The Effects of Dextromethorphan on Driving Performance and the Standardized Field Sobriety Test

Dextromethorphan (DXM) is abused most commonly among adolescents as a recreational drug to generate a dissociative experience. The objective of the study was to assess driving with and without DXM ingestion. The effects of one‐time maximum daily doses of DXM 120 mg versus a guaifenesin 400 mg dose were compared among 40 healthy subjects using a crossover design. Subjects’ ability to drive was assessed by their performance in a driving simulator (STISIM^® Drive driving simulator software) and by conducting a standardized field sobriety test (SFST) administered 1‐h postdrug administration. The one‐time dose of DXM 120 mg did not demonstrate driving impairment on the STISIM^® Drive driving simulator or increase SFST failures compared to guaifenesin 400 mg. Doses greater than the currently recommended maximum daily dose of 120 mg are necessary to perturb driving behavior.     

A Proposal for a Framework Convention on Global Health

This article searches for solutions to the most perplexing problemsin global health—problems so important that they affectthe fate of millions of people, with economic, political, andsecurity ramifications for the world's population. No State,acting alone, can insulate itself from major health hazards.It is for this reason that safeguarding the world's populationrequires cooperation and global governance. What is truly needed,and what richer countries instinctively do for their own citizens,is to meet what I call ‘basic survival needs.’ Byfocusing on the major determinants of health, the internationalcommunity could dramatically improve prospects for good health.A vehicle such as a Framework Convention on Global Health (FCGH)could powerfully improve global health governance. Such a FrameworkConvention would commit States to a set of targets, both economicand logistic, and dismantle barriers to constructive engagementby the private and charitable sectors. It would stimulate creativepublic/private partnerships and actively engage civil societystakeholders. A FCGH could set achievable goals for global healthspending; define areas of cost effective investment to meetbasic survival needs; build sustainable health systems; andcreate incentives for scientific innovation for affordable vaccinesand essential medicines.     

A sudden death with lung embolism after inadvertent infusion of zinc oxide shake lotion

A 74-year old woman in postoperative treatment after a colonic surgery died immediately after perfusion of about 1.5 mL of a white emulsion which was believed to contain 1% propofol via cardiac catheter into the right atrium. It was strongly suspected that a syringe with a zinc oxide shake lotion (consisting of 20% ZnO, 20% talc, 25% glycerol and 35% water) which was intended for external treatment had been mistaken for the propofol syringe. During autopsy, an anatomic cause of death could not be found. In order to exclude an intoxication and to determine the significance of the perfusion fluid in this context, toxicological and histological investigations were performed. Propofol and other drugs applied to the patient were found in therapeutic or sub-therapeutic range. However, in comparison to a control case, the zinc concentrations determined by AAS were about 200 times higher in lung tissue, 10 times higher in heart blood and 3–4 times higher in kidney and liver tissue. No increase was seen in venous blood. Histology showed a strong embolism of the lung tissue with birefingent sharp-edged crystals, which were identified as the talcum, and an amorphous component (ZnO). The same embolism was seen to a medium extent also in the brain sections and to a low extent in heart, liver, pancreas and kidney. Pulmonary embolism by talcum and zinc oxide was established as the cause of death which occurred by syringe swap due to insufficient security precautions in the drug administration. The results are discussed in context of pulmonary microembolism cases frequently described for drug addicts after injection of crashed talcum containing tablets.