Thiopurine S-methyltransferase (TPMT) is involved in the metabolism of thiopurine drugs. Patients that due to genetic variation lack this enzyme or have lower levels than normal, can be adversely affected if normal doses of thiopurines are prescribed. The evidence for measuring TPMT prior to starting patients on thiopurine drug therapy has been reviewed and the various approaches to establishing a service considered. Until recently clinical guidelines on the use of the TPMT varied by medical specialty. This has now changed, with clear guidance encouraging clinicians to use the TPMT test prior to starting any patient on thiopurine therapy. The TPMT test is the first pharmacogenomic test that has crossed from research to routine use. Several analytical approaches can be taken to assess TPMT status. The use of phenotyping supported with genotyping on selected samples has emerged as the analytical model that has enabled national referral services to be developed to a high level in the UK. The National Health Service now has access to cost-effective and timely TPMT assay services, with two laboratories undertaking the majority of the work at national level and with several local services developing. There appears to be adequate capacity and an appropriate internal market to ensure that TPMT assay services are commensurate with the clinical demand.
Introduction Novel psychotropic substances also known as legal highs are a major concern in UK prisons, fuelling violence and putting a strain on resources for inmates requiring medical treatment for adverse effects. We provide a clinical toxicology service including routine screening for novel psychoactive substances. In 2015, we were approached by Her Majesty Prison Service search dog training team to advise on which novel psychoactive substances to target, and again in 2016 to further provide analytical support to test five letters which the dogs positively identified for novel psychotropic substances during routine searches of prison mail rooms. Here we provide the first analytical confirmation that letters sent to inmates are being used to smuggle novel psychotropic substances into UK prisons. Results Novel psychotropic substances were detected on all five letters and these included the stimulants ethylphenidate, methiopropamine and methoxiphenidaine, the sedative etizolam and the third generation synthetic cannabinoids 5F-AKB-48, AB-FUBINACA, MDMB-CHMICA. Other compounds detected include the class A drug cocaine, class B drug methylphenidate and the cutting agents lignocaine, benzocaine and procaine. Conclusion Novel psychotropic substances smuggled into UK prisons is a major safety and security concern. By analytically confirming letters sent to inmates do contain novel psychotropic substances, we have produced categorical evidence to support anecdotal suggestions that novel psychotropic substances are entering UK prisons in this manner.
Background Vitamin D deficiency is still thought to be widespread in the UK and in recent years the number of cases of rickets reported in children has increased. In this study, the distribution of vitamin D and the prevalence of vitamin D deficiency have been determined for a multi-ethnic population from the inner-city area of Birmingham, UK, where a vitamin D testing service has been readily available for over 10 years.Methods Serum 25-hydroxyvitamin D concentration was determined using an automated platform (Nichol's Advantage Speciality System) for 830 outpatient samples collected randomly at the end of summer (September).Results In our total study population, prevalence of vitamin D deficiency, defined as a 25-hydroxyvitamin D concentration o10 mg/L, was high (24%): one in eight Caucasians, one in four Black Afro-Caribbeans and one in three Asians were found to be deficient. Levels of deficiency were much higher in Asian women, with almost one in two individuals (43%) found to have a vitamin D level below 10 mg/L.
ConclusionOur study has shown that widespread vitamin D deficiency in a UK inner-city population remains an issue. In concordance with other studies, we found a high prevalence of vitamin D deficiency in Afro-Caribbean and Asians, and, in particular, women. It is clear that more routine screening of vitamin D is needed.
Background: We have developed a new thiopurine S-methyltransferase (TPMT) phenotyping method that measures TPMT activity in whole blood. To evaluate this assay, we compared it with conventional TPMT phenotyping, which uses a red blood cell (RBC) lysate and genotyping for analysis of common TPMT mutations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.