BACKGROUND

Drug use and abuse is a public health issue that has come into focus in the Philippines in the past years. Excluding the years of the COVID-19 pandemic, there has been a yearly increase in the number of admissions to treatment and rehabilitation centers. The census in the University of the Philippines-Philippine General Hospital (UP-PGH) National Poison Management and Control Center (NPMCC) shows a parallel increase in drug-positive patients consulting in the emergency room (ER).

OBJECTIVE

The objective of this study was to describe the demographic, clinical, and drug use profiles of substance users admitted to the UP-PGH and referred to the NPMCC for drug testing.

METHODS

This is a cross-sectional study where participants included patients aged 10 years and above who were referred to the NPMCC for drug testing within three days of the ER consult. Once consent or assent from children was obtained, patients were interviewed and examined. Urine samples were collected for drug screening using drugs of abuse screening test kits. A split sample was sent to the UP Drugs of Abuse Research Laboratory (UP DARL) for analysis using the liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF/MS). The data was encoded in the REDcap platform. The results were analyzed and summarized using descriptive statistics.

RESULTS

Three hundred eighty-four (384) individuals participated in the study and submitted urine samples for testing from 1 January 2019 to 28 February 2020. One hundred thirty-four (134) samples were positive for substances of abuse detected by drug screening test kits for methamphetamine (MAP), delta-9-tetrahydrocannabinol (THC), cocaine, 3,4-methylenedioxymethamphetamine (MDMA), benzodiazepines, and opioids, and by LC-QTOF/ MS analysis. Majority of the patients were males with an average age of 34.54 ± 1.16 years old. Many complained of neurobehavioral changes necessitating consultation at the hospital emergency room. The neurologic and cardiovascular systems were frequently affected. By using the drugs of abuse test kit, methamphetamine was the most common substance of abuse detected and was seen in 40.3% of the samples. Amphetamine type stimulants were the most common group of drugs identified by LC-QTOF/ MS analysis and was seen in 103 instances. New psychoactive substances detected more frequently than others include paramethoxymethamphetamine (PMMA), 3,4- methylenedioxy methamphetamine (MDMA) and 3,4- methylenedioxyamphetamine (MDA). A few cathinones like butylone and cathinone were also detected.

CONCLUSION

Methamphetamine was the most common substance of abuse detected in urine samples of the participants. New psychoactive substances were also detected in urine samples when LC-QTOF/MS analysis was utilized. Most persons who use drugs are unemployed young- to mid-adult males. The participants often had neurobehavioral and cardiovascular signs and symptoms.

Human ; Methamphetamine

A 24-year-old Filipino male was diagnosed with hemolytic anemia when he presented with abrupt onset of anemia, hemoglobinuria, and increased bilirubins, after intentionally ingesting mothballs containing paradichlorobenzene. He was transfused with six units of packed red blood cells (PRBC) and was discharged improved. Paradichlorobenzene, a known oxidant, causes denaturation and precipitation of hemoglobin. These precipitates form Heins bodies within the erythrocytes that are removed by the reticuloendothelial system, fragmenting cells to produce hemoytic anemia from paradicholorobenzene ingestion as confirmed by the UP-National Poison Management and Control Center.

Human ; Male ; Adult ; Hemoglobinuria ; 4-dichlorobenzene ; Anemia, Hemolytic ; Chlorobenzenes ; Erythrocytes ; Hemoglobins ; Poisons ; Oxidants ; Mononuclear Phagocyte System ; Bilirubin

BACKGROUND: The monofilament test is a simple and inexpensive tool used for the detection of diabetic peripheral neuropathy in the community setting but it is unclear whether its use can be extended to patients with neuropathy that is not due to diabetes.

OBJECTIVE: We aimed to determine the sensitivity and specificity of the monofilament test in detecting peripheral neuropathy, diabetic or non-diabetic, using Nerve Conduction Studies (NCS) as the gold standard.

METHODS: In a health assessment activity in Marinduque, patients were assessed by a neurologist as to whether or not they have neuropathy. Monofilament testing was done using the NHANES protocol with a 10-g Semmes Weinstein monofilament. Nerve Conduction Study was used as the gold standard.

RESULTS: Fourteen patients were included in the study. A positive monofilament test was found to be significantly associated with a positive NCS result (p<0.015). The sensitivity of the monofilament test was 57.1%; the specificity was 100%. Positive predictive value was 1, negative predictive value was 0.7, pre-test probability was 83% and post-test probability was 96%.

CONCLUSION: Monofilament testing was found to be useful in detecting peripheral neuropathy in the community setting. If monofilament testing is positive, then peripheral neuropathy is ruled in. If the test is negative but the clinical suspicion is high, then NCS may be warranted. This cuts back the need for NCS to detect neuropathy in the community setting by more than half.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Nutrition Surveys ; Neurologists ; Diabetic Neuropathies ; Sensitivity And Specificity ; Probability ; Neural Conduction