood, Metformin poisoning
- Abstract
Background & Objectives: To improve the interpretation of fatal intoxications by establishing fatal and non-fatal reference concentrations of metformin in postmortem femoral blood and to further evaluate risk factors associated with fatal metformin intoxication., Methods: All forensic autopsies in Sweden where metformin was detected in femoral blood 2011-2016 were identified in the National Board of Forensic Medicine databases (NFMD). The cases were classified as single substance intoxications, A (n = 22), multiple substance intoxications, B (N = 7) and postmortem controls, C (N = 13). The control group consisted of cases where metformin was detected, but the cause of death excluded the incapacitation by metformin or other substances. Strict inclusion criteria were used, and all postmortem cases were assessed by two independent reviewers. All other cases where the inclusion criteria of groups A-C where not met formed group O (N = 78). The forensic findings logged in the NFMD where linked to national registers whereby information on comorbidities, dispensed drugs and clinical data could be obtained., Results: The mean age was 66 ± 10 years in the total study population and did not differ between the groups. The proportion of men was 64% in group A, 71% in B, 77% in C and 74% in group O. The median values of metformin in group A (48.5 μg/g; range 13.0-210 μg/g) and B (21.0 μg/g; range 4.40-95.0 μg/g) were significantly (p < 0.001 and p = 0.015 respectively) higher than those of the control group C (2.30 μg/g ; range 0.70-21.0 μg/g). The median concentration of metformin in group A and B was also significantly higher than in group O (4.60 μg/g; range 0.64-54.0 μg/g) (p < 0.001 and p = 0.040 respectively). The results suggest that intoxication with metformin as a cause of death should be considered when the postmortem femoral blood level exceeds about 10 μg/g, although higher levels may be seen in postmortem in cases without incapacitation. The metformin intoxication was confirmed to be intentional in 23% (n = 5) of the single intoxications. Underlying factors identified as important for the remaining fatal metformin intoxications included living alone, any contraindication for the use of metformin, known alcohol abuse and a history of stroke or cardiovascular disease., Conclusions: The reported post mortem femoral blood concentrations of metformin can hopefully contribute to a better interpretation of results in suspected poisonings and obscure cases. Living in a single household, history of cardiovascular disease and contraindications, predominantly alcohol abuse, were associated with fatal metformin intoxication., (Copyright © 2019 Elsevier B.V. All rights reserved.)
- Published
- 2019
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88. Selective serotonin re-uptake inhibitors and the risk of violent suicide: a nationwide postmortem study.
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Forsman J, Masterman T, Ahlner J, Isacsson G, and Hedström AK
- Subjects
- Adult, Age Factors, Aged, Cross-Over Studies, Humans, Logistic Models, Middle Aged, Odds Ratio, Registries, Risk, Selective Serotonin Reuptake Inhibitors therapeutic use, Sex Factors, Sweden, Forensic Toxicology, Selective Serotonin Reuptake Inhibitors toxicity, Suicide statistics & numerical data
- Abstract
Purpose: We endeavored to investigate whether previous findings of an association between antemortem exposure to selective serotonin re-uptake inhibitors (SSRI) and method of suicide could be replicated., Methods: Using the Swedish National Board of Forensic Medicine's toxicology database and the Swedish National Board of Health and Welfare's national registries of causes of death and prescriptions, 10,002 incidents of suicide were retrieved. Risks of violent suicide conferred by SSRIs, expressed as odds ratios (ORs) with 95% confidence intervals (CIs), were estimated using logistic regression. In accordance with previous work, suicide by violent means-cases-were defined as death attributable to causes designated by ICD-10 codes X70-X83 and Y20-Y33; and suicide by non-violent means-controls-by codes X60-X69 and Y10-Y19., Results: Our results imply that SSRI exposure confers a risk of violent suicide for shorter treatment durations; and that antemortem exposure to other substances (including illegal drugs) confounds estimates of risk. After adjustment for age, sex, and other substances, SSRIs treatment not exceeding 28 days conferred an almost fourfold risk of violent suicide (OR 3.6 [95% CI 1.9-6.8]), a finding partly in line with a recent Swedish study that employed a case-crossover design., Conclusions: Although risks associated with shorter treatment duration may reflect latencies to onset of therapeutic effect, it is unclear how latencies would influence the choice of suicide method, unless conditions for which SSRIs are prescribed are themselves associated with violent suicide. Finally, in the total dataset, SSRIs were not associated with an increased risk of violent suicide; however, by adjusting for other substances, we avoided the spurious conclusion that the effect of medications in this regard is protective.
- Published
- 2019
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89. A case of massive metoprolol and amlodipine overdose with blood concentrations and survival following extracorporeal corporeal membrane oxygenation (ECMO).
- Author
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Nordmark Grass J, Ahlner J, Kugelberg FC, Steinwall J, Forsman P, and Lindeman E
- Subjects
- Adult, Amlodipine blood, Female, Humans, Metoprolol blood, Suicide, Attempted, Treatment Outcome, Amlodipine administration & dosage, Drug Overdose blood, Drug Overdose therapy, Extracorporeal Membrane Oxygenation, Metoprolol administration & dosage
- Published
- 2019
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- View/download PDF
90. Evaluating the hip-flask defence in subjects with alcohol on board: An experimental study.
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Kronstrand C, Nilsson G, Chermà MD, Ahlner J, Kugelberg FC, and Kronstrand R
- Subjects
- Adult, Aged, Alcohol Drinking blood, Alcohol Drinking urine, Central Nervous System Depressants blood, Central Nervous System Depressants pharmacokinetics, Central Nervous System Depressants urine, Dose-Response Relationship, Drug, Drug Administration Schedule, Ethanol pharmacokinetics, Female, Humans, Male, Middle Aged, Substance Abuse Detection, Sweden, Young Adult, Driving Under the Influence legislation & jurisprudence, Ethanol blood, Ethanol urine
- Abstract
Driving under the influence of alcohol is a major problem for traffic-safety and a popular defence argument is alleged consumption after driving, commonly referred to as the hip-flask defence. Forensic toxicologists are often called as expert witnesses in drinking and driving cases where the suspect has claimed the hip-flask defence, to assess the credibility of the explanation. Several approaches to help the expert have been introduced but the scientific data used to support or challenge this is solely based on data from controlled single doses of ethanol administered during a short time and in abstinent subjects. In reality, we believe that even in drinking after driving cases, the subject many times has alcohol on board at time of the hip-flask drink. This questions the applicability of the data used as basis to investigate the hip-flask defence. To fill this knowledge gap, we aimed to investigate how blood and urine ethanol kinetics vary after an initial drinking session of beer and then a subsequent hip-flask drink of three different doses of whiskey. Fifteen subjects participated in the study and each provided 10 urine samples and 17 blood samples over 7h. The initial drink was 0.51g ethanol/kg and the second was either 0.25, 0.51, or 0.85g/kg. Our data suggested that the difference between the ethanol concentrations in two consecutive urine samples is a more sensitive parameter than the ratio between urine and blood alcohol to detect a recent intake when ethanol from previous intakes are already present in the body. Twelve subjects presented results that fully supported a recent intake using the criteria developed from a single intake of ethanol. Three subjects showed unexpected results that did not fully support a recent intake. We conclude that data from one blood sample and two urine samples provide good evidence for investigating the hip-flask defence even if alcohol was on board at the time of the hip-flask drink., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2019
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91. A non-fatal intoxication and seven deaths involving the dissociative drug 3-MeO-PCP.
- Author
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Johansson A, Lindstedt D, Roman M, Thelander G, Nielsen EI, Lennborn U, Sandler H, Rubertsson S, Ahlner J, Kronstrand R, and Kugelberg FC
- Subjects
- Adult, Akathisia, Drug-Induced, Catatonia chemically induced, Chromatography, Liquid, Designer Drugs analysis, Female, Half-Life, Hallucinogens analysis, Humans, Hypertension chemically induced, Male, Phencyclidine adverse effects, Phencyclidine analysis, Phencyclidine poisoning, Substance-Related Disorders diagnosis, Tachycardia chemically induced, Tachypnea chemically induced, Tandem Mass Spectrometry, Young Adult, Designer Drugs adverse effects, Designer Drugs poisoning, Hallucinogens adverse effects, Hallucinogens poisoning, Phencyclidine analogs & derivatives
- Abstract
Introduction: 3-methoxyphencyclidine (3-MeO-PCP) appeared on the illicit drug market in 2011 and is an analogue of phencyclidine, which exhibits anesthetic, analgesic and hallucinogenic properties. In this paper, we report data from a non-fatal intoxication and seven deaths involving 3-MeO-PCP in Sweden during the period March 2014 until June 2016., Case Descriptions: The non-fatal intoxication case, a 19-year-old male with drug problems and a medical history of depression, was found awake but tachycardic, hypertensive, tachypnoeic and catatonic at home. After being hospitalized, his condition worsened as he developed a fever and lactic acidosis concomitant with psychomotor agitation and hallucinations. After 22h of intensive care, the patient had made a complete recovery. During his hospitalization, a total of four blood samples were collected at different time points. The seven autopsy cases, six males and one female, were all in their twenties to thirties with psychiatric problems and/or an ongoing drug abuse., Methods: 3-MeO-PCP was identified with liquid chromatography (LC)/time-of-flight technology and quantified using LC-tandem mass spectrometry., Results: In the clinical case, the concentration of 3-MeO-PCP was 0.14μg/g at admission, 0.08μg/g 2.5h after admission, 0.06μg/g 5h after admission and 0.04μg/g 17h after admission. The half-life of 3-MeO-PCP was estimated to 11h. In the autopsy cases, femoral blood concentrations ranged from 0.05μg/g to 0.38μg/g. 3-MeO-PCP was the sole finding in the case with the highest concentration and the cause of death was established as intoxication with 3-MeO-PCP. In the remaining six autopsy cases, other medications and drugs of abuse were present as well., Conclusion: Despite being scheduled in January 2015, 3-MeO-PCP continues to be abused in Sweden. Exposure to 3-MeO-PCP may cause severe adverse events and even death, especially if the user does not receive life-supporting treatment., (Copyright © 2017 Elsevier B.V. All rights reserved.)
- Published
- 2017
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92. Post-mortem concentrations of drugs determined in femoral blood in single-drug fatalities compared with multi-drug poisoning deaths.
- Author
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Jones AW, Holmgren A, and Ahlner J
- Subjects
- Accidents statistics & numerical data, Central Nervous System Depressants blood, Databases, Factual, Drug Overdose blood, Drug Overdose mortality, Ethanol blood, Forensic Toxicology, Humans, Substance-Related Disorders blood, Substance-Related Disorders mortality, Suicide statistics & numerical data, Sweden epidemiology, Illicit Drugs blood, Pharmaceutical Preparations blood, Poisoning blood, Poisoning mortality
- Abstract
Background: Reference concentrations of drugs in post-mortem femoral blood furnishes useful information when poisoning (intoxication) deaths are investigated. However, few publications compare the concentrations of drugs in single-drug fatalities with multi-drug intoxications. This article attempts to fill this gap in knowledge., Methods: We searched a national forensic toxicology database (TOXBASE) and found N=13,963 deaths attributed by pathologists to intoxication by drugs (poisoning). The manner of death, whether accidental, suicidal or undetermined intent, was also available. To compare drug concentrations in living and deceased persons, we used information from people arrested for driving under the influence of drugs (DUID)., Results: The percentage of drug intoxication deaths classified as undetermined intent decreased and accidental overdose deaths increased during the study period. In 2010 manner of death was considered accidental, suicidal or undetermined, in 41%, 30% and 28% of victims, respectively. Most of the deceased had taken multiple drugs (mean three drugs/case) and four or more drugs were identified in 35% of deaths. In single-drug fatalities ethanol (1585), morphine (114), citalopram (28), propoxyphene (51), flunitrazepam (70), propiomazine (46), tramadol (20) and zopiclone (15) were most prevalent. Alprazolam and diazepam were common findings in multi-drug deaths, although these benzodiazepines were rarely encountered in mono-drug intoxication deaths. Median blood concentrations were appreciably higher (2-10 fold) in single-drug fatalities compared with multi-drug deaths. The blood concentrations in DUID suspects were mostly lower than in the multi-drug poisoning deaths., Conclusion: This compilation of femoral blood concentrations of drugs in poisoning deaths provides a useful reference material, because we have distinguished between mono-drug intoxication deaths and poisoning with multiple-drugs., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
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93. Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving.
- Author
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Ahlner J, Holmgren A, and Jones AW
- Subjects
- Adult, Age Factors, Alcoholic Intoxication complications, Alcoholic Intoxication mortality, Databases, Factual, Female, Forensic Pathology, Humans, Male, Middle Aged, Postmortem Changes, Sex Factors, Substance-Related Disorders complications, Sweden epidemiology, Automobile Driving, Crime, Substance-Related Disorders mortality
- Abstract
Background: Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem., Methods: This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma., Results: Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p<0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p<0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p<0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p<0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids., Conclusions: This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
- Full Text
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94. Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden.
- Author
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Tjäderborn M, Jönsson AK, Sandström TZ, Ahlner J, and Hägg S
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Prevalence, Sweden epidemiology, Young Adult, Automobile Driving psychology, Prescription Drugs adverse effects, Psychotropic Drugs adverse effects, Substance-Related Disorders epidemiology
- Abstract
Aims: To determine the prevalence of non-prescribed drug use among subjects suspected of drug-impaired driving with a psychoactive prescription drug, and to identify associated factors., Methods: Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was our outcome, defined as a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors., Results: In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with non-prescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with non-prescribed use., Conclusions: Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
- Full Text
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95. High prevalence of previous arrests for illicit drug use and/or impaired driving among drivers killed in motor vehicle crashes in Sweden with amphetamine in blood at autopsy.
- Author
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Jones AW, Holmgren A, and Ahlner J
- Subjects
- Adolescent, Adult, Aged, Autopsy, Female, Humans, Male, Middle Aged, Prevalence, Sweden epidemiology, Accidents, Traffic statistics & numerical data, Amphetamine blood, Crime statistics & numerical data, Forensic Toxicology, Illicit Drugs, Substance-Related Disorders epidemiology
- Abstract
Background: Amphetamine, and to a lesser extent the secondary amine methamphetamine, are major recreational drugs of abuse in Sweden. These central stimulant amines are identified in blood from roughly 50% of people arrested for driving under the influence of drugs (DUID). However, much less information is available about the presence of amphetamine in blood of drivers killed in road-traffic crashes., Methods: This retrospective 10-year study (2001-2010) used a forensic toxicology database (TOXBASE) to retrieve information about road-traffic crashes when the driver had amphetamine and/or methamphetamine in autopsy blood. Forensic toxicology results were available from over 95% of all drivers killed on Swedish roads during this 10-year period., Results: Amphetamine was present in the blood of 106 drivers (3.9%) either alone or together with other psychoactive substances (e.g. alcohol, cannabis, diazepam, alprazolam, etc.). The vast majority of fatalities were male (95%) with a mean age (±standard deviation) of 37±11.4 years (range 16-67 years). The mean (median) and highest concentrations of amphetamine in femoral blood were 1.36 mg/L (1.0mg/L) and 6.74 mg/L, respectively. Many of the victims (75%) had been arrested previously for use of illicit drugs or DUID. The median number of previous arrests was 4 (range 0-83) and amphetamine or methamphetamine were among the drugs identified in blood samples from 89% of cases (0-100%)., Conclusion: The high prevalence of repeat DUID offending and/or use of illicit drugs among the drivers killed in road-traffic crashes suggests that an early intervention and treatment for stimulant abuse might have been more beneficial than conventional punishments for such drug-related crimes., (Copyright © 2015 Elsevier B.V. All rights reserved.)
- Published
- 2015
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96. Validation of an LC-MS/MS method for the determination of zopiclone, N-desmethylzopiclone and 2-amino-5-chloropyridine in whole blood and its application to estimate the original zopiclone concentration in stored specimens.
- Author
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Nilsson GH, Kugelberg FC, Ahlner J, and Kronstrand R
- Subjects
- Chromatography, Liquid, Drug Stability, Forensic Toxicology, Humans, Models, Statistical, Specimen Handling, Tandem Mass Spectrometry, Azabicyclo Compounds blood, Hypnotics and Sedatives blood, Piperazines blood, Pyridines blood
- Abstract
2-Amino-5-chloropyridine (ACP) is a degradation product of zopiclone (ZOP) and its two main metabolites N-desmethylzopiclone (NDZOP) and zopiclone N-oxide (ZOPNO). ACP may be formed when specimens are stored. ZOP instability in blood makes interpretation of concentrations difficult especially in cases of prolonged sample storage. This study investigated how ACP could be used to estimate the original concentration of ZOP in authentic samples. For that purpose, an analytical liquid chromatography tandem mass spectrometry (LC-MS/MS) method for the quantitation of ACP, ZOP, and NDZOP in blood was developed and validated. Due to poor extraction recovery, ZOPNO was not included in the analytical method. The method was then applied to investigate ACP formation, ZOP and NDZOP degradation in stored ZOP post-dosed authentic whole blood and two mathematical models were used to calculate the original concentration of ZOP. During storage, ACP was formed in amounts equimolar to the ZOP and NDZOP degradation. Results from samples in which ACP had been formed were used to test two models to estimate the original ZOP concentration. The correlation tests of the models showed strong correlations to the original ZOP concentration (r = 0.960 and r = 0.955) with p < 0.01 and explained more than 90 % of the ZOP concentration. This study showed that the equimolar degradation of ZOP and NDZOP to ACP could be used to estimate the original concentration of ZOP.
- Published
- 2015
- Full Text
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97. Corrigendum to "A population-based study on toxicological findings in Swedish homicide victims and offenders from 2007 to 2009" [Forensic Sci. Int. 244 (2014) 25-29].
- Author
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Hedlund J, Ahlner J, Kristiansson M, and Sturup J
- Published
- 2014
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98. Influence of UGT2B7, OPRM1 and ABCB1 gene polymorphisms on postoperative morphine consumption.
- Author
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Bastami S, Gupta A, Zackrisson AL, Ahlner J, Osman A, and Uppugunduri S
- Subjects
- ATP Binding Cassette Transporter, Subfamily B genetics, Adult, Age Factors, Aged, Analgesia, Patient-Controlled methods, Analgesics, Opioid administration & dosage, Dose-Response Relationship, Drug, Female, Genotype, Humans, Hysterectomy methods, Middle Aged, Pain, Postoperative drug therapy, Polymorphism, Single Nucleotide, Regression Analysis, Glucuronosyltransferase genetics, Morphine administration & dosage, Receptors, Opioid, mu genetics
- Abstract
Therapeutic modulation of pain with morphine and other opioids is associated with significant variation in both effects and adverse effects in individual patients. Many factors including gene polymorphisms have been shown to contribute to the interindividual variability in the response to opioids. The aim of this study was to investigate the significance of UGT2B7, OPRM1 and ABCB1 polymorphisms for interindividual variability in morphine-induced analgesia in patients undergoing hysterectomy. The frequency of these polymorphisms was also investigated in forensic autopsies as morphine is also a very commonly abused drug. Blood samples were collected from 40 patients following abdominal hysterectomy, 24 hr after initiation of analgesia through a patient-controlled analgesia (PCA) pump. Samples were genotyped and analysed for morphine and its metabolites. We also genotyped approximately 200 autopsies found positive for morphine in routine forensic analysis. Patients homozygous for UGT2B7 802C needed significantly lower dose of morphine for pain relief. The same trend was observed for patients homozygous for ABCB1 1236T and 3435T, as well as to OPRM1 118A. The dose of morphine in patients included in this study was significantly related to variation in UGT2B7 T802C. Age was significantly related to both dose and concentration of morphine in blood. Regression analysis showed that 30% of differences in variation in morphine dose could be explained by SNPs in these genes. The genotype distribution was similar between the forensic cases and the patients. However, the mean concentration of morphine was higher in forensic cases compared to patients. We conclude that gene polymorphisms contribute significantly to the variation in morphine concentrations observed in individual patients., (© 2014 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).)
- Published
- 2014
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99. A population-based study on toxicological findings in Swedish homicide victims and offenders from 2007 to 2009.
- Author
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Hedlund J, Ahlner J, Kristiansson M, and Sturup J
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Central Nervous System Depressants analysis, Child, Child, Preschool, Ethanol analysis, Female, Humans, Infant, Male, Middle Aged, Narcotics analysis, Registries, Retrospective Studies, Sweden epidemiology, Young Adult, Crime Victims statistics & numerical data, Criminals statistics & numerical data, Homicide statistics & numerical data, Substance Abuse Detection, Substance-Related Disorders epidemiology
- Abstract
Background and Objectives: Previous research on the toxicology of homicide has shown that about half of offenders and victims have psychoactive substances in their blood. The purpose of this study was to examine this topic in a Swedish setting., Methods: Toxicological data were sought in a database for all victims (n=273) and perpetrators (n=257) of homicide in Sweden from 2007 to 2009. Sufficient tests were identified for 97.1% of all victims (n=265) and 46.7% of all offenders (n=120). Additional information was obtained from court records and police reports., Results: A majority of individuals involved in homicides displayed positive toxicology (57.0% of victims and 62.5% of offenders). The most commonly detected substances, in both victims and offenders, were ethanol (44.9% vs. 40.8%) and benzodiazepines (8.3% vs. 19.2%). The difference between offenders and victims concerning benzodiazepines was statistically significant (OR 2.6; p=0.002). Perpetrators of homicide–suicide had a lower prevalence of positive toxicology (30.8%) than other homicide offenders (67.3%; p = 0.01) [corrected] and victims in unsolved cases more often exhibited positive drug toxicology compared to victims in solved cases (36.1% vs. 8.3%; p < 0.001) corrected., Conclusions: The results of the study support the notion that substance abuse is firmly linked to committing homicide and to becoming a victim thereof., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2014
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100. Quantitative analysis of zopiclone, N-desmethylzopiclone, zopiclone N-oxide and 2-amino-5-chloropyridine in urine using LC-MS-MS.
- Author
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Nilsson GH, Kugelberg FC, Ahlner J, and Kronstrand R
- Subjects
- Azabicyclo Compounds metabolism, Chromatography, High Pressure Liquid, Healthy Volunteers, Humans, Hydrogen-Ion Concentration, Hypnotics and Sedatives metabolism, Limit of Detection, Piperazines metabolism, Reference Standards, Reproducibility of Results, Tandem Mass Spectrometry, Azabicyclo Compounds urine, Hypnotics and Sedatives urine, Piperazines urine, Pyridines urine
- Abstract
A simple liquid chromatography-tandem mass spectrometry method was validated to allow determination of zopiclone (ZOP), N-desmethylzopiclone (NDZOP), zopiclone N-oxide (ZOPNO) and 2-amino-5-chloropyridine (ACP) in urine at concentrations up to 3,000 ng/mL within 3.5 min. This method was used for quantitative analysis of the analytes in authentic urine samples obtained 10 h after oral administration of zopiclone (Imovane(®)) and in aliquots of the same urine samples after different storage conditions. In addition, pH of each studied urine sample was measured over time. The results showed that formation of ACP occurred at elevated pH and/or temperature by degradation of ZOP, NDZOP and ZOPNO. This method was also applied to samples obtained from two female victims of drug-facilitated assault. One sample had been exposed to long-term storage conditions at different temperatures and at pH >8.2, which resulted in high concentrations of ACP. The other sample, which was exposed to pH <6.5, showed no formation of ACP. ACP is formed both from ZOP and from its metabolites NDZOP and ZOPNO depending on the pH of the urine, time of storage and/or the temperature conditions. For correct interpretation in forensic cases, ZOP, its major metabolites and ACP should be analyzed. When ACP is identified in urine, the concentrations of ZOP, NDZOP and ZOPNO should be interpreted with great caution., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2014
- Full Text
- View/download PDF
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