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Introduction: Clinicians managing patients with acute recreational drug or new psychoactive substance toxicity typically depend on self-reported drug(s) used. This study compares patient self-report (and/or from other sources) to the substance(s) that were subsequently identified in serum. Methods: A prospective sample of 1,000 adults presenting to a tertiary care, urban emergency department in London, United Kingdom, with acute recreational drug/new psychoactive substance toxicity was collected from 1 February 2019 to 2 February 2020. A total of 939 appropriate samples underwent qualitative analysis by high-resolution mass spectrometry with comparison to a database of drugs/metabolites. Data on the stated drug(s) used were extracted from the routine medical chart/records; results were batched by drug class, when appropriate, and analysis was performed using R software. Results: Seven hundred and ninety-nine (85.1%) patients were male with a median (IQR) age of 34 years (27 to 42 years). Six hundred and thirty-five (67.6%) patients reported using two or more drugs. The median (IQR) positive predictive value of a self-report substance having been taken was 0.68 (IQR: 0.44–0.86); conversely, the median negative predictive value of a substance having not been taken was 0.90 (IQR: 0.53–0.95). There was variability in the accuracy of reporting. For example, self-reported opioid use had a 90.5% likelihood that opioids were detected on analysis, whereas hallucinogens were only detected in 18.8% of samples when use was reported. Individuals were also mostly accurate in not underreporting substances. For example, those not explicitly reporting gamma-hydroxybutyrate use were 97.5% truly negative. Discussion: Overall, most users were relatively accurate in their self-report of what class of drugs they had used, although there was variability in this accuracy. However, other drugs were present even when not reported, for example, opioids with disproportionate detection of prescription and over-the-counter (non-prescription) opioids that were unreported. Conclusions: Self-report (and/or collateral reports) had overall relatively high concordance with the likelihood that a substance was, or was not, recently used. Therefore, clinicians can make initial treatment decisions based on the self-reported drug(s) used in most cases. [ABSTRACT FROM AUTHOR]

Abstract Background Recreational drug use has been identified as a significant risk factor for the transmission of human immunodeficiency virus (HIV). This behavior is particularly prevalent among young men who have sex with men (YMSM). However, limited research has been conducted to investigate the correlation between recreational drug use and HIV incidence within this population. Objective To examine HIV incidence and explore the association between recreational drug use and HIV incidence among YMSM. Methods A retrospective cohort study was conducted by a local non-governmental organization (NGO) among MSM aged 18–24 years from October 2017 to December 2023 in Tianjin, China. Participants were included if they had at least two HIV test records during this period. HIV incidence density and its 95% confidence interval (CI) were calculated using person-years (PYs) with a Poisson distribution. Risk factors for HIV incidence were identified using univariable and multivariable Cox proportional hazards regression models. Results A total of 56 HIV seroconversions were reported with 2901.9 PYs, resulting in an overall incidence density of 1.9/100 PYs (95% CI: 1.4–2.4). Among YMSM who do not use recreational drugs (YMSM-URD), the incidence density was 1.1/100 PYs (95% CI: 0.5–1.6), while it was 2.8/100 PYs (95% CI: 1.9–3.7) among those who do use recreational drugs (YMSM-RD). Adjusted for confounders, factors associated with HIV infection included recreational drug use (adjusted hazard ratio = 2.6, 95% CI = 1.4–4.7) and unprotected anal intercourse in the past six months (adjusted hazard ratio = 2.3, 95% CI = 1.2–4.4). Conclusions Recreational drug use and unprotected anal intercourse significantly increase the risk of HIV infection. To effectively mitigate the spread of HIV, interventions should focus on these risk factors by employing HIV counseling and testing clinics, collaborating with NGOs focused on MSM, and establishing peer education programs aimed at YMSM.

Ketamine is one of the most commonly abused drugs globally, posing a severe risk to social stability and human health, not only it is being used for recreational purposes, but this tasteless, odourless, and colourless drug also facilitates sexual assaults when it is mixed with drinks. Ketamine abuse is a threat for safety, and this misuse is one of the main uses of the drug. The crucial role of ketamine detection is evident in its contributions to forensic investigations, law enforcement, drug control, workplace integrity, and public health. Electrochemical sensors have gained considerable interest among researchers due to their various advantages, such as low cost and specificity, and particularly screen-printed paper-based electrode (SPBE) biosensors have gained attention. Here, we reported an ePAD (electrochemical paper-based analytical device) for detecting the recreational drug ketamine. The advantages of using a paper-based electrode are that it reduces the electrode's production costs and is disposable and environmentally friendly. At the same time, nanographite sheets (NGSs) assisted in amplifying the signals generated in the cyclic voltammetry system when ketamine was present. This ePAD was developed by immobilizing a ketamine aptamer on NGS electrodes. The characterization of proper synthesized NGSs was performed by Scanning Electron Microscopy (SEM), XRD (X-ray Diffraction), Fourier-transform infrared spectroscopy (FTIR), and UV-Vis spectroscopy. Electrochemical techniques, including cyclic voltammetry (CV) and linear sweep voltammetry (LSV), were employed to validate the results and confirm each attachment. Furthermore, the versatility of the proposed sensor was explored in both alcoholic and non-alcoholic beverages. The developed sensor showed a low LOD of about 0.01 μg/mL, and the linear range was between 0.01 and 5 μg/mL. This approach offers a valid diagnostic technique for onsite service with minimal resources. This cost effective and portable platform offers desirable characteristics like sensitivity and selectivity and can also be used for POC (point of care) testing to help in the quick identification of suspicious samples and for testing at trafficking sites, amusement parks, and by the side of the road. [ABSTRACT FROM AUTHOR]

Nitrous oxide, commonly known as ‘laughing gas’, has become a popular recreational drug. Whippets, small canisters containing gas in pressurized form, can be easily obtained from a food store. However, inhaling nitrous oxide from these canisters, which contain a 100% concentration, can lead to hypoxia, resulting in seizures or even death. Inhalation of nitrous oxide rarely causes pneumothorax, pneumomediastinum, and pneumopericardium.This case study highlights the potential dangers of recreational abuse of nitrous oxide.

Background: Understanding the risk behaviors associated with sexually-transmitted hepatitis C virus (HCV) infection among men who have sex with men (MSM) may inform the public health policies and interventions aiming to achieve HCV microelimination. Methods: HIV-positive MSM who had one of the following conditions were enrolled to undergo face-to-face questionnaire interviews to collect information on their sexual practices in the past 12 months: (1) elevation of aminotransferases in the past 6 months; (2) acquisition of sexually transmitted infections in the past 6 months; and (3) previous HCV infections. Plasma HCV RNA were tested at enrolment and every 3 months during follow-up. Baseline characteristics and risky behaviors were compared to identify factors associated with HCV viremia between HCV-viremic MSM and HCV-aviremic MSM in multivariate analysis. Results: Among 781 MSM with a median age of 36 years, 57 (7.3%) had HCV viremia and 724 (92.7%) no HCV viremia during follow-up. A high proportion (38.9%) of the participants reported having used recreational drugs in the past 12 months, with 34.4% of them having slamming, but only 4.8% reported having shared their injection equipment. In multivariate analysis, use of recreational drugs (adjusted odds ratio [aOR], 2.14; 95% CI, 1.16–3.96), having participated in group sex (aOR, 2.35; 95% CI 1.24–4.40) and having had condomless receptive anal intercourse (aOR, 1.97; 95% CI 1.07–3.62) were significantly associated with HCV viremia. Conclusion: Among high-risk HIV-positive MSM, use of recreational drugs and risky sexual contacts were associated with HCV viremia, suggesting the mucosal contacts as the major route of HCV transmission.

Restriction of gamma-hydroxybutyrate (GHB) in 1990 resulted in a shift toward the use of gamma-butyrolactone (GBL) or 1,4-butanediol (1,4-BD), which remain unregulated in most countries, including Taiwan. Self-reported GBL and 1,4-BD use are less common than GHB use, and the prevalence of GBL or 1,4-BD abuse may be underestimated. The first patient, a 45-year-old male, used GBL to enhance his sexual activity. He developed respiratory system and central nervous system (CNS) suppression; he was intubated and admitted to the intensive care unit. His urine GHB concentration was 289.5 mg/L. The second patient was a 24-year-old male who used 1,4-BD in conjunction with mixed new psychoactive substances to enhance his sexual activity. He also developed CNS suppression, and his urine GHB concentration was 1192.4 mg/L. By reporting these cases, we highlight the recreational use of GHB precursors, such as GBL and 1,4-BD, which is relatively unfamiliar to clinicians. Patients may present with CNS and respiratory depression after the voluntary recreational use of these drugs.

We present the development of an electrochemical paper-based analytical device (ePAD) for the detection of methamphetamine. Methamphetamine is a stimulant that young people use as an addictive narcotic, and it must be detected quickly since it may be hazardous. The suggested ePAD has the advantages of being simple, affordable, and recyclable. This ePAD was developed by immobilizing a methamphetamine-binding aptamer onto Ag-ZnO nanocomposite electrodes. The Ag-ZnO nanocomposites were synthesized via a chemical method and were further characterized via scanning electron microscopy, Fourier transform infrared spectroscopy, and UV-vis spectrometry in terms of their size, shape, and colloidal activity. The developed sensor showed a limit of detection of about 0.1 μg/mL, with an optimum response time of about 25 s, and its extensive linear range was between 0.01 and 6 μg/mL. The application of the sensor was recognized by spiking different beverages with methamphetamine. The developed sensor has a shelf life of about 30 days. This cost-effective and portable platform might prove to be highly successful in forensic diagnostic applications and will benefit those who cannot afford expensive medical tests. [ABSTRACT FROM AUTHOR]

Ketamine is one of the most commonly abused drugs globally, posing a severe risk to social stability and human health, not only it is being used for recreational purposes, but this tasteless, odourless, and colourless drug also facilitates sexual assaults when it is mixed with drinks. Ketamine abuse is a threat for safety, and this misuse is one of the main uses of the drug. The crucial role of ketamine detection is evident in its contributions to forensic investigations, law enforcement, drug control, workplace integrity, and public health. Electrochemical sensors have gained considerable interest among researchers due to their various advantages, such as low cost and specificity, and particularly screen-printed paper-based electrode (SPBE) biosensors have gained attention. Here, we reported an ePAD (electrochemical paper-based analytical device) for detecting the recreational drug ketamine. The advantages of using a paper-based electrode are that it reduces the electrode’s production costs and is disposable and environmentally friendly. At the same time, nanographite sheets (NGSs) assisted in amplifying the signals generated in the cyclic voltammetry system when ketamine was present. This ePAD was developed by immobilizing a ketamine aptamer on NGS electrodes. The characterization of proper synthesized NGSs was performed by Scanning Electron Microscopy (SEM), XRD (X-ray Diffraction), Fourier-transform infrared spectroscopy (FTIR), and UV-Vis spectroscopy. Electrochemical techniques, including cyclic voltammetry (CV) and linear sweep voltammetry (LSV), were employed to validate the results and confirm each attachment. Furthermore, the versatility of the proposed sensor was explored in both alcoholic and non-alcoholic beverages. The developed sensor showed a low LOD of about 0.01 μg/mL, and the linear range was between 0.01 and 5 μg/mL. This approach offers a valid diagnostic technique for onsite service with minimal resources. This cost effective and portable platform offers desirable characteristics like sensitivity and selectivity and can also be used for POC (point of care) testing to help in the quick identification of suspicious samples and for testing at trafficking sites, amusement parks, and by the side of the road.

To the Editor, In 1998 Sildenafil was approved by the Food and Drug Administration as first line therapy for erectile dysfunction. Since then, phosphodiesterase type 5 inhibitors (PDE5i) represent the first-line treatment of erectile dysfunction (ED), improving physiological erectile function, sexual orgasmic function, psychological self-esteem, couples’ relationship, and quality of life. [...]

Nitrous oxide, commonly known as 'laughing gas', has become a popular recreational drug. Whippets, small canisters containing gas in pressurized form, can be easily obtained from a food store. However, inhaling nitrous oxide from these canisters, which contain a 100% concentration, can lead to hypoxia, resulting in seizures or even death. Inhalation of nitrous oxide rarely causes pneumothorax, pneumomediastinum, and pneumopericardium. This case study highlights the potential dangers of recreational abuse of nitrous oxide. [ABSTRACT FROM AUTHOR]

Background: It is unclear about the impact of recreational drug use on the adherence, drug–drug interaction and the occurrence of sexual transmitted diseases (STDs) among people living with HIV. Material and methods: A retrospective study was conducted between Dec 2016, and July 2018 to assess the clinical impact of recreational drug consumption in people living with HIV with antiretroviral therapy. We collected data of the demographics, recreational drug use, laboratory results and STDs diagnoses. Potential drug–drug interactions were checked with reference databases. The association between recreational drug use and STDs, HIV viral load suppression and drug interactions were evaluated. Results: A total of 462 participants were enrolled, included 384 recreational drug users and 78 non-recreational drug users. Younger age (adjusted odds ratio [aOR], 0.94; 95% CI: 0.91–0.98; p = 0.001), longer HIV infection period (aOR, 1.11; 95% CI: 1.03–1.20; p = 0.009) and poor antiretroviral drug adherence (1–2 pills missing per month: aOR, 6.82; 95% CI: 3.50–13.27; p 2 pills missing per month: aOR, 3.50; 95% CI: 1.28–9.61; p = 0.015) were factors associated with recreational drug use. Methamphetamine and nitrites were two most common recreational drugs. Recreational drug use was significantly associated with STDs in one-year follow-up period (aOR, 2.43; 95% CI: 1.11–5.32; p = 0.027) but was not significantly associated with unsuppressed viral load, though a trend was observed (OR, 2.23; 95% CI: 0.92–5.37; p = 0.074). Potential interactions with recreational drugs included 33.1% antiretroviral drugs and 31.3% medications for comorbidities. Conclusion: Recreational drug was associated with STDs. A great proportion of the patients consuming recreational drugs had potential interactions with antiretroviral drugs and medications for comorbidities. The association of recreational drug use and unsuppressed viral load warrants further investigation.

We present the development of an electrochemical paper-based analytical device (ePAD) for the detection of methamphetamine. Methamphetamine is a stimulant that young people use as an addictive narcotic, and it must be detected quickly since it may be hazardous. The suggested ePAD has the advantages of being simple, affordable, and recyclable. This ePAD was developed by immobilizing a methamphetamine-binding aptamer onto Ag-ZnO nanocomposite electrodes. The Ag-ZnO nanocomposites were synthesized via a chemical method and were further characterized via scanning electron microscopy, Fourier transform infrared spectroscopy, and UV-vis spectrometry in terms of their size, shape, and colloidal activity. The developed sensor showed a limit of detection of about 0.1 μg/mL, with an optimum response time of about 25 s, and its extensive linear range was between 0.01 and 6 μg/mL. The application of the sensor was recognized by spiking different beverages with methamphetamine. The developed sensor has a shelf life of about 30 days. This cost-effective and portable platform might prove to be highly successful in forensic diagnostic applications and will benefit those who cannot afford expensive medical tests.

Alpha-pyrrolidinovalerophenone (α-PVP) is a designer drug, the mechanism of action of which resembles that of cocaine and amphetamine. New data about the side effects of α-PVP are emerging. We present a case report of an acute ischemic stroke following the recreational use of α-PVP. The ischemic lesions were located in the middle cerebral artery and deep watershed areas of the left cerebral hemisphere. Occupational therapy and physiotherapy were initiated, and the patient was discharged with only a mild right hemiparesis.

Introduction: Chemsex in a European context is the use of any of the following drugs to facilitate sex: crystal methamphetamine, mephedrone and gamma‐hydroxybutyrate (GHB)/gamma‐butyrolactone (GBL) and, to a lesser extent, cocaine and ketamine. This study describes the prevalence of self‐reported recreational drug use and chemsex in HIV‐positive men who have sex with men (MSM) accessing HIV services in four countries. It also examines the problematic impacts and harms of chemsex and access to chemsex‐related services. Methods: This is a cross‐sectional multi‐centre questionnaire study of HIV‐positive MSM accessing nine HIV services in the UK, Spain, Greece and Italy. Results: In all, 1589 HIV‐positive MSM attending HIV services in four countries completed the questionnaire. The median age of participants was 38 years (interquartile range: 32–46 years) and 1525 (96.0%) were taking antiretroviral therapy (ART). In the previous 12 months, 709 (44.6%) had used recreational drugs, 382 (24.0%) reported chemsex and 104 (6.5%) reported injection of chemsex‐associated drugs ('slamsex'). Of the 382 engaging in chemsex, 155 (40.6%) reported unwanted side effects as a result of chemsex and 81 (21.2%) as a result of withdrawal from chemsex. The reported negative impacts from chemsex were on work (25.1%, 96), friends/family (24.3%, 93) and relationships (28.3%, 108). Fifty‐seven (14.9%) accessed chemsex‐related services in the past year, 38 of whom (67%) felt the service met their needs. Discussion: A quarter of participants self‐reported chemsex in the past 12 months. There were high rates of harms from chemsex across all countries, including negative impacts on work, friends/family and relationships. Although a minority of those engaging in chemsex accessed support, most found this useful. [ABSTRACT FROM AUTHOR]

Abstract Background HIV-infected men who have sex with men (MSM) who use recreational drugs (RD) or excessive alcohol (EA) may be involved in risky sexual behaviours, including unprotected anal intercourse (UAI). This study describes the prevalence RD/EA-use among HIV-infected MSM, and compares those who used RD/EA with those who did not. Methods This cross-sectional study included HIV-infected MSM who were recruited in a convenient sample from two AIDS-treatment centres and events for HIV-infected MSM in Israel in 2016. Participants completed anonymous questionnaires including RD/EA-use and their sexual behaviours. RD/EA-use was defined as consumption of any psychoactive stimulants or dissociative anaesthetics, or an uptake of alcohol until drunkenness before or during sex. Results Of all 276 HIV-infected MSM, 202 (73.2%) used RD/EA. Those who used RD/EA were younger, reported earlier sexual debut, had more sexual partners, were more likely to perform UAI with casual partners, more commonly involved in paid sex, used psychiatric medications and more likely to be unsatisfied with their health-status compared to those who did not use RD/EA. HIV-infected MSM who used RD/EA reported a lower CD4-count and higher viral-load than those who did not. In a multivariate analysis, being younger, reported earlier sexual debut and been prescribed psychiatric drugs were associated with RD/EA-use among HIV-infected MSM. Conclusions A large proportion of HIV-infected MSM used RD/EA and also engaged in risky sexual behaviours. A subset of HIV-infected MSM can benefit from mental support during their routine treatment at the AIDS treatment centres and should also receive harm reduction intervention by their providers in order to minimize potential risks pertaining to RD/EA-use.

Alpha-pyrrolidinovalerophenone (α-PVP) is a designer drug, the mechanism of action of which resembles that of cocaine and amphetamine. New data about the side effects of α-PVP are emerging. We present a case report of an acute ischemic stroke following the recreational use of α-PVP. The ischemic lesions were located in the middle cerebral artery and deep watershed areas of the left cerebral hemisphere. Occupational therapy and physiotherapy were initiated, and the patient was discharged with only a mild right hemiparesis. [ABSTRACT FROM AUTHOR]

Background: HIV-infected men who have sex with men (MSM) who use recreational drugs (RD) or excessive alcohol (EA) may be involved in risky sexual behaviours, including unprotected anal intercourse (UAI). This study describes the prevalence RD/EA-use among HIV-infected MSM, and compares those who used RD/EA with those who did not.Methods: This cross-sectional study included HIV-infected MSM who were recruited in a convenient sample from two AIDS-treatment centres and events for HIV-infected MSM in Israel in 2016. Participants completed anonymous questionnaires including RD/EA-use and their sexual behaviours. RD/EA-use was defined as consumption of any psychoactive stimulants or dissociative anaesthetics, or an uptake of alcohol until drunkenness before or during sex.Results: Of all 276 HIV-infected MSM, 202 (73.2%) used RD/EA. Those who used RD/EA were younger, reported earlier sexual debut, had more sexual partners, were more likely to perform UAI with casual partners, more commonly involved in paid sex, used psychiatric medications and more likely to be unsatisfied with their health-status compared to those who did not use RD/EA. HIV-infected MSM who used RD/EA reported a lower CD4-count and higher viral-load than those who did not. In a multivariate analysis, being younger, reported earlier sexual debut and been prescribed psychiatric drugs were associated with RD/EA-use among HIV-infected MSM.Conclusions: A large proportion of HIV-infected MSM used RD/EA and also engaged in risky sexual behaviours. A subset of HIV-infected MSM can benefit from mental support during their routine treatment at the AIDS treatment centres and should also receive harm reduction intervention by their providers in order to minimize potential risks pertaining to RD/EA-use. [ABSTRACT FROM AUTHOR]

Although recreational drug use is associated with risky sexual behaviors and HIV infection among men who have sex with men (MSM), it is unclear to what extent these behaviors and outcomes differ between single-drug users and polydrug users in China. This is a cross-sectional study conducted from July to September 2016 among MSM in three cities of Sichuan Province, China. Multinomial logistic regression was performed to examine factors correlated with single-drug and polydrug use. A total of 1,122 participants were included in the study. Overall, 28% of MSM have ever used recreational drugs, of whom 64.0% were single-drug users, and 36.0% were polydrug users. Factors associated with both single-drug and polydrug use included: receptive sexual role (single-drug use: AOR = 1.79, 95% CI: 1.05–3.07; polydrug use: AOR = 6.00, 95% CI: 2.54–14.17), engaging in group sex (AOR = 2.23, 95% CI: 1.28–3.87; AOR = 4.68, 95% CI: 2.41–9.08), frequent alcohol use (AOR = 3.11, 95% CI: 1.75–5.52; AOR = 6.41, 95% CI: 2.50–16.47), seeking partners mainly by Internet (AOR = 4.87, 95% CI: 3.31–7.17; AOR = 4.58, 95% CI: 2.58–8.14), history of STIs (AOR = 1.86, 95% CI: 1.08–3.21; AOR = 3.32, 95% CI: 1.77–6.26) and HIV infection (AOR = 1.76, 95% CI: 1.02–3.02; AOR = 3.19, 95% CI: 1.62–6.26). Our findings suggest the urgent need for HIV and STIs prevention programs among MSM in China to integrate strategies that mitigate recreational drug use. [ABSTRACT FROM AUTHOR]

• Seizures occurred in 4% of recreational drug presentations to emergency departments. • Fentanyl, synthetic cannabinoids, and MDMA associated with increased seizures. • Seizures after recreational drug use associated with worse clinical outcomes. Seizures are a recognized and potentially serious complication of recreational drug use. This study examined a large international data set of presentations to Emergency Departments with acute recreational drug toxicity, the European Drug Emergencies Plus (Euro-DEN Plus) Network, to compare presentations with and without seizures and estimate incidence and associated drugs. Amongst 23,947 presentations between January 2014 and December 2017, there were 1013 (4.2%) with reported seizures. Clinical and demographic features were similar between individuals who had a seizure and those who did not, although rates of coma, cardiac arrest, intubation, intensive care admission, and death were significantly higher in those with seizures. There was a significant association between specific drugs and a higher seizure incidence, including fentanyl (odds ratio 2.63, 95% confidence interval 1.20–5.80), and synthetic cannabinoids (OR 2.90, 95% CI 2.19–3.84). Other drugs were associated with a lower seizure incidence, including heroin (OR 0.46, 95% CI 0.35–0.61), clonazepam (OR 0.22, 95% CI 0.06–0.91), and cannabis (OR 0.65, 95% CI 0.50–0.86). This substantiates observations that the synthetic cannabinoids as a group of novel psychoactive substances are clinically different in consequence of intoxication than cannabis, and that individuals who suffer a seizure in the context of recreational drug intoxication are likely to have worse outcomes overall. Utilising this information of what substances have a greater risk of seizures, could provide tailored harm reduction and education strategies to users to reduce the risk of seizures and their associated complications. [ABSTRACT FROM AUTHOR]

This paper reports an electrochemical paper analytical device (EPAD) for detection of recreational drug; methylenedioxymethamphetamine (MDMA). MDMA is used as an addictive narcotic by youth and there is an urgent need to detect this drug as it is a potential neurotoxic agent. The proposed EPAD represents many advantageous features of being simple, low-cost, consistent and disposable. The working electrode of the EPAD features zinc oxide nanorods (ZnONRs). The morphological, optical, elemental composition and phase analysis of the synthesized ZnONRs has been characterized by field emission scanning electron microscopy (FESEM), UV-Vis spectroscopy, energy dispersive X-ray spectroscopy (EDAX), photo-luminescence (PL) and X-ray diffraction (XRD). The developed sensor showed optimum response at 7.0 pH and wide linear range of 1 µM-1 mM with a low detection limit of 0.1 µM for MDMA. Evaluation of the sensor also revealed best results in terms of analytical recovery (95%) and accuracy (95%). The designed EPAD could prove to be very effective in case of forensic diagnostic applications. This work provides a reliable diagnostic method for remote areas with limited resources, and will also help people who cannot afford expensive medical tests and have limited access to power and trained personnel. [ABSTRACT FROM AUTHOR]