Inside Diagnostics winter 2017/18 by nal von minden GmbH

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Inside Diagnostics Winter 2017/18

Cannabidiol â&#x20AC;&#x201C; medical cannabis

The many branches of the marijuana plant

Winter = cold and flu season?

How you can arm yourself against the most infectious time of the year

In this issu

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Rapid Tests Laboratory Diagnosis Laboratory Service Consulting & Service

Inside Diagnostics

Foreword

Imprint

Dear reader,

Inside Diagnostics Customer magazine from nal von minden GmbH Responsible according to press law: Thomas Zander Editor-in-chief: Iris Schubert Editorial Team: Iris Schubert, Krystina Beer, Nicola Barabas, Helen Murr, Daniela Beer, Angela Metz, Manuela Kaml, Sonay Öktem, Manuela Duschinger, Andreas Ott, Ulrike Tischler, Julia Rummel inside-diagnostics@nal-vonminden.com Graphics: Julia Stigler, Leonie Britzelmeier

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kiing, walks through snowy woods, curling up all cosy on the sofa – these are some of the nicer aspects of winter. However, our immune system often struggles through the colder months, leading to nasty colds and flu-like infections. Our articles on the topics of colds and nutrition outline how to differentiate between colds and flu, as well as which vitamins and minerals strengthen the immune system. In this issue of Inside Diagnostics, we have also put together a number of other fascinating articles for you: The current state of affairs concerning the medical use of cannabidiol, and the potential consequences for mothers and their unborn babies following crystal meth consumption during pregnancy. As a small highlight, this issue also contains a double page with the editorial team’s pick of best articles and funniest pictures from 2017. Enjoy reading! Your Inside Diagnostics editorial team

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Page 4 Cannabinoid drug rapid tests Drug-Screen cannabis rapid test for urine, saliva or whole blood/serum/ plasma THC urine rapid tests with various cut-off levels available (each given in ng/mL): Urine: 25, 50, 150, 200, 300, 500 Saliva: 12 Whole blood/serum/plasma: 12 Page 6 Methamphetamine drug rapid testsDrug-Screen methamphetamine rapid test for urine, saliva or whole blood/serum/plasma MET urine rapid tests with various cut-off levels available (each given in ng/ML): Urine: 300, 500, 1000 Saliva: 50 Whole blood/serum/plasma: 50 Page 10 Influenza A/B Product code: 241005N-10, 241005N-25, 242006N-10

Inside Diagnostics

Content Topics Cannabidiol – medical cannabis �� 4 Crystal-Meth-Babies – When babies are born with an addiction �� 6 Just a cold or full-blown �� 10 Vitamin and mineral supplements – Staying healthy during the winter months �� 12 nvm Inside Prize Draw �� 8 Best of 2017 �� 14 Contact �� 16 Cannabidiol – medical cannabis | Page 4

More and more countries are allowing the use of hemp for medical purposes. As of early 2017, Germany also now allows the prescription of cannabis as a medication. More on page 4.

Cover © istockphoto.com/FGorgun

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Rapid Tests Cannabidiol – medical cannabis

Cannabidiol – medical cannabis More and more countries are now legalising cannabis for medical use The stand on legalisation

s early as 1996, California legalised the use of cannabis in medicine following a referendum on the issue, and today around 50% of US states allow its use in one form or another. In recent years, doctors in an increasing number of countries have started to prescribe cannabis as a medication. Its therapeutic effects are driven by cannabinoids, particularly ∆9-tetrahydrocannabinol (THC, dronabinol) and cannabidiol (CBD). In contrast to THC, CBD is not subject to narcotics law, and is thus gaining prominence under the nickname of ‘medical cannabis’.

Botanical background Like THC, CBD is derived from the leaves of the hemp (cannabis) plant, which itself has two derivatives. The two genera, ‘Cannabis sativa’ and ‘Cannabis indica’, differ in the composition of their phytocannabinoids - which is the reason behind the plants’ different effects. Whereas ‘cannabis sativa’ generally has a higher THC content, species of the genus ‘cannabis indica’ are among the CBD-rich varieties. In several countries, hemp with a high proportion of CBD and low levels of THC (under 0.2% in most EU countries, under 1% in Switzerland) may legally be grown as industrial hemp. The plant’s fibres are used, for example, in the production of clothing, ropes and paper, whilst the seeds are predominantly used for deriving oils containing CBD. With increasing interest in the therapeutic potential of CBD, both the cultivation and the growth of certain strains of CBD-rich varieties of hemp are on the rise. As a result, hemp strains consisting of up to 19% CBD are on the horizon.

physical damage. In contrast, CBD is considered only slightly psychoactive to antipsychotic. As an indirect antagonist of the CB1 receptor, CBD is able to counteract the psychogenic effects of THC. There is an absence of the ‘cannabis high’ associated with THC, and instead more of a ‘stoned’ sensation. Above all, CBD is accredited with a high potential in medicine - it is antimicrobial, anti-inflammatory and a tumour-inhibitor, for example. In addition to this, the substance has antiemetic, cramp-soothing, pain-easing, anxiety-relieving and neuro-protective effects. To date there have been scarcely any funded studies into CBD. Most data has stemmed from cell research, animal testing or isolated cases and is used in the treatment of epilepsy, multiple sclerosis, schizophrenia or certain tumours.

Dose administration CBD can be administered in many forms, including oils, solutions, sprays, capsules, tablets or other edible variants. As CBD is usually only given in high dosages and often has to be paid for by the patients themselves, its use in therapy can incur enormous personal costs. This is likely a reason why the use of cheaper CBD-oils is usually favoured instead.

Effects of CBD vs. THC THC is known for its psychoactive effects. It binds to the cannabinoid receptors CB1 and CB2, which are predominantly found in the brain and in immune cells. With the activation of receptors comes, amongst other things, a euphoric and relaxed state of mind. Alongside this is a subjective alteration in perception, as well as the alleviation of pain and a decrease in memory capabilities. However, the long-term or heavy consumption of cannabis may result in psychic, social and even

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www.istockphoto.com © Azure-Dragon, Nastasic

Rapid Tests Cannabidiol â&#x20AC;&#x201C; medical cannabis

CBD and our tests

Zero-tolerance boundary

Using our THC rapid tests, low doses (<0.1 mg/ml) and sporadic use of CBD would not lead to a positive result. However, it is important to note that even CBD products derived from industrial hemp contain traces of THC, meaning that high doses can also cause a positive THC test result. In addition, when CBD is present in the liver, it inhibits the cytochrome P450 enzymes CYP2C19 and CYP2D6. In turn, this can cause an accumulation of certain substances (THC included) and their metabolites. Furthermore, CBD is often administered in conjunction with THC â&#x20AC;&#x201C; it is not uncommon for a CBD:THC ratio of 1:1 to be recommended.

CBD is not subject to the narcotics act (in Germany) and, due to its lack of psychoactive effects, is considered low-risk for misuse. However, under some circumstances, it can also be wise to follow a zero-tolerance approach. It must be asked whether it makes sense to develop a rapid test that can specifically detect the consumption of even small quantities of CBD.

Sources: [1] https://hanfverband.de/ (09-2017) [2] http://www.pharmazeutische-zeitung.de/index.php?id=67762 (09-2017) [3] Bergamaschi MM, et al. Safety and Side Effects of Cannabidiol, a Cannabis sativa Constituent. Current Drug Safety. 2011; 6(4):237-49. [4] Zhornitsky S and Potvin S. Cannabidiol in Humans-The Quest for Therapeutic Targets. Pharmaceuticals. 2012; 5(5):529-52.

UTi, DBe

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Rapid Tests Crystal-Meth-Babies

Crystal-Meth-Babies

When babies are born with an addiction You feel strong and confident, with a high level of performance and concentration. You don’t need sleep, you’re not hungry or thirsty, but you do have a heightened sex drive. Crystal meth is a pick up, making you above all awake and active. You have a feeling of great mastery – you are unstoppable and can do everything and anything…until you can’t. Those consuming crystal meth regularly underestimate the effects, and by that time it’s already too late – you can be addicted after the first hit. Methamphetamines belong to a group of psychostimulants and lead to increased activity in the central and peripheral nervous system. As early as 1934, methamphetamine was known to the German population as Pervitin, or more colloquially ‘panzer-’ or ‘housewife- chocolate’. Today we know it as crystal meth, ice, yaba, crank or ‘C’.

and memory, paranoia, a distorted sense of reality, sleep disturbance, a change in personality, an accelerated aging process, tooth decay, death of nerve cells, and muscle wastage, to name but a few. Crystal meth is destructive.

Crystal Meth is destructive.

Whether as a cheap party drug, an aid to concentrate in school or studies, a performance enhancer in work or sport, or just a way to endure everyday life and escape nightmares – the reasons for taking crystal meth are as numerous as the kinds of people who consume it. In the last seven years, the number of those consuming crystal meth has risen quickly and steadily. It is no longer just the problem of run down areas or the big cities. Crystal meth is on the rise, and the developments are more and more shocking every year. The stereotypical images of a ‘meth-head’ bring much to the imagination. Before-and-after shots show disfigured people with eczema and heavily worn-out, aged faces after using for just a short time. However, this is not always the case and can certainly differ from person to person. Effects are sometimes not even seen on those who have been using crystal meth for years. There is no rule or time frame dictating how long the body will continue to function. For some, the deterioration is quickly visible, but others experience the positive effects for years before the treacherous poison begins to close in. Long term damage following consumption includes damage to the nasal mucous membrane, malnutrition as a result of appetite loss, and with it an impaired immune system, loss of concentration

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Consumption also affects hormone balance, raising the risk of unwanted pregnancies. It delays menstruation or stops it completely. Often, women consuming crystal meth don’t even notice a change in their body until the 20th week of pregnancy. As the substance is able to pass through the placenta, the unborn child is also supplied with the drug. Ante-natal growth disorders, severe deformities and organ damage, and mental illnesses such as schizophrenia or depression are just some of the many consequences that consumption can have on a foetus. The potential for dependency has been demonstrated through figures from the Perinatal Centre of Dresden University Hospital. Between January 2007 and May 2016, a total of 145

www.istockphoto.com © robtek, kaarsten

Rapid Tests Crystal-Meth-Babies

ICE

Crank

Crystal Meth Yaba

Uppers

newborns whose mothers had used crystal meth either before or during pregnancy were treated. In 2011, the number of affected newborns rose sharply from fewer than 10 per year, to just fewer than 20 in 2012. In 2013 this number rose to almost 30 and has since reached new levels every year.

room. Despite the mothers claiming that they were no longer using, statistics showed that more than 50% had continued consumption - even shortly before giving birth. AMe

Over half of the affected women were between the ages of 20 and 30. According to the accounts given by most women, their consumption ceased the moment that they knew they were pregnant. 80% agreed to a drug screening in the delivery

http://www.partypack.de/Crystal-Meth.147.0.html http://www.thueringen.de/th3/tmik/crystal/infos/anzeichen/ http://www.focus.de/regional/dresden/crystal-im-kreisssaal-immer-mehr-meth-babys-in-sachsen_id_5443825.html pädiatrische praxis 87, 483–496 (2017) Mediengruppe Oberfranken – Fachverlage GmbH & Co. KG

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nvm inside Prize Draw

Take part

Dear reader,

and win!

We are pleased to give you the opportunity once again to win a great prize! In this edition we are giving away a Philips â&#x20AC;&#x2DC;Wake-up Lightâ&#x20AC;&#x2122;. All you have to do is answer the following question:

ed in order e n in k s r u o s e o d What D? to produce vitamin mi bears m u g d n a te la o c o a) Ch ys b) Sun and UVB ra ess c) Cold and darkn Up for grabs is a Philips Wake-up Light LED! Wake up more easily and feeling recuperated Sunrise simulation for natural waking Two different alarm tones: birdsong and radio Touch screen for simple operation Four brightness display settings Also functions as bedside lamp Snooze function

Take part via: www.nal-vonminden.com/gewinnspiel.html or gewinnspiel@nal-vonminden.com Participation deadline is 15.05.2018

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Good luck!

Your Inside Diagnostics Team

nvm inside Prize Draw

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simply fill in the form & win!

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Signature Participation Conditions 1. The promoter of this competition is nal von minden GmbH. 2. To take part, fill in the form and fax it to +49 941 29010 50, or send it by post to nal von minden GmbH, Iris Schubert, Friedenstraße 32, 93053 Regensburg. It is also possible to take part via email. Send the correct answer along with your full address to gewinnspiel@nal-vonminden.com with the subject heading ‘Gewinnspiel‘, or simply fill in the online form on our website at www.nal-vonminden.com/de/ueber-uns/gewinnspiel.html. The winner is chosen in a prize draw. Those taking part must have an address in Germany, Switzerland or in Austria and be at least 18 years old at the time of participation. nal von minden employees or those involved in the conception or implementation of this competition are not permitted to take part. Only one entry per person is permitted. An illegal or repetitive attempt at participation in the competition will result in the competition closing. Participation is free and does not depend on the purchase of goods or services. By taking part in the competition, the participant agrees to these conditions. The competition closes on 15.05.2018. 3. The winner will be informed by writing and will receive their prize by post. 4. The promoter of this competition witholds the right to change the conditions of this competition within the promotion period, and to end or cancel at any time. This is especially the case in cases of force majeure or if the competition cannot continue to be carried out for organisational, technical or legal reasons. In such cases, the partcipants are not entitled to any claims against the promoter. Through participation, individuals can win a Philips Wake-up Light LED. The prize cannot be exchanged for cash or another prize. 5. The promoter of this competition takes no responsibility if the prize is lost or damaged during delivery. 6. Any liability for damages of nal von minden GmbH and their officers, employees and agents in connection with the competition, irrespective of the legal reason is, as far as legally permissible, limited to cases of intent or gross negligence. 7. This is not subject to legal recourse. 8. Should one or more of the above clauses be partially or fully invalidated, void or unfeasible, the remaining clauses are not invalidated. A corresponding clause will be applied instead. This also applies in the case of omissions. 9. The promoter’s decision in respect of all matters to do with the competition will be final and no correspondence will be entered into. Legal recourse is excluded. Data Protection 1. The promoter utilises data shared by those participating - (name, address), in as far as this is in accordance with German data protection law. The data collected will be used to conclude contracts between the two parties. The promoter additionally holds the right to send future issues of ‚Inside Diagnostics‘ to the email address provided, as long as the participant in question has consented to the legal requirements of the shipment. The receipt of future copies of the Inside Diagnostics magazine can be cancelled at any time at the end of each promotional email. In accordance with the Federal Data Protection Act, particpants and users have the right to information regarding their stored data and, where necessary, a right to report, block or delete this data. Participation in the promotion is then no longer possible.

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Infectious Diseases Just a cold or full-blown flu?

Just a cold or full-blown flu?

The season of colds and flu begins anew every year and comes for us all

… runny nose, scratchy throat, feeling run down – the sniffles, a cough, pain swallowing, aching head and limbs, fatigue, chills and a temperature or fever. But what is it that we are actually harbouring? Just a cold, or a full-blown case of the flu with all its potential complications? To begin with, the symptoms are similar, which is why many don’t realise that they have the flu and thus begin treatment too late. A cold is a respiratory infection caused mostly by viruses such as the adeno-, rhino- or RS (respiratory-syncytial) virus. It’s a pain, but the symptoms generally wear off without medication after a week or so - provided you get plenty of rest, sleep and peace and quiet.

To further help things along: •

Drink plenty, as the body loses more fluid than usual when you have a fever – as a rule of thumb: for every degree over 37°C, the body needs an additional half litre or litre of liquids every day – preferably water or unsweetened fruit tee.

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• •

Eat plenty of food rich in vitamins. Avoid cold and stress.

With a cold, the symptoms tend to appear one at a time, relatively scattered – some people are completely spared a fever and experience only a slightly raised temperature that wears off after a few days. Once the cold has subsided, the patient is soon back to normal. On average, adults will catch a cold 4 times per year whereas children are affected up to 8 times. A ’real‘ case of the flu (influenza), however, is a serious illness which can lead to the development of further conditions and can even be life-threatening if not properly treated. It is highly contagious and spreads in the style of an epidemic. The influenza virus resides in the oral mucosa and pharyngeal mucous membranes of the infected person. Whenever they cough or sneeze, droplets containing the virus are projected into the air, ready to be inhaled by others. Should the infected per-

www.shutterstock.com © Aleksandra Suzi www.istockphoto.com © DNY59

Infectious Diseases Just a cold or full-blown flu?

son also cover their mouth with their hand and subsequently shake hands with another person, the virus can be spread by direct contact.

The effects of the

symptoms on the body are intense. They usually occur fairly suddenly and without forewarning. The first signs are a stuffy nose, coughing and a sore throat, usually accompanied by outbreaks of sweating and shivering. Simultaneous to this is a headache and aching limbs, nausea, a loss of appetite as well as a persistently high fever (including over 40 degrees). The worst symptoms subside within a week – similar to with a cold, though the affected person will have to battle enduring fatigue and coughing for some time afterwards. If having the flu is taken too lightly and consequently not properly treated, the affected person stands the danger of a lung infection (pneumonia) or, in the worst case scenario, an infection of the heart muscles or brain which can often be lethal. Statistics (from the Robert-Koch-Institute) show that, in Germany alone, 5000-10,000 people die every year from complications related to the flu. Worldwide these statistics rise to 250,000 to 500,000 deaths.

Overall it can be said that a cold creeps up on you, though its course is fairly mild. Influenza, however, hits you like a tonne of bricks and can take a significant toll on the body. Through timely visits to the doctor, both illnesses can soon be shaken off and their more serious potential implications avoided.

Vaccinations – prevention is better than cure! An effective form of protection against infection is a flu vaccination. This is particularly recommended for at-risk groups such as pregnant women, small children, those over 60 and those with underlying conditions. The optimal time for vaccination is BEFORE the cold and flu season, which usually begins at the beginning of each year and can continue into spring. In 2016 the first flu-related deaths were reported as early as in January in Berlin and Saxony. The flu season had started earlier than usual, kicking off in mid-December 2015. Last winter (2016-2017) the flu season was also quite severe and arrived earlier than expected. According to the Robert-Koch-Institute, approximately 114,000 flu cases were diagnosed using laboratory diagnostic equipment, with about 30,000 severely-affected patients treated in hospital.

Vaccination is recommended in October or November, allowing maximum immunity to be reached after two weeks at most. Otherwise, stay fit and eat a diet rich in vitamins. You can read more about this in the next Inside Diagnostics report - ‘Vitamin and mineral supplements’. SOe

Depending on their medical history, and following a physical examination, the attending doctor can decide whether their patient is suffering from a cold or a case of the flu. If the illness continues to get worse, or if there is a possibility that its course could cause the patient to take a turn for the worse, it is highly important to establish which virus is present. If the cold is suspected, an influenza rapid test can first be carried out – just in case – to allow for the best approach to treatment. Such a test detects the presence of influenza viruses, and requires only a swab taken from the nose or throat to be deposited onto a test strip. If a coloured line develops in the results field, then an infection with influenza can no longer be ruled out – we are not looking at a simple cold, but rather a case of the flu.

https://influenza.rki.de/ https://www.internisten-im-netz.de/krankheiten

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Infectious Diseases Vitamin & mineral supplements

Vitamin and mineral supplements

Staying healthy during the winter months Winter = cold and flu season? Does it have to be this way, or can vitamin- and mineral supplements see our immune systems through these dark times? We are in the midst of the coldest, wettest time of year. It’s dark in the morning when we leave the house and already dark again by the time we get back. We are exposed to less fresh air, fewer daylight hours and too much warm, dry air from our radiators which weaken our immune systems and irritate our airways. Our immune system is constantly fending off viruses, bacteria and other disease pathogens and, as a result, we experience an increased cluster of illnesses during winter in comparison to summer. To find out more about the difference between a ‘real’ case of the flu (influenza) and the common cold, see our Inside Diagnostics article ‘Just a cold or full-blown flu?’ There have been innumerable discussions about whether vitamins help to protect against outbreaks of cold and flu and, if so, whether these should be consumed as part of our natural diet or as supplements/preparations. But which vitamins are the best, and how much of them should we take?

The role of vitamin C and zinc in reducing the risk of colds Vitamin C is by far the most well-known vitamin used against colds. It is activated when cold pathogens have already entered the body and it is therefore important that sufficient vitamin C levels are maintained: Vitamin C leads to the formation of leukocytes – our body’s so-called ‘health police’. In addition to this, free radicals are rendered harmless and body-cleaning antioxidants are activated.

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With regards to daily vitamin C intake, the German Nutrition Society (German: Deutschen Gesellschaft für Ernährung) recommends 100mg - of which 10mg is sufficient for staving off deficiencies. As our reserves dwindle during the winter time, it is important to quickly load up on a high dose of vitamin C at the onset of a cold. Typical winter fruits such as oranges, mandarins and dates all have particularly high vitamin C content. Even two glasses of freshly-pressed orange juice provide 100mg – enough to maintain a healthy immune system. Deficiency can set in if vitamin levels drop too low, leaving us more at risk of infections, tiredness and lethargy, weakened muscles, aching joints and bleeding gums. A prolonged deficiency can have more serious consequences, such as fevers, diarrhoea, muscular atrophy and aching bones. It is thus recommended to not only treat a deficiency when it occurs, but also to consume vitamin C as a preventative measure – even if this means falling back on supplements to our diet. As well as vitamin C, zinc has also proven itself in contributing to the prevention and treatment of colds. The trace element that’s known to many as an ingredient in antiseptic ointments has been shown to reduce the duration and severity of colds – provided that it is consumed within 24 hours of the onset of symptoms. Zinc is so helpful against colds because, as an antioxidant, it hinders the propagation of pathogens in the nasal mucous membrane, and relieves the inflammatory response in the nose by suppressing the release of histamines. As a result, the nasal mucous membranes are less swollen and it is easier to breathe. The German Nutrition Society (German: Deutschen Gesellschaft für Ernährung) recommends a daily intake of at least 7-10mg of zinc to meet normal levels. Foods rich in zinc include beef, whole-grain produce and legumes. If consumed as a supplement, zinc lozenges or effervescent

http://www.sport-fitness-gesundheit.de/gesundheit/erkaeltungszeit-das-immunsystem-mit-vitaminen-staerken.html https://www.woerwagpharma.de/de/gesundheitsthemen/gesundes-immunsystem/ so-unterstuetzen-vitamin-c-und-zink-bei-erkaeltung/ www.shutterstock.com © sanddebeautheil

www.istockphoto.com © onairjiw, einegraphic

Infectious Diseases Vitamin & mineral supplements

approximately 80% of north-Europeans suffer from a lack of vitamin D. For those suffering from a deficiency, however, it is possible to rectify it. This can be done either through the consumption of supplements or by visiting a solarium. However, as the latter poses dangers associated with artificial lighting, it is recommended to stick to dietary supplements.

Vitamins should be used in combination with getting enough sleep and avoiding stress tablets are recommended, as they are able to work directly on the mucous membranes and fight against the pathogens on the spot.

Vitamin D: The body’s sun reservoir Technically-speaking, vitamin D is not a vitamin, but rather a kind of hormone. Unlike most other vitamins, the human body is not necessarily dependent on the supply of vitamin D via consumption, but can also produce the vitamin itself through the skin. The only thing our skin needs is sufficient exposure to the sun and UVB rays. Should our vitamin D pool be sufficiently filled during the summer months, this is normally enough to see us through the winter. The lighter your skin colour, the more vitamin D you produce and therefore the less sunlight you need. However, the older and/or less healthy your skin, the more hindered your capability to produce vitamin D is. If production is diminished by the aforementioned factors or by reduced exposure to daylight – as occurs in winter – this can lead to a vitamin D deficiency.

Alongside the consumption of the vitamins mentioned above, others like vitamin A, E, B6 and minerals like selenium are important for strengthening the immune system. Vitamin A can be derived through animal products such as milk and eggs, but also from fruit and vegetables like apricots, spinach and kale. As antioxidants, they protect our skin and strengthen our body’s defences. Vitamin E can be found in plant oils and nuts, which is important for the protection of cell membranes. A deficiency in this area can mean the impaired function of immune cells. Good sources of vitamin B6 are, amongst others, bananas and fish, as well as wheat, rice and millet. Vitamin E helps with antibody production and in turn regulates the immune system. Like vitamin B6, selenium is found in large quantities in fish and cereal crops, but is also in meat. It works like antioxidants to protect the body from free radicals. In addition to the consumption of the above vitamins and minerals, maintaining a healthy lifestyle is important. Fresh/ freshly-prepared food as part of a predominantly vegetable-based diet – preferably lightly cooked or raw - is an important foundation of our body’s defences. Furthermore, we should ensure that we exercise enough, avoid stress and get sufficient sleep in order to fend off colds and flu. KBe

Vitamin D has a number of functions in the body, one of which is that it acts as a great immune-system booster. It also regulates cell growth and prevents the formation of malignant tumours and cancers, as well as protecting tissues from aging and skin from damage caused by UV-rays. In addition to this, it strengthens the bones, is a natural mood lifter, heightens concentration abilities and fights against the so-called ‘winter blues‘. These effects become much more noticeable with age, meaning that vitamin D can be of particular benefit to our brains the older we get. Just as its functions are numerous, so are the symptoms and consequences of a vitamin D deficiency – this meaning a level of under 20 ng/ml. From tiredness to susceptibility to infections, a deficiency can even lead to osteoporosis and heart-rhythm disorders. The condition is rather common –

http://www.fuersie.de/gesundheit/gesund/artikel/welche-vitamine-brauche-ich-im-winter http://www.vitamind.net/koerperspeicher/ http://www.fr.de/wissen/gesundheit/erkaeltung-grippe-diese-lebensmittel-staerken-die-abwehr-a-292005

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nvm inside Best of 2017

Best of

2017

... Inside Diagnostics article rapid Tests European Drug Report Nutrition Superfoods

Infectiology Urinary Tract Infection

Current developments on the European drug market

The european drug report 2017

SuperfoodS vS Bad'foodS ' When grocery shopping turns into a nightmare

A healthy lifestyle is becoming more and more important for many people. In our often hectic and stressful lives, more and more of us are now searching for ways to stay fit and healthy by looking after our body as well as our soul.

n addition to exercise and relaxation, a good diet is of utmost importance. While many contend with increasingly common food intolerances, trying to find food with suitable ingredients (something they must do out of necessity rather than the result of a lifestyle choice) others have voluntarily turned to so-called super foods. For them, health and wellbeing are also highly significant. The promises of super foods are comprehensive: quinoa, chia seeds and açaì berries not only keep you fit, but also radiant, intelligent, and beautiful. Of course, it is sensible to look after your lifestyle and watch your diet, but inevitably comes the question: How much is too much? Is the trend going too far? Have we become too concerned with which ingredients we put in our food and are we too easily won over by the promises of others?

‘Bad‘ food, ‘good‘ food and ‘super’ foods? Stomach aches, headaches, and feeling under the weather – those with intolerances of certain foods are bound to identify with these symptoms, some more strongly than others. It is also not easy to identify the actual culprit. In addition to lactose, gluten and fructose can also cause problems. The number of those who give up certain foods as a result of a (supposed) intolerance seems to be on the rise as much as the selection of foods sporting a ‘-free’ label (lactose-free, glutenfree etc), something more and more people are resorting to. Though this trend may be a source of ridicule for many, an actual intolerance can be very unpleasant, as well as potentially dangerous for those affected. An example of this is celiac disease, which is characterised by a serious intolerance to gluten. Its consumption leads to inflammation of the small intestine and the damaging of the mucosa there. This causes great discomfort to patients, who suffer from diarrhea, weight loss, abdominal pain and fatigue as well as wider conditions such as anaemia, osteoporosis and infertility. However, celiac disease only occurs in those with a genetic predisposition to

The continuing availability of new psychoactive substances (NPS), the continuing rise of drug-related deaths and the growing health risk associated with highly-potent synthetic opioids – these 3 topics are in the spotlight with the release of this year’s drug report from the EMCDDA (European Monitoring Centre for Drugs and Drug Addiction). The yearly report paints as precise a picture as possible regarding the current situation on the European drug market, as well as resulting political strategies. Data from the 28 member states, as well as Turkey and Norway, is examined and consolidated in a comprehensive result report. The number of drug-related deaths rises for the third year in a row.

t the forefront of the 2017 Drug Report is concern over the fact that the number of drug-related deaths has risen for the third year in a row. The sharp rise between 2014 (7950 deaths through overdose) and 2015 (8441 deaths through overdose) gives cause for concern. As in earlier years, heroin and other opioid overdoses are responsible for many deaths – this includes many opioids which are used as part of substitution treatment. This highlights the importance of good clinical practice in order to avoid the misuse of these substances. Various measures have already been implemented in an attempt to counteract the number of drug-related deaths in the last several years. This has included the provision of rooms in which addicts can be supervised whilst taking their substitution drug, as well as the provision of naloxone – a substance that counteracts the effects of an overdose and which can be taken home by addicts, their family or those close to them.

how many of these drugs have been newly discovered over the course of the year. This number stood at 66 in 2015, compared with the 98 new drugs that found their way onto the market in 2015. Several aspects could be responsible for this drop in numbers, such as changes to NPS legislation amongst several member states which make it much harder for the drugs to be manufactured. A further reason for the decline could lie in stricter laboratory controls in China. The EMCDDA director Alex Goosdeel has emphasised that, despite these positive developments, the ‘all clear’ can by no means yet be given. As the NPS market shifts increasingly onto the internet and the black market, larger numbers of highly-potent substances are appearing and playing a part in both deaths and acute poisoning.

Other Substances opioids Benzodiazepines Arylcyclohexylamines

Oh no!

Nature calling again?

Number and categories of new psychoactive substances notified to the EU Early Warning System for the first time, 2005-16 Synth. cannabinoids cathinones Phenethylamines

Urinary tract infections (UTIs) are a nightmare for many women, who in our society are 8 times more likely to be affected than men. Approximately 50-60% of women will experience a urinary tract infection at least once in their lifetime. The so-called bladder infection (cystitis) predominantly affects females for the simple reason that the anus is closer to the urethral opening in women than in men. Women also have a shorter urethra, making it is easier for germs (bacteria, and more rarely viruses, parasites or fungi) to reach the bladder and cause cystitis. The most common culprit for this is the bacteria known as Escherichia coli, which occurs naturally in the gut.

New psychoactive substances – still a serious problem Though new psychoactive substances are no longer flooding the drug market in such high numbers and speed as they did before, the danger they pose is still a grave problem, especially due to their widespread availability. Information on updates regarding new psychoactive substances is published through the EU Early-Warning System. Here it is established

round 10% of all patients develop a chronic, ongoing infection. This means the infection crops up at least twice every six months, or more than 3 times per year. Such infections are known as recurrent cystitis, but do not mean that the infection is there to stay – though it will reoccur after

several months if a previous infection has not cleared up or was left untreated.

Which symptoms are characteristic of a bladder infection? •

A burning sensation during urination, as well as the feeling of needing to push against resistance.

•

Feeling the continuous urge to urinate, though only producing small amounts of urine (so-called pollakisuria) with each visit to the toilet.

•

Pain in the lower abdominal area, caused by spasmodic contracting of the bladder during urination.

The following can increase the risk of a UTI: •

Urinary- or prostate infection in a sexual partner

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Antidepressants Benzodiazepine Sports medicine Performance Diagnostics

depression Symptoms, diagnosis & treatment

Antidepressants The (un)calming effects of benzodiazepine Nowadays, the medical treatment of depression and sleep disorders is common practice. In Germany, the number of those being treated for these conditions exceeds one million, many of whom are being prescribed benzodiazepines for conditions such as sleep deprivation, anxiety disorders or psychological issues. As a result of their calming and anxiolytic effects, they are commonly referred to as 'tranquilisers‘ and, due to this effect, are even used in clinical settings prior to surgical procedures for those with epilepsy, tetanus, febrile seizures, and other conditions that cause muscles to be put under increased stress.

Sedatives can also become addictive and lead to dependency. If taken regularly for several weeks, withdrawal symptoms will begin to show themselves in the form of sweating, panic attacks and sleep disturbance. Often these symptoms, which prompted the prescribing of benzodiazepine, in fact reemerge with more intensity as side effects of its consumption. Medications containing lorazepam are particularly responsible for significant side effects. In depressive patients, it can also induce suicidal thoughts, as well as difficulties in perception. Research is currently underway in order to ascertain whether long-term use can also lead to a higher risk of dementia.

What is happening in the brain following consumption?

A Sports medicine Performance diagnostics as a basis for successful training in the modern day

How good am I? How should I train in order to get better? Am I healthy? A performance diagnosis can shed light on such questions! They can also be used to give training advice, record progress and identify or exclude medical risks. Whereas some years ago only high performance athletes trained several times per week, this is a trend that has also developed amongst those who do sport in their free time or as a hobby. They generally have less time to dedicate to training, but since goals are being constantly raised, it’s no wonder that modern performance diagnostics has long since found its way into the realm of leisure. In a time when no cost or effort

Heroin Cocaine Tobacco

The various side effects of benzodiazepines

is spared when aiming for self-imposed goals, performance diagnostics can help to identify and prevent the wrong kind of training and instead encourage people to take a healthier and more efficient approach.1 Determining current fitness levels A performance diagnosis comprises an examination and test procedure, which provide information on the individual’s current state of health, resilience and performance. Based on these results, it is possible to establish a personal training plan suited to each individual. As a result, their personal sporting goals will be much easier to reach. The principal and most well-known methods of performance diagnoses are lactate testing, heart rate monitoring and ergospirometry.

Aside from its calming capabilities, the consumption of benzodiazepines also carries high risks and can lead to numerous unwanted side effects. Older patients in particular should discuss with their doctors the fact that the breakdown of such medication in old age takes longer than in young people. There are also a number of complications that may occur. Many long-term patients also complain about the so-called ‘emotional anesthesia‘ caused by the use of benzodiazepines. Through their direct effect on the nervous system, they do not only inhibit sensitivity to fear and anxiety, but also positive emotions such as joy. This ‘dulling‘ frequently has social consequences not only for the patient, but also their partners, families and friends. With such side effects, it can be difficult for people to maintain social relationships.

Methadone

2 Addiction

igher, faster, further: these days it’s not only the professionals training. Many of those making a hobby of sport no longer wish to rely solely on hard work. With the aim of raising the bar of their own performance, runners use smart phone apps, electronic diaries and heart rate monitors to document every kilometer run and then compare their performance with others on various social networks.3

Potential damage of various drugs and medication

s a result of benzodiazepine’s direct effects on the central nervous system, the brain‘s stimuli are suppressed. The neurotransmitter 'Gamma-Amino-Butyric acid (GABA)‘ suppresses chemicals such as serotonin, noradrenaline and acetylcholine, which in turn has an effect on memory, concentration, emotions and motor skills.

Benzodiazepine Buprenophine Amphetamine Cannabis

Barbiturate

Alcohol

GHB Khat

LSD Ecstasy

Poppers

Ketamine 4-MTA Methylphenidate Inhalants

Anabolic Substances

Treating depression

Physical Damage

The potential for physical damage is here laid out against the potential for psychological dependency, and reflects each substance’s individual damage potential. The circle diameters represent the average potential for social damage with regard to economic costs for the community, criminal acts and family conflicts.

Heart rate measurement was the first milestone in the success story of performance diagnostics in the context of leisure. The mobile measurement of heart rates through wrist monitors and chest straps revolutionised this area. Whereas, several years ago, manual measurement and stop watches were the methods of choice, it is now possible to identify pre-

Depression is a very common and also relatively treatable illness. Treatment depends on the type and severity of the depression. In many cases, for example, mild depression can be treated with ambulant psychotherapy. In cases of moderate depression, a mix of treatments, medicines, and psychotherapy are commonly used. This can also be the case with severe depression, though treatment is often undertaken on an in-patient basis in a psychiatric ward. Staying in a clinic allows for more comprehensive care for the patient by doctors, and offers the possibility for targeted adjustments to medication. In addition, it offers the patient a proper structure to their day.

As well as the aforementioned forms of treatment, there are a diverse number of further approaches to treatment, which are used for certain forms of depression or in severe cases. These include, amongst others, methods such as sleep deprivation (for in-patients) or light therapy, which can be used as a supplement to psychotherapy or medication – particularly in the cases of winter depression. Please be aware that this article is merely an overview of depression, its diagnosis and treatment. Under no circumstances should self-diagnosis suffice or replace a visit to the doctor. iS

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http://www.dhs.de/suchtstoffe-verhalten/medikamente/benzodiazepine.html https://de.wikipedia.org/wiki/Schädlicher_Gebrauch_von_Benzodiazepinen http://www.spiegel.de/gesundheit/diagnose/valium-und-co-die-gefaehrlichen-nebenwirkungen-von-benzodiazepinen-a-883500.html http://www.apotheken-umschau.de/Depression http://www.netdoktor.de/krankheiten/depression/ https://www.therapie.de/psyche/info/index/diagnose/depression/

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nvm inside Best of 2017

â&#x20AC;&#x2030;...

... Inside Diagnostics editorial team ent m t i omm ditorial c l l Fu the e rfect e p m fro or the f ! team photo

es Sometim g up uchin a little to d! ;-) e is requir

A great big THANK YOU to the whole Inside Diagnostics team as well as to our readers, and hereâ&#x20AC;&#x2DC;s to many more issues! The b est made ideas are on stoma a full ch. :-)

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