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Background: Workplace Drug Testing (WDT) is a worldwide practice that is crucial in anti-drug efforts. This study aimed to provide compherensive information about the WDT applications in Türkiye with data obtained from two major cities in two different regions of Türkiye., Methods: The retrospective assessment of forensic toxicological analysis results in urine, hair or urine&hair samples collected from 220 WDT cases in İzmir (3 rd largest city) and Adana (5 th largest city) from 2016 to 2022 years was carried. The screening and confirmation analysis were performed with immunoassay and liquid chromatography-tandem mass spectrometry (LC-MS/MS), respectively., Results: Cases with a positive result from one of urine or hair tests were accepted as positive. 20.5% ( n  = 45) of the cases were detected positive, and most applicants were identified as drivers (84.4%, n  = 38). Urine samples of 23.5% ( n  = 52) were screened by immunoassay, and THC ( n  = 1) and opiate ( n  = 1) were detected. In the LC-MS/MS analysis, benzodiazepines were detected most in urine as a single substance, while cannabinoids and codeine were detected in the hair. Multidrug combinations used in treatment were detected in urine and hair. It was detected both alone and among the substances accompanying cannabinoids and amphetamines., Conclusions: This study presents 7-year WDT results of two different major cities in Türkiye. The method of WDT application differs across the country so a standard procedure should be performed. In our country, where zero tolerance against substance use is adopted, the detection of illegal and controlled substances in cases clearly shows that WDT practice should be routinized.

Metformin is the most commonly used drug for the treatment of type 2 diabetes (T2D), which is dramatically increasing due to factors such as increasing obesity, physical inactivity, and aging of the population. Metformin analysis was carried out in composite wastewater samples seasonally collected from wastewater treatment plants in 10 cities in 2019 and 2020 30 cities in 2021 in Turkiye. Metformin was measured in all wastewater samples, with an average concentration of 97.81 μg/l in 2019, 75.19 μg/l in 2020, and 69.13 μg/l in 2021. This study was utilized to predict metformin usage in different sociodemographic regions in Turkiye using a wastewater-based epidemiology (WBE) approach. As a result of the analysis, the average metformin consumption in Turkiye was estimated to be 22.2 ± 9.6 [1.9-63.8] g/d/1,000 persons (mean ± SD [range]). Furthermore, these estimates were compared with data for time, sociodemographic characteristics, and patient numbers. Assessing the correlation with estimates and the socioeconomic classes of the cities in question revealed that cities with high-income levels had the lowest metformin use rate. Finally, the study provides supporting data aiding the development of public health strategies for decreasing the overall load of T2D across Turkiye., (© 2024 John Wiley & Sons Ltd.)

Despite various preventative measures, cocaine smuggling is still a major problem worldwide. A recent method of smuggling is the transportation of cocaine with various chemicals or with impregnated materials such as cloth and paper. This study aims to examine the change in the amount of cocaine on the paper surface and attempts to decide the best fingermark development method in the case of smuggling trafficking in the form of impregnated paper with the least effect on the cocaine concentration on the paper. The papers (n = 6 + 1) were prepared for each fingermark development method, including a blank paper, were dipped into a working solution prepared by dissolving 0.38 mg cocaine in 500 mL methanol. Fingermarks were developed by applying various chemicals, including Iodine vapor, 1,2-Indandione, DFO (1,8-diazafluoren-9-one), ThermaNin, 5-MTN (5-methylthioninhydrin), and silver nitrate chemicals and Ninhydrin, which is the most commonly used reagent for visualizing latent prints, particularly on paper surfaces. Also, the natural fingermarks of four different donors, two women and two men between 20 and 50 years of age, were used to compare with the presence of cocaine. Different from others, this study examined the application of DFO and 1,2-Indandione as alternatives to other chemicals and revealed that it is possible to identify cocaine using these methods. The order of success was Ninhydrin > DFO > 1,2-Indandione > ThermaNin > Iodine vapor = 5-MTN. To the best of our knowledge, the current study is the first to investigate fingermark identification methods along with the amounts of cocaine on cocaine-impregnated papers., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Despite preventive legislation, the popularity and consumption of new psychoactive substances (NPS) have been steadily increasing in recent years. This study provides a rapid and sensitive method for the quantitation and the detection of 56 NPS from surface water. Sample clean-up and pre-concentration were performed by solid-phase extraction (SPE) with Oasis HLB (6 cc/500 mg) cartridge. Following the chromatographic separation with Shim-pack FC-ODS column, the all substances were quantified by liquid chromatography-tandem mass spectrometry. The method was optimized and validated for all NPS. Despite the wide variety of physicochemical properties of the analytes, the recoveries for all compounds studied were in the range of 69-117%. The limit of quantitation (LOQ) ranging from 2.5 to 15 ng/L was reached for reliable and accurate quantification of analytes. The analytical method developed was successfully applied to the surface water samples. While synthetic cannabinoids were not detected, mephedrone from the synthetic cathinone group was detected under the LOQ. This novel method was expected to be a part of future environmental routine analyses as a satisfactory method., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Immunoassay tests are used in clinical and forensic toxicology laboratories to determine illicit drug use in biological samples. Therefore, this study aims to optimize the cutoff concentrations of DOA I Plus in the blood and compare the LC-MS/MS results. 680 authentic forensic whole blood specimens with Randox Evidence DOA I Plus array were screened for drug of abuse and confirmed by LC-MS/MS. Regarding the manufacturer recommended threshold values, 139 out of 680 authentic blood samples were positive for one or more analytes, while 541 were negative. Nearly all of the 139 positive blood samples confirmed by LC-MS/MS were true positive for one or more analytes, while 522 of the 541 negative blood samples were true negative. The overall sensitivity and the specificity were 87.8% and 99.6%, respectively. THC was considered in detail, and a receiver operator characteristic curve analysis was performed to determine the optimum cutoff for THC, as it accounts for 78% of all positive results according to the manufacturer's recommended thresholds. The optimal threshold value for THC was determined at a concentration of 23 ng/mL, while these values for other parameters were defined as recommended by the manufacturer.

Wastewater-based epidemiology (WBE), as a rapid tool, is used to measure and monitor illicit drug consumption in the population. This method is also used to bridge biomarkers of exposure, contaminants, and human health. Smoking cigarettes and tobacco use are everyday habits in nowadays community. This systematic review and meta-analysis aimed to calculate nicotine consumption globally. The related studies were retrieved within international databases including Scopus, Google Scholar, and Web of Science, up to February 2021. It included twenty-one articles containing 87 measurements covering 275.3 million people with total wastewater samples of 2250. Results showed that the highest and lowest nicotine consumption rate (mg/1000 inh./day) was in Portugal (5860) and Vietnam (1201), respectively. The global pooled nicotine consumption rate was 2476 mg/1000 inh./day (95% CI (2289-2663). Based on WBE results, the average daily cigarette smoked per smoker is 14 (95% CI: 10-18 cigarettes/inh./day), close to the value of 14.2 reported by the survey and interview studies. Risk assessment of the nicotine consumption rate through WBE was calculated by the margin of exposure (MOE) approach. In total, 82% of nicotine consumption measurements were located in the "risk" level (MOE < 100), and 18% of the MOE values were between 100-1000. The results reveal that nicotine consumption risks need immediate global and local action strategies. Finally, these findings are helpful for healthcare agencies and policy-makers to take action against tobacco use prevalence., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The COVID-19 pandemic has been a major challenge worldwide, forcing countries to take restrictive measures beyond conventional methods in their fight against the spread of the disease. Followingly, many studies have been conducted on the effects of these measures on mental health. Wastewater-based epidemiology (WBE) was used in this study to monitor and estimate changes in antidepressant use under normal conditions (2019) and COVID-19 pandemic conditions (2020). Likewise, this study utilized wastewater-based epidemiology (WBE) to monitor and assess changing trends from the pre-pandemic period (2019) to COVID-19 pandemic conditions in antidepressant use (2020). Wastewater samples were collected from 11 cities in Turkey throughout six sampling periods covering the pre-pandemic and during-pandemic periods (June 2019-December 2020). Then, samples were analyzed via LC-MS/MS method. As a result, we observed that venlafaxine was the drug with the highest concentration (mean ± SD: 103.6 ± 112.1 mg/1000p/day). Moreover, city number 6 presented the highest venlafaxine use and the most dramatic increase during the pandemic period. Finally, this study revealed the potential of WBE to estimate the changing trends in mental health during the ongoing pandemic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

In routine forensic toxicology practices, blood alcohol concentration (BAC) levels are measured in traffic accidents that ended up in emergency departments. Nevertheless, since the elimination of ethanol from the blood is fast and the detection time is short, BAC cannot indicate the occurrence of chronic excessive alcohol consumption. Phosphatidylethanol (PEth) is a unique ethanol direct biomarker that occurs only in the presence of phospholipase D enzyme in erythrocyte membranes during alcohol intake, and it indicates alcohol intake. In this study, both whole blood and dried blood samples were collected from 50 patients who were admitted to Cukurova University Hospital Emergency Department due to a traffic accident. While studying BAC in whole blood samples, PEth 16:0/18:1 analysis was performed on dried blood samples by LC-MS/MS. According to the BAC (50 mg/dL) value, the legal limit in Turkey, the optimal threshold PEth 16:0/18:1 value was set as 160 ng/mL and over. This study determined that 15 people with above PEth 16:0/18:1 concentrations above 160 ng/mL were classified as excessive alcohol consumption. The data obtained in this study showed a positive correlation between BAC and PEth concentration when driving under the influence of ethanol., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Although there have been significant advances in fingerprinting techniques, studies on how these techniques affect other criminal evidence are limited. Synthetic cannabinoids (SC), which are illegal substances frequently encountered in crime scenes and are widely used worldwide, are available in various forms in the market (pill, powder, liquid, and herbal product). These synthetic cannabinoid substances have recently been introduced to places such as prisons and rehabilitation centers, primarily via an infused piece of paper. The first seizure of the paper-impregnated form of AB-PINACA and AB-FUBINACA in Turkey was observed in 2014. This study investigates the effects of fingerprint development methods on the concentrations of these SCs impregnated on paper. Therefore, eccrine and sebaceous fingerprints of volunteers were imprinted on the papers before and after they were impregnated with AB-PINACA and AB-FUBINACA. Six different fingerprint development methods were applied. Fingerprint development methods were later checked in 384 fingerprints. AB-PINACA and AB-FUBINACA infused on papers were extracted by the liquid-extraction method, and concentrations were analyzed via LC-MS/MS. After applying Thermanin, 1,2-indandione, iodine vapor, DFO, and 5-MTN fingerprint development methods, the concentration levels of AB-FUBINACA were 26.25, 19.60, 21.43, 17.76, and 17.77 ng/cm 2 , while the concentration levels of AB-PINACA were 1.1, 0.98, 1.31, 1.28, and 1.22 ng/cm 2 , respectively. Finally, although the best fingerprint visualization was obtained on papers that were applied the Ninhydrin method, the method failed to detect SCs on papers., (© 2021 American Academy of Forensic Sciences.)

Toxic heavy metals released into the environment through various industrial processes have potential adverse effects on the environment and human health. In order to reveal these adverse health effects, it is vital to carry out toxicological studies by performing biomonitoring. This study aimed to assess the level of Cr, As, Cd, Hg, and Pb in the breast milk samples of mothers in the Cukurova region, Turkey, and its association with health risk to infants. Ten-milliliter postpartum milk samples were collected from 34 breast-feeding mothers in the first 2 months of their postpartum period and living in the Cukurova region, Adana. The measurement of target heavy metals levels was performed by using inductively coupled plasma mass spectroscopy (ICP-MS). The average breast milk levels of Cr, As, Cd, Hg, and Pb were 8.25, 1.64, 0.37, 2.60, and 12.12 μg/L, respectively. Evaluation of breast milk samples for these toxic heavy metals revealed the high exposure level for Cr and As. However, the mothers who participated in the study were not occupationally exposed to these metals. This study showed that Cr, As, Cd, Hg, and Pb cross the placenta and blood-brain barrier prenatally and accumulate in breast milk postnatally., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Persistent organic pollutants (POPs) continue to threaten the environment and human health. We have investigated levels of polychlorinated biphenyls (PCBs) and organochlorinated pesticides (OCPs) in breast milk samples. A questionnaire was also obtained from the study participants. A total of 48 healthy lactating mothers (mean age: 29.5±0.8 years) living in Istanbul volunteered to participate in this study. High-resolution analyses of several OCPs and PCB congeners were done by gas chromatography. The levels of seven major PCB congeners (28, 52, 101, 118, 138, 153, and 180) and eight OCPs (α-benzenehexachloride, β-benzenehexachloride, δ-benzenehexachloride, hexachlorobenzene (HCB), and 2,4'-dichlorodiphenyldichloroethylene (2,4DDE), 4,4'-dichlorodiphenyldichloroethylene (4,4DDE), 2,4'-dichlorodiphenyltrichloroethane (2,4DDT), and 4,4'-dichlorodiphenyltrichloroethane (4,4DDT)) were determined. The analysis showed that the highest levels of PCBs were observed in PCB 52 (22.99±8.78 ng/g lipid), PCB 101 (12.22±7.8 ng/g lipid), PCB 28 (11.44±5.16 ng/g lipid), and PCB 153 (1.70±0.74 ng/g lipid). The highest OCPs detected were 4,4DDT (3.33±2.05 ng/g lipid) and 4,4DDE (0.86 ± 0.39 ng/g lipid), and the lowest was observed in HCB (0.016 ± 0.01 ng/g lipid). Our findings show that traces of PCBs and OCPs are still present in breast milk of lactating women living in Istanbul, and these pollutants decline in multipara women compared to primipara mothers. We also suggest that breast milk is a useful and representative biological tool for human biomonitoring of POPs., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study assesses association between occupational and environmental pesticide exposure on pesticide applicators directly exposed to pesticides and inhabitants of the Cukurova region by analyzing blood and hair samples. Hair and blood samples were collected from 132 volunteers, 66 of whom are pesticide applicators, and the rest are non-farmer residents, in 10 villages nearby the Ceyhan River between March and June in 2017. Samples were then analyzed via the liquid chromatography-tandem mass spectrometer. As the analysis result, a total number of 31 pesticides were detected in hair samples, whereas a total number of 15 pesticides were observed in blood samples. Twenty of the pesticides (64.5%) detected in the hair and 3 (20%) detected in the blood were significantly higher in the applicators than the non-farm residents. Also, 5 pesticides (16.1%) observed in the hair and 7 observed (46.6%) in the blood were banned pesticides. This study investigated the pesticide exposures on people living in the region via hair and blood samples. Our study revealed that, in addition to individuals who are occupationally exposed to pesticides, individuals from all parts of the society, especially those living in the agricultural region, have a certain level of pesticide exposure., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Synthetic cannabinoids are a significant public health and safety problem that complicates drug tests with their ever-changing structures in our country and worldwide. The fact that most synthetic cannabinoids cannot be detected in biological samples by routine drug of abuse screening tests also causes an increase in the use of these substances in return. In this study, 500 urine samples of randomly selected probationers, analyzed with an enzymatic immunoassay test at Ege University Institute of Drug Addiction, Toxicology and Pharmaceutical Sciences (BATI) and tested negative, were then selected for retrospective analysis. Synthetic cannabinoids and their metabolites were quantitatively scanned in the collected urine samples via the liquid-liquid extraction method with the LC-MS/MS. Of the 500 studied urine samples, 108 (21.6%) were positive for 20 synthetic cannabinoids and their metabolites. The two most detected synthetic cannabinoids were 5F-NPB-22 (58%) and (S)-AB-FUBINACA (36%), and their mean concentrations were 72.94 ± 47.51 ng/mL and 5.84 ± 14.7 ng/mL, respectively. These results were also compared with national statistics from the general population. It resulted that immunoassay screening tests used in this study were insufficient, and urine samples should be studied in clinical and forensic cases with a validated chromatographic method., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Synthetic cannabinoids (SCs) are the most rapidly growing class of recreational designer drugs. Illicit drug manufacturers began to produce herbal smoking materials under a variety of brands names, e.g. "Spice, K2, Bonsai, Yucatan Fire". They were appeared on the European market in 2008. In this study, types of SCs in the herbal product sold as "Bonsai" in Turkey were determined and the identification of these substances in biological samples collected from rats depending on the inhalation of different amounts of plant material were aimed. To determine the SC species in the content of the plant product, analysis was performed via gas chromatography-mass spectrometry. Liquid-liquid extraction methods were utilized for blood and organ samples, while solid-phase extraction with β-glucuronidase enzyme treatment was applied for urine sample preparation. The relationship between the amount of burned plant and the amount of SCs accumulated in the blood, urine and organ samples of rats exposed to the plant product by inhalation was examined by liquid chromatography-tandem mass spectrometry. AB-FUBINACA and 5F-NPB-22 were detected in the herbal product. A significant correlation was found between the amount of herbal product inhaled and the prevalence of SCs, especially in lung tissues while no SCs were detected in the blood and urine samples of rats. There is currently no study on biological samples of individuals exposed to herbal products containing SCs by inhalation. Regarding the findings obtained in this study, the overall increase in the amounts of herbal product inhaled was demonstrated to pose a potential risk to humans., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The magnetic nanocomposites composed of copper sulphide, iron oxide, and graphene oxide (CuS/Fe 3 O 4 /GO) were synthesized through a facile sol-gel combined with hydrothermal techniques for photodegradation of methylene blue (MB) as a model organic pollutant. The as-prepared samples were characterized by powder X-ray diffraction (XRD), vibrating sample magnetometer (VSM), differential reflectance spectroscopy (DRS), Fourier transform infrared spectroscopy (FTIR), field emission scanning electron microscopy (FESEM), and energy dispersive X-ray analysis (EDX) and results confirmed successful synthesis of magnetic nanocomposite. Presence of Fe 3 O 4 and GO in nanocomposite induced a synergistic effect in CuS performance as CS 88 F 6 G 6 (i.e. 88% CuS, 6% Fe 3 O 4 , and 6% GO). The photocatalytic degradation efficiency of MB reached up to 90.3% after exposure to visible light irradiation for 80 min. The composite nanosheets are photostable, reusable, and magnetically recoverable, revealing potential application in removal of organic pollutants.

Alcohol and tobacco are the most frequently consumed substances in the world. Both are significantly associated with the increasing number of different diseases. Thus, monitoring nicotine and alcohol use is vital for public health planning and intervention strategies. This study aimed to calculate estimates of alcohol and nicotine use in 11 cities of Turkey using wastewater-based epidemiology. In 2019, daily composite wastewater samples from 18 wastewater treatment plants were collected for a week per season. The 24-h composite samples were collected via auto-samplers. Sample preparation for wastewater samples collected was done using liquid-liquid extraction and solid-phase extraction. Nicotine and ethyl sulfate (EtS) were analyzed using validated liquid chromatography-tandem mass spectrometry method. The estimated average nicotine consumption was 2.84 mg/p/day, and the average alcohol consumption was 3.46 ± 1.83 ml/p/day. The highest nicotine consumption was observed in Kayseri city; the highest alcohol consumption was calculated for Mersin city. In this study, the cigarette and alcohol consumption estimate obtained by wastewater-based epidemiology (WBE) was found to be higher than the Turkey Tobacco and Alcohol Market Regulatory Authority report. To our knowledge, this study is the most comprehensive one so far applied using WBE for 11 cities in Turkey and evaluates alcohol and nicotine use together., (© 2020 John Wiley & Sons, Ltd.)

Wastewater-based epidemiology (WBE) is an ever-increasing discipline that enables researchers to track near-real-time data concerning the recreational use of illicit drugs. Community illicit drug use was estimated in eleven Turkish cities, using eighteen wastewater treatment plants, representing the metropolitan cities and rural areas with different socio-demographic characteristics. In this study, 24-h composite influent wastewater samples were collected for 1 week per season between March 2019 and December 2019. Heroin, amphetamine, methamphetamine, ecstasy, cocaine, and marijuana were covered as illicit drugs in this study. Solid-phase extraction, LC-MS/MS separation, identification, and quantification were used as the analytical methods. Overall results indicate that both cocaine and MDMA usage increased in all cities on weekends. More specifically, it was observed that the average amount of cocaine use regarding 11 cities was 14.7 mg/1000 person/day, while figures for other substances are as follows: 9.5 for amphetamine, 34.5 for methamphetamine, 38.4 for MDMA, 42.2 for heroin, and lastly 5412 mg/1000p/day for marijuana. This study holds the position of being the most comprehensive one conducted, considering spatial and temporal datasets on illicit drug consumption obtained via WBE in Turkey.

Wastewater-based epidemiology (WBE) is a complementary, well-established comprehensive, cost-effective, and rapid technique for monitoring of illicit drugs used in a general population. This systematic review and meta-analysis is the first to estimate the rank and consumption rate of illicit drugs through WBE studies. In the current study, the related investigations regarding the illicit drug consumption rate based on WBE were searched among the international databases including Scopus, PubMed, Science direct, Google scholar, and local database, Magiran from 2012 up to May 2019. The illicit drug consumption rate with 95% confidence intervals was pooled between studies by using random effect model. The heterogeneity was determined using I 2 statistics. Also, subgroup analyses were conducted to examine the possible effects of year and location of studies on observed heterogeneity. Meta-analysis of 37 articles indicates that the overall rank order of illicit drugs according to their pooled consumption rate can be summarized as tetrahydrocannabinol or cannabis (7417.9 mg/day/1000 people) > cocaine (655.7 mg/day/1000 people) > morphine (384.9 mg/day/1000 people) > methamphetamine (296.2 mg/day/1000 people) > codeine (222.7 mg/day/1000 people) > methadone (200.2 mg/day/1000 people) > 3,4-methylenedioxymethamphetamine (126.3 mg/day/1000 people) > amphetamine (118.2 mg/day/1000 people) > 2-ethylidene-1,5-dimethyl-3, 3-diphenylpyrrolidine (33.7 mg/day/1000 people). The pooled level rate was 190.16 mg/day/1000 people for benzoylecgonine (main urinary cocaine metabolite), 137.9 mg/day/1000 people for 11-nor-9-carboxy-delta9-tetrahydrocannabinol (main metabolite of cannabis), and 33.7 mg/day/1000 people for 2-ethylidene-1,5-dimethyl-3, 3-diphenylpyrrolidine (main metabolite of methadone). The I 2 values for all selected drugs were 100% (P value < 0.001). The results of year subgroup indicated that the changes of heterogeneity for all selected drugs were nearly negligible. The heterogeneity within studies based on continents subgroup just decreased in America for drugs like 11-nor-9-carboxy-delta9-tetrahydrocannabinol (I 2  = 24.4%) and benzoylecgonine (I 2  = 94.1%). The outcome of this meta-analysis can be used for finding the illicit drugs with global serious problem in view of consumption rate (i.e., cannabis and cocaine) and helping authorities to combat them.

Increased alcohol consumption, especially among young people, is a major concern in Turkey as it is around the world due to negative effects on public health and safety. Regarding this, it is pivotal to monitor and therefore control alcohol use in public. In this case, wastewater-based epidemiology (WBE), which is the in-depth analysis of wastewater and a relatively new method, can deliver complementary information concerning the abuse of different substances. The proven potential of the WBE approach offers new promises in the process of monitoring alcohol use, namely the monitoring of the levels of ethyl sulfate (EtS) as a urinary biomarker of alcohol consumption, and it is a powerful mean to estimate alcohol use at the community level. In this study, raw 24-h composite wastewater samples were collected from Seyhan and Yüregir wastewater treatment plants (WWTPs) in Adana Province for one week per season (October 2016-August 2017). The fast and validated analytical method was performed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) and therefore applied to the analysis of ethyl sulfate (EtS). Obtained concentration values were back-calculated, and regional and temporal social usage rates were determined. Higher values were calculated for both WWTPs on Sunday. Alcohol consumption in the region served by Seyhan WWTP was higher than Yüregir WWTP. The results showed that the levels of alcohol consumption during given periods in Adana ranged from 659.8 to 8998.7 mL/day/1000 per person with an average value of 4983.9 and 3924.2 mL/day/1000 inhabitant in Seyhan WWTP and Yüregir WWTP, respectively. This study shows that weekly and annual trends in alcohol consumption can be detected quickly from wastewater analysis.

Objective: This study aims to explain whether EtG and EtS, which are two non-oxidative ethanol metabolites secreted by the liver and used as markers of alcohol intake related to an incident, were also present in whole blood samples of patients with traffic accident injuries. Methods: EtG and EtS concentrations in all of the whole blood samples were sent to the Forensic Medicine Department of Cukurova University for testing Blood Alcohol Concentrations (BAC) via validated liquid chromatography-tandem mass spectrometer method. Results: The scope of the study covers 200 patients that were admitted to medical services within 12 h following the incident. Of all patients 16.5% were found to be BAC positive, while 35.5 and 23.5 were positive for EtG and EtS, respectively. All samples with a positive BAC result were also positive for EtG and EtS. Conclusion: Detection of EtG and EtS, minor metabolites along with ethanol in the blood can serve as an objective tool to provide further analysis regarding alcohol-related traffic accidents at emergency services.

Background: Organophosphates, pythyreoids, carbamate pesticides and fungicides are heavily used in agriculture. They may have dangerous effects on newborn health especially on immune system and growth via prenatal transmission by placenta or postnatal transmission by breastfeeding., Methods: In 2015, 144 non-persistent pesticides in 64 milk samples of 32 mothers were studied by OuEChERS method in liquid chromatography/tandem mass spectrometer in neonatal Intensive Care Unit in Adana, a city in Cukurova region which is an important agricultural area in Turkey., Results: Pesticides were detected in milk samples of 11 mothers (34.3%) and 21 (32.8%) of milk samples. In five mothers, fungicides (in 5/10 samples propicanozole-PP, in 4/10 samples bromucanozole-BM), in five mothers, organophosphates (in 10/10 samples primyphosphomethyl-PPM), in one mother, both organophosphates and fungicide (in 1/2 samples PPM and in 1/2 samples buprimate) were detected. However, the estimated daily intakes (EDI) were less than acceptable daily intakes (ADI) for PPM, PP and BM, respectively., Conclusions: Although pesticides levels in human milk did not exceed the ADIs, we suggest monitoring pesticides in human breast milk especially for newborn health.

Wastewater-based epidemiology (WBE) is a rapidly developing discipline that has the potential to monitor real-time data on regional and temporal differences regarding the use of illicit drugs. With WBE, metabolic products discharged for drug consumption are rapidly collected by sewage systems, which provide valuable evidence on the types and quantities of drugs consumed by a given community. In this study, the samples were collected from the wastewaters entering the facilities in Seyhan and Yuregir Waste Water Treatment Plants (WWTPs), in Adana Province. Composite wastewater analysis was performed by using liquid chromatography tandem mass spectrometry (LC-MS/MS) and the analysis revealed multiple drugs including cocaine and its main metabolite, benzoylecgonine, amphetamine-like stimulants including amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), and 3,4-methylenedioxyethamphetamine (MDEA), opiates including morphine, codeine, heroin metabolite 6-acetylmorphine (6-MAM), the metabolite of cannabis, 11-nor-carboxy-THC (THC-COOH), and the main metabolite of Δ9-tetrahydrocannabinol (THC), 11-hydroxy (THC-OH). Mean drug consumption rates were as follows: cocaine, 0.18; amphetamine, 0.43; methamphetamine, 0.06; MDMA (ecstasy), 1.30; heroin, 1.03; THC (marijuana), 28.60 doses/day/1000 persons (15-64years). The consumption rates for some illicit drugs showed a significant difference between seasons, regions, and weekdays-weekends., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the effects of orally administered dehydrated garlic powder on cytokine excretion in the urinary tract., Materials and Methods: A total of 60 healthy volunteers, randomized into 3 groups, were given a single oral dose of 1 g or 3 g of dehydrated garlic powder or placebo. Urine samples were obtained 6.0 and 24.0 h after garlic intake and assayed for interleukin-8 (IL-8), interleukin- 12 (IL-12), tumor necrosis factor-alpha (TNF-α), diallyl disulfide (DADS) and diallyl sulfide (DAS)., Results: Significant increases in IL-12 levels over baseline were noted in urine samples obtained after oral intake of 1 g and 3 g of garlic powder (P < .001). In the 1 g and 3 g garlic powder treatment groups, time-dependent variations in IL-12 levels over the study period were significantly different from the placebo group (P < .001). In both garlic treatment groups, urinary levels of IL-8 and TNF-α were not significantly different from baseline and placebo levels (P > .017). DADS and DAS were not detected in the urine samples at any time after garlic powder intake., Conclusion: Oral intake of doses of garlic traditionally used for daily supplementation increases urinary levels of IL-12, which is a potent stimulator of T helper cell 1 (Th-1) immune responses. This observation encourages further studies investigating the immunostimulatory role of garlic in the urinary tract.

Ethyl glucuronide (EtG) is a direct metabolite of ethanol and has been utilized as a marker for alcohol intake. This study presents development, validation and application of a new hydrophilic interaction liquid chromatography-tandem mass spectrometry (HILIC-MS/MS) method for the analysis of EtG in human hair samples. The linearity was assessed in the range of 5-2000 pg/mg hair, with a correlation coefficient of >0.99. The method was selective and sensitive, with a limit of detection (LOD) and limit of quantitation (LOQ) of 0.05 pg/mg and 0.18 pg/mg in hair, respectively. Differently from the extraction procedures in the literature, a fast and simple liquid-liquid method was used and highest recoveries and cleanest extracts were obtained. The method was successfully applied to 30 human hair samples which were taken from those who state they consume alcohol. EtG concentrations in the hair samples of alcohol users participated in this study, ranged between 1.34 and 82.73 pg/mg. From the concentration of EtG in hair strands 20 of the 30 subjects can be considered regular moderate drinkers., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

In Cukurova region, pesticide poisonings still remain an unfortunate cause of death, which led to the present study. The autopsy records of Adana Branch of the Council of Forensic Medicine, between 2006 and 2008, were evaluated retrospectively. Deaths that were attributed to pesticide poisoning were included in the scope of the study to identify the type of pesticide, and etiology of intoxication. The frequency and distribution of intoxications were also analyzed in terms of sex and age. In the studied period, a total of 4199 autopsies were referred to the forensic toxicology laboratory for pesticide analysis. Seventy-two cases were positive for pesticide analysis. Of these, 42 (58.33%) were male and 30 (41.67%) were female, with a mean age of 38.8 ± 20.6 years. Among the inspected pesticides, endosulfan was found to be the most common with 47.2% of prevalence, followed by dichlorvos. This report showed that certain pesticides, endosulfan in particular, remains as common cause of poisonings in Cukurova region.

The present study focused on the analysis of serum cholinesterase levels and the pulmonary function tests in seasonal farm workers who were chronically exposed to pesticides, mostly organophosphorus, in comparison with non-farm workers in the farming areas of Cukurova region, Turkey. Serum cholinesterase levels and pulmonary function tests using spyrometer in 50 male seasonal farm workers (study group) were compared to 50 male non-farm workers (control group) in this cross-sectional study. The mean serum cholinesterase enzyme level in the farm worker group (7095.5 ± 1699.4 U/L) was significantly lower than those of the control group (9716.4 ± 1484.4 U/L) (p < .001). There was no significant difference between pulmonary function tests of 2 groups (p > .05). These results show that chronic environmental organophosphorus exposure caused a decrease in the serum cholinesterase enzyme levels in farm workers, emphasizing the importance of primary prevention.

We determined and compared the levels of BHC and DDT isomers and metabolites and HCB in the adipose tissue of 82 cases of autopsies performed at the Morgue Department of Adana Branch of the Council of Forensic Medicine. The relationships between the age, gender, and body mass indexes of cases, and the accumulation of OCs residues were also investigated. Detectable concentrations of p,p'-DDE were found in 100% of adipose tissue samples. Concentrations of OCs in female adipose tissues were significantly higher than male adipose tissues (p < 0.05). The presented work is highly significant, being the first study pointing out the chronic exposure to organochlorine pesticides in Cukurova region.

Forensic toxicological analyses have traditionally focused on the use of blood, body fluids, and certain organs in examinations of deaths due to intoxication. However, in some situations, putrefaction and contamination make proper sampling from tissues impossible, such as in exhumation cases. In these cases, bone marrow might be useful as an alternative specimen since it is a potential depot for drugs. This study aims to determine pesticides in postmortem and putrefied bone marrow of pesticide treated rabbits, so as to reveal the diagnostic value of toxicological analysis of bone marrow in exhumation cases. Out of thirteen rabbits, a 110 mg/kg dose of endosulfan was orally given to six through a gavage tool, and a 2500 mg/kg dose of diazinon was given to six using the same method. One rabbit was not treated with anything and served as a control sample. Venous blood, liver, lung, kidney, brain, and bone marrow samples were collected just after spontaneous death or cervical dislocation. After this, the rabbits were buried in soil. All of them were exhumed 1 month later, and putrefied viscera and bone marrow were sampled. Blood and tissue samples underwent solvent extraction and solid phase extraction, and then the samples were analyzed by GC-MS. Mean residue levels of diazinon in early postmortem samples were 85 mg/kg, 71 mg/kg, 23 mg/kg, 21 mg/kg, 19 mg/kg, and 0.4 mg/l in the liver, bone marrow, kidney, lung, brain, and blood, respectively. Mean residue levels of diazinon in the putrefied body were 3327 mg/kg in putrefied viscera and 1783 mg/kg in the bone marrow. Mean residue levels of endosulfan isomers and metabolites in early postmortem samples (blood, liver, lung, kidney, brain, and bone marrow) were 0.46 mg/kg (endosulfan sulfate), 0.32 mg/kg (alpha and beta isomers of endosulfan), and 0.14 mg/kg (endosulfan ether) while the same levels were 0.26 mg/kg (endosulfan sulfate), 0.24 mg/kg (alpha and beta isomers of endosulfan), and 0.1 mg/kg (endosulfan ether) in putrefied samples (putrefied bone marrow and putrefied viscera). Based on these experimental results, it can be concluded that cause of death can be determined as acute pesticide poisoning by toxicological analysis of samples from bone marrow and putrefied viscera in exhumation cases.

Diabetic ketoacidosis (DKA) is a widely known acute metabolic complication of diabetes mellitus (DM), which can be potentially fatal. It is not difficult to diagnose when a patient with DM comes with symptoms such as coma, fruity breath, hyperglycemia, acidosis, and tachypnea. If the patient has not been diagnosed with DM before, then other sicknesses characterized by an increased anion gap should be considered. A 12-year-old boy with type 1 DM and repeated earlier admissions for DKA was admitted to the emergency department in another apparent case of DKA with coma, hyperglycemia, and profound metabolic acidosis. When his condition did not improve with initial treatment, intoxication was suspected as an alternate cause of his condition. Further laboratory tests detected methanol and amitriptyline. The patient underwent hemodialysis and recovered completely. This case illustrates that a seemingly obvious medical condition can mask serious intoxication. This report is the only publication on two different entities characterized by an increased anion gap and at the end the patient has been cured completely without any complications.

The relaxation of cavernous smooth muscle is critical for inducing and maintaining a penile erection. The neurogenic- and endothelium-dependent relaxation of corpus cavernosum smooth muscle and the degenerative effect of subacute ethanol treatment on the endothelial cells of corpus cavernosum was investigated in mice. In the cavernous strips contracted with phenylephrine, electrical field stimulation (EFS), acetylcholine and exogenous nitric oxide (NO) induced relaxations in the control group. Ethanol treatment abolished the endothelium-dependent relaxations induced by acetylcholine but failed to alter the relaxation to EFS and NO. L-nitroarginine, a NO synthase inhibitor, reduced relaxations induced by EFS and acetylcholine, but not those induced by NO in control and ethanol-treated mice. L-arginine prevented the response inhibited by L-nitroarginine. ODQ, a guanylyl cyclase inhibitor, inhibited relaxations in response to EFS, NO and acetylcholine in control and ethanol-treated mice. Corpus cavernosum tissues were investigated using electron microscopy and endothelial damage was observed in ethanol-treated mice. These results suggest that ethanol impairs the endothelial function of corpus cavernosum in mouse, and it may lead to erectile dysfunction through a reduced NO release via endothelial impairment.