Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

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I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 448 - 451

An assessment of falsely convicted type 1 diabetics in Jamaica by using the breathalyzer test

TAZHMOYE V., CRAWFORD DONOVAN, A. McGROWDER, JOAN M. RAWLINS

Independent Health Policy Consultant, Christiana P.O., Manchester, Jamaica, Department of Pathology, Faculty of Medical Sciences, Mona Campus, Kingston, Jamaica Department of Paraclinical Sciences, St. Augustine, Trinidad and Tobago.

Correspondence Address :
Tazhmoye V. Crawford
Email: crawfordtazhmoye@yahoo.co.uk.
Tel: (876).362.3628

Abstract

Objective: The close similarity between the symptoms of alcohol intoxication and low blood glucose levels makes it difficult for breathalyzers to make the distinction between a diabetic and an individual who is driving under the influence (DUI) of alcohol or driving while intoxicated (DWI). In Jamaica, it is illegal if a person’s blood alcohol concentration (BAC) is ≥ 35 microgram per 100 milliliter of breath on the breathalyzer and the intoxilyzer devices. The aim of the present study was to examine the extent to which the breathalyzer test provided false blood alcohol measurements in persons with type 1 diabetes mellitus. Design: The purposive and snowball sampling methods were used to collect information from motorists who were accused and charged by the police for DUI/DWI. Data was collected during the period from 2007-2009, from respondents at the St. Andrew Traffic Court, at their work stations and other convenient locations. The data were stored and analyzed by using SPSS version 17.0.

Results: Of the 53 respondents, 73.6% were of type 1 diabetes mellitus status and 53.8% were those who were suspected by the police to be DUI/DWI and hence, the breathalyzer test resulted in 42.9% of the respondents showing a reading of ≥ 35 microgram per 100 millilitre of breath. The findings showed a correlation (χ² = 0.75) between the respondents with type 1 diabetes mellitus and wobbly (41.7%) and faintish/dizzy (20.8%) equilibrium when examined by the police. There was a high association between the diabetics who were unlikely to consume alcohol and those who were unlikely to be DUI/DWI (C = 0.725, P < 0.01, α = 0.01). The respondents of type 2 diabetes were 14 (26.4%), of which 8 failed the breathalyzer examination and were subjected to a blood test.
Conclusions: Motorists with type 1 diabetes mellitus, who were subjected to a breathalyzer examination, were charged and they faced the court for being accused of DUI/DWI. The ignorance of the police officers and the respondents on this matter can result in similar repeated cases of this nature.

Keywords

Diabetes Mellitus, Alcohol, Driving, Breathalyzer

How to cite this article :

TAZHMOYE V. ,CRAWFORD DONOVAN, A. McGROWDER, JOAN M. RAWLINS. AN ASSESSMENT OF FALSELY CONVICTED TYPE 1 DIABETICS IN JAMAICA BY USING THE BREATHALYZER TEST. Journal of Clinical and Diagnostic Research [serial online] 2011 June [cited: 2018 Sep 22 ]; 5:448-451. Available from
http://jcdr.in/back_issues.asp?issn=0973-709x&year=2011&month=June&volume=5&issue=3&page=448-451&id=1306

Diabetes mellitus comprises a group of complex metabolic disorders in which elevated blood glucose levels can result in serious medical complications. Type 1 diabetes arises from the lack of insulin which is caused by the auto-immune destruction of the insulin producing β-cells in the pancreatic islets of Langerhans and requires lifelong insulin therapy. Insufficient insulin may result in hyperglycaemia and ketosis may develop (1). In acute diabetic ketoacidosis (DKA), there is increased lipolysis in the adipose tissue and increased ketogenic flux in the liver, resulting in a rise in the circulating ketone bodies, namely acetoacetate (AcAc), beta-hydroxybutyrate (BHB) and acetone. In DKA, the ketone body ratio (BHB: AcAc) rises from normal (1:1) to as high as 10:1.

Acetone is formed by the decarboxylation of acetoacetate and it contains two methyl groups that absorb infrared radiation in the 3.4 micron region of the spectrum. It is considered as a normal constituent of the breath of healthy persons (2), albeit in a very low concentration. In type 1 diabetics, the concentration of the breath acetone is highest in the morning (3). The acetone concentration in the breath ranges from a relatively high 0.5 ppmv for healthy individuals to hundreds of ppmv for critically ill, ketoacidotic diabetics (4). The National Highway Traffic Safety Administration (NHTSA) in the USA has found that dieters and diabetics may have acetone levels which are hundreds and even thousand of times higher than those in others (5). Acetone is one of the many substances that can be falsely identified and measured as ethanol by some breathalyzermachines. The first generation of infrared breath-alcohol analyzers uses a single wavelength infrared filter (3.4 μm) and therefore is not able to distinguish ethanol from acetone in a person’s breath.(6) Elevated concentrations of acetone in blood and breath can occur during fasting, due to the consumption of low carbohydrate diets or in poorly treated diabetes mellitus (6). This study examined the extent to which the breathalyzer tests provided false blood alcohol measurements in individuals with type 1 diabetes mellitus.

Material and Methods

Data collection procedure: This study utilized both quantitative and qualitative approaches. The former represented field work by using an interview schedule, while the latter pertained to secondary data from the desk research of legislation and the work of other scholars. The field work engaged a sample size of 53 diabetics from whom the information was collected - via face-to-face and telephone interviews. This was done by using a 26-item interview schedule. In addition, an elite interview was conducted with law enforcement officers at the senior levels. Practical demonstrations on the use of the breathalyzer and the intoxilyzer were done. The methods of sampling in this study were the purposive and the snowball types. In the method of purposive sampling, the researchers selected a sample based on their experience or knowledge of the group which was to be sampled (7) and this was used to collect information from motorists who were accused and charged by the police for DUI/DWI. Snowball sampling is a non-probability sampling technique, whereby the researcher collects data on a few members of the target population, who maybe difficult to locate. These individuals may be asked to recommend other individuals to provide information, based on similar cases as theirs (8). Face-to-face interviews were conducted under the purposive method, while telephonic conversations was deemed to be more suitable (by the respondents) for the latter. At the start of the interview, the respondents were told about the nature of the study, its scope for the policy-legislative improvement and the sensitization of the law enforcement officers, and the level of confidentiality that would be exercised.

The data was collected during the period from 2007-2009, from respondents at the St. Andrew Traffic Court, individual’s work stations and other locations, as well as via the telephone. Although the faceto- face interviews were concentrated in the parishes of Kingston and St. Andrew, some of the respondents were from other parishes in Jamaica. The respondents who were charged by the police while driving in the corporate area, were expected to be present before a resident magistrate in the parish where their cases resided.

Instrument design: The 26-item interview schedule reflected 3 overarching considerations, namely: demographic characteristics (gender, age, occupation); medical/health status (type of diabetes, equilibrium condition when stopped by the police, the period of time for meal consumption prior to a breathalyzer test); and sociolegal status (alcohol consumption, breathalyzer result, verdict in terms of being charged and court’s decision). The close-ended instrument was intended to assess the diabetic and alcohol status of the respondents; the knowledge of the law enforcement officers regarding the similarity of the acetone in the breath of a diabetic versus an alcohol-ingested individual; and how such a matter was treated under the law.

Protocol on the breathalyzer test and on the arresting of individuals: A driver is usually asked to comply with a breathalyzer test if the police suspects him/her to be driving under the influence/driving while intoxicated (DUI/DWI), or if there is a motor vehicle accident. Apart from a breathalyzer test, the suspect is subjected to a sobriety test (that is walking in a straight line); asked to speak to detect slurred speech and the suspect’s eyes are looked closely at to see whether they are glossy. If these are evident, then the police would declare that such an individual is in no condition to drive.

Where the motorist’s blood alcohol concentration (BAC) is ≥ 35 microgram per 100 milliliter of breath on the breathalyzer device, the motorist is thereafter taken to the station to do an intoxilyzer, which produces a receipt of the reading. The motorist’s information that is captured on this receipt are name, date and place of birth, current address, driver’s license number, date of issue for driver’s license, the registration number of the motor vehicle, the place of the intoxilyzer screening, the date of screening, the time of screening, the reason for the screen/test (suspicion or accident), the name of the officer, the officer’s number, the name of the operator (analyst) of the intoxilyzer, the registration number of the analyst, and the confirmation of correct information. Copies of the receipt which are produced by the intoxilyzer, are provided to the investigating officer and the motorist, and they are also placed on the motorist’s file and taken to court. Where the motorist is placed under arrest, he/she becomes liable to face the court, thus resulting in a US$110.00 fine or 6 months in prison. In addition, the individual’s driver’s license would be suspended for one year.

Only special police who are referred to as analysts, are allowed to conduct the BAC-related tests, as they are gazetted, specially trained to use the devices, promulgated and approved by the Minister of National Security. There are 20 breathalyzer centres throughout the parishes of Jamaica. When a suspect failed to comply with the police in adhering to a breathalyzer test, or to give sufficient breath that was required for a proper reading by the device, then such an individual was subject to be charged. If the suspect was unable to give a breathalyzer test for the reason of medical or other conditions, then such an individual would be allowed the option of a blood test. When the individual was taken from an accident scene to the hospital and became admitted, such a person could refuse both the breathalyzer and the blood tests while in hospital. Such a person would not be charged. If the individual agreed, the blood would be usually drawn and tested by medical personnel. Where a blood test was done, the suspect would be given a sample of the said blood, so that he/she could take it to another laboratory if he/she so wished, for the reason of transparency. Section 34D (1, 2, 3) of the Jamaican legislation made provision for this. The said legislation states specifically that “any person is required to provide a specimen of blood - such a specimen shall be taken only with the consent of that person; at a hospital and by a medical practitioner or a qualified laboratory technician” (9).

Statistical analysis and technique: The primary data were stored and analyzed by using SPSS version 17.0. Frequencies were used to determine the number and percentage responses to the variables which were involved. Cross tabulations were also used to determine the relationships between the respective variables. The data analysis also included a wide range of correlation coefficients such as Chi square, contingency coefficients and Cramer’s V.

Results

A majority of the respondents (73.6%) of this study were of the diabetes mellitus type 1 status as compared to the type 2 diabetes mellitus (26.4%). The respondents were mainly males (77.4%) as compared to the females (22.6%); who were within the age range of 20-39 (37.8%), 40-59 (37.8%) and ≥ 60 (24.6%) years old; and were professionals (52.8%), business operators (20.8%) and trade personnel (26.4%) (Table/Fig 1).

(Table/Fig 2) intimates, that of the type I diabetics (73.6%), a majority (41.7%) showed wobbly disposition during the sobriety tests which were carried out by the police, who pulled them over (while driving) for the reason of being DUI/DWI suspects or just for regular security checks. The findings of this study also showed a correlation (χ2 = 0.75) between the respondents’ unstable equilibrium and the period between their last meal, prior to the breathalyzer test. A majority of the respondents (50%) claimed to have been feeling hungry, having not consumed a meal many hours prior to the test. This was followed by those who ate ≤ 1 hour prior (20.8%), 2-4 hours prior (20.8%) and ≥ 5 hours prior (8.3%) to the test.

None of the respondents were cognizant that persons with diabetes mellitus (especially type 1) had the propensity to possess high levels of acetone in their breath and that this could be detected as ethanol on a breathalyzer device. While 21 (39.6%) respondents who had a breathalyzer test done, claimed that the law enforcement officers (police) had explained to them the reason and purpose of such tests, 42.9% of the type 1 diabetics said that they did not know about this, nor did they remember (19%) their results.

Of the 14 (26.4%) respondents of type 2 diabetes mellitus, eight (57.14%), having failed the breathalyzer test, were subjected to a blood test. Four (4) of these had evidence of alcohol consumption; but however below the intoxication level. The other four (4) respondents pleaded guilty to alcohol consumption (Table/Fig 3). Further, 52.4% of the type 1 diabetics who were subjected to a breathalyzer examination were charged and they faced the court for being accused of DUI/DWI, 9% of whom pleaded guilty, claiming tobe frustrated of trying to convince the authorities that he/she had not consumed alcohol for the reason of being on diabetic medication and that this was against the advice of his/her physician. However, the court ruled a guilty verdict on 52.4% of the type 1 and 50% of the type 2 diabetics who had done the breathalyzer and the blood tests respectively.
The findings revealed a relationship and a high association between the individuals with type 1 diabetes and the failure of a breathalyzer examination (χ2 = 0.35), resulting in a guilty verdict by the court (C = 0.677, p < 0.01, α = 0.01), regardless of a not-guilty plea. Similarly, the respondents of the diabetes mellitus status were less likely to have consumed alcohol, let alone to be classified as a DUI/DWI under the law (C = 0.725, p<0.01).

Discussion

A majority of the respondents who had type 1 diabetes mellitus were males, who showed wobbly disposition during the sobriety tests which were carried out by the police, when stopped for being DUI/DWI suspects or for regular security checks. The signs and symptoms of hypoglycaemia in type 1 diabetics include slurred speech, slow gait, impaired motor control, fumbling hand movements and mental confusion, staggering, drowsiness, flushed face, and disorientation. These are all symptoms of intoxication. Further, there was also a significant correlation between the respondents’ unstable equilibrium and the period between their last meals, prior to a breathalyzer test. The majority of the respondents claimed to have been feeling hungry, having not consumed a meal many hours prior to the test. Type 1 diabetics who were experiencing symptoms that were very similar to alcohol intoxication were most likely to fail the field sobriety tests. The test involved an individual suspected of DUI being asked by the law enforcement officers to walk in a straight line, in an effort to assess and determine that individual’s co-ordination, balance and impairment.

Diabetic ketoacidosis is an acute and potentially fatal complication of type 1 diabetes which is typically characterized by hyperglycaemia, metabolic acidosis and ketone bodies such as acetoacetate, betahydroxybutyrate and acetone. Acetone is one of the compounds that is detected on many breathalyzer instruments as ethanol. In intoxilyzers such as those which were used in this study, acetone is detected because it absorbs infrared energy in the 3.38 to 3.40 micron range, the same range where ethanol is found. Breath acetone is generally regarded as an indicator of a serious loss of metabolic control in DKA. Brick (1993) found that the acetone in the breath of an untreated diabetic can contribute to erroneously high BAC (10). In another study by Mormann et al., diabetic subjects were found to have acetone levels which were sufficient to produce a BAC of 0.06 percent (11). Further, none of the respondents in this study were cognizant that persons with type 1 diabetes mellitus had the propensity to possess high levels of acetone in their breath and as a result, this could be detected as ethanol on a breathalyzer device. A key finding in this study was that of just over one-half of the type 1 diabetics who were subjected to a breathalyzer examination were charged and they faced the court for being accused of DUI/DWI. The court ruled a guilty verdict on just over one-half of type 1 and type 2 diabetics who had underdone the breathalyzer and the BAC tests. Approximately one-tenth of those who pleaded guilty claimed to be frustrated in attempting to convince the police authorities that they had not consumed alcohol for the reason of being on diabetic medication and that this was against the advice of their physician. There was also significant relationship between the individuals withdiabetic mellitus (mainly type 1) and with the failure of a breathalyzer examination, resulting in a guilty verdict by the court, regardless of a not-guilty plea by the defendants. In the United States of America, it is a misdemeanor for an individual to drive a vehicle with a BAC of 0.08% or higher (0.02% in most states for drivers under 21) (12).

The breathalyzer provided the law enforcement officers with a noninvasive test, providing immediate results to determine a motorist’s BAC at the time of testing. Most handheld breathalyzers use a silicon oxide sensor to determine the BAC. It does not however determine an individual’s level of intoxication, as this varies by a subject’s individual alcohol tolerance. The BAC can vary between individuals who consume identical amounts of alcohol, due to gender, weight and genetic pre-disposition (13). There are limitations with the BAC testing, such as the lack of specific, as thousands of organic molecules such as acetone that contain the methyl group and the corresponding carbon-hydrogen bond absorb the light producing false positives. Intoxilyzers are well known to have specificity difficulties which distinguish between ethanol and other similarly sized molecules, which can result in high false positives due to the large amount of substances having the same wavelength interference as ethanol (14) (15). Further, breathalyzers are very sensitive to temperature and will give false readings if not adjusted or recalibrated to account for the ambient or surrounding air temperatures. The temperature of the subject is also very important. The failure of the law enforcement officers in using the devices properly or of the administrators in having the machines properly maintained and re-calibrated as required, are the particularly common sources of error (16). Improper software calibration affects the accuracy of the sensor of the breathalyzer, which degrades over time and with repeated use (17).

This study possesses the potential to provide scope for policy and legislative directions in Jamaica, relating to a more detailed and scientific analysis of a type 1 diabetic, who may be wrongfully charged for DUI and DWI. Through this study, law enforcement officers will be sensitized on the matter of the acetone in the breath of a genuine DUI, DWI and a type 1 diabetic. This could result in the kind of questions that they would ask a civilian, as well as the confirmation of an individual’s BAC or diabetic status via a blood test.

Conclusion

This study showed that some individuals with type 1 diabetes mellitus, who were subjected to a breathalyzer examination, were charged and that they faced the court for being accused of DUI/ DWI. Neither the police nor the type 1 diabetics in this study were cognizant of the fact that elevated acetone levels in patients withtype 1 diabetes could cause increased BAC levels. This resulted in a wrongful conviction.

Acknowledgement

Appreciation is hereby extended to the following members of the Jamaica Constabulary Force, who provided the necessary opportunity and the information that contributed to this paper: Mr. Gary A. McKenzie (Inspector of Police and Analyst), Mr. Bertram Millwood (Principal Director for Drug Law Enforcement, Attorney-at- Law and former Deputy Commissioner of Police) and Mr. Radcliffe Lewis (Superintendent of Police).

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