DANIEL ROMERO MUñOZ
Projetos de Pesquisa
Unidades Organizacionais
Departamento de MedicinaLegal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina - Docente
LIM/40 - Laboratório de Imunohematologia e Hematologia Forense, Hospital das Clínicas, Faculdade de Medicina
LIM/40 - Laboratório de Imunohematologia e Hematologia Forense, Hospital das Clínicas, Faculdade de Medicina
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bookPart Introdução à ética médica e à bioética(2022) MUñOZ, Daniel Romero- Determination of antidepressants in whole blood using hollow-fiber liquid-phase microextraction and gas chromatography-mass spectrometry(2014) SANTOS, Marcelo Filonzi dos; FERRI, Caio Caleiras; SEULIN, Saskia Carolina; LEYTON, Vilma; PASQUALUCCI, Carlos Augusto Goncalves; MUNOZ, Daniel Romero; YONAMINE, MauricioA hollow-fiber liquid-phase microextraction (HF-LPME), used in three-phase mode, and combined with gas chromatography-mass spectrometry (GC-MS), was developed to quantify antidepressants and their major metabolites (amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, desmethylclomipramine, fluoxetine, and norfluoxetine) in whole blood samples, using their deuterated analogs as internal standards. The HF-LPME system comprised a disposable 8-cm polypropylene porous hollow fiber, 4.0 ml of sample solution (0.5 ml of blood added to 3.5 ml of 0.1 M NaOH: donor phase), dodecane (organic phase), and 0.1 M formic acid (acceptor phase) for extraction. After stirring the system, the acceptor phase was evaporated under a nitrogen stream and resuspended in 30 mu l of methanol. Derivatization was not required. A 2.0-mu l aliquot of this solution was injected into a GC-MS system. The method was validated after the optimization of several parameters that may influence the extraction efficiency. The limits of quantification for all antidepressants were below the therapeutic levels (20.0 ng/ml). The average intraday and interday precisions were within 9.7 and 9.8 %, respectively, for all analytes. The calibration curves were linear in the concentration range of 20-1,200 ng/ml. The developed method was applied to seven actual postmortem samples. Tricyclic antidepressants were detected in all of the analyzed cases. To our knowledge, this is the first demonstration of usefulness of HF-LPME for analysis of antidepressants in postmortem forensic cases.
- A continuidade do uso de anfetaminas por motoristas de caminhão no Estado de São Paulo, Brasil, a despeito da proibição de sua produção, prescrição e uso(2013) OLIVEIRA, Lucio Garcia de; ENDO, Ligia Goes; SINAGAWA, Daniele Mayumi; YONAMINE, Mauricio; MUNOZ, Daniel Romero; LEYTON, VilmaAmphetamine use by truck drivers for occupational purposes is widely known. The production and consumption of amphetamines was banned by the Brazilian National Health Surveillance Agency (ANVISA) in October 2011. This study analyzes persistent amphetamine use by truck drivers since the ban was implemented. A convenience sample of 427 truck drivers was taken along highways in Sao Paulo State in 2012. Participants were asked to answer a structured questionnaire and provide a urine sample to screen for recent amphetamine consumption through toxicological analysis. Among the interviewed drivers, 7% had used some illicit drug recently and 2.7% had used amphetamines. Amphetamines are still consumed by truck drivers despite the risks and the recent ban. The authorities should thus monitor the possession and use of amphetamines by drivers in order to effectively enforce the ban.
- Alcohol use among fatally injured victims in SAo Paulo, Brazil: bridging the gap between research and health services in developing countries(2017) ANDREUCCETTI, Gabriel; LEYTON, Vilma; LEMOS, Nikolas P.; MIZIARA, Ivan Dieb; YE, Yu; TAKITANE, Juliana; MUNOZ, Daniel Romero; REINGOLD, Arthur L.; CHERPITEL, Cheryl J.; CARVALHO, Heraclito Barbosa deBackground and aimsMost studies reporting alcohol use among fatally injured victims are subject to bias, particularly those related to sample selection and to absence of injury context data. We developed a research method to estimate the prevalence of alcohol consumption and test correlates of alcohol use prior to fatal injuries. Design, Setting and ParticipantsCross-sectional study based on a probability sample of fatally injured adult victims (n=365) autopsied in SAo Paulo, Brazil. Victims were sampled within systematically selected 8-hour sampling blocks, generating a representative sample of fatal injuries occurring during all hours of the day for each day of the week between June 2014 and December 2015. MeasurementsThe presence of alcohol and blood alcohol concentration (BAC) were the primary outcomes evaluated according to victims' socio-demographic, injury context data (type, day, time and injury place) and criminal history characteristics. FindingsAlcohol was detected in 30.1% [95% confidence interval (CI)=25.6-35.1)] of the victims, with a mean blood alcohol level (BAC) level of 0.11%w/v (95% CI=0.09-0.13) among alcohol-positive cases. Black and mixed race victims presented a higher mean BAC than white victims (P=0.03). Fewer than one in every six suicides tested positive for alcohol, while almost half of traffic-related casualties were alcohol-positive. Having suffered traffic-related injuries, particularly those involving vehicle crashes, and injuries occurring during weekends and at night were associated significantly with alcohol use before injury (P<0.05). ConclusionsNearly one-third of fatal injuries in SAo Paulo between June 2014 and December 2015 were alcohol-related, with traffic accidents showing a greater association with alcohol use than other injuries. The sampling methodology tested here, including the possibility of adding injury context data to improve population-based estimates of alcohol use before fatal injury, appears to be a reliable and lower-cost strategy for avoiding biases common in death investigations.
bookPart Perícia médica(2022) GIANVECCHIO, Victor Alexandre Percinio; GIANVECCHIO, Daniele Muñoz; MACIEL, Daniele Pimentel; MUñOZ, Daniel Romero- Amphetamine, cocaine and cannabinoids use among truck drivers on the roads in the State of Sao Paulo, Brazil(2012) LEYTON, V.; SINAGAWA, D. M.; OLIVEIRA, K. C. B. G.; SCHMITZ, W.; ANDREUCCETTI, G.; MARTINIS, B. S. De; YONAMINE, M.; MUNOZ, D. R.Drugs are important risk factors for traffic accidents. In Brazil, truck drivers report using amphetamines to maintain their extensive work schedule and stay awake. These drugs can be obtained without prescription easily on Brazilian roads. The use of these stimulants can result in health problems and can be associated with traffic accidents. There are Brazilian studies that show that drivers use drugs. However, these studies are questionnaire-based and do not always reflect real-life situations. The purpose of this study was to demonstrate the prevalence of drug use by truck drivers on the roads of Sao Paulo State, Brazil, during 2009. Drivers of large trucks were randomly stopped by police officers on the interstate roads during morning hours. After being informed of the goals of the study, the drivers gave written informed consent before providing a urine sample. In addition, a questionnaire concerning sociodemographic characteristics and health information was administered. Urine samples were screened for amphetamines, cocaine, and cannabinoids by immunoassay and the confirmation was performed using gas chromatography-mass spectrometry (GC-MS). Of the 488 drivers stopped, 456 (93.4%) provided urine samples, and 9.3% of them (n = 42) tested positive for drugs. Amphetamines were the most commonly found (n = 26) drug, representing 61.9% of the positive samples. Ten cases tested positive for cocaine (23.8%), and five for cannabinoids (11.9%). All drivers were male with a mean age of 40 +/- 10.8 years, and 29.3% of them reported some health problem (diabetes, high blood pressure and/or stress). A high incidence of truck drivers who tested positive for drug use was found, among other reported health problems. Thus, there is an evident need to promote a healthier lifestyle among professional drivers and a need for preventive measures aimed at controlling the use of drugs by truck drivers in Brazil.
- Prevalence of drugs in oral fluid from truck drivers in Brazilian highways(2017) BOMBANA, Henrique Silva; GJERDE, Hallvard; SANTOS, Marcelo Filonzi dos; JAMT, Ragnhild Elen Gjulem; YONAMINE, Mauricio; ROHLFS, Waldo Jose Caram; MUNOZ, Daniel Romero; LEYTON, VilmaTraffic accidents are responsible for 1.25 million deaths worldwide and are the most common cause of death among those aged 15-29 years. In Brazil, traffic accidents caused more than 44,000 deaths in 2014. The use of psychoactive drugs is an important risk factor for being involved in traffic accidents. Previous studies have found that psychoactive substances are commonly used by truck drivers in Brazil to maintain their extensive work schedule and stay awake while driving during nighttime hours. The state of Sao Paulo is one of the most important states regarding goods transportation. Important highways cross through Sao Paulo to other regions from Brazil and to other countries in Latin America. This study aims to determine the prevalence of illicit drug use by truck drivers in the state of Sao Paulo through toxicological analyses of oral fluid. Truck drivers were randomly stopped by police officers on federal roads during morning hours. Oral fluid samples were collected using the Quantisal (TM) device. In addition, a questionnaire concerning sociodemographic characteristics and health information was administered. Oral fluid samples were screened for amphetamine, cocaine, and tetrahydrocannabinol (Delta 9-THC) by ELISA and the confirmation was performed using ultra performance liquid chromatography with tandem mass spectrometry detection (UPLC-MS/MS). Of the 764 drivers stopped, 762 agreed to participate. The participants were driving an average of 614 km and 9.4 h a day. Of the total samples, 5.2% (n = 40) tested positive for drugs. Cocaine was the most frequently found drug (n = 21), followed by amphetamine (n = 16) and D9-THC (n = 8). All drivers were men with an average age of 42.5 years. With these results we were able to verify that many truck drivers were still consuming psychoactive drugs while driving, and cocaine was the most prevalent one. This reinforces the need for preventive measures aimed at controlling the use of illicit drugs by truck drivers in Brazil.
- Prevalence of at-risk drinking among Brazilian truck drivers and its interference on the performance of executive cognitive tasks(2016) OLIVEIRA, Lucio Garcia de; LEOPOLDO, Kae; GOUVEA, Marcela Julio Cesar; BARROSO, Lucia Pereira; GOUVEI, Paula Adriana Rodrigues; MUNOZ, Daniel Romero; LEYTON, VilmaBackground: Binge drinking (BD) has been associated with an increase in the risk of alcohol-related injuries. Alcohol continues to be the main substance consumed by truck drivers, a population of special concern, since they are often involved in traffic accidents. The aim of this study was to estimate the prevalence of BD and its interference in the executive functioning among truck drivers in Sao Paulo, Brazil. Methods: A non-probabilistic sample of 684 truck drivers was requested to answer a structured research instrument on their demographic data and alcohol use. They performed cognitive tests to assess their executive functioning and inventories about confounding variables. The participants were then divided according to their involvement in BD. Results: 17.5% of the interviewees have reported being engaged in BD. Binge drinkers showed a better performance on one test, despite having done so at the expense of more mistakes and lower accuracy. More interestingly, binge drinkers took three seconds longer than non-binge drinkers to inhibit an inadequate response, which is worrisome in the context of traffic. Overall, the deleterious effect of BD on performance remained after controlling for the effects of confounding variables in regression logistic models. Conclusions: As the use of alcohol among truck drivers may be as a way to get by with their work conditions, we believe that a negotiation between their work organization and public authorities would reduce such use, preventing negative interferences on truck drivers' cognitive functioning, which by its turn may also prevent traffic accidents.
article Carimbo médico: uma necessidade legal ou uma imposição informal?(2011) FONTASA-ROSA, Julio Cesar; PAULA, Fernando Jorge de; MOTTA, Marcia Vieira da; MUNOZ, Daniel Romero; SILVA, Moacyr da- Uso de anfetaminas por motoristas de caminhão em rodovias do Estado de São Paulo: um risco à ocorrência de acidentes de trânsito?(2013) TAKITANE, Juliana; OLIVEIRA, Lucio Garcia de; ENDO, Ligia Goes; OLIVEIRA, Keziah Cristina Barbosa Gruber de; MUNOZ, Daniel Romero; YONAMINE, Mauricio; LEYTON, VilmaThe use of amphetamines in Brazil is common among truck drivers, which may be an important factor in the occurrence of traffic accidents. This article seeks to estimate the prevalence of amphetamine use among truck drivers. Drivers (N = 134) were stopped on two different highways in Sao Paulo state and they were asked to answer a questionnaire and provide a urine sample for toxicological analysis. All data were analyzed on Stata 8.0. All participants were males with low levels of schooling, whose mean age was 40.8 years. The presence of amphetamines was detected in 10.8% of all urine samples collected, being commonly justified in order to make truck drivers able to maintain their state of awareness. Amphetamine use was detected among truck drivers on Sao Paulo highways. The problem is that when the stimulant effects wear off, sleepiness due to sleep deprivation reduces concentration and good driver performance, making drivers vulnerable to traffic accidents and the related effects.