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Inside Diagnostics Fall 2013
AlCohol testIng • Alkohol testing • EtG • TruTouch
hEPATITIS c The correct treatment determines the course of healing
Rapid Tests Laboratory Diagnostics Laboratory Service Consulting & Service
Inside Diagnostics Forword
Forword
Dear Reader, We are very pleased to observe that our magazine appeals to you so much and that our readers are always eager to read the next issue. Of course, we appreciate greatly your interest as well as the commitment of our Editor in Chief, Philipp Strauss, who has left the editorial board for professional reasons. We wish him success for the future and thank him warmly for his good collaboration.
We dedicate this new issue to the substantial topic of alcohol testing. In addition, you will find an article about the Hepatitis C Virus, an illness whose consequences and incidence is still largely underestimated. This said, the chances to cure the patient rises with each appropriate treatment. If you have comments or suggestions for the next issue, please contact us. We wish you a pleasant read.
For the next issue, we welcome Your Editorial Team. Nicolas Kennof, to this role.
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Subscribe to our customer magazine Write to us: inside-diagnostics@nal-vonminden.com Executive editor: Inside Diagnostics Nicolas Kennof Tel.: 0941 29010-36 inside-diagnostics@nal-vonminden.com
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Inside Diagnostics Contents
Contents Themes Alcohol Testung ������������������������������������������������� 4 Hepatitis C ��������������������������������������������������������� 6 Overview of Drugs and Medicine ���������������������� 8 Detection period and saliva tests �������������������� 10 Pregnancy detection ���������������������������������������� 12
nvm Inside Short News ������������������������������������������������������ 14 Conference calendar 2014 ������������������������������ 15
Alcohol testIng | Page 4
Flag
Alcohol remains the most consumed drug around the world. In our article on page 4, you can find everything about the topic: from the facts to the detection methods and the innovative laws concerning alcohol testing.
Inside Diagnostics nal von minden GmbH Customer Magazine Contact: nal von minden GmbH Nicolas Kennof Friedenstraße 32 93053 Regensburg
Editors: Torsten Winkler, Kristina Sambs, Raffaela Seiband, Lukas Eder, Thomas Schott, Anne Kaiser, Andrea Kreuzer, Franziska Stöckinger, Frederica Swaine inside-diagnostics@nal-vonminden.com Layout: Martina Kastenmaier, Kasia Orlowska
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Rapid Tests Alcohol testing
Alcohol testing
So the detection of alcohol can succeed Alcohol is still the most abused “drug� in the world. The long tradition of alcohol consumption goes back to the times of around 8000 BC, when viniculture began. Perhaps, or rather probably, it is exactly because of this tradition that alcohol remains rather socially acceptable and even sometimes socially imposed. No other drug claims more road accident victims annually, no other drug is more often involved in criminal offences and no other drug has tormented and torn apart more families than alcohol.
Alcohol is found everywhere in the body where water can also be found, i.e. practically everywhere. It is therefore logical, that despite casual handling of this psychoactive substance in many situations, the detection of alcohol is desirable and even essential. There are various procedures available to detect alcohol which will be dealt with in more detail in the following text. Basically the following applies: Alcohol is found everywhere in the body where water can also be found, i.e. practically everywhere. This opens up many possibilities for analysts. From urine to blood, from breath to tissue fluid, from saliva to hair, from breast milk to seminal fluid, everything could generally be used to detect alcohol. The repertoire is, however, restricted through some factors: basically, a specimen should be collected regardless of sex, whereby breast milk and seminal fluid are ruled out for standard analytics. The remaining matrices are then used in daily life to detect alcohol consumption. Which matrix is used in each individual case depends primarily on three factors: 1. What question is to be answered regarding detection or rather what detection time is required? 2. In which environment is the alcohol test performed? 3. Which type of sample is allowed by the legislature in order to answer a specific question? All three questions are closely intertwined. For example: If an
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employer is carrying out an alcohol check during a labour inspection, he or she would usually like to know whether the employer is currently under the influence of alcohol. Therefore, he or she may use the TruTouch (see page 6) as a preliminary test for determining of tissue alcohol levels, since he or she would like to test many employers in the shortest time possible. In case of a positive result, a private discussion is likely to be planned, without performing other analytics, since this is not a mandatory requirement by the legislature. In a different setting the same question (current influence) may result in completely different analytics: during a traffic check a policeman is likely to use preliminary saliva and breath testing (also traditionally still often urine testing). Then in case of a positive result, he or she may ask for confirmation through blood testing (or sometimes two different procedures by means of breath alcohol testing). Confirmation through blood testing is administered here; since it is a mandatory requirement by the legislature (in Germany) in order to initiate legal consequences. On the other hand, in Australia, a confirmation through saliva tasting is sufficient in order to withdraw a driving licence of the accused. In principle, the detection time will be determined in analytical terms with the choice of the matrix and the cut-off. Current alcohol consumption can be best detected through breath, blood, saliva and tissue alcohol testing. Recent consumption of alcohol (up to 3 days) can be best detected through urine testing and past alcohol consumption (up to 1 year) can be detected by means of hair samples. The measurement of alcohol in breath is fast, easy and does not require any specific environment. However, it should be taken into consideration that during the absorption phase, i.e. when the alcohol concentration in blood is still increasing, the breath alcohol concentration is often clearly above the blood alcohol concentration and thereby it can lead to false positive results. On the other hand, the breath alcohol concentration in the elimination phase, i.e. when alcohol is not consumed but degraded, is slightly under the blood alcohol concentration.
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Rapid Tests Alcohol testing
The measurement of blood alcohol has probably the longest tradition in proving that a delinquent was under the influence of alcohol at the time of inquiry. The disadvantage of this matrix is that only a doctor with the respondent’s consent or rather by judicial order may take a blood sample which in the legal sense represents bodily harm. Furthermore, all common methods are designed for use in laboratories, whereby no significance can be attached to on-site blood testing but only in forensic context. In order to make past alcohol consumption analytically visible, alcohol is not detected directly (in urine and hair) but through an alcohol metabolite [ethyl glucuronide (EtG)]. About 0.2% of the consumed alcohol amount is metabolised in this way. Due to the fast excretion rate of alcohol at approximately 0.1% per hour, alcohol itself is only detectable for up to a maximum of one day. On the otherhand, EtG can be detected for up to 72 hours. Furthermore, EtG is incorporated into hair during its growth and remains there throughout the life span of hair. Therefore through hair analysis, the history of hair can be “read”. This is particularly useful for the determination of driving suitability in Germany regarding licence reacquisition (MPA).
The aim of workplace alcohol testing is to keep the workplace free from alcohol and thereby reduce the risk of occupational accidents. In the field of workplace alcohol testing there are other aspects which are also important. The aim of workplace alcohol testing is always, especially in high risk areas , to keep the workplace free from alcohol and thereby to reduce the risk of occupational accidents. Studies show that the most important factor achieving this aim and thereby changing the alcohol drinking behaviour of employees is the frequency of testing. However unfortunately this is often in opposition to economical conditions of the company. The TruTouch technology represents a new opportunity for implementation of an appropriate test algorithm. It determines alcohol content in
TruTOuch The TruTouch determines alcohol content in the finger tissue by means of near-infrared light (NIR). This value correlates with blood alcohol concentration. You will receive a result in just a few seconds.
the finger tissue by means of near-infrared light (NIR), which correlates particularly well with blood alcohol concentration levels. The measurement is obtained by placing a finger on the sensor for only a few seconds. This makes a daily check of the entire workforce possible. Furthermore, TruTouch can perform biometric identification, and check the identity of an employer in conjunction with screening for alcohol. By connecting the device to an access control system, a company can ensure that only workers in a sober state can gain access to the company premises or get a key to a bus or to a HGV. It is therefore clear that both alcohol and alcohol testing have a long tradition. Alongside the well established testing methods, there are now also new innovations in this field: from alcohol markers such as EtG, enabling prolonged detection of alcohol consumption through new test formats (e.g. EtG urine rapid tests), to completely new methods such as TruTouch, proposing new and improved application areas with its tissue alcohol measurement. This said, it is clear much more time will pass until all such innovations can find their way into legislation and thereby gain widespread application. TW
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Infectiology Hepatitis C
Hepatitis C
Still Underestimated On the 28th July 2013 World-Hepatitis-Day, was held in Duisburg. The objectives, according to the local news, were to globalise awareness for this topic and the encouragement of prevention, diagnosis and treatment. Considering today’s knowledge about the virus and the related fear of being infected, this is an important objective. Hepatitis C – Then and Now The HC-Virus has been known since 1988 and since 1991 has been detectable in blood via antibodies. While during 2011 the number of new infections was on a decline, sadly more new infections were reported during 2012 and 2013. It is now estimated that worldwide 200 million people are carriers of the HC-virus – about thrice the number of people compared to those carrying HIV. Areas most seriously affected are countries such as Egypt, Libya, Bolivia or Burma. Fortunately Europe is the region with the lowest risk of infection (under 1% on average) Yet across Europe variations are still visible, where France reports a higher risk of up to 2.5%. This higher prevalence could however be explained through French policy of general screening for HCV antibodies during every visit to the doctor. However, as a general principle too few of those infected are not being treated despite the availability of very good treatment options as they are not aware of being HCV-positive. Commonly, the infection only becomes evident years later after the liver is already severely damaged or is exhibiting a tumour. This progression of the disease is already life-threatening. An early diagnosis can therefore save lives as the younger the patient and the earlier the diagnosis is made, the better the chance of recovery. Infected people may not always experience possible symptoms such as tiredness, general exhaustion, fever, reduced performance, nausea, joint and muscle pains or abdominal pains. Furthermore if experienced, these symptoms do not immediately suggest a HCV infection. The objective of therapy is to eliminate the virus from the body of the patient in order to prevent the further development liver inflammation. This reduces the risk of liver cirrhosis and similar secondary diseases. Further objectives of a HCV therapy are the elimination of the risk of infecting others and to reduce the symptoms of a chronic Hepatitis.
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People at risk of a HCV infection are recipients of blood or blood products before 1992 as the test for detection of antibodies to HCV only has existed since 1991. This is also true for transplant recipients, hemodialysis patients, medical staff as well as blood-, organ and tissue donators. Part of the circle of people at risk always are active and former drug consumers, prisoners and people with already known HBV or HIV infections. Also people in close contact to HCV infected people, e.g. sexual partners, children of HCV positive mothers or people with migration background from countries with a higher HCV infection rate, carry the risk of being infected. Risk of Contagion Infection with the Hepatitis C Virus occurs through direct contact with contaminated blood. Studies detect that the HCV virus can also be transmitted through other body fluids such as saliva, sweat, tears, sperm and breast-milk, however, the possibility for contamination to occur in these ways is very rare. Hepatitis and Drug Addiction Drug addicts regularly endanger themselves by using non sterile needles, other accessories or aspiration tubes. The Hepatitis C Virus is significantly more resistant outside the bodily with a significantly high survival time. Unlike with HIV, even small amounts of contaminated blood (e.g. on the tip of needles) are sufficient for an infection. The Hepatitis C Virus in the
Drug addicts regularly endanger themselves by using previously used needles, according accessories or aspiration tubes. drug scene poses great challenges for doctors. It is not rare for a heroin addict, with a history of sharing needles, to be positive for both HBV and HIV. Co-infections are commonly the most difficult aspect of a diagnosed HCV infection. Co-infection as Challenge In case of a co-infection with HIV in general two problems will occur: The more life threatening factor for the patient is the liver di-
Infectiology Hepatitis C
sease. About 10% of co-infected patients develop liver failure already within 10-20 years. This often linked to the immunosuppression due to HIV. Further problems are the hepatotoxic effects triggered by the anti-retroviral substances in HIV medication. These can cause such severe liver damage, that the treating doctor might be forced to stop the medication. In general, patients with a HIV co-infection can also be treated with pegylated) Interferon-α and Ribavirin. A simultaneous therapy of both infections also is possible however interactions of the different medication must be balanced. For example an interaction of Ribavirin and Didanosin (DDI) can damage cell metabolism and therefore lead to lactate acidosis. Similarly Zidovudin and Stavudin combined with Ribavirin can enhance lipodystrophy or anaemia. In case of a co-infection with HBV it should be observed, that an accompanying liver disease increases the risk of liver cirrhosis or of a hepatocellular carcinoma and hence worsens the prognosis. The approach that both viruses influence – or even suppress - themselves negatively in their replication is existent, however equally distinctive liver cell damage can be observed co-infection cases. This damage is lower in case of infections with only HBV or HCV. It is also important that in case of a co-infection, no HBs antigen and only anti-HBc-IgG can be detected in the patient’s blood despite a HBV replication. For the treatment of HBV-/HCV infection similar fundamentals apply as for a HIV-/HCV infection. In general also in case of co-infections, the therapy guidelines of the respective monoinfections should be adhered to. The medication should be set according to the dominance of the respective infection. For example, in case the HCV infection is prevalent, it is treated as in case of a mono-infection with (pegylated) Interferon-α and Ribavirin. A study performed with 19 HBV/HCV co-infected patients highlighted that 100% of patients with HCV-genotype-2 and -3. 88% of patients infected with HCV Genotype-1 responded superficially to HCV aligned therapy. New Therapy for Genotype-1 Infected Patients: Triple Therapy So far, the early mentioned combi-therapy of Ribavirin tablets and injected Interferon-α has been used for treatment.
In contrast to the response of patients infected with Genotype 2 and 3, that of patients with Genotype 1 was less positive. As triple therapy with a new DDA (directacting antiviral agent) Boceprevir and Telaprevir – both are protease inhibitors – a cure is now within reach. According to the magazine “Ärzteblatt” the SVR-Rate (Sustained Virological Response) could be raised to two-thirds when the DDA was combined with Interferon and Ribavirin. Even better results are expected with the combination of several DDAs working in different ways. Furthermore a simultaneous therapy of the NS5A Inhibitor Daclatasvir and the NS3-protease-inhibitor Asunaprevirein can reach a SVR even in the case of patients that did not respond to Interferon. Finally it can be determined that infected people definitely do have a prospect of being cured. However, this by itself is not sufficient. Hepatitis C has to be diagnosed and treated and for this, visits to the doctor are essential and the earlier, the better. The objective therefore should be to point out the risk to patients and simultaneously support them on their way, give hope, motivation and courage as fear usually prevents everything else. HCV Antibody Rapid Test by nal von minden The first indication of a possible infection is offered by pointof-care diagnostics. An initial result can already be obtained on location in the practice or in the advice centre. Yet, in this setting the window period must be observed and if necessary a second test should be performed a few months later. Rapid tests should only be considered as diagnostic aids, and an unequivocal diagnosis can only be made after a clear laboratory examination. nal von minden offers rapid tests for HCV. We are looking forward to provide you with more information. Please call us at: 0049 941/ 290 10-0. FS,RS
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Infektiologie Hepatitisof C Drugs and Medicaments Rapid Tests Overview
Overview of Drugs and Medicaments Substance
Trade Name
Alcohol
Street Name
Symptoms After Consumption
Alk, booze
Varies according to mood and amount of alcohol.
Amphetamine
Adderall®, Dexedrine®
Speed, Pep
Euphoria, increased self-awareness, increased blood pressure
Barbiturate
e.g. Luminal®, Veronal®
Barbs, Barbis, Downers
Reduced judgment, dizziness, lack of motivation
Benzodiazepine
e.g. Valium®, Librium®, Tafil®, Rohypnol®
Benzos, Rohyps, Dias, Rohpies
Anxiolytic, sedative, relaxing, possible hypoventilation
Buprenorphin
Norspan®, Subutex®
-
Reduced cravings, painkiller
Cannabis (THC)
Marinol®, Cesamet®
Joint, Shit, Gras, Weed
Inner peace and well-being, increased need for communication, increased heart rate
Cotinine (Nicotine-Metabolite)
Nicorette®
Cigs
Effectively free acting Metabolite
Ecstasy (MDMA)
-
XTC, Adam
Euphoria, increased communication, dilated pupils.
EDDP (Methadon metabolite)
-
-
Effect-free Metabolite
Ethylglucuronid
-
-
Effect-free Metabolite
Fentanyl
Abstral®, Fentadolon®, Matrifen®
China White, Fentora
Analgesic effect, pupillary constriction, possible hypoventilation
Ketamine
Ketanest®, Ketalar®
Special K, Ket, Lady K, Kitty
Hallucinations, increased salivation and increased blood pressure
Cocaine
-
Coke, Snow, Coca, Charly, Crack
Euphoria, increased self-awareness, dilated pupils.
LSD
Delysid®
Acid
Hallucinations, dilated pupils, increased salivation
MDA (MDMA-Metabolite)
-
Hug Drug
Increased emotions, increase in talking, hallucinations
Methamphetamine
Pervitin®, Desoxyn®
Crystal, Ice
Euphoria, increased productivity, sweating
Methadone
Methaddict®, L-Polamidon®, Eptadona®
Po, Dollies, Juice
Reduced cravings, tiredness and sleepiness
Methaqualone
Mandrax®, Normi-Nox®
Seven-one-fours, Seventeen, Lemmon714
Aphrodisiac, euphoric
Methylphenidate
Ritalin®
Kiddie-Coke
Euphoria, increased productivity, increased sensitivity
Opiate
e.g. Capros®, Bronchicum mono®, Makatussin Codein®
Stoff, Sugar H, White Stuff
At peace, relaxed
Oxycodon
Oxygesic®, Targin®
-
Painkiller, possible hypoventilation
Paracetamol
Captin®, Perfalgan®, Grippex®, Gelonida®, Acetaminophen
PCM
Painkiller, antipyretic
Phencyclidine
Semyl®
Angel Dust, Peace Pill
Confusion, aggressiveness, motor function disorders
Propoxyphene
Novrad®, Darvon®
Darvon
Painkiller, possible hypoventilation
Spice, K2
Inner peace and well-being, sometimes stressful
Tramal
Painkiller, sedative, nausea
Synthetic Cannabis Tramadol
Tramal®, Travex®, Dolevar®
Trazodone
Thombran®, Trittico®
Tricyclic Antidepressants
e.g. Anafranil®, Saroten®, Aponal®
Zaleplone
Sonata, Starnoc, Andante
sedative, relaxing
Zolpidem
Ambien®, Ivadal®, Stilnox®
At peace, relaxed
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Mood lifting, anti depressant, promotes sexual desire and erectile ability TCA
Uplifting feeling, increased salivation
* The detectability is generaly dependent on the used test system. When using a lower cut-off level, this will increase the detectability. For information on other drugs or detection times please contact us.
Rapid Tests Overview of Drugs Infektiologie and Medicaments Hepatitis C
Detection Time in Urine Based at Standard Cut-off*
Standard Cut-Off (Urine)
Rapid Test
0,2 ‰
ALC
1000 ng/ml
AMP
300 ng/ml
BAR
300 ng/ml
BZD
10 ng/ml
BUP
50 ng/ml
THC
200 ng/ml
COT
500 ng/ml
MDMA/XTC
100 ng/ml
EDDP
300 ng/ml
EtG
1 - 2 Days
10 ng/ml
FYL
2 - 4 Days
1000 ng/ml
KET
300 ng/ml
COC
20 ng/ml
LSD
500 ng/ml
MDA
Up to 72 Hours
1000 ng/ml
MET
Up to 48 Hours
300 ng/ml
MTD
300 ng/ml
MQL
300 ng/ml
MPD
300 ng/ml
MOR
1 - 3 Days
100 ng/ml
OXY
2 Days
5000 ng/ml
PCM
25 ng/ml
PCP
6 - 36 Hours
300 ng/ml
PPX
1-3 Days
50 ng/ml
Spice
1 - 3 Days
100 ng/ml
TML
25 ng/ml
TZD
1000 ng/ml
TCA
100 ng/ml
ZAL
50 ng/ml
ZOL
Detection Time in Blood*
Detection Time in Saliva*
Up to 12 Hours 1 - 3 Days, Strong pH- and dose-dependent 1 Day (quick-acting Barbiturates) up to a number of weeks (long-working Barbiturates) 1-3 Days (quick-acting Benzodiazepines) up to a number of weeks (long-working Bezodiazepines and chronic abuse)
Up to 24 Hours
Up to 72 Hours
Few hours to several days Few hours to several days
2 - 6 Days
1 - 3 Days (Depending on Drug Use)
Few Hours(THC), 2 - 3 Days (THC-COOH), With regular use several weeks.
Few Hours (THC), 1 -2 Days (THCCOOH), With regular use several weeks.
Up to 24 Hours
Up to 14 Hours (THC, Single Use)
2 -3 Days 1 - 3 Days, strong pH-dependent
Up to 24 Hours
2 - 7 Days 1-3 Tage
wenige Stunden
2 - 4 Days
A few hours (Cocaine), up to 48 Hours (Benzoylecgonine)
2 - 4 Days
Up to 12 Hours
1 - 3 Days, Strong pH- and dose-dependent
Up to 24 Hours
1 - 7 Days
-
Up to 24 Hours
3 - 7 Days 1-3 Days
Up to 6 Hours
2 - 4 Days
Few minutes (Heroin), a few hours to 1 day (Morphine, Codeine)
7 - 14 Days
Up to 24 Hours
2 - 3 Days
1 - 2 Tage
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To Several Days
A few hours
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Rapid tests Detection times
What is the meaning of my test’s Cut-off?
Correlation of cut-offs, sample material and detection times in one glance In drug analytics a cut-off signifies a defined detection limit. Below the cut-off a test is assessed as negative, above as positive. In the analytics of narcotics and medication the cut-off is set in a way that -due to the sensitivity and specificity of immunological test methods- not the complete sensitivity of the test is used. If you were to go to the limits of the procedure, even the passive smoking of one cannabis cigarette would lead to a positive THC- test result. Hence, it would result in positive test results of actually abstinent people. Therefore it can happen that a test result is assessed as negative even though drugs and medications are present in the sample, however in concentrations below the cut-off. The cut-off level is recommended by various international societies, e.g. the SAMSHA (Substance Abuse and MentalHealth Services Administration) or the EWDTS (European Workplace Drug Testing Society). The level of the detection limit varies from drug to drug, e.g. with THC it amounts to 50 ng/ml. This equals the concentration of a dissolved sugar cube in 60,000 litre liquid (1.5 tank trucks). What is expressed by cut-offs in drug analytics and when should you use which cut-off? In principle, the lower the cut-off is set, the longer consumption can be detected. Vice versa it applies that the higher the cut-off, the lower the detection time.
Blood Saliva Urine Exceptions: Benzo, THC
Hair Effect Hours
Days
Weeks
Month
Log (Time)
When which cut-off is used depends on the statement that is required by the test result. In drug analytics different problem areas exist.
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For example during traffic controls, police officers need to know if the delinquent is currently under the influence of drugs. Similarly in emergency rooms it is of upmost importance to understand if the patient is under influence of drugs at the moment of treatment. In addition a prescribing doctor will want to know if his patients are taking the prescribed amount or if they are consuming other drugs in addition. In prisons, doctors usually are interested if inmates have consumed drugs at all – no matter in which form or over which time period. What does this mean for the cut-off level? To answer this question, firstly the detection time of certain drugs has to be considered. When measuring the drug in urine, it can take up to one hour after consumption of the drug until it can be detected as only then it is excreted with the urine.
How long a drug can be detected for is dependent on different factors, e.g.:
substance, dose, frequency of consuption, weight of the patient and cut-off of the test method. How long a drug can be detected in urine samples is dependent on various factors, e.g. the substance, dose, frequency of consumption, weight of the patient and of course the cut-off of the used test method. Quite often, the effect of the drug has already stopped and the detected consumption is so far in the past that it is actually no longer of interest. This also means that in the end no statement can be made regarding the consumed amount, as long as it remains unclear when the consumption took place. This means that the cut-off should be chosen in such a way that it suits the situation – as described above. If a current consumption is to be detected, the cut-off should be set very high, if however consumption in the past is to be detected, the cut –off should be set lower.
Rapid tests Detection times
Here it should also be mentioned that the concentration of the drug in urine is dependent on various factors. An example illustrating one of these factors is the amount of consumed liquid. The more a patient has drunk the lower the concentration of the drug is in urine. By comparing the concentration of the drug with the Creatinine in urine, a dilution of the drug concentration by drinking liquid can be detected. Creatinine is a metabolite obligatory excreted by urine, i.e. it has to be excreted by urine. Excretion by urine takes place at a fairly constant rate of about 1.0 to 1.5 gram per day. Due to this constant excretion rate, the concentration of the urine can be determined and hence conclusions regarding the concentration of the drug in urine can be made. A rapid test only insufficiently allows for this conclusion. This means that urine is a specimen not free of deviations. Therefore in certain cases it might be necessary to use different specimens. Blood or Saliva as Specimen?
Due to the more complicated circumstances of blood sampling, it is sometimes necessary, to first obtain a court order if the patient initially rejects a blood examination. Blood is an effective sample material, but sampling can be difficult in certain situations. Therefore saliva as a sample matrix is a real alternative especially as the characteristics of saliva as a sample material are comparable to those of blood samples. The half time of both materials is nearly identical therefore also current consumption can be detected without delay over a similar time period. Also the recommended cut-off values are comparable to those of blood. The great advantage of saliva as sample material is the actual sampling process. A sample can be taken at any point in time by anyone – also under visual control, whereby the sample cannot be falsified. Furthermore the sampling is stress and pain-free for the patient as well as hygienic. Additionally the privacy of the patient is respected and no religious feelings are hurt. Due to all these facts many experts are of the opinion that saliva is the sample material of the future in analytics of drugs and medication.
A common specimen is blood, which is regularly used as sample material for many other examinations. In drug analytics it must be noted that the concentration of the drug in blood is much lower than the concentration of the same drug in urine. This also means that the cut-offs have to be adjusted accor- Book dingly. According to §24a StVG (German Legal Code for Traf- RECOMMENDATION More about the topic fic) the cut-off for Amphetamine is 25 ng/ml, while for urine regarding analytics of drug it is 1000 ng/ml according to the SAMSHA recommendation. and medication can be Immunological tests must therefore be significantly more sen- found in our textbook of sitive to be able to detect drugs in blood. Blood as a sample the same name. The book Entdecken Sie is available as free downunser umfas material is ideally suited for many issues related to acute drug sendes Angeb ot! load on our homepage. consumption. However, the half life of the drug in urine is considerably longer hence urine is better suited for issues related to a longer period of time. Sampling can also be problematic. In general blood samples are taken intravenously which can means personal injury to the patient and the sampling process cannot be readily performed. Blood sampling also means that the risk of infection to the treating staff as well as that of the patient is considerably increased. Ein Handbu ch für alle Ber ufsgruppen “Analytik von um das The Drogen und ma Medikamente zusammeng efasst und vers n” - kompak t tändlich erkl ärt. ✓ Drogen problematik heute ✓ Die wich tigsten Drogen Medikam und ente ✓ Probenm aterialen ✓ Analyse nverfahren ✓ Erklärun g der wichti gsten Begriff e ✓ Einsatzg ebiete von Sch Bewertu nelltests und ng der Erge bnisse ✓ Grenze n der Verfahre n ✓ Häufig gestellte Frag en
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Gynecology Pregnancy
Pregnancy
How can you safely check if you are really pregnant? Hardly any test result is expected with so much tension as the one of a pregnancy test. This is of course understandable since a positive result means a whole new life. The quality of tests is critical, for example how easy is it to perform and when does the test deliver a reliable result. “A little bit pregnant” is not a possibility. Pregnancy rapid test The most common way to detect pregnancy is through a urine screen test that can be done at home easily and gives a reliable result after a few minutes. This „stick test” screens for the presence of the hormone hCG (human chorionic gonadotropin), which is responsible for the maintenance of pregnancy. The test strip contains antibodies which react upon contact with the hCG hormone. The developing placenta produces hCG once the fertilized egg has taken root in the womb. This happens several days after fertilization. In urine, hCG (or its subunit β - hCG) can be measured positively around 14 days after fertilization. Since the fertile phase is approximately in the middle of the cycle, the pregnancy test reacts mostly commonly at the time of the expected menstrual period. It is at exactly this point that women are looking for certainty, because their period is absent. In the first weeks of the pregnancy, the hCG concentration in the blood rises steadily, where the hormone levels double approximately every two days. The maximum is reached somewhere between the eighth and tenth week of the pregnancy. A so-called “early test” can already detect a pregnancy 10 days after conception, as it can detect very small amounts of hCG. If a pregnancy test is done too early, it can be negative despite the existence of pregnancy. When using a urine rapid test it is to be noted that, especially at an early time of testing, the concentration of hCG in the urine is still very low. If testing before the absence of menstruation it is best to use the first morning urine, because it
In the 1960s, women had to rely on help from the animal kingdom to detect pregnancies.
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will contain a higher concentration of hCG. The intake of medication has generally no influence on the test result, unless containing hCG itself. Pregnancy tests at the gynecologist By using a blood test gynecologists can determine whether the pregnancy hormone hCG is present or not. In blood the hormone can be detected as early as six to nine days after fertilization. The gynecologist usually performs a urine test first; and only in rare cases is an additional blood test undertaken. Furthermore, an ultrasound examination, is another safe way to test for pregnancy. This pregnancy test is also done by the physician, but can only reliably detect pregnancy from the seventh day after a missed period. From frog tests to positive results via internet Until the 1960s, women had to rely on help from the animal kingdom in the determination of a pregnancy. The “African clawed frog” (also called pharmacist frog) was injected subcutaneously into the dorsal lymph sac with urine or blood of a female subject. If the female was spawning after 12 to 24 hours or spermatorrhea was observed in the male, then the tested woman was declared as pregnant. Compared to that, today‘s testing methods are much easier. Today, modern stick tests are so widespread that it has caused some strange marketing ideas. In the U.S., positive pregnancy tests can be ordered via the Internet and are advertised with the following headlines: „You want to surprise your parents? Or your partner? Maybe you simply want him to finally make a marriage proposal?“ That, once again, proves that there is simply a market for everything on the internet! If it does not happen right away: ovulation tests can help Not all couples can fulfill their baby wish right away, and many have to try for several months before they can celebrate a positive outcome. For family planning it is very important that the woman knows her personal cycle precisely, because good timing is crucial. The fertile phase of the cycle can be limited to 3-6 days to 1 day after ovulation. An exact determination of ovulation is therefore essential in fulfilling the dream of having children.
Gynecology Pregnancy
The problem is the often irregular female cycle.
In the first phase of the cycle an egg cell matures in the ovary. This process generally takes 14 days, but can vary as well as the time of ovulation. With ovulation, the fertilized egg cell enters the fallopian tube and moves through the fallopian tube towards the uterus. If the fertilized egg cell meets a sperm cell along the way, it is fertilized; when it reaches the uterus it can settle there. So it is important to accurately determine the time of ovulation, so that the sperm can meet a fertilized egg cell. The problem is often an irregular female cycle. A woman can become pregnant for around 5 days per cycle. After ovulation, the ovum is then only able to be fertilized within 12-24 hours, whilst sperm has a life span of 3 to a maximum of 6 days in the woman‘s body. The fertile phase can therefore be limited to 3-6 days before, to 1 day after the ovulation. Ovulation is triggered by an increase of the hormone hLH. Its concentration rises up to 20 times of its regular level in the first 24 to 36 hours before the ovulation. After that, the hormone concentration decreases again. With an ovulation test, you can determine the time of ovulation, since the result line is the same or a more intense colour than the control line, when the hLH concentration is higher. The tests are performed daily until the hLH increase is detected (positive result). The chan-
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ce for conception is highest, when there is sexual intercourse in the next 34 to 36 hours. Very dilute urine may give false results on an ovulation test. Shortly after a pregnancy, abortion, hormone treatment or after the onset of menopause, the test should not be performed. Hormonal contraceptives (the pill) may cause incorrect results. Also, some diseases (such as ovarian cysts or hormonal disorders) may falsify the test result. It is advisable to consult a doctor in such cases. Alcohol, common painkillers or antibiotics generally have no influence on the test result. The results of an ovulation test should not be used for birth control, because the uncertainty is too large.
An exact determination of ovulation is therefore essential in fulfilling the
dream of having children. KS
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Inside Diagnostics Short News
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Fake drugs in online pharmacies The number of licensed mail order pharmacies located in Germany is, according to the German Institute for Medical Documentation and Information (DIMDI), at just 3,000. However, the real number of dubious online pharmacies is enormous. While an approved online pharmacy has to undergo the same legal requirements and controls as an established pharmacy, the different forms of fraud of dubious rogues are very diverse. The most „innocent“ case is the profitable resale of original drugs from bulk packaging in smaller packages. However, today the sale of counterfeit drugs plays a much more essential role. European customs authorities confiscate over two million drug packs, with 34 million counterfeit tablets, every
year. Over half of the detected counterfeit drugs did not contain active ingredients, 19 percent had an incorrect amount and 16 percent were the completely wrong drugs. Counterfeit drugs are a health hazard. The effects are unpredictable and the intake can be fatal. To confirm their reliability, the licensed mail order pharmacies have developed a safety logo. In three simple steps you can check whether your source is a safe one for drugs and medicine or not. Therefore the online customer only has to click on the imbedded safety logo. If a new homepage is loading with the URL „versandapotheken.dimdi.de/“ (the last slash is significant), the pharmacy is registered with the DIMDI. AK
Influenza vaccination: Simple nasal spray can replace the needle
Silk Road The so-called „eBay for drugs“ was seized by the FBI and the suspected operator was arrested. Silk Road was a promotional site on the Internet, which served as a black market for the trade of all kinds of illegal drugs.
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In the winter of 2012/2013 3.4 million Germans suffered from the flu. The Robert Koch Institute estimates the mortality rate at around 8000 people in Germany every year. The influenza virus is especially dangerous for the human immune system, because the virus is able to change and can therefore not be detected. The advantages of the flu vaccination are promoted widely but since last year a nasal spray for children aged 2 to 6 years has also been approved for vaccination against influenza. In this case, the vaccine is a live vaccine where as the syringe provides better protection with an inactive vaccine. The advantage is of course the avoidance of the syringe, an element which is favored by parents of very young children. In addition, it is hoped that it will increase the acceptance and willingness to be vaccinated annually. RS
Inside Diagnostics Conference Calender
Conference Calender 2014 JanuarY Messe Arab Health 27.01.2014 - 30.01.2014 • Dubai, VAE MARCH
travel insurance does not pay for mental disorders The District Court of Munich has decided that a travel insurance company does not have to pay for the cancellation of trip in the case of mental illness. This decision refers to the following case: a couple booked to travel to Mexico before the husband was diagnosed with moderate depression. This diagnosis made the couple unable to proceed with the trip as planned and 2161€ in cancellation fees was incurred because of the terms and conditions of the service provider. The District Court of Munich stated that the decision of the Insurance Company is legal, and does not unfairly disadvantage the policy holder. This decision was expected as it is mentioned in the terms and conditions he accepted when subscribing to the travel insurance. The Court emphasized its decision on the base that mental illnesses are difficult to diagnose. The inclusion of such uncertainties would be reflected in the price calculation of the service, which could lead to a significant increase for the consumers. AK
Spring issue 2014
Theme overview
7. Europäische Konferenz zur Gesundheitsförderung in Haft 12.03.2014 - 14.12.2014 • Bonn, DE Messe Arab Lab 17.03.2014 - 20.03.2014 • Dubai, VAE Visit us a 15. Münchner AIDS & Hepatitis-Tage a conferenct e 21.03.2014 - 23.03.2014 • München, DE April Analytika in München 01.04.2014 - 04.04.2014 • München, DE 19. Suchttherapietage Tübingen 02.04.2014 - 04.04.2014 • Tübingen, DE DGIM - 120. Kongress der Deutschen Gesellschaft für innere Medizin 26.04.2014 - 29.04.2014 • Wiesbaden, DE MAY Messe Africa Health 06.05.2014-09.05.2014 • Johannesburg, DE 24th European Congress of Clinical Microbiology and Infectious Diseases 10.05.2013-13.05.2014 • Barcelona, ES JunE 19. Suchttherapietage in Hamburg 10.06.2014-13.06.2014 • Hamburg, DE 44. Treffen der Oberr. Rechtsmediziner zusammen mit der 23. Frühjahrstagung der Dt. Ges. f. Rechtsmedizin - Region Süd 13.06.2014-14.06.2014 • Basel, CH
Chlamydia
Oncology (FOB) Influenza Clostridium Page 15
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