One image is worth more than a thousand words:producing an atlas of medical signs for teaching clinical and forensic toxicology

Clinical and forensic toxicology are critically involved in the acquisition of basic skills to correctly suspect intoxication,collect biological and non-biological materials for toxicological analysis,comprehend the complexities inherent to laboratory activity,and understand the fundamentals of toxicokinetics and toxicodynamics that underlie the interpretation of results.This works presents a pedagogical innovation proposal for the teaching of clinical and forensic toxicology based on a compilation of more than 3000 cases where the image was fulcra for suspicion.The experience in this article follows the model practiced in bachelors,masters,and PhD degrees,as well as in other continuing training courses,where we are teaching toxicology for more than 15 years.All these levels of education are considered fundamental to the sound development of this science.This approach aims also to offer strength to the intervention of the true toxicologist in all the toxicological phases,besides the classic analytical chemistry.Indeed,it is impossible to provide effective clinical and forensic toxicological interpretations without a proper and broad education,and not thinking exclusively in terms of laboratory techniques.In the future,it will be interesting to evaluate knowledge retention and to propose a database of videos of signs related to intoxications.

Gabapentin prevalence:clinical and forensic experience in St.Louis,Missouri,USA

Gabapentin(Neurontin)is an anti-epileptic drug that has had wide off-label prescription use since market release due to presumed negligible abuse potential.However,trends in drug misuse have demonstrated that gabapentin misuse is occurring,particularly in those with a history of opioid misuse.This is concerning,because although gabapentin has no direct ligand activity at opioid receptors,it does potentiate the analgesic effect of opioids,and concurrent use of gabapentin and opioids may increase the risk of respiratory depressive effects of opioids.This study investigates the incidence of gabapentin detected in urine samples collected for clinical drug screening purposes in a local hospital emergency department and in postmortem samples submitted by medical examiners in the St.Louis metropolitan area.The prevalence of gabapentin and co-detected drugs in both populations is contrasted,compared,and discussed.This study found that 30%of urine samples collected from patients with suspected drug intoxication presenting to SSM Health Saint Louis University Hospital,a quaternary care medical center,were positive for gabapentin,and nearly two thirds of those were also positive for oxycodone.Over a 6-month period,the incidence of gabapentin positive postmortem cases increased from 18%to 20%.Nearly all gabapentin positive postmortem cases were also positive for an opioid,the most significant being fentanyl,suggesting that gabapentin misuse may be due to its potentiating effect of opioid drug action.This study also highlights the limited utility of immunoassay-based urine drug screens.

Ethnopharmacological,phytochemical and clinical studies on Fenugreek(Trigonella foenum-graecum L.)

Trigonella foenum-graecum(fenugreek)belonging to the family Fabaceae,is widely used for both culinary as well as clinical purposes since antiquity.Folkloric medicines across globe particularly use this plant for boosting immunity and combating digestive and reproductive impairments.The plant is rich reservoir of different phytoconstituents attributed to their diverse pharmacological effects.Therefore,the present article is planned on its ethnomedicinal uses,botanical description,phytochemistry,pharmacology,toxicology,clinical efficacy,mechanism of action and nanoparticle synthesis.In all pharmacological studies,the dose,major bioactive,type of extract and possible outcomes is also discussed,to establish its specific role against a particular ailment.It was hypothesized that the nanoparticle synthesis will lead to the enhanced pharmacology.Results showed that ethnomedicinal data well supports the different pharmacological aspects of Trigonella formulations in different countries.Trigonelline(phytoestrogen)renders most of therapeutic potential of Trigonella.The reported therapeutics can also be accounted as the synergistic pharmacology of different bioactives.Nanoparticle synthesis significantly improves its pharmacological efficacy.Clinical studies well validated its antidiabetic and reproductive health improving efficacies.Though no serious toxic effects were observed with the use of this plant but further well-designed placebo trials are still needed to demonstrate its full therapeutic potential.