DOCSLIB.ORG

Msc (Medsci) Forensic Toxicology

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Msc (Medsci) Forensic Toxicology 12/6/2017 Drugs of abuse in Forensic Toxicology/ Group work Dr Calum Morrison Forensic Medicine and Science Intended Learning Outcomes 05 December 2017 • Develop an • Develop group awareness of work skills – drugs of abuse individual in forensic contribution toxicology 1 12/6/2017 What is a poison? • Any substance which has a harmful effect on a living system • “All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy.” • Paracelsus (1493–1541) What does a Forensic Toxicologist do? • Answers the question: “Have alcohol, drugs or poisons played a role in a death or crime?” 2 12/6/2017 Classification of poisons – according to chemical properties • Acidic – Ibuprofen • Basic – Amphetamine • Neutral – Steroids Classification of drugs – according to effect • Stimulants – MDMA – Cocaine • Analgesics – Opioids – Non-steroidal anti-inflammatory drugs (NSAIDs) e.g. ibuprofen • Antidepressants 3 12/6/2017 Classification of drugs – according to route • Inhalation • Insufflation • Injection – IV, IM, subcutaneous • Oral – sublingual • Dermal Drugs of abuse • Any substance, because of some desirable effect, is used for some purpose other than that intended. – Solvents • Any substance the possession or supply of which is restricted by law because of its potential harmful effect on the user. – Licit and illicit drugs 4 12/6/2017 Lets talk about 1 class of compounds • Stimulants……. Amphetamine 5 12/6/2017 Origin • Synthetic (1900s) • Made from phenyl-2-propanone Active ingredients • (S)-isomer is more potent (racemic) Appearance • White powder (sulphate or hydrochloride salt) • Occasionally pills Methamphetamine 6 12/6/2017 Origin • Synthetic (1960s) • Made from pseudoephedrine Active ingredients • (S)-isomer abused/used for ADHD (Desoxyn®) • (R)-isomer is a decongestant in the USA Appearance • White crystalline powder (hydrochloride salt) Levomethamphetamine Methamphetamine 7 12/6/2017 Ecstasy Origin • Synthetic (1914) • Made from safrole/isosafrole Active ingredient • 3,4-methylenedioxymethamphetamine Appearance • Brightly coloured pills with logos • Crystals 8 12/6/2017 Cocaine 9 12/6/2017 Origin • South America • India Active ingredients • Cocaine, crunch Appearance • White powder (hydrochloride salt) • White pellets (free base) Names • Coke/Charlie or crack/rocks, proper Administration • Snorting, IV • Smoking (‘crackles’) • Topical Legislation • Class A, not prescribed in the UK 10 12/6/2017 Khat Origin • East Africa • Arabian Peninsula Active ingredient • Cathinone Appearance • Leaves, tea or tincture 11 12/6/2017 Names • Chat, quat Administration • Oral Legislation • Both plant and active ingredient are Class C (Khat as of June 2014) Cathinones Origin • Synthetic • Research chemicals/bath salts/aroma liquids Appearance • Crystalline powders Legislation • Cathinones – Class B • Methcathinone – Class A 12 12/6/2017 Active ingredients 4-MEC Pentylone α-PVP (flakka) Ethcathinone 28th August 2015 Mexedrone Buphedrone Legal Butylone MDPV Mephedrone Methylone Names • Meow meow, M-cat, Mollies Administration • Oral – Dissolved/bombing – Tablets – Aroma liquid • IV • Smoking • Snorting (sold as cocaine) 13 12/6/2017 Other stimulants Caffeine Origin • Africa • Asia Appearance • White crystals • Consumed orally as tea/coffee or tablets Legislation • Uncontrolled 14 12/6/2017 Nicotine Origin • Americas • Australia/Pacific Appearance • Dried tobacco leaves • Smoked Legislation • Uncontrolled (must be 18 to purchase cigarettes) Developing the discussion process (1 hour) • Everyone contributed well to the session on day 6 – lets now look at some other parts of group work • In your groups of 4, subdivide the following tasks between different co- workers – Post mortem re-distribution – Concentrations and some effects associated with toxicity – Assessment of this drug’s effect on society – A simple summary of metabolism • Investigate a chemical or drug that is mainly used as a drug of abuse • Again we can summarise on the board, this time on the sub - topics • You will try and ask other groups some questions 15.
Load more

Recommended publications
  • House Bill No. 2191
    SECOND REGULAR SESSION HOUSE BILL NO. 2191 99TH GENERAL ASSEMBLY INTRODUCED BY REPRESENTATIVE QUADE. 5582H.01I D. ADAM CRUMBLISS, Chief Clerk AN ACT To repeal section 579.060, RSMo, and to enact in lieu thereof one new section relating to controlled substances, with penalty provisions. Be it enacted by the General Assembly of the state of Missouri, as follows: Section A. Section 579.060, RSMo, is repealed and one new section enacted in lieu 2 thereof, to be known as section 579.060, to read as follows: 579.060. 1. A person commits the offense of unlawful sale, distribution, or purchase of 2 over-the-counter methamphetamine precursor drugs if he or she knowingly: 3 (1) Sells, distributes, dispenses, or otherwise provides any number of packages of any 4 drug product containing detectable amounts of ephedrine, levomethamphetamine, 5 phenylpropanolamine, propylhexedrine, or pseudoephedrine, or any of their salts, optical 6 isomers, or salts of optical isomers, in a total amount greater than nine grams to the same 7 individual within a thirty-day period, unless the amount is dispensed, sold, or distributed 8 pursuant to a valid prescription; or 9 (2) Purchases, receives, or otherwise acquires within a thirty-day period any number of 10 packages of any drug product containing any detectable amount of ephedrine, 11 levomethamphetamine, phenylpropanolamine, propylhexedrine, or pseudoephedrine, or any 12 of their salts or optical isomers, or salts of optical isomers in a total amount greater than nine 13 grams, without regard to the number of transactions, unless the amount is purchased, received, 14 or acquired pursuant to a valid prescription; or 15 (3) Purchases, receives, or otherwise acquires within a twenty-four-hour period any 16 number of packages of any drug product containing any detectable amount of ephedrine, 17 levomethamphetamine, phenylpropanolamine, propylhexedrine, or pseudoephedrine, or any EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law.
    [Show full text]
  • The Stimulants and Hallucinogens Under Consideration: a Brief Overview of Their Chemistry and Pharmacology
    Drug and Alcohol Dependence, 17 (1986) 107-118 107 Elsevier Scientific Publishers Ireland Ltd. THE STIMULANTS AND HALLUCINOGENS UNDER CONSIDERATION: A BRIEF OVERVIEW OF THEIR CHEMISTRY AND PHARMACOLOGY LOUIS S. HARRIS Dcparlmcnl of Pharmacology, Medical College of Virginia, Virginia Commonwealth Unwersity, Richmond, VA 23298 (U.S.A.) SUMMARY The substances under review are a heterogenous set of compounds from a pharmacological point of view, though many have a common phenylethyl- amine structure. Variations in structure lead to marked changes in potency and characteristic action. The introductory material presented here is meant to provide a set of chemical and pharmacological highlights of the 28 substances under con- sideration. The most commonly used names or INN names, Chemical Abstract (CA) names and numbers, and elemental formulae are provided in the accompanying figures. This provides both some basic information on the substances and a starting point for the more detailed information that follows in the individual papers by contributors to the symposium. Key words: Stimulants, their chemistry and pharmacology - Hallucinogens, their chemistry and pharmacology INTRODUCTION Cathine (Fig. 1) is one of the active principles of khat (Catha edulis). The structure has two asymmetric centers and exists as two geometric isomers, each of which has been resolved into its optical isomers. In the plant it exists as d-nor-pseudoephedrine. It is a typical sympathomimetic amine with a strong component of amphetamine-like activity. The racemic mixture is known generically in this country and others as phenylpropanolamine (dl- norephedrine). It is widely available as an over-the-counter (OTC) anti- appetite agent and nasal decongestant.
    [Show full text]
  • (19) United States (12) Patent Application Publication (10) Pub
    US 20130289061A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2013/0289061 A1 Bhide et al. (43) Pub. Date: Oct. 31, 2013 (54) METHODS AND COMPOSITIONS TO Publication Classi?cation PREVENT ADDICTION (51) Int. Cl. (71) Applicant: The General Hospital Corporation, A61K 31/485 (2006-01) Boston’ MA (Us) A61K 31/4458 (2006.01) (52) U.S. Cl. (72) Inventors: Pradeep G. Bhide; Peabody, MA (US); CPC """"" " A61K31/485 (201301); ‘4161223011? Jmm‘“ Zhu’ Ansm’ MA. (Us); USPC ......... .. 514/282; 514/317; 514/654; 514/618; Thomas J. Spencer; Carhsle; MA (US); 514/279 Joseph Biederman; Brookline; MA (Us) (57) ABSTRACT Disclosed herein is a method of reducing or preventing the development of aversion to a CNS stimulant in a subject (21) App1_ NO_; 13/924,815 comprising; administering a therapeutic amount of the neu rological stimulant and administering an antagonist of the kappa opioid receptor; to thereby reduce or prevent the devel - . opment of aversion to the CNS stimulant in the subject. Also (22) Flled' Jun‘ 24’ 2013 disclosed is a method of reducing or preventing the develop ment of addiction to a CNS stimulant in a subj ect; comprising; _ _ administering the CNS stimulant and administering a mu Related U‘s‘ Apphcatlon Data opioid receptor antagonist to thereby reduce or prevent the (63) Continuation of application NO 13/389,959, ?led on development of addiction to the CNS stimulant in the subject. Apt 27’ 2012’ ?led as application NO_ PCT/US2010/ Also disclosed are pharmaceutical compositions comprising 045486 on Aug' 13 2010' a central nervous system stimulant and an opioid receptor ’ antagonist.
    [Show full text]
  • Whoexpertcommittee Ondrugdependence
    Thisreportcontainsthecollectiveviewsof an international groupof expertsanddoesnotnecessarilyrepresentthedecisions Tile World 1lealth Organization is a specialized agcncyof the United Nations with orthestatedpolicyof theWorldHealthOrganization primary responsibility for international health'matters anti public health. Through this organization, which was created in 1948, the health professions of' some I65 countries exchange their knowledge and experience with the aim of making possible will permit them lo lead a socially and ccommlically productive lil_. WHOExpertCommittee By means of direct technical cooperation whh its Membcr Stales, and by stimt,- hhensiveding suchhealthcooperationservices, tamonghe preventionthem, WllOprornotesthcdevclopmcntorcomprc-anti control of diseascs, thc improvement o[ environmental conditions, tile development of health manpower, the coordination onDrugDependence anti development of biomedical and health services research, and thc planning and implementation of health programmes. These broad fiekls of endeavour encompass a wide variety of activities, such as developing systems of primary health cltre that reach the whole population of Mem- ber countries; promoting tile health of`mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; having achieved tile eradication or smallpox, promoting mass immunization against a numbcr of other preventable diseases; improving mental health; providing safe water supplies: anti training health
    [Show full text]
  • Chiral Separation of Methamphetamine and Amphetamine on an Agilent Infinitylab Poroshell 120 Chiral-V Column with Detection by LC/MS
    Application Note Clinical Research Chiral separation of methamphetamine and amphetamine on an Agilent InfinityLab Poroshell 120 Chiral-V column with detection by LC/MS Authors Abstract Carl Griffin and William Long An Agilent InfinityLab Poroshell 120 Chiral-V 2.1 × 150 mm, 2.7 μm column Agilent Technologies, Inc. (p/n 683775-604) was used to analyze methamphetamine and amphetamine Wilmington, DE, USA by LC/MS, using a mobile phase of methanol with 0.1 % acetic acid and 0.02 % ammonium hydroxide. The analysis was accomplished in 5 minutes, with a resolution Rs of 1.9 or better for racemic amphetamine and methamphetamine. Introduction H NH Experimental N 2 Superficially porous particle columns are An Agilent 1290 Infinity LC system CH3 a popular tool in liquid chromatography. with an Agilent 6460 triple quadrupole Superficially porous particle columns (S)-(+)-Methamphetamine (S)-(+)-Amphetamine LC/MS was used in this experiment. The generate high efficiency at lower Dextromethamphetamine Dextroamphetamine system was modified from its standard pressure relative to their totally porous configuration to have low system volume 1 particle column counterparts . This is H NH and dispersion. Table 1 shows the primarily due to a shorter mass transfer N 2 instrument configuration details. Table 1 distance and substantially narrower CH lists the Agilent InfinityLab Poroshell 120 particle size distribution of the particles 3 Chiral-V 2.1 × 150 mm, 2.7 μm column in the column2. The current trend with (R)-(–)-Methamphetamine (R)-(–)-Amphetamine used in this work. Table 2 shows the LC superficially porous particles is reducing Levomethamphetamine Levoamphetamine and MS parameters.
    [Show full text]
  • Amphetamines
    Received: 8 May 2020 Revised: 19 June 2020 Accepted: 6 July 2020 DOI: 10.1002/bdr2.1774 TERATOGEN UPDATE Teratogen update: Amphetamines Joan D. Garey1 | Shari I. Lusskin1,2,3 | Anthony R. Scialli1 1Reproductive Toxicology Center, A Non- Profit Foundation, Washington, District of Abstract Columbia, USA Amphetamines are synthetic noncatecholamine sympathomimetic amines that 2Department of Psychiatry, Icahn School act as psychostimulants. They have been prescribed for the treatment of of Medicine at Mount Sinai, New York, attention-deficit/hyperactivity disorder (ADHD), narcolepsy, and additional New York, USA health conditions. Amphetamines are also drugs of abuse. Some experimental 3Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of animal studies suggested adverse developmental effects of amphetamines, Medicine at Mount Sinai, New York, including structural malformations. These effects were most often observed in New York, USA experimental animals at higher dose levels than those used for treatment or Correspondence abuse and at dose levels that produce maternal toxicity. Controlled studies of Joan D. Garey, Reproductive Toxicology amphetamine use for the treatment of ADHD and other indications did not Center, A Non-Profit Foundation, 2737 Devonshire Pl NW, #120, Washington, suggest that amphetamines are likely to cause structural malformations, DC 20008-3459. although there are three studies associating medication for ADHD or metham- Email: [email protected] phetamine abuse with gastroschisis. We did not locate studies on the neuro- Funding information behavioral effects of prenatal exposures to therapeutic amphetamine use. Reproductive Toxicology Center, A Non- Amphetamine abuse was associated with offspring neurobehavioral abnormal- Profit Foundation ities, but lack of adequate adjustment for confounding interferes with interpre- tation of the associations.
    [Show full text]
  • Testing for Amphetamine and Methamphetamine Abuse Using
    Healthcare & Life Sciences Accurate Biological Testing for Amphetamine and Methamphetamine Abuse Using Chiral HPLC and MS Detection In this study, optimized methods are presented for sample preparation and chiral chromatography for the LC/MS analysis of amphetamine and methamphetamine enantiomers in urine. Introduction from several tens to several hundreds of milligrams, depending on Methamphetamine and amphetamine, powerful CNS stimulants the purity and the isomeric composition, and will metabolize to 3 that have a variety of ethical uses, have side effects of increased amphetamine and 4-hydroxymethamphetamine. Amphetamine confidence, sociability, and energy that have resulted in their metabolizes mainly to 1-phenyl-2-propanone, with smaller extensive abuse as recreational psychoactive drugs. This extends to amounts of 4-hydroxyamphetamine. However, since up to 54% their abuse in sports because of the additional properties of increased of methamphetamine is excreted unchanged and 10-23% as mental alertness and suppression of fatigue.1 Negative side effects amphetamine following oral ingestion, it is usually the parent drug 1 include hypertension and tachycardia. In the usually uncontrolled that is monitored. situations of drug abuse, they exhibit similar psychoactive Culpability for the illicit use of amphetamine and methamphetamine effects, although amphetamine is generally less potent than rests on the ability to distinguish the contribution to the measured methamphetamine. abused product from possible alternative sources of the L-enantiomer. Illicit use of these drugs continues to be high. Public Health Therefore, the separation of the enantiomers is a more accurate England recently reported that the number of people stating their approach for testing. A chiral method can also be used to indicate main injecting drug to be amphetamines and amphetamine-type the synthetic route that was used by the illegal source, which can be substances (such as mephedrone) nearly tripled between 2002 and useful as part of a criminal investigation.
    [Show full text]
  • Public Comment on Synthetic Cathinones, Tetrahydrocannabinol (THC), and Synthetic Cannabinoids Dear Judge Pryor
    FEDERAL DEFENDER SENTENCING GUIDELINES COMMITTEE Lyric Office Centre 440 Louisiana Street, Suite 1350 Houston, Texas 77002-1634 Chair: Marjorie Meyers Phone: 713.718.4600 October 26, 2017 Honorable William H. Pryor, Jr. Acting Chair United States Sentencing Commission One Columbus Circle, N.E. Suite 2-500, South Lobby Washington, D.C. 20002-8002 Re: Public Comment on Synthetic Cathinones, Tetrahydrocannabinol (THC), and Synthetic Cannabinoids Dear Judge Pryor: Synthetic cathinones and cannabinoids are “understudied substances.”1 Not enough information is available about these substances at this time for the Commission to make informed and just guideline amendments to address these drugs either individually or as a class. A far better approach is to amend Note 6 to give courts meaningful guidance on determining which of the listed substances are most similar to the unlisted substance. Specifically, we recommend guidance that will focus courts on the relative potency or impotency of unlisted substances and on medical and public health evidence of direct harms of the different drugs. With this approach, over time, courts and researchers will study these substances in a way that may, at some point, provide enough information for the Commission to specifically address them in the guidelines. We recognize the strong urge to do something to address the harms from synthetic drugs. And we share it. Unfortunately, amending the guidelines to specifically address these synthetic substances individually or as a class will not deter their production, sale, or use. As discussed below, despite a strong belief by many that we can stop people from certain actions by lengthening the threatened punishment, the research shows that lengthening punishment does not deter.
    [Show full text]
  • Pdf" Deleted By
    advice from FSANZ. The following advice on phenylisobutylamine (more correctly referred to below as 1-phenylbutan-2-amine) was provided to the TGA by at Drug Import/Export Licensing and Compliance, Office of Chemical Safety, Department of Health and Ageing [Website: www.health.gov.au/treaties Fax: 02 6289 2500 Email: [email protected] ] "1-Phenylbutan-2-amine Is chemical closely related to amphetamine, and research indicates it offers similar physiological stimulus and effects to amphetamines, however it is not considered a prohibited import or prohibited export. I would recommend contacting the Australian Federal Police about the status of both these substances in regards to the Criminal Code Act 1995." I assume that the Office of Chemical Safety should also be responsible for advice on whether it would be captured under the derivatives definition with respect to Schedule 9 of the SUSMP although this often seems to be left up to the individual State and Territory enforcement agencies via their own legislation. Regards, |Director of Chemistry | Office of Laboratories and Scientific Services l Therapeutic Goods Administration | Fax: 02 6232 8442 | From: Ian Beer <[email protected]> To: Date: 22/10/2012 01:46 PM Subject: RE: Supplements Information on analysis [SEC=UNCLASSIFIED] Hi Any news on a quotation for the analysis of the supplements? NMI will be doing the analysis for Phenylisobutylamine so we would like to have the other products tested soon. Would the TGA have an expert who would have knowledge of the health effects of Phenylisobutylamine and what its legal status would be? Regards Ian Beer Team Leader Enforcement NSW Food Authority safer food, clearer choices Direct line 9741 4859 | Fax +61 2 9741 4898 | Mob 0413 018 521 please consider the environment before printing this email From: Sent: Thursday, 11 October 2012 2:22 PM To: Ian Beer 2 Subject: RE: Supplements Information on analysis [SEC=UNCLASSIFIED] Ian, I suspect that the short answer is 'no'.
    [Show full text]
  • Break the Cycle: Methamphetamine and Community-Oriented Policing in Indian Country
    This project was supported by cooperative agreement numbers 2010-CK-WX-K023 and 2011-CK-WX-K02 awarded by the Office of Community Oriented Policing Services, U.S. Department of Justice. The opinions contained herein are those of the author(s) and do not necessarily represent the official position or poli- cies of the U.S. Department of Justice. References to specific agencies, companies, products, or services should not be considered an endorsement by the author(s) or the U.S. Department of Justice. Rather, the references are illustrations to supplement discussion of the issues. The Internet references cited in this publication were valid as of the date of publication. Given that URLs and websites are in constant flux, neither the author(s) nor the COPS Office can vouch for their current validity. Recommended citation: Copple, James E., and Colleen K. Copple. 2016. Break the Cycle: Methamphetamine and Community- Oriented Policing in Indian Country. Washington, DC: Office of Community Oriented Policing Services. Cover photo by Blend Images ISBN: 978-1-935676-92-8 Published 2016 A guide for tribal law enforcement and community stakeholders Break the Cycle Methamphetamine and Community-Oriented Policing in Indian Country By James E. Copple and Colleen K. Copple George Burba Indian people are struggling with these problems: meth and suicide. They didn’t struggle with these problems when they were young, so these problems are foreign to them, and there are no words in their languages for these problems. These problems are an evil that attacks the mind and leaves that person empty. These problems have changed the balance of things, and it isn’t supposed to be like this.
    [Show full text]
  • Teratogen Update: Amphetamines
    Received: 8 May 2020 Revised: 19 June 2020 Accepted: 6 July 2020 DOI: 10.1002/bdr2.1774 TERATOGEN UPDATE Teratogen update: Amphetamines Joan D. Garey1 | Shari I. Lusskin1,2,3 | Anthony R. Scialli1 1Reproductive Toxicology Center, A Non- Profit Foundation, Washington, District of Abstract Columbia, USA Amphetamines are synthetic noncatecholamine sympathomimetic amines that 2Department of Psychiatry, Icahn School act as psychostimulants. They have been prescribed for the treatment of of Medicine at Mount Sinai, New York, attention-deficit/hyperactivity disorder (ADHD), narcolepsy, and additional New York, USA health conditions. Amphetamines are also drugs of abuse. Some experimental 3Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of animal studies suggested adverse developmental effects of amphetamines, Medicine at Mount Sinai, New York, including structural malformations. These effects were most often observed in New York, USA experimental animals at higher dose levels than those used for treatment or Correspondence abuse and at dose levels that produce maternal toxicity. Controlled studies of Joan D. Garey, Reproductive Toxicology amphetamine use for the treatment of ADHD and other indications did not Center, A Non-Profit Foundation, 2737 Devonshire Pl NW, #120, Washington, suggest that amphetamines are likely to cause structural malformations, DC 20008-3459. although there are three studies associating medication for ADHD or metham- Email: [email protected] phetamine abuse with gastroschisis. We did not locate studies on the neuro- Funding information behavioral effects of prenatal exposures to therapeutic amphetamine use. Reproductive Toxicology Center, A Non- Amphetamine abuse was associated with offspring neurobehavioral abnormal- Profit Foundation ities, but lack of adequate adjustment for confounding interferes with interpre- tation of the associations.
    [Show full text]
  • Decongestants, Antihistamines and Nasal Irrigation for Acute Sinusitis in Children (Review)
    Decongestants, antihistamines and nasal irrigation for acute sinusitis in children (Review) Shaikh N, Wald ER This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2014, Issue 10 http://www.thecochranelibrary.com Decongestants, antihistamines and nasal irrigation for acute sinusitis in children (Review) Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 3 METHODS ...................................... 3 RESULTS....................................... 5 Figure1. ..................................... 6 DISCUSSION ..................................... 8 AUTHORS’CONCLUSIONS . 8 ACKNOWLEDGEMENTS . 8 REFERENCES ..................................... 8 CHARACTERISTICSOFSTUDIES . 12 DATAANDANALYSES. 14 APPENDICES ..................................... 14 WHAT’SNEW..................................... 17 HISTORY....................................... 17 CONTRIBUTIONSOFAUTHORS . 17 DECLARATIONSOFINTEREST . 17 SOURCESOFSUPPORT . 17 DIFFERENCES BETWEEN PROTOCOL AND REVIEW . .... 18 INDEXTERMS .................................... 18 Decongestants, antihistamines and nasal irrigation for acute sinusitis in children (Review) i Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention
    [Show full text]