Patricia N. Quiroga

Potential utility of the peripheral analgesic properties of morphine in stomatitis-related pain: a pilot study.

To determine the potential clinical utility of peripheral opioid action using a clinical model of cancer treatment‐induced inflammation and pain that allowed for topical application of morphine in the damaged tissue (oral mucosa). This pilot study followed a two blocks design. Ten patients with painful oral mucositis were enrolled in the first block (dose–response relationship finding) and randomized in two groups to receive oral rinses with 15 ml of either 1‰ or 2‰ morphine solution. Twenty‐two patients were enrolled into the second block (efficacy and safety determination). Additionally, serum concentrations of morphine were measured in five representative patients. In the first block (n=10) a dose–response relationship for topical morphine was found. Rinses with 2‰‐morphine solution showed better pain relief (median 80%, range 70–80%) than those with 1‰ (median 60%, range 55–70%; P=0.0238). Therefore, subsequent patients enrolled for the second block (n=22) received oral rinses with 2‰‐morphine solution. In these patients the time to good (≥50%) or to complete (100%) pain relief was 28 (±12) min after the first mouthwash, and the duration of relief was on average 216 (±25) min. Twenty patients (90%) received the successive mouthwashes every 3 h and 10% of them every 2 h. The duration of severe pain at the moment of swallowing was 5.17 (±1.47) days. Only six patients needed supplementary analgesia, and the time elapsed before the first supplemental analgesic was 1.18 (±0.8) days. The duration of severe functional impairment was 1.52 (±1.31) days, thus allowing us to feed the patient by mouth with liquid‐food supplementation. During our experiment no systemically active detectable concentrations of morphine were found (GC–MS analysis). The most important side effect attributable to morphine mouthwashes was burning/itching sensation (very mild to mild intensity). Patients with painful chemoradiotherapy‐induced stomatitis could be alleviated using topical morphine mouthwashes.

First analytical chemistry study on drug abuse in the Buenos Aires (Argentina) University students

One hundred samples were randomly selected from urine specimens collected from Buenos Aires University students, 50 males and 50 females, whose ages ranged from 19 to 47 years. Cocaine (COC), cannabinoids (CNNs), amphetamines (AMs), benzodiazepines (BZDs), barbiturates (BBTs), opiates (OPs) and salicylates (SAs) were searched for by ELISA, FPIA, normalized TLC, HPLC and GC/MS techniques. The presence of COC was detected in five samples, CNN in two and SA in twelve. No evidence of AMs, BZDs, BBTs or OPs was found.

Tramadol Induced QTc-Interval Prolongation: Prevalence, Clinical Factors and Correlation to Plasma Concentrations

UNLABELLED In recent years, several cases of torsade de pointes have been associated with many opioids. However, to present no cases have been reported with tramadol. OBJECTIVE To evaluate the effect of tramadol on QT-interval in the clinical setting. RESEARCH DESIGN AND METHODS Medical history and comorbidities predisposing to QT interval prolongation were registered for patients requiring medical assistance that involved tramadol administration. Ionograms and ECGs were performed at baseline and intratreatment; QT interval was analyzed after correction with Bazzet, Fridericia, Framinghan and Hogdes formula. RESULTS 115 patients were studied (50.4% males) All patients had received tramadol 150-400 mg/day during 3.0-5.0 days at the moment of intratreatment control. Plasma concentrations of tramadol were 201-1613 ng/mL. Intratreatment electrocardiographic control, as mean ± SD (range), showed QTcB 372±32 (305 to 433), QTcFri 356±37 (281 to 429), QTcFra 363±33 (299 to 429), QTcH 362±30 (304 to 427), ΔQTcB 26±40 (-73 to 110), ΔQTcFri 24±48 (-97 to 121), ΔQTcFra 22±42 (-81 to 109) and .QTcH 22±38 (-68 to 110) ms. QTc interval presents high correlation with plasma tramadol concentrations (for .QTc, R>0.77). Renal failure was associated with a relative risk for ΔQTc > 30 ms of 1.90 (IC95% 1.31-2.74) and for ΔQTc > 60 ms of 4.74 (IC95% 2.57-8.74). No patient had evidence of arrhythmia during the present study. CONCLUSION Tramadol produces QTc interval prolongation in good correlation with plasma drug concentrations; renal failure is a risk factor for higher concentration and QT prolongation by tramadol.

False-positive phencyclidine immunoassay results caused by metronidazole

Dear Editor,Qualitative urine drug screens are frequently ordered in workplace [1], forensic and emergency department [2]. These are typically on-site immunoassay tests and are used to identify the...