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See detailDetermination of phenolic organohalogens in human serum from a Belgian population and assessment of parameters affecting the human contamination
Dufour, Patrice ULg; PIRARD, Catherine ULg; CHARLIER, Corinne ULg

in Science of the Total Environment (2017), 599-600

Many in vitro or in vivo studies highlighted the potential deleterious effects of phenolic organohalogenated compounds (POHs) on the health, particularly on the thyroid system homeostasis, however few ... [more ▼]

Many in vitro or in vivo studies highlighted the potential deleterious effects of phenolic organohalogenated compounds (POHs) on the health, particularly on the thyroid system homeostasis, however few large scale human epidemiological studies have been carried out, especially in Europe. Further studies monitoring the human contamination by POHs, the sources of exposure and the influence of these compounds on thyroid health are still needed. Therefore we determined the concentrations of 16 POHs (pentachlorophenol (PCP), tetrabromobisphenol A (TBBPA), 4 bromophenols (BPs), 3 hydroxy-polybromodiphenylethers (OH-PBDEs) and 7 hydroxy-polychlorobiphenyls (OH-PCBs)) in serum from 274 people aged from 18 to 76 years old living in Liege (Belgium) and the surrounding area. A questionnaire about their alimentary habits, life style and home environment was also administered to the volunteers. The predominant compound measured in the population was PCP (median concentration of 593.0 pg mL−1). 4-OH-CB 107, 4-OH-CB 146 and 4-OH-CB 187 were detected in all samples and contributed for 75% of the sum of OH-PCBs (ΣOH-PCBs). The median measured in our population for ΣOH-PCBs was 143.7 pg mL−1. TBBPA and 2,4,6-tribromophenol were detected in 31% and 63.8% of the samples respectively while the detection frequency observed for the other BPs and the OH-PBDEs was close to zero. We computed multivariate regression models in order to assess the influence of demographic and lifestyle parameters on the PCP and ΣOH-PCBs contamination levels. Significant correlation was found between the PCP concentration and sex, smoker status, sea fish consumption and level of education, although the model seemed to be a poor (R2 = 0.14) predictor of the PCP concentration. The model computed for ΣOHPCBs was more explanatory (R2 = 0.61) and involved age, BMI and sea fish consumption. Finally, we assessed the parameters affecting the ΣOH-PCBs/ΣPCBs ratio. The model proposed involved age, BMI, smoker status and parent PCB level, and explained 41% of the variability of the ΣOH-PCBs/ΣPCBs ratio. [less ▲]

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See detailLes retardateurs de flamme bromés : impact sur l'environnement et la santé des individus exposés
Dufour, Patrice ULg; Charlier, Corinne ULg

in Annales de Biologie Clinique (2017), 75(2), 146-157

Depuis l’antiquité, l’homme utilise des moyens chimiques pour protéger ses biens des incendies. Efficaces et faciles d’emploi, les retardateurs de flamme bromés sont utilisés depuis plusieurs décennies de ... [more ▼]

Depuis l’antiquité, l’homme utilise des moyens chimiques pour protéger ses biens des incendies. Efficaces et faciles d’emploi, les retardateurs de flamme bromés sont utilisés depuis plusieurs décennies de façon massive dans l’industrie du plastique. À l’instar d’autres composés organohalogénés, les retardateurs de flamme bromés sont très persistants dans l’environnement et capables de s’accumuler le long de la chaîne alimentaire. De nombreux auteurs ont mis en évidence leur présence dans notre environnement, chez différentes espèces animales mais également dans le sérum humain. Plus inquiétant encore, l’homme est exposé à ces polluants dès la grossesse et par la suite via le lait maternel. Cette exposition pourrait avoir des conséquences sur notre santé. De nombreuses études in vitro, in vivo ou épidémiologiques ont mis en lumière une influence néfaste des retardateurs de flamme bromés sur notre système endocrinien, principalement au niveau de la fonction thyroïdienne mais également de la reproduction, du neurodéveloppement chez l’enfant et du métabolisme avec un risque accru de développer un diabète. Si une certaine prise de conscience a déjà eu lieu au niveau des autorités et de certaines grandes entreprises, de nouvelles études sont nécessaires pour confirmer les tendances déjà dégagées, élucider les mécanismes sous-jacents et déterminer s’il existe des synergies avec d’autres polluants tels que par exemple les PCB. [less ▲]

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See detailBiocompatibility of polymer-infiltrated-ceramicnetwork (PICN) materials with Human Gingival Keratinocytes (HGKs)
GRENADE, Charlotte ULg; Gillet, Marie-Claire ULg; PIRARD, Catherine ULg et al

in Dental Materials (2017), 33

Objective. Biocompatibility of polymer-infiltrated-ceramic-network (PICN) materials, a new class of CAD–CAM composites, is poorly explored in the literature, in particular, no data are available regarding ... [more ▼]

Objective. Biocompatibility of polymer-infiltrated-ceramic-network (PICN) materials, a new class of CAD–CAM composites, is poorly explored in the literature, in particular, no data are available regarding Human Gingival Keratinocytes (HGK). The first objective of this study was to evaluate the in vitro biocompatibility of PICNs with HGKs in comparison with other materials typically used for implant prostheses. The second objective was to correlate results with PICN monomer release and indirect cytotoxicity. Methods. HGK attachment, proliferation and spreading on PICN, grade V titanium (Ti), yttrium zirconia (Zi), lithium disilicate glass-ceramic (eM) and polytetrafluoroethylene (negative control) discs were evaluated using a specific insert-based culture system. For PICN and eM samples, monomer release in the culture medium was quantified by high performance liquid chromatography and indirect cytotoxicity tests were performed. Results. Ti and Zi exhibited the best results regarding HGK viability, number and coverage. eM showed inferior results while PICN showed statistically similar results to eM but also to Ti regarding cell number and to Ti and Zi regarding cell viability. No monomer release from PICN discs was found, nor indirect cytotoxicity, as for eM. Significance. The results confirmed the excellent behavior of Ti and Zi with gingival cells. Even if polymer based, PICN materials exhibited intermediate results between Ti–Zi and eM. These promising results could notably be explained by PICN high temperature–high pressure (HT–HP) innovative polymerization mode, as confirmed by the absence of monomer release and indirect cytotoxicity [less ▲]

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See detailLa cigarette électronique : état des connaissances à propos des aspects toxicologiques
DEVILLE, Marine ULg; CHARLIER, Corinne ULg

in Revue Médicale de Liège (2017), 72(1), 20-24

La cigarette électronique, aussi appelée e-cigarette, est présentée comme une alternative au tabagisme qui serait moins nocive pour la santé. Son fonctionnement repose sur la conversion d’un liquide en ... [more ▼]

La cigarette électronique, aussi appelée e-cigarette, est présentée comme une alternative au tabagisme qui serait moins nocive pour la santé. Son fonctionnement repose sur la conversion d’un liquide en vapeur, sous l’action de la chaleur générée par un filament présent dans un atomiseur. Le liquide est majoritairement composé de propylène glycol et/ou de glycérine, utilisé(s) pour produire l’effet de fumée, auxquels s’ajoutent des arômes et, éventuellement, de la nicotine. A l’exception de cette dernière, potentiellement létale lorsqu’elle est ingérée à haute dose, ces constituants sont généralement reconnus comme sans danger. Cependant, les conséquences d’une inhalation chronique de propylène glycol sont méconnues. Avantageusement, les composés qui rendent la cigarette traditionnelle particulièrement nuisible – nitrosamines, formaldéhyde, métaux, monoxyde de carbone,… - sont soit absents, soit présents en faible quantité dans la vapeur d’une e-cigarette, sans comparaison avec les taux mesurés dans la fumée d’une cigarette conventionnelle. Il en résulte un profil de toxicité rassurant pour la e-cigarette, bien que son efficacité dans le sevrage tabagique reste à démontrer. [less ▲]

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See detailLes agents chélateurs : alerte à l'abus !
MISTRETTA, Virginie ULg; CHARLIER, Corinne ULg

in Revue Médicale de Liège (2016), 71(12), 551-556

L’exposition aux métaux lourds est un phénomène courant en raison de leur prévalence dans l’alimentation et dans l’environnement; leur toxicité demeure une préoccupation importante pour la santé publique ... [more ▼]

L’exposition aux métaux lourds est un phénomène courant en raison de leur prévalence dans l’alimentation et dans l’environnement; leur toxicité demeure une préoccupation importante pour la santé publique. Les agents chélateurs sont des substances chimiques utilisées pour augmenter l’élimination de certains métaux présents à des concentrations anormalement élevées dans l’organisme. Leurs indications cliniques approuvées sont limitées, particulièrement en raison des effets indésirables qu’ils peuvent induire. Malheureusement, trop souvent, les agents chélateurs sont utilisés avec pour objectif de vérifier le niveau d’imprégnation de l’organisme par les métaux lourds. Il s’agit d’un usage inapproprié et abusif. Afin d’attirer l’attention des praticiens sur cette problématique, les bons et les mauvais usages des chélateurs de métaux sont passés en revue [less ▲]

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See detailStrychnine poisoning still happens in 2015
DEVILLE, Marine ULg; Lemaire, Eric ULg; DENOOZ, Raphael ULg et al

Conference (2016, August 29)

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See detailLes prothèses de hanche au cobalt sont-elles dangereuses ?
MISTRETTA, Virginie ULg; KURTH, William ULg; Charlier, Corinne ULg

in Medecine Sciences : M/S (2016), 32(8-9), 732-738

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See detailLoss of treatment benefit when heroin-assisted treatment is stopped after 12 month
Demaret, Isabelle ULg; Quertemont, Etienne ULg; Litran, Géraldine et al

in Journal of Substance Abuse Treatment (2016), 69

Purpose: In 2013, during a recent heroin-assisted treatment trial, participants in heroinassisted treatment (HAT) decreased significantly more their street heroin use than participants in oral methadone ... [more ▼]

Purpose: In 2013, during a recent heroin-assisted treatment trial, participants in heroinassisted treatment (HAT) decreased significantly more their street heroin use than participants in oral methadone treatment. After the trial, HAT was discontinued. To examine whether the treatment benefits were sustained three months after the trial, the use of street heroin by the participants was analysed in a follow-up study. Results: At the follow-up assessment, street heroin use increased in the experimental group. The two groups no longer showed a significant difference (p=0.55) in the level of street heroin use. Conclusion: A predetermined and forced end of HAT was followed by a significant increase in the level of street level use. [less ▲]

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See detailA Simple Tiered Methodology for the Determination of Ambient Air Quality Guidelines
PIRARD, Catherine ULg; Brouhon, Jean-Marc; Fourmeaux, Annick et al

in Clean : Soil, Air, Water (2016), 44(5), 464-473

Within the scope of the renewal of industrial operating permits in Belgium, the Walloon Agency for Air and Climate needed air quality criteria for a wide range of toxics. Due to the plethora of different ... [more ▼]

Within the scope of the renewal of industrial operating permits in Belgium, the Walloon Agency for Air and Climate needed air quality criteria for a wide range of toxics. Due to the plethora of different existing values for some compounds or the total lack for others, the development of a simple methodology was required to provide both quality and intervention criteria, corresponding respectively to a chemical concentration for which no adverse health effects are expected for a lifetime exposure, and the chemical concentration in air associated with a risk for human health deemed significant. The tiered methodology developed here allows the selection of air guidelines from available databases, and proposes, if needed, approaches based on well-proven procedures to derive air quality guidelines from occupational exposure limits, drinking water guidelines, tolerable daily intakes, or as a last resort acute lethal toxicity data if nothing else is available. If this method has been successfully applied to more than 550 compounds, all values produced should be validated according to the purpose of the guidelines, the technical feasibility of achieving the threshold produced, and the specificity of the environment conditions and the targeted population. Moreover, the criteria obtained from non-air-related data should be critically examined and handled with caution. [less ▲]

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See detailPostmortem Concentration and Redistribution of Diazepam, Methadone and Morphine with Subclavian and Femoral Vein Dissection/Clamping
Lemaire, Eric ULg; Schmidt, Carl; DENOOZ, Raphael ULg et al

in Journal of Forensic Sciences (2016), 61(6), 1596-1603

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See detailValidation of a novel and rapid method for simultaneous determination of some phenolic organohalogens in serum by GC-MS
Dufour, Patrice ULg; PIRARD, Catherine ULg; Charlier, Corinne ULg

in Journal of Chromatography. B : Analytical Technologies in the Biomedical & Life Sciences (2016), 1036

Over the last decades, more and more studies focused on the impact of endocrine disruptors on the environment and human health. Among them, phenolic organohalogens (POHs) are a particular concern because ... [more ▼]

Over the last decades, more and more studies focused on the impact of endocrine disruptors on the environment and human health. Among them, phenolic organohalogens (POHs) are a particular concern because of their structural resemblance with natural hormones. There are different methods that are known to quantify these compounds in human serum, however, the current extraction techniques are long, fastidious and using harmfull chemicals such as diazomethane and sulfuric acid. Consequently, we developed an alternative, sensitive and faster method to simultaneously quantify pentachlorophenol (PCP), tetrabromobisphenol A (TBBPA), 4 bromophenols, 7 hydroxypolychlorinated biphenyls (OH-PCBs) and 3 hydroxy-polybrominated diphenyl ether (OH-PBDEs) in human serum sample. The clean-up and the enrichment of the sample were performed in a single extraction step using strong anion-exchange solid phase cartridge. After a rapid liquid–liquid extraction step to remove acidic traces, the extract was derivatized using trimethylsilyldiazomethane (TMSD) and finally analyzed by a gas-chromatograph coupled with an electron negative capture chemical ionization source combined with a triple quadrupole mass spectrometer (GC-ENCI-MS) operating in single ion monitoring. The whole procedure was validated according to the total error approach. The inter and intra assay precision were demonstrated to be lower than 20% and the relative bias to be lower than 15% in the dosing range of concentrations. The limit of quantification (LOQ) ranged from 2 pg mL−1 and 5 pg mL−1, except for the PCP (44.6 pg mL−1) and for the 2,4,6-tribromophenol (49.6 pg mL−1). Finally, the method was successfully applied to measure the POH background contamination in serum samples collected from 20 Belgian blood donors recruited in CHU Mont-Godinne (Namur, Belgium) aged between 21 and 69 years old. [less ▲]

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See detailPoliteal vein blood sampling and the post-mortem redistribution of diazepam, methadone and morphine
Lemaire, Eric ULg; Schmidt, C.; DENOOZ, Raphael ULg et al

in Journal of Forensic Sciences (2016)

Postmortem redistribution (PMR) refers to the site- and time-related blood drug concentration variations after death. We compared central blood (cardiac and subclavian) with peripheral blood (femoral and ... [more ▼]

Postmortem redistribution (PMR) refers to the site- and time-related blood drug concentration variations after death. We compared central blood (cardiac and subclavian) with peripheral blood (femoral and popliteal) concentrations of diazepam, methadone, and morphine. To our knowledge, popliteal blood has never been compared with other sites. Intracardiac blood (ICB), subclavian blood (SB), femoral blood (FB), and popliteal blood (PB) were sampled in 30 cases. To assess PMR, mean concentrations and ratios were compared. Influence of postmortem interval on mean ratios was also assessed. Results show that popliteal mean concentrations were lower than those for other sites for all three drugs, even lower than femoral blood; mean ratios suggested that the popliteal site was less subject to PMR, and estimated postmortem interval did not influence ratios except for diazepam and methadone FB/PB. In conclusion, our study is the first to explore the popliteal site and suggests that popliteal blood is less prone to postmortem redistribution. [less ▲]

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See detailTemporal variability of urinary concentrations of phthalate metabolites, parabens and benzophenone-3 in a belgian adult population
DEWALQUE, Lucas ULg; PIRARD, Catherine ULg; Vandepaer, Sarah et al

in Environmental Research (2015), 142

In the present study, we investigated the temporal within-person variability of the exposure biomarker for phthalates, parabens and benzophenone-3 (BP3) in 32 Belgian adults, each providing 11 urine spots ... [more ▼]

In the present study, we investigated the temporal within-person variability of the exposure biomarker for phthalates, parabens and benzophenone-3 (BP3) in 32 Belgian adults, each providing 11 urine spots during 4 months. We calculated the intraclass coefficient correlation (ICC), the sensitivity and the specificity to assess the temporal reproducibility and to investigate the predictive ability of the spot measurements for these classes of chemicals. Additionally, we explored the temporal variability of the estimation of the cumulative risk of exposure to phthalates (hazard index; HI). We observed fair ICC ranging from 0.55 to 0.68 for parabens, monoethyl phthalate (MEP), mono-iso-butyl phthalate (MiBP) and BP3, but lower ICC, from 0.20 to 0.49, for monobenzyl phthalate (MBzP), mono-n-butyl phthalate (MnBP), mono-2-ethylhexyl phthalate (MEHP), mono-2-ethyl-5-oxo-hexyl phthalate (5-oxo-MEHP) and mono-2-ethyl-5-hydroxy-hexyl phthalate (5-OH-MEHP). The ICC estimated for HI (0.49) reflected a moderate reproducibility. The measurements in spot samples were moderate to good predictor of the 4-month level of exposure for parabens, MEP, MnBP, MiBP, BP3 and HI (sensitivity ranging from 0.67 to 0.77), but lower predictor for MEHP, 5-oxo-MEHP, 5-OH-MEHP and MBzP (sensitivity ranging from 0.58 to 0.63). The sensitivity could be increased when several spot urinary levels were averaged to predict the long-term level of exposure. Globally, our results indicate that a single spot measurement seems to correctly represent the long-term exposure for parabens, BP3, MEP, MiBP and HI. Additional spot samples seemed to be needed for the proper exposure assessment of the other target compounds. [less ▲]

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See detailHigh reactive oxygen species in fibrotic and non-fibrotic skin of Patients with diffuse cutaneous systemic sclerosis
BOURJI, Khalil; MEYER, Alain; CHATELUS, Emmanuel et al

in Free Radical Biology & Medicine (2015), 87

Systemic Sclerosis (SSc) is a chronic multisystemic connective tissue disease characterized by progressive fibrosis affecting skin and internal organs. Despite serious efforts to unveil the pathogenic ... [more ▼]

Systemic Sclerosis (SSc) is a chronic multisystemic connective tissue disease characterized by progressive fibrosis affecting skin and internal organs. Despite serious efforts to unveil the pathogenic mechanisms of SSc, they are still unclear. High levels of Reactive Oxygen Species (ROS) in affected patients have been shown, and ROS are suggested to play a role in fibrosis pathogenesis. In this study we evaluate ROS levels in non-fibrotic and fibrotic skin of patients with SSc and we compare them with those obtained from healthy controls. Patients and Methods We enrolled 9 SSc patients fulfilling the EULAR/ACR classification criteria and 7 healthy controls. Patients included were 4 men and 5 women with mean age of 46 ±10 yrs. Controls were matched by sex and age. All patients were affected by diffuse cutaneous form of SSc and the ANA pattern anti-Scl70. Mean disease duration was 7.5±5 yrs. Skin involvement was evaluated by modified Rodnan Skin Score (mRSS). Skin samples (4 mm punch biopsy) were taken from fibrotic skin and non-fibrotic skin of patients and from healthy controls as well. To detect ROS, specimens were analyzed immediately after sampling by electron paramagnetic resonance spectroscopy. Blood samples have been drawn from all patients and controls to assess oxidative stress biomarkers. Results ROS levels (expressed as median and range, unit of measurement was nmol/l/min/mg of dry weight) were 24.7 (10.9– 47.0) in fibrotic skin, 18.7 (7.3–34.0) in non-fibrotic skin and 7.7 (3.5–13.6) in healthy controls skin. ROS levels in Fibrotic and Non-fibrotic skin of SSc patients were significantly higher than in Healthy Controls (p=0.002 and p=0.009, respectively). ROS levels in fibrotic skin were raised in comparison to non-fibrotic skin, when samples related to each patient were compared (p=0.01). ROS levels in fibrotic skin were correlated with forced vital capacity (r= -0.75, p=0.02) and erythrocyte sedimentation rate (r=0.70, p=0.04). All other clinical and lab parameters showed no significant correlation. When compared to controls, blood from SSc patients showed lower ascorbate (vitamin C) levels (8 [3.8-9.8] vs. 10.5 [9-19.1] mg/L, p=0.004) and higher lipid peroxides (873.5 [342-1973] vs. 422 [105-576] μmol/L, p=0.004). Conclusion Our results indicate the presence of high oxidative stress both in non-fibrotic skin and fibrotic skin of SSc patients, but with higher tendency in the latter. Raised ROS levels in non-fibrotic skin of SSc patients might be a hint of early involvement in skin fibrogenesis. However, a longitudinal prospective study is necessary for such proof. [less ▲]

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See detailFish consumption patterns and hair mercury levels in children and their mothers in 17 EU countries
Castano, Argelia; Cutanda, Francisco; Esteban, Marta et al

in Environmental Research (2015), 141

The toxicity of methylmercury (MeHg) in humans is well established and the main source of exposure is via the consumption of large marine fish and mammals. Of particular concern are the potential ... [more ▼]

The toxicity of methylmercury (MeHg) in humans is well established and the main source of exposure is via the consumption of large marine fish and mammals. Of particular concern are the potential neurodevelopmental effects of early life exposure to low-​levels of MeHg. Therefore, it is important that pregnant women, children and women of childbearing age are, as far as possible, protected from MeHg exposure. Within the European project DEMOCOPHES, we have analyzed mercury (Hg) in hair in 1799 mother-​child pairs from 17 European countries using a strictly harmonized protocol for mercury anal. Parallel, harmonized questionnaires on dietary habits provided information on consumption patterns of fish and marine products. After hierarchical cluster anal. of consumption habits of the mother-​child pairs, the DEMOCOPHES cohort can be classified into two branches of approx. similar size: one with high fish consumption (H) and another with low consumption (L)​. All countries have representatives in both branches, but Belgium, Denmark, Spain, Portugal and Sweden have twice as many or more mother-​child pairs in H than in L. For Switzerland, Czech Republic, Hungary, Poland, Romania, Slovenia and Slovakia the situation is the opposite, with more representatives in L than H. There is a strong correlation (r=0.72) in hair mercury concn. between the mother and child in the same family, which indicates that they have a similar exposure situation. The clustering of mother-​child pairs on basis of their fish consumption revealed some interesting patterns. One is that for the same sea fish consumption, other food items of marine origin, like seafood products or shellfish contribute significantly to the mercury levels in hair. We conclude that addnl. studies are needed to assess and quantify exposure to mercury from seafood products, in particular. The cluster anal. also showed that 95​% of mothers who consume once per wk fish only, and no other marine products, have mercury levels 0.55 μg​/g. Thus, the 95th percentile of the distribution in this group is only around half the US-​EPA recommended threshold of 1 μg​/g mercury in hair. Consumption of freshwater fish played a minor role in contributing to mercury exposure in the studied cohort. The DEMOCOPHES data shows that there are significant differences in MeHg exposure across the EU and that exposure is highly correlated with consumption of fish and marine products. Fish and marine products are key components of a healthy human diet and are important both traditionally and culturally in many parts of Europe. Therefore, the communication of the potential risks of mercury exposure needs to be carefully balanced to take into account traditional and cultural values as well as the potential health benefits from fish consumption. European harmonized human biomonitoring programs provide an addnl. dimension to national HMB programs and can assist national authorities to tailor mitigation and adaptation strategies (dietary advice, risk communication, etc.) to their country's specific requirements. [less ▲]

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See detailDetermination of blood concentration levels of psychotrope medications in Rwandan patients
Hahirwa, Innocent; DENOOZ, Raphael ULg; Karangwa, Charles et al

in Acta Clinica Belgica (2015)

OBJECTIVES: In Rwanda, no therapeutic monitoring of psychotropic drugs is done. This results in difficult treatment optimisation and exposition to a high risk of toxicity and drug ineffectiveness for ... [more ▼]

OBJECTIVES: In Rwanda, no therapeutic monitoring of psychotropic drugs is done. This results in difficult treatment optimisation and exposition to a high risk of toxicity and drug ineffectiveness for patients under treatment. This study aimed to determine blood concentration levels of psychotropic drugs in Rwandan patients and identify problems associated with the lack of therapeutic drug monitoring (TDM) of these drugs. METHODS: The analysis was performed on 1 ml of serum sample using prazepam as internal standard. Regarding the step of sample preparation, we used a liquid-liquid extraction with a mixture of organic solvents: diethyl ether/dichloromethane/hexane/n-amyl alcohol (50/30/20/0.5:V/V). A Waters Alliance 2695 was used for analysis. The chromatography was run on a Symmetry C8 column and as mobile phase acetonitrile and phosphate buffer (pH 3.8) were used. RESULTS: Concerning the results, serum samples from 128 patients were analysed. Twenty-one different psychotropic drugs belonging to various pharmacological classes were detected and quantified. Analytical results were put into three categories based upon therapeutic reference ranges (TRR) of various drugs: subtherapeutic, therapeutic and supratherapeutic. For a total of 237 analyses, results within TRR represented 46% while 47 and 8% of results were, respectively, below and above TRR. CONCLUSION: It was therefore concluded that patients under psychotropic treatment in Rwanda are exposed to both the risk of drug ineffectiveness and the risk of toxicity (54%) with only 46% of results within the TRR. Consequently, TDM is needed to optimise psychotropic treatment in Rwandan patients. [less ▲]

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