Fatal Poisoning Research Articles

Epidemiology of Fatal Poisonings from Organophosphorus Compounds in Rangpur District, Bangladesh

Background: Organophosphorus compound (OPC) poisoning represents a significant public health issue in low- and middle-income countries. Globally, the WHO estimates three million annual cases of pesticide poisoning, resulting in 220,000 deaths, predominantly in international settings. In Bangladesh, OPCs are frequently used for suicide in rural areas due to their affordability, toxicity, and accessibility. Objective: This study aimed to determine the prevalence, incidence by age and sex, and marital status of victims in cases of fatal organophosphorus poisoning in Rangpur District. Methods: This retrospective study analyzed all medicolegal autopsies conducted between October 2005 and January 2007 at the mortuary of Rangpur Medical College based on the history and preliminary findings of the deceased. Results: Of the 282 medicolegal autopsies performed during the study period, 60 (21%) resulted from organophosphorus poisoning. Females accounted for the majority of victims (31, 52%) compared to males (29, 48%). The highest prevalence of organophosphorus poisoning occurred in the Mithapukur area (17, 28%), with the age group 21-30 years showing the highest incidence (38%). Acute poisoning was more prevalent among married individuals (80%) compared to unmarried individuals (20%). Conclusion: Organophosphorus poisoning remains a significant healthcare challenge in Bangladesh. Enhanced awareness, restricted availability, and preventive measures are crucial for reducing mortality and morbidity associated with OPC poisoning.

Post-mortem distribution of MDPHP in a fatal intoxication case.

The synthetic cathinone (SC) 3,4-methylenedioxy-α-pyrrolidinohexanophenone (MDPHP), is structurally correlated to the 3,4-methylenedioxypyrovalerone (MDPV). In recent years, the number of intoxication cases has increased even if little is known about the pharmacokinetics properties. The post-mortem (PM) distribution of MDPHP remains largely unexplored. In these reports, MDPHP levels were quantified in blood, gastric content and urine. This study aimed to describe the MDPHP PM distribution in several specimens, i.e. central and peripheral blood (CB and PB), right and left vitreous humor (rVH and lVH), gastric content (GCo), urine (U) and hair. The samples were collected from a cocaine-addicted 30-year-old man with a PM interval estimated in 3-4 h. Autopsy examination revealed unspecific findings, i.e. cerebral and pulmonary edema. No injection marks were observed. Toxicological analyses were performed using a multi-analytical approach: headspace gas chromatography for blood alcohol content (BAC); gas chromatography-mass spectrometry (GC-MS) for the main drugs of abuse; liquid chromatography-tandem mass spectrometry (LC-MS/MS) for benzodiazepines and new psychoactive substances (NPS). BAC was negative (0.02 g/L). MDPHP concentrations were: 1,639.99 ng/mL, CB; 1,601.90 ng/mL, PB; 12,954.13 ng/mL, U; 3,028.54 ng/mL, GCo; 1,846.45 ng/mL, rVH; 2,568.01 ng/mL, lVH; 152.38 (0.0-1.5 cm) and 451.33 (1.5-3.0 cm) ng/mg, hair. Moreover, hair segments were also positive for 3,4-dimethylmethcathinone (DMMC < limit of quantification: 0.01 ng/mg), α-PHP (0.59 ng/mg, 0.0-1.5 cm; 3.07 ng/mg, 1.5-3.0 cm), cocaine (6.58 ng/mg, 0.0-1.5 cm; 22.82 ng/mg, 1.5-3.0 cm), and benzoylecgonine (1.13 ng/mg, 0.0-1.5 cm; 4.30 ng/mg, 1.5-3.0 cm). MDPHP concentrations were significantly higher than those reported in the literature for fatal cases. For these reasons, the cause of death was probably the consumption of a lethal amount of MDPHP. Because CB and PB were similar, PM redistribution was not relevant.

Genomic Characterization and Comparative Genomic Analysis of the Foodborne Burkholderia gladioli pv. cocovenenans.

The Burkholderia gladioli pv. cocovenenans (B. cocovenenans) has been linked to fatal food poisoning cases, which could produce the deadly toxin of bongkrekic acid (BA). However, genomic characterization and toxin production pathways of B. cocovenenans strains remain elusive. This study aimed to explore the BA-producing ability associated with the evolution of the bon gene cluster and to analyze the intraspecies genomic diversity and phylogenetic relationships of B. gladioli based on the 17 genomes of B. cocovenenans strains isolated from Shenzhen City, China. Genome sequencing results suggested that the genome sizes of these B. cocovenenans strains were mostly approximately 8 Mb, with a GC content of approximately 68%. The evolutionary tree analysis of the whole-genome sequences showed that significant divergences and distinct cluster were exhibited among these B. cocovenenans strains. Comparative genomic analysis indicated that the genomes of strains 2020051, 2021031, and 2021067 contained the complete and entire bon gene cluster, supporting that these strains displayed obviously BA-producing ability. The genomes of strains 2021028 and 2020041 lacked the entire bon gene cluster. However, the genomes of strains 2021037, 2021024, 2021035, and 2021031 exhibited disruptions in their bon gene clusters. This finding indicated the loss of specific genes within the cluster, suggesting a reduced capability for BA production in these strains. The present results indicated that the bon gene cluster in the genome played a key role in the toxin BA biosynthesis of different B. cocovenenans strains. This study provided a comprehensive understanding of the relationship between genomic diversity and BA production of this lethal foodborne pathovar, which will potentially contribute to the risk identification and food poisoning outbreak prevention of B. cocovenenans.

Case report: Fatal long-term intoxication by 2,4-dinitrophenol and anabolic steroids in a young bodybuilder with muscle dysmorphia

A case of chronic intoxication by 2,4-dinitrophenol (2,4-DNP) is reported in a 21-year-old bodybuilder, also known as an abuser of anabolic steroids, who died after ingesting 2 grams of this substance after 6 months of repeated consumption. The bodybuilder presented the triad of symptoms – tachycardia, tachypnoea, profuse sweating – from 6 months before his death, and was hospitalised for multiple organ failure 4 months before his death. Medical staff attributed this serious episode to his consumption of 2,4-DNP. Although the triad of symptoms persisted, he denied continuing to consume 2,4-DNP during consultations with his general practitioner, who therefore looked into a possible diagnosis of endocrine or tumour disorder. The bodybuilder died of multi-organ failure. The autopsy found diffuse visceral congestion and yellowish colouration of integuments. Toxicology demonstrated not only lethal acute 2,4-DNP intoxication (blood concentration was 88 mg/L), but also chronic intoxication (segmental hair concentrations were 5.1 to 25.5 ng/mg). Different anabolic steroids were also identified in the hair. Continued uncontrolled consumption of 2,4-DNP despite the consequences for his health, combined with an obvious preoccupation with his physical appearance, supported the suspected diagnosis of “muscle dysmorphia”, a psychiatric disorder in which dangerous substances are trivialised. Primary care professionals, the first to come into contact with intoxication cases, should receive training on how to detect and manage cases with symptomology that mimics 2,4-DNP use. A large study evaluating the outcomes of acute intoxication cases if “aggressive” management had been immediately implemented may help us determine the optimal course of action that minimises fatalities.

Findings of synthetic cathinones in post-mortem toxicology

Synthetic cathinones (SCs) are a group of new psychoactive substances with amphetamine-like effects but generally higher potency. The aim of this study was to assess the incidence and significance of SCs in post-mortem (PM) investigations in Finland, focusing on the three most prevalent substances: α-PVP, α-PHP, and α-PiHP. All PM cases positive for SCs during 2018–2023 were investigated with respect to cause and manner of death, PM blood and urine concentrations, and concomitant use of other drugs of abuse. There were 136 findings of α-PVP, α-PHP, or α-PiHP in 118 death cases, in which the median age at death was 35 years and 82 % were males. Concomitant opioids, stimulants, or sedatives were found in 69–92 % of cases, and cannabis in 39–47 %. In two cases (1.7 %), SCs were the only findings of abused drugs. Thirty-four fatal poisonings (29 %) were identified in which at least one of the three SCs was implicated in the cause of death. The median (range) femoral blood concentrations of α-PVP, α-PHP, and α-PiHP in these poisoning cases were 0.18 (0.03–2.6) mg/L, 0.16 (0.02–0.58) mg/L, and 0.14 (0.03–2.1) mg/L, respectively. α-PVP, α-PHP and α-PiHP were found in 4.0 % of all drug abuse cases and in 2.7 % of all fatal poisonings related to drug abuse, while for amphetamine/methamphetamine, these figures were 44 % and 21 %, respectively. Despite their lower prevalence in PM cases, SCs appear to have similar abuse liability and similar drug use patterns to amphetamine.

Особливості харчування українців в умовах геноциду 1932–1933 рр. (на основі спогадів очевидців Голодомору)

Based on 155 accounts of the Holodomor witnesses (covering the whole USSR territory), the author comprehensively studied the peculiarities of the diet of Ukrainians in the conditions of the crime of genocide committed by the communist totalitarian regime in 1932 and 1933. The traditional diet of Ukrainians was before the 1930s was described. It is known that that since ancient times, Ukrainians were primarily involved in agriculture, as well as cattle breeding and gathering, which determined the traditional diet of the nation, whose daily ration consisted of food of plant and animal origin. From the products of plant origin, they cooked cereal and vegetable dishes (bread, halushky, zatirka, noodles, porridge, kulish, chur, solomakha, mamalyha, lemishka, borsch, yushka, soup, cabbage soup, potatoes, pancakes, hashbrowns, dumplings), and from the products of animal origin, they cooked meat, dairy and fish dishes (sausages, blood sausages, roast, saltyson, kholodets, dushenyna, kruchenyky, sichenyky, khliaka, riazhanka, butter, sour cream, cheese, etc.). The most important dish on the table of Ukrainians was and still is bread. It has been analyzed and proved that during the Holodomor genocide years, the destruction of traditional Ukrainian nutrition, along with customs and traditions related to it took place. The communist totalitarian regime, by taking away all edible supplies, doomed Ukrainians to hungry death. To survive, Ukrainians ate surrogates, plants (leaves, weeds, grass); small animals, insects, birds (hedgehogs, cats, dogs, gophers, sparrows, crows, pigeons, storks, frogs, mollusks, snails, dragonflies); cow’s milk (families that had a cow called it a feeder and a savior); vegetables, fruits, berries; rotten potatoes, beets (dug up in early spring); offal; human flesh (cases of corpse-eating and cannibalism were recorded). Consumption of such products caused the most severe stomach diseases and even fatal poisonings. People suffered from vomiting, diarrhea, swelling, weakness, inflammation, and unbearable pain. Epidemics and various diseases, often fatal ones (smallpox, dysentery, louse-borne typhus and typhoid fever, malaria, pellagra, glanders, dropsy) spread in Ukraine Due to hunger, Ukrainians developed mental disorders, their consciousness was clouded, their thinking, will, and memory were disturbed, and their behavior changed. Keywords: Holodomor, 1932–1933, genocide, non-traditional food, surrogates, moral and psychological effects.

MANTRACHIKITSA: FACTS AS MENTIONED IN THE AYURVEDIC CLASSICS

Mantra, indicates chanting of some prescribed verses for designated purposes, is a controversial but interesting and important topic. Scientific validation of mantra is difficult to establish due to the factors like – difficulty in (1) understanding the meaning of the verses, (2) understanding the mode of action, (3) understanding the effect scientifically etc. But traditional experience and classical references strongly support the use and efficacy of Mantra in different references. A number of researches are also already conducted in different levels with the aim to understand it scientifically. In the Ayurvedic classics a number of indications and benefits of Mantra are mentioned in different references like Vishachikitsa (in snakebite mentioned with top priority), Grahachikitsa (conditions that occur due to effect of some unseen, unundentifiable aetiologies etc.). The Ayurvedic scholars have discussed in detail about mantra with special reference to method of learning, practising etc. As a widely discussed noninvasive treatment procedure that is getting topmost priority in a condition like snakebite (a very dangerous and usually fatal poisoning) a discussion on Mantra basing upon the Ayurvedic classics is considered to be informative and thought provoking for the scientific forum.

The Link Between Paraquat and Demyelination: A Review of Current Evidence.

Paraquat (1,1'-dimethyl-4,4'-bipyridilium dichloride), a widely used bipyridinium herbicide, is known for inducing oxidative stress, leading to extensive cellular toxicity, particularly in the lungs, liver, kidneys, and central nervous system (CNS), and is implicated in fatal poisonings. Due to its biochemical similarities with the neurotoxin 1-methyl-4-phenylpyridinium (MPP+), paraquat has been used as a Parkinson's disease model, although its broader neurotoxic effects suggest the participation of multiple mechanisms. Demyelinating diseases are conditions characterized by damage to the myelin sheath of neurons. They affect the CNS and peripheral nervous system (PNS), resulting in diverse clinical manifestations. In recent years, growing concerns have emerged about the impact of chronic, low-level exposure to herbicides on human health, particularly due to agricultural runoff contaminating drinking water sources and their presence in food. Studies indicate that paraquat may significantly impact myelinating cells, myelin-related gene expression, myelin structure, and cause neuroinflammation, potentially contributing to demyelination. Therefore, demyelination may represent another mechanism of neurotoxicity associated with paraquat, which requires further investigation. This manuscript reviews the potential association between paraquat and demyelination. Understanding this link is crucial for enhancing strategies to minimize exposure and preserve public health.

The Circumstances Surrounding Fatal Pediatric Opioid Poisonings, 2004-2020.

There is little understanding of the circumstances behind fatal pediatric opioid poisonings. Our objective was to characterize opioid fatalities according to child, family, and household factors. We used data from the National Fatality Review-Case Reporting System to describe the circumstances behind the deaths of children 0 to 17 years of age who died of an opioid poisoning (ie, prescription opioid, heroin, illicit fentanyl) between 2004 and 2020. Decedents were stratified into age groups: 0-4, 5-9, 10-14, and 15-17 years. The majority (65.3%) of the 1696 fatal opioid poisonings occurred in the child's own home. Prescription opioids contributed to 91.8% of deaths, heroin contributed to 5.4%, and illicit fentanyl to 7.7%. Co-poisonings with nonopioid substances occurred in 43.2% of deaths. Among 0- to 4-year-olds, 33.9% died of homicide and 45.0% had a primary caregiver with a history of substance use/abuse. Among 10- to 14-year-olds and 15- to 17-year-olds, respectively, 42.0% and 72.8% of decedents had a history of substance use/abuse. In each age group, at least 25.0% of children were victims of previous child maltreatment. A history of maltreatment and substance use-whether on the part of the caregiver or the child-are common factors surrounding fatal pediatric opioid poisonings, the majority of which occur in the child's own home. Families with children of all ages would benefit from interventions focused on opioid prescribing, storage, disposal, and misuse. These findings also underscore the urgency of ensuring that access to naloxone becomes universal for families with a history of maltreatment and/or substance use.

Synthetic Cathinones' Comprehensive Screening and Classification by Voltammetric and Chemometric Analyses: A Powerful Method for On-Site Forensic Applications.

The use of synthetic cathinones (SCs) has increased in recent years, posing significant public health problems due to their adverse effects and potential for fatal poisonings. The structural diversity and rapid emergence of new SC analogues create challenges for law enforcement and drug screening techniques. This work presents for the first time the electrochemical detection of SCs using differential pulse voltammetry (DPV) on a boron-doped diamond electrode (BDDE). We analyzed 15 SCs, including well-known compounds such as mephedrone, methylone, and ephylone, revealing distinct electrochemical profiles with two characteristic reduction peaks (R1 and R2). The method was optimized in Britton-Robinson buffer (0.1 mol L-1, pH 8.0) and demonstrated a high selectivity and sensitivity. Multivariate statistical methods, including principal component analysis and hierarchical cluster analysis, classified SCs into six distinct groups. The DPV optimization and analytical parameter determination, including the limit of detection (LOD), were performed for the least electroactive SC, 4'-methyl-α-pyrrolidinohexanophenone, yielding an LOD of 3.8 μmol L-1, suitable for screening street samples. Interference studies with common illicit drugs and adulterants confirmed the selectivity of the DPV-BDDE method. Preliminary identification of SCs in 46 real seized samples was successfully performed using this method with results validated by liquid chromatography-mass spectrometry (LC-MS). The method also identified three SCs not included in the original set: bupropion, benzylone, and dipentylone. The DPV-BDDE method offers a rapid, robust, and portable approach for the selective screening of SCs in forensic applications, demonstrating significant advantages over traditional colorimetric tests.

Investigation of a family cluster poisoning incident caused by Galerina sulciceps mushroom

Mushroom poisoning is the most important cause of death in food-borne poisoning in China, mainly caused by amanitin, which is caused by rapid progression, complex mechanism and latency. Early identification, diagnosis and treatment are important to improve the prognosis of fatal mushroom poisoning. This article analyzes the clinical characteristics, identification process and treatment of 14 patients with amanitin-containing Galerina sulciceps mushroom poisoning in a family, so as to improve the identification ability of the first physician in recognizing and managing early-stage mushroom poisoning, and to increase the cure rate through early bundle therapy of mushroom poisoning.

Suitability of Hair Testing in Medical Dispensing Errors: A Fatal Case of Gliclazide Poisoning

ABSTRACTA patient was prescribed a new treatment, 40 mg furosemide. Her pharmacist mistakenly dispensed 40 mg gliclazide instead. After 3 weeks of treatment, the patient was found in a coma, was hospitalised and died after a week. Hair sample was collected during post‐mortem examination and tested for gliclazide on three 2 cm sections, starting at the root end. Hair strands were decontaminated, segmented and incubated in the presence of diazepam‐d5, and a solid–liquid extraction has been performed. Finally, toxicological analyses were performed by UFLC Shimadzu Prominence ‐ MS/MS Sciex 6500 QTRAP. Gliclazide was found on the proximal (238 pg/mg), median (77 pg/mg) and distal (69 pg/mg) segments. The concentration in the proximal segment was largely higher than in the other two, which demonstrates repeated intake of gliclazide by the patient during at least the last 2 months before death. The lower concentrations in the medial and distal segments, as well as a part of the concentration in the proximal segment, may be linked to external hair contamination. These could be due to either radial sweat diffusion, possibly occurring in the last week hospitalisation of the patient, or to biological fluids contamination during post‐mortem examination. This case illustrates the opportunity to confirm slow and fatal chronic poisoning by gliclazide using hair analysis and shows the benefit of hair testing for the investigation of medical or dispensing errors.

Paraquat Poisoning: Insights from Autopsy, Histology, and Liquid Chromatography with Tandem Mass Spectrometry in Multidisciplinary Forensic Toxicology Practice.

The herbicide paraquat (PQ) is responsible for a significant number of fatalities resulting from self-poisoning. Nevertheless, only a limited number of comprehensive studies focusing on fatal PQ poisoning, which include examination of autopsy findings, histopathology, and quantitative analysis of post-mortem samples, have been published. This study aimed to evaluate autopsy findings, histopathology, and quantitative analysis of PQ in post-mortem human serum samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS), a simple, sensitive, and specific method. Autopsies were performed on all deaths due to PQ poisoning, and serum samples were sent to the toxicology laboratory for chemical analysis. The method was successfully applied to seven human serum samples, and the results indicate its reliability for detecting PQ. The study reports fatal serum PQ levels ranging from 0.5 to 372.0 µg/mL. The comprehensive data presented in this study can be useful for further research and practical applications.

Identification of fentanyl analogs and potential biomarkers in urine using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and liquid chromatography-quadrupole/time of flight mass spectrometry (LC-Q/TOF-MS)

Novel synthetic opioids are a class of drugs abused for their potent analgesic effect and are responsible for many fatal intoxications, particularly within the United States. A targeted assay was developed and validated using LC-MS/MS, capable of identifying nineteen fentalogs. Solid phase extraction was used to isolate analytes of interest from urine. Limits of detection ranged from 0.05 to 0.1 ng/mL and the limit of quantitation was 0.5 ng/mL. Extraction efficiencies using the optimized procedure were 77–88 % for all targeted species. Bias, precision, matrix effects and interferences were within acceptable thresholds for all analytes. The validated assay was used to identify analytes of interest from thirty-seven individuals that had used fentanyl and related substances. In addition to quantitative analyses, a non-targeted liquid chromatography quadrupole time-of-flight mass spectrometry (LC-Q/TOF-MS) assay was also used to identify additional substances and potential biomarkers. Additional N-oxide and N-dealkylated species were identified using this approach, and the potential for biomarker use is presented, given the stability of some analytes within this class.

Improving Estimates of the Prevalence of Opioid Use Disorder in the United States: Revising Keyes et al.

The United States faces an ongoing drug overdose crisis, but accurate information on the prevalence of opioid use disorder (OUD) remains limited. A recent analysis by Keyes et al used a multiplier approach with drug poisoning mortality data to estimate OUD prevalence. Although insightful, this approach made stringent and partly inconsistent assumptions in interpreting mortality data, particularly synthetic opioid (SO)-involved and non-opioid-involved mortality. We revise that approach and resulting estimates to resolve inconsistencies and examine several alternative assumptions. We examine 4 adjustments to Keyes and colleagues' estimation approach: (A) revising how the equations account for SO effects on mortality, (B) incorporating fentanyl prevalence data to inform estimates of SO lethality, (C) using opioid-involved drug poisoning data to estimate a plausible range for OUD prevalence, and (D) adjusting mortality data to account for underreporting of opioid involvement. Revising the estimation equation and SO lethality effect (adj. A and B) while using Keyes and colleagues' original assumption that people with OUD account for all fatal drug poisonings yields slightly higher estimates, with OUD population reaching 9.3 million in 2016 before declining to 7.6 million by 2019. Using only opioid-involved drug poisoning data (adj. C and D) provides a lower range, peaking at 6.4 million in 2014-2015 and declining to 3.8 million in 2019. The revised estimation equation presented is feasible and addresses limitations of the earlier method and hence should be used in future estimations. Alternative assumptions around drug poisoning data can also provide a plausible range of estimates for OUD population.

Development of a simple estimation method of serum caffeine concentration using a point-of-care test kit for urinary caffeine.

Serum caffeine concentration is an indicator of caffeine intoxication; however, it is difficult to measure it in most emergency departments. We developed a simple estimation method using a point-of-care test kit for urinary caffeine. Caffeine-spiked human serum (100, 50, 25, and 10µg/mL) was diluted 10-, 20-, 50-, and 100-fold with phosphate-buffered saline and applied to the kit. After 5min incubation, the kit was scanned by a flatbed scanner and the membrane image was processed with ImageJ. When the 20-fold diluted serum was applied, serum samples with initial caffeine concentration ≤ 25 and ≥ 50µg/mL were caffeine-negative and -positive, respectively. When the 100-fold diluted serum was applied, none of the caffeine-spiked serum samples gave positive results. Therefore, we proposed the following test procedure: (i) 20-fold diluted serum was initially tested and (ii) 100-fold diluted serum was additionally tested when the initial result was caffeine positive. Using this procedure, caffeine concentration is expected to be classified into three levels: ≤ 25, > 25- ≤ 100, and > 100µg/mL, which almost correspond to no or mild, severe, and potentially fatal intoxication, respectively. The test procedure was validated using postmortem heart blood from two cases of fatal caffeine intoxication (caffeine concentration: 276 and 175µg/mL) and two cases of other intoxication. Our developed method using point-of-care urinary caffeine test kits enabled simple estimation of serum caffeine concentration.

Acute impacts of invasive toads on the population demography of a native predator in tropical Australia

If an animal’s size, age and/or sex influence its vulnerability to an invasive species, the arrival of such an invader can cause rapid changes in the population demography of an affected species. We studied free-ranging varanid lizards (Yellow-spotted monitors, Varanus panoptes) at a site in tropical Australia during the influx of fatally toxic cane toads, Rhinella marina. Mortality was inferred from shifts in population structure, as well as the survival rates (time to death) of 107 radio-tracked lizards. Of 57 deaths whose cause was unambiguous, 32 were due to fatal poisoning by ingesting a cane toad; the other 25 lizards were consumed by pythons. Size and age structure shifted between years, such that the population post-invasion was dominated by smaller, younger lizards, and by females rather than males. Radiotelemetric monitoring confirmed that survival rates were reduced more in males than in females in the post-toad year, with males most at risk late in the dry-season, when food was scarce and females were nesting rather than foraging. Pythons disproportionately consumed larger female lizards during the nesting season. Toad-induced poisoning of adult male varanids (which are larger and bolder than females) likely produced a population that was more resilient to toad impact, but less easily surveyed by conventional techniques.

ANALYSIS OF THE NUMBER OF DEATHS DUE TO POISONING BY THE MOST COMMON POISONOUS SUBSTANCES IN THE LVIV REGION IN 2018-2023

Drunkenness is an acute social and cultural problem in Ukraine. Alcoholic poisoning occupies a leading position among household poisonings. Alcohol is the cause of more than 60% of all fatal poisonings. Each year, more than 40,000 people in Ukraine die from alcohol poisoning. Carbon monoxide poisoning also occupies a leading position, the statistics are very sad, adults die, children die. Poisoning with narcotics and psychotropic substances is a very urgent medical and social problem, which is far from being solved today. Aim of the work. To analyse the mortality rate due to poisoning by the most common types of poisons by age and sex of the deceased in Lviv and the region for the period 2018-2023. Materials and methods. In the work, a statistical analysis of expert conclusions from the archive of the Lviv Regional Bureau of Forensic Medicine for the period 2018-2023 was conducted. Results. The article provides quantitative indicators of cases of fatal poisoning, their prevalence trends, identifies the most common poisonous substances, and analyses mortality rates by age and sex. Conclusions. There is a downward trend in the total number of deaths due to poisoning. In 2023, the number of poisoning deaths will be almost halved compared to 2018. The most common poison is ethyl alcohol, 60% of people from the total number of poisonings, the second place in terms of number of deaths was carbon monoxide poisoning 21.5%, the third place was poisoning by narcotic substances 5.1%. Mortality due to poisoning in men is more than 5 times higher than in women, and men in their 40s and 50s die most often.

Does a postmortem redistribution affect the concentrations of the 7 azaindole-derived synthetic cannabinoid 5F-MDMB-P7AICA in tissues and body fluids following pulmonary administration to pigs?

Many fatal intoxications have been reported in connection with the consumption of newer, highly potent synthetic cannabinoids. Yet, a possible postmortem redistribution (PMR) might complicate reliable interpretation of analytical results. Thus, it is necessary to investigate the PMR-potential of new synthetic cannabinoids. The pig model has already proven to be suitable for this purpose. Hence, the aim of this study was to study the PMR of the synthetic cannabinoid 5F-MDMB-P7AICA and its main metabolite 5F-MDMB-P7AICA-dimethylbutanoic acid (DBA). 5F-MDMB-P7AICA (200 µg/kg body weight) was administered by inhalation to anesthetized and ventilated pigs. At the end of the experiment, the animals were euthanized and stored at room temperature for 3 days. Tissue and body fluid samples were taken daily. Specimens were analyzed after solid phase extraction using a standard addition method and LC–MS/MS, blood was quantified after protein precipitation using a validated method. In perimortem samples, 5F-MDMB-P7AICA was found mainly in adipose tissue, bile fluid, and duodenum contents. Small amounts of 5F-MDMB-P7AICA were found in blood, muscle, brain, liver, and lung. High concentrations of DBA were found primarily in bile fluid, duodenum contents, urine, and kidney/perirenal fat tissue. In the remaining tissues, rather low amounts could be found. In comparison to older synthetic cannabinoids, PMR of 5F-MDMB-P7AICA was less pronounced. Concentrations in blood also appear to remain relatively stable at a low level postmortem. Muscle, kidney, fat, and duodenum content are suitable alternative matrices for the detection of 5F-MDMB-P7AICA and DBA, if blood specimens are not available. In conclusion, concentrations of 5F-MDMB-P7AICA and its main metabolite DBA are not relevantly affected by PMR.

Loperamide positive deaths in Sweden 2012–2022 and Finland 2017–2022: Fatal loperamide intoxication exclusively for Sweden

Loperamide, a potent μ-opioid receptor agonist used as an antidiarrheal drug, exhibits increased bioavailability at supratherapeutic doses, causing potential central nervous system effects. Its misuse for opioid withdrawal relief and euphoria can lead to dangerously elevated blood levels, causing severe cardiac dysrhythmias and death. This study aimed to compare loperamide positive autopsy cases in Sweden and Finland after the introduction of postmortem toxicological analysis of loperamide, focusing on loperamide’s role in fatalities and identifying common characteristics among those affected. All cases with detected loperamide in femoral blood at forensic autopsies in Sweden (2012–2022) and Finland (2017–2022) were included. In Sweden, loperamide was detected in 126 individuals, and in Finland, in 111 individuals. The incidence of individuals positive for loperamide in postmortem femoral blood increased steadily over the study duration in both Sweden and Finland. Loperamide related fatalities were observed exclusively in Sweden (n=80), predominantly involving younger males with histories of substance abuse, typically classified as accidental deaths. The group of loperamide nonrelated deaths in Sweden mirrored the entirety of cases in Finland. The concentration of loperamide in postmortem femoral blood was significantly higher in cases where loperamide was considered the cause of death (median 0.140 μg/g) compared to cases where loperamide contributed (median 0.080 μg/g), as well as in deaths unrelated to loperamide in both countries (Sweden: median 0.029 μg/g; Finland: median 0.010 μg/ml). The high limit of quantification for loperamide in Sweden may underestimate therapeutic users in epidemiological assessments. This study underscores the absence of loperamide misuse in Finland and indicates a rising trend of loperamide abuse in Sweden.