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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- 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.
- 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.
- Trends in the use of psychoactive substances by truck drivers in SAo Paulo State, Brazil: A time-series cross sectional roadside survey (2009-2016)(2019) LEYTON, Vilma; BOMBANA, Henrique Silva; MAGALHAES, Juliana Gallottini; PANIZZA, Helena Nascimento; SINAGAWA, Daniele Mayumi; TAKITANE, Juliana; CARVALHO, Heraclito Barbosa de; ANDREUCCETTI, Gabriel; YONAMINE, Mauricio; GJERDE, Hallvard; MUNOZ, Daniel RomeroObjective: Truck drivers represent a group that is susceptible to the use of stimulant substances to reduce the symptoms of fatigue, which may be caused by a stressful and exhausting work environment. The use of psychoactive substances may increase the risk for involvement in road traffic crashes. Previous studies have demonstrated that amphetamine, cocaine, and cannabis are the 3 main drugs used by Brazilian truck drivers. We studied the prevalence of amphetamine, benzoylecgonine (indicating use of cocaine), and -9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH; indicating use of cannabis) in urine samples from truck drivers in the state of SAo Paulo, Brazil, using the same methodology during 8 years (2009-2016).Methods: Samples were collected during a health program supported by the Federal Highway Police. Toxicological analyses were performed using immunoassays and gas chromatography-mass spectrometry.Results: The total prevalence of illicit drugs was 7.8%. Benzoylecgonine was the most prevalent substance (3.6%), followed by amphetamine (3.4%) and THC-COOH (1.6%). We found the highest drug prevalence in 2010 (11.3%) and the lowest in 2011 (6.1%). We could detect a slight change in the pattern of stimulant use: until 2010, amphetamine was the most prevalent substance; however, in 2011 benzoylecgonine became the most frequently detected substance. This lasted until 2015, probably due to changes in Brazilian legislation regarding appetite suppressants; the most common one is metabolized to amphetamine.Conclusion: These data show that the use of psychoactive substances by truck drivers in Brazil did not decrease during the study period. This reinforces the need for further preventive measures to reduce drug use among drivers, which could lead to a decrease in traffic crashes in Brazil.
- Association Between Travel Length and Drug Use Among Brazilian Truck Drivers(2015) SINAGAWA, Daniele Mayumi; CARVALHO, Heraclito Barbosa De; ANDREUCCETTI, Gabriel; PRADO, Natanael Vitoriano Do; OLIVEIRA, Keziah Cristina Barbosa Gruber De; YONAMINE, Mauricio; MUNOZ, Daniel Romero; GJERDE, Hallvard; LEYTON, VilmaObjective: To investigate whether the use of the stimulants amphetamines and cocaine by truck drivers in Brazil was related to travel length. Methods: Truck drivers were randomly stopped by the Federal Highway Police on interstate roads in Sao Paulo State during morning hours from 2008 to 2011 and invited to participate in the project ""Comandos de Saude nas Rodovias"" (Health Commands on the Roads). Participants were asked about the use of drugs, travel distance, and age, and gender was recorded. Samples of urine were collected and analyzed for amphetamine, benzoylecgonine (a metabolite of cocaine), and carboxytetrahydrocannabinol (THC-COOH; a metabolite of cannabis) by immunological screening and quantification by gas chromatography-mass spectroscopy. Results: Current use of amphetamine, cocaine, and cannabis was reported by 5.7%, 0.7%, and 0.3% of the truck drivers, respectively. Amphetamine, benzoylecgonine, and THC-COOH were found in urine samples from 5.4%, 2.6,% and in 1.0% of the drivers, respectively. There was a significant association between the positive cases for amphetamine and reported travel length; 9.9% of urine samples from drivers who reported travel length of more than 270km were positive for amphetamine, and 10.9% of those drivers reported current use of amphetamines. In most cases, appetite suppressants containing amphetamines had been used, but the purpose was most often to stay awake and alert while driving. Truck drivers with travel length of more than 270km had significantly higher odds ratio (OR) for having a urine sample that was positive for amphetamine when adjusted for age as confounding factor (OR = 9.41, 95% confidence interval [CI], 3.97-22.26). No significant association was found between the use of cocaine or cannabis and travel length. Conclusion: Truck drivers who reported driving more than 270km had significantly higher frequencies of urine samples positive for amphetamine and reported significantly more frequent current use of amphetamines than those who reported shorter driving distances.
- Use of alcohol and illicit drugs by trauma patients in Sao Paulo, Brazil(2022) BOMBANA, Henrique Silva; BOGSTRAND, Stig Tore; GJERDE, Hallvard; JAMT, Ragnhild Elen Gjulem; CARVALHO, Heraclito Barbosa de; ANDREUCCETTI, Gabriel; BERNINI, Celso de Oliveira; MUNOZ, Daniel Romero; LEYTON, Vilma; GREVE, Julia Maria D'AndreaIntroduction: Alcohol and illicit drugs impair cognitive and psychomotor skills and may thereby increase the risk of involvement in a road traffic crash and other types of injuries. However, the knowledge on the use of psychoactive substances among injured patients presenting to emergency departments in low and middle-income countries remains limited. Aims: To estimate the prevalence of alcohol and illicit drug use among patients with traumatic injuries admitted to an emergency department in Sao Paulo, Brazil. Methods: Blood samples from injured patients requiring hospitalization for more than 24 h due to road traffic crashes, falls, or violence, were collected from July 2018 to June 2019. The samples were analyzed for alcohol and illicit drugs. Results: A total of 376 patients were included in this study; the median age was 36 years and 80% of patients were male. The majority (56%) of injuries resulted from road traffic crashes, with approximately half of them being motorcyclists. Alcohol, drugs, or both were detected in 32% of samples. The proportion that tested positive was highest for males (35%), for the age group 18-39 years (41%), for singles (43%), and for patients injured at nighttime (4 4%). Patients injured due to violence had the highest prevalence of alcohol or drugs in their blood samples (4 4%). Alcohol was most prevalent (23%), followed by cocaine (12%) and cannabis (5%). Conclusion: The use of alcohol and illicit drugs was common among injured patients in Sao Paulo; it was likely a contributing factor in a third of the injurious accidents. Alcohol was the most prevalent substance followed by cocaine and cannabis.
- Hollow-fibre liquid-phase microextraction and gas chromatography-mass spectrometric determination of amphetamines in whole blood(2020) BOMBANA, Henrique Silva; SANTOS, Marcelo Filonzi dos; MUNOZ, Daniel Romero; LEYTON, VilmaHere, we present a fully validated method using a hollow-fibre liquid-phase microextraction technique for the determination by gas chromatography-mass spectrometry (GC-MS) of amphetamine (AMP), methamphetamine (MET), fenproporex (FEN), 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA) and 3,4-methylenedioxyethylamphetamine (MDEA) in whole blood. The validation parameters presented successful values within those recommended by the Scientific Working Group for Forensic Toxicology (SWGTox) in the Standard Practices for Method Validation in Forensic Toxicology. The limits of detection ranged from 1 to 3 ng/mL, and the limits of quantification ranged from 2 to 5 ng/mL. The determination coefficients (r(2)) ranged from 0.990 to 0.997, and the method presented good intraday and interday accuracy (from 90.4% to 97.2%) and satisfactory recovery (from 68% to 110%). No carryover was observed. The heteroscedasticity was tested, and only AMP presented homoscedasticity. Weighting factors were applied to correct the linearity of MET (1/x(2)), MDA (1/x), FEN (1/x(1/2)), MDMA (1/x(2)) and MDEA (1/y). Dilution integrity was tested at ratios of 1:2, 1:5 and 1:10, and all maintained intraday precision (from 94.9% to 99.3%) and interday precision (from 89.4% to 94.9%). The validated method was applied to six real whole blood samples from individuals suspected of consuming ecstasy, and MDMA, MDA and amphetamine were successfully identified and quantified.
- Alcohol in combination with illicit drugs among fatal injuries in Sao Paulo, Brazil: An epidemiological study on the association between acute substance use and injury(2018) ANDREUCCETTI, G.; CHERPITEL, C. J.; CARVALHO, H. B.; LEYTON, V; MIZIARA, I. D.; MUNOZ, D. R.; REINGOLD, A. L.; LEMOS, N. P.Injury deaths have a major impact on public health systems, particularly in the Latin American region; however, little is known about how different drugs, in combination or not with alcohol, interact with each injury type. We tested an epidemiological protocol for investigating alcohol and other drug acute use among fatally injured victims taking into account the injury context for all injury causes in Sao Paulo, Brazil. Blood alcohol and drug content were fully screened and confirmed following a probability sample selection of decedents (n = 365) during 19 consecutive months (2014-2015). Drug concentrations, including benzodiazepines, cannabis, cocaine, and opioids were determined by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography tandem mass spectrometry (LC-MS/MS). Toxicology data were interpreted in combination with injury context retrieved from police records regarding cause, place of injury, and victims' criminal history. More than half of all fatally injured victims studied were under the influence of at least one substance (55.3%). Alcohol was the leading substance consumed before a fatal injury event (30.1%), followed by cocaine (21.9%) and cannabis (14%). Illicit drug use (cocaine and cannabis) comprised more than two thirds of all drug-related deaths. Alcohol-positive deaths are over-represented among road traffic injuries, while drug-positive deaths are more prevalent among intentional injuries. Victims who had previous criminal convictions were significantly more likely to have used illicit drugs compared to those who did not have a criminal background. We estimated that one in every two fatal injuries in the city of Sao Paulo is associated with acute substance use by the victim. The health burden attributed to alcohol- and drug-related fatal injury events has reached significant higher levels in Latin American cities such as Sao Paulo compared globally.